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Objective: To evaluate the effectiveness of interventions targeting alcohol consumption, drug use and smoking for college/university students.Participants: College/University students. Methods: Studies were eligible if: (1)included students attending universities/colleges; (2)implemented in a university/college setting; (3)aimed to improve at least one of the following behaviors: alcohol and/or drug use and/or smoking; (4)were RCTs. The effect of the interventions on behaviors was determined by the percentage of studies that reported an effect. Due to the heterogeneity of outcomes meta-analysis was not conducted.Results: 88 studies met criteria. University-based interventions were effective for reducing alcohol-related outcomes (drinking patterns, BAC, consequences, problem drinking). Inconsistent findings for drug and smoking were observed. Conclusions: University-based interventions have the potential to improve health for students. While there is a breadth of research examining the efficacy of interventions to reduce alcohol consumption, further research is needed to determine the best approach for addressing smoking and drug use among students.

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. [ABSTRACT FROM AUTHOR]

Background: Mobile app-based interventions have the potential for wide-reach and therefore may be a useful tool in up-scaling physical activity interventions. In larger-scale interventions, face-to-face assessments are less cost-effective, and researchers often rely on surveys or activity trackers to assess outcomes. However, there is limited evidence of valid muscular fitness assessments that can be self-administered within mHealth interventions. As such, this study will evaluate the concurrent validity of upper and lower body muscular fitness that have been independently assessed by participants via the ecofit app, and face-to-face assessments conducted by a trained researcher. Methods: This study compared baseline data from two muscular fitness tests from the ecofit two-armed randomised controlled trial and self-assessed data collected via the ecofit smartphone app (i.e., validated 90-degree push-up and 60-second sit-to-stand test). To assess the concurrent validity, the self-assessed push-up and sit-to-stand tests (i.e., collected via the ecofit app) were correlated using Spearman's correlation coefficient against the researcher-assessed results (i.e., objective results collected during baseline assessment for the ecofit trial). Bland-Altman plots were also used to allow visualisation of the differences between the self- and research-assessed tests. Results: Participants (N = 54) completed the push-up (24.1%) and sit-to-stand (100%) tests within 14-days of receiving the app. The results revealed a strong significant correlation for the push-up test (0.83, p<0.001) and a moderate significant correlation for the sit-to-stand test (0.63, p<0.001). Conclusion: This study provides support for the concurrent validity of self-reported upper and lower body muscular fitness assessments (i.e., the push-up and sit-to-stand tests) in mHealth. While these tests may be a feasible option for large scale physical activity interventions, more research is needed to determine the generalisability of these results. [ABSTRACT FROM AUTHOR]

• Acceptability of the TaylorActive intervention website was rated mostly high in the video-tailored and text-tailored intervention groups. • Usability was rated high across the 3 groups with no significant between-group differences. • Usage of the TaylorActive website was modest in both video-tailored and text-tailored intervention groups. • Perceived usefulness of the TaylorActive website for increasing physical activity was rated low in both intervention groups, albeit significantly higher compared to the control group. • Satisfaction with the TaylorActive website was mixed. Intervention participants liked its ease of use, personalized feedback, and tracking of progress; however, they found completing action plans and survey questions each week repetitive and tedious. This study aimed to examine the usage, acceptability, usability, perceived usefulness, and satisfaction of a web-based video-tailored physical activity (PA) intervention (TaylorActive) in adults. In 2013–2014, 501 Australian adults aged 18+ years were randomized into a video-tailored intervention, text-tailored intervention, or control group. Over 3 months, the intervention groups received access to 8 sessions of personally tailored PA advice delivered via the TaylorActive website. Only the delivery method differed between the intervention groups: video-tailored vs. text-tailored. Google Analytics and telephone surveys conducted at post intervention (3 months) were used to assess intervention usage, acceptability, usability, perceived usefulness, and satisfaction. Quantitative and qualitative process data were analyzed using descriptive statistics and thematic content analysis. Of 501 recruited adults, 259 completed the 3-month post-intervention survey (52% retention). Overall, usage of the TaylorActive website with respect to number of website visits, intervention sessions, and action plans completed was modest in both the video-tailored (7.6 ± 7.2 visits, mean ± SD) and text-tailored (7.3 ± 5.4 visits) groups with no significant between-group differences. The majority of participants in all groups used the TaylorActive website less than once in 2 weeks (66.7% video-tailored, 62.7% text-tailored, 87.5% control; p < 0.001). Acceptability was rated mostly high in all groups and, in some instances, significantly higher in the intervention groups compared to the control group (p < 0.010). Usability was also rated high; mean Systems Usability Scores were 77.3 (video-tailored), 75.7 (text-tailored), and 74.1 (control) with no significant between-group differences. Perceived usefulness of the TaylorActive intervention was low, though mostly rated higher in the intervention groups compared to the control group (p < 0.010). Satisfaction with the TaylorActive website was mixed. Participants in both intervention groups liked its ease of use, personalized feedback, and tracking of progress, but also found completing action plans and survey questions for each session repetitive and tedious. Providing personally tailored PA advice on its own (through either video or text) is likely insufficient to ensure good retention, usage, perceived usefulness, and satisfaction with a web-based PA intervention. Strategies to address this may include the incorporation of additional intervention components such as activity trackers, social interactions, gamification, as well as the use of advanced artificial intelligence and machine learning technologies to allow more personalized dialogue with participants. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: This study examined potential parenting-related mediators of children's physical activity and dietary behavior change in the Healthy Dads, Healthy Kids (HDHK) community program. Methods: A randomized controlled trial was conducted with 45 overweight/obese (mean [SD] age = 39.8 [5.4] years; BMI = 32.4 [3.8]) fathers and their children (n = 77; 58% boys; mean [SD] age = 7.7 [2.5] years). Families were randomized to either the HDHK program or wait-list control group. The program involved 7 sessions. Fathers and their children were assessed at baseline and at 14 weeks for physical activity (pedometery) and core food intake (Questionnaire). Fathers' lifestyle-related parenting practices included; self-efficacy, beliefs, modeling, logistic support, rules, cophysical activity, shared mealtime frequency and intentions. Results: Significant intervention effects were found for cophysical activity and modeling physical activity. Cophysical activity mediated children's physical activity in the intervention ('mediated effect,' AB = 653, 95% CI = 4-2050) and was responsible for 59.5% of the intervention effect. Fathers' beliefs mediated children's percent energy from core foods (AB = 1.51, 95% CI = 0.05-5.55) and accounted for 72.9% of the intervention effect. Conclusions: Participation in the HDHK program positively impacted on fathers' cophysical activity with their child and beliefs about healthy eating which mediated changes in children's diet and physical activity behaviors. [ABSTRACT FROM AUTHOR]

Background: To examine if a composite activity-sleep behaviour index (ASI) mediates the effects of a combined physical activity and sleep intervention on symptoms of depression, anxiety, or stress, quality of life (QOL), energy and fatigue in adults. Methods: This analysis used data pooled from two studies: Synergy and Refresh. Synergy: Physically inactive adults (18–65 years) who reported poor sleep quality were recruited for a two-arm Randomised Controlled Trial (RCT) (Physical Activity and Sleep Health (PAS; n = 80), or Wait-list Control (CON; n = 80) groups). Refresh: Physically inactive adults (40–65 years) who reported poor sleep quality were recruited for a three-arm RCT (PAS (n = 110), Sleep Health-Only (SO; n = 110) or CON (n = 55) groups). The SO group was omitted from this study. The PAS groups received a pedometer, and accessed a smartphone/tablet "app" using behaviour change strategies (e.g., self-monitoring, goal setting, action planning), with additional email/SMS support. The ASI score comprised self-reported moderate-to-vigorous-intensity physical activity, resistance training, sitting time, sleep duration, efficiency, quality and timing. Outcomes were assessed using DASS-21 (depression, anxiety, stress), SF-12 (QOL-physical, QOL-mental) and SF-36 (Energy & Fatigue). Assessments were conducted at baseline, 3 months (primary time-point), and 6 months. Mediation effects were examined using Structural Equation Modelling and the product of coefficients approach (AB), with significance set at 0.05. Results: At 3 months there were no direct intervention effects on mental health, QOL or energy and fatigue (all p > 0.05), and the intervention significantly improved the ASI (all p < 0.05). A more favourable ASI score was associated with improved symptoms of depression, anxiety, stress, QOL-mental and of energy and fatigue (all p < 0.05). The intervention effects on symptoms of depression ([AB; 95%CI] -0.31; − 0.60,-0.11), anxiety (− 0.11; − 0.27,-0.01), stress (− 0.37; − 0.65,-0.174), QOL-mental (0.53; 0.22, 1.01) and ratings of energy and fatigue (0.85; 0.33, 1.63) were mediated by ASI. At 6 months the magnitude of association was larger although the overall pattern of results remained similar. Conclusions: Improvements in the overall physical activity and sleep behaviours of adults partially mediated the intervention effects on mental health and quality of life outcomes. This highlights the potential benefit of improving the overall pattern of physical activity and sleep on these outcomes. Trial registration: Australian New Zealand Clinical Trial Registry: ACTRN12617000680369; ACTRN12617000376347. Universal Trial number: U1111–1194-2680; U1111–1186-6588. Human Research Ethics Committee Approval: H-2016-0267; H-2016–0181. [ABSTRACT FROM AUTHOR]

Objectives: Some online, personally tailored, text-based physical activity interventions have proven effective. However, people tend to 'skim' and 'scan' web-based text rather than thoroughly read their contents. In contrast, online videos are more engaging and popular. We examined whether web-based personally tailored physical activity videos were more effective in promoting physical activity than personally tailored text and generic information.Methods: 501 adults were randomised into a video-tailored intervention, text-tailored intervention or control. Over a 3-month period, intervention groups received access to eight sessions of web-based personally tailored physical activity advice. Only the delivery method differed between intervention groups: tailored video versus tailored text. The primary outcome was 7-day ActiGraph-GT3X+ measured moderate-to-vigorous physical activity (MVPA) assessed at 0, 3 and 9 months. Secondary outcomes included self-reported MVPA and website engagement. Differences were examined using generalised linear mixed models with intention-to-treat and multiple imputation.Results: Accelerometer-assessed MVPA increased 23% in the control (1.23 (1.06, 1.43)), 12% in the text-tailored (1.12 (0.95, 1.32)) and 28% in the video-tailored (1.28 (1.06, 1.53)) groups at the 3-month follow-up only, though there were no significant between-group differences. Both text-tailored (1.77 (1.37, 2.28]) and video-tailored (1.37 (1.04, 1.79)) groups significantly increased self-reported MVPA more than the control group at 3 months only, but there were no differences between video-tailored and text-tailored groups. The video-tailored group spent significantly more time on the website compared with text-tailored participants (90 vs 77 min, p=0.02).Conclusions: The personally tailored videos were not more effective than personally tailored text in increasing MVPA. The findings from this study conflict with pilot study outcomes and previous literature. Process evaluation and mediation analyses will provide further insights.Trial Registration Number: ACTRN12615000057583. [ABSTRACT FROM AUTHOR]

Process evaluations can help to optimise the implementation of school-based physical activity interventions. The purpose of this paper is to describe the process evaluation of a school-based high-intensity interval training (HIIT) program for older adolescent students, known as Burn 2 Learn (B2L). B2L was evaluated via a cluster randomised controlled trial in 20 secondary schools (10 intervention, 10 control) in New South Wales, Australia. Teachers (n = 22 (55% female)) from the 10 intervention schools, delivered the program over three phases (Phases 1 and 2, 6 months; Phase 3, 6 months) to older adolescent students (n = 337 (50% female); mean ± standard deviation (SD) age = 16.0 ± 0.4 years). Process evaluation data were collected across the 12-month study period. Teachers delivered 2.0 ± 0.8 and 1.7 ± 0.6 sessions/week in Phases 1 and 2 respectively (mean total 25.9 ± 5.2), but only 0.6 ± 0.7 sessions/week in Phase 3. Observational data showed that session quality was high, however heart rate (HR) data indicated that only half of the students reached the prescribed threshold of ≥85% predicted HRmax during sessions. Over 80% of teachers reported they intended to deliver the B2L program to future student cohorts. Almost 70% of students indicated they intended to participate in HIIT in the future. Teachers considered the program to be adaptable, and both students and teachers were satisfied with the intervention. B2L was implemented with moderate-to-high fidelity in Phases 1 and 2, but low in Phase 3. Our findings add to the relatively scant process evaluation literature focused on the delivery of school-based physical activity programs. [ABSTRACT FROM AUTHOR]

Objectives: Examining mediators of intervention efficacy in an m-health intervention targeting physical activity and sleep in 160 Australian adults. Design: Nationwide randomised controlled trial. Main outcome measures: Moderate- and vigorous-intensity physical activity (MVPA), assessed using the Active Australia Questionnaire; sleep quality (Pittsburgh Sleep Quality Index); and sleep hygiene practices (Sleep Hygiene Index). Hypothesised psychosocial (e.g. self-efficacy) and behavioural (i.e. MVPA, sleep quality, sleep hygiene) mediators were tested on primary endpoint data at 3 months using bias-corrected bootstrapping (PROCESS 2 for SPSS). All outcomes and mediators were assessed using self-report. Results: At three months, the intervention had significantly improved sleep quality (d = 0.48, 95% CI: −2.26, −0.33, p = 0.009) and sleep hygiene (d = 0.40, 95% CI: −3.10, −0.19, p = 0.027). Differences in MVPA were not significant (d = 0.24, 95% CI: −35.53, 254.67, p = 0.139). Changes in MVPA were mediated by self-efficacy, perceived capability, environment, social support, intentions and planning, some of which showed inconsistent mediation (suppression). None of the hypothesised psychosocial factors mediated sleep outcomes. Changes in sleep hygiene mediated changes in sleep quality. Conclusions: Several psychosocial factors mediated changes in physical activity but not in sleep outcomes. Mediation effects of sleep hygiene on sleep quality highlight the importance of providing evidence-based strategies to improve sleep quality. [ABSTRACT FROM AUTHOR]

Background: The study aim was to examine the mechanisms of physical activity behaviour change in the multi-component eCoFit randomised controlled trial (RCT) among adults diagnosed with, or at risk of, T2D. Method: The RCT included two phases: phase 1 (weeks 1–10) integrated group sessions (outdoor physical activity and cognitive mentoring) and the use of the eCoFit smartphone application (app), and phase 2 (weeks 11–20), which included the use of the eCoFit smartphone application only. Participants (n = 84) were assessed at baseline and 10 and 20 weeks from baseline. Physical activity was assessed using pedometers, and the following mediators were tested: action self-efficacy, barrier self-efficacy, recovery self-efficacy, implementation intentions, intention to have regular physical activity, outcome expectations, risk perception and implicit associations related to physical activity. The PROCESS INDIRECT Macro was used to perform mediation analyses. Results: Significant mediation pathways were found for implementation intention measured at 10 weeks, AB (95% CI = 486.04 [128.19, 1073.42]). No significant pathways were found for the other social–cognitive and implicit attitudinal mediators. Conclusion: Increased daily steps among the intervention participants were explained by increased implementation intentions. The eCoFit study successfully operationalised implementation intentions in the smartphone app designed to promote outdoor physical activity. Trial Registration: The trial was approved by a University Human Research Committee and is registered with the Australian New Zealand Clinical Trial Registry (ACTRN12615000990527). [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]

High Intensity Interval Training (HIIT) may be effective for accumulating VPA. However, the contribution of HIIT to overall physical activity is unknown. Our primary aim was to explore the impact of school-based HIIT on physical activity. The secondary aim was to explore within-individual changes in physical activity after participating in HIIT. Participants [n = 65; 15.8(0.6)years] were randomized to a HIIT or control group. Intervention groups participated in three HIIT sessions/week. GENEActiv accelerometers assessed objective physical activity at baseline and week-one, to detect changes in MPA and VPA. Intervention effects were examined using linear mixed models and evidence of a change in physical activity (i.e., compensation) were examined using multilevel linear regression models. The group-by-time interaction effects for MPA and VPA were small and moderate, respectively. Adjusted difference between groups for VPA was 1.70 min/day, 95%CI –1.96 to 5.36;p= 0.354;d= 0.55). Embedding HIIT within the school-day had a moderate effect on VPA compared to controls. Compensation analyses (i.e., individual level) suggested that adolescents were more active on days when they participated in HIIT. Further studies are needed to test the effects of HIIT on adolescents’ physical activity over extended time periods. [ABSTRACT FROM PUBLISHER]

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. [ABSTRACT FROM AUTHOR]

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). [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]

Background: Web-based physical activity interventions that apply computer tailoring have shown to improve engagement and behavioral outcomes but provide limited accountability and social support for participants. It is unknown how video calls with a behavioral expert in a Web-based intervention will be received and whether they improve the effectiveness of computer-tailored advice.Objective: The purpose of this study was to determine the feasibility and effectiveness of brief video-based coaching in addition to fully automated computer-tailored advice in a Web-based physical activity intervention for inactive adults.Methods: Participants were assigned to one of the three groups: (1) tailoring + video-coaching where participants received an 8-week computer-tailored Web-based physical activity intervention ("My Activity Coach") including 4 10-minute coaching sessions with a behavioral expert using a Web-based video-calling program (eg, Skype; n=52); (2) tailoring-only where participants received the same intervention without the coaching sessions (n=54); and (3) a waitlist control group (n=45). Demographics were measured at baseline, intervention satisfaction at week 9, and physical activity at baseline, week 9, and 6 months by Web-based self-report surveys. Feasibility was analyzed by comparing intervention groups on retention, adherence, engagement, and satisfaction using t tests and chi-square tests. Effectiveness was assessed using linear mixed models to compare physical activity changes between groups.Results: A total of 23 tailoring + video-coaching participants, 30 tailoring-only participants, and 30 control participants completed the postintervention survey (83/151, 55.0% retention). A low percentage of tailoring + video-coaching completers participated in the coaching calls (11/23, 48%). However, the majority of those who participated in the video calls were satisfied with them (5/8, 71%) and had improved intervention adherence (9/11, 82% completed 3 or 4 modules vs 18/42, 43%, P=.01) and engagement (110 minutes spent on the website vs 78 minutes, P=.02) compared with other participants. There were no overall retention, adherence, engagement, and satisfaction differences between tailoring + video-coaching and tailoring-only participants. At 9 weeks, physical activity increased from baseline to postintervention in all groups (tailoring + video-coaching: +150 minutes/week; tailoring only: +123 minutes/week; waitlist control: +34 minutes/week). The increase was significantly higher in the tailoring + video-coaching group compared with the control group (P=.01). No significant difference was found between intervention groups and no significant between-group differences were found for physical activity change at 6 months.Conclusions: Only small improvements were observed when video-coaching was added to computer-tailored advice in a Web-based physical activity intervention. However, combined Web-based video-coaching and computer-tailored advice was effective in comparison with a control group. More research is needed to determine whether Web-based coaching is more effective than stand-alone computer-tailored advice.Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN): 12614000339651; http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=ACTRN12614000339651+&isBasic=True (Archived by WebCite at http://www.webcitation.org/6jTnOv0Ld). [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM PUBLISHER]

Objectives: To examine the effect of a gender-tailored, Social Cognitive Theory (SCT)-based weight loss maintenance (WLM) intervention on men's physical activity and healthy eating cognitions and behaviours in the 12 months after completing a weight loss programme.Design: A two-phase, assessor-blinded, randomized controlled trial.Methods: Ninety-two overweight/obese men (mean [SD] age: 49.2 years [10.1], BMI: 30.7 [3.3] kg/m(2) ) who lost at least 4 kg after completing the 3-month SCT-based SHED-IT Weight Loss Program were randomly allocated to receive (1) the SCT-based SHED-IT WLM Program; or (2) no additional resources (self-help control group). The 6-month gender-tailored SHED-IT WLM Program was completely self-administered and operationalized SCT behaviour change principles to assist men to increase moderate-to-vigorous physical activity (MVPA) and decrease energy-dense, nutrient-poor (discretionary) food consumption after initial weight loss. After randomization (WLM baseline), men were reassessed at 6 months (WLM post-test) and 12 months (6-month WLM follow-up). SCT cognitions (e.g., self-efficacy, goal setting), MVPA, and discretionary food consumption were assessed with validated measures.Results: Following significant improvements in cognitions, MVPA and discretionary food consumption during the weight loss phase, intention-to-treat, linear mixed models revealed no significant group-by-time differences in cognitions or behaviours during the WLM phase. Initial improvements in MVPA and some cognitions (e.g., goal setting, planning, and social support) were largely maintained by both groups at the end of the study. Dietary effects were not as strongly maintained, with the intervention and control groups maintaining 57% and 75% of the Phase I improvements in discretionary food intake, respectively.Conclusions: An additional SCT-based WLM programme did not elicit further improvements over a self-help control in the cognitions or behaviours for MVPA or discretionary food intake of men who had lost weight with a SCT-based weight loss programme. Statement of contribution What is already known on this subject?Weight regain after weight loss (WL) is common. As successful weight loss maintenance (WLM) requires sustained improvements in cognitions and behaviours, health psychology can contribute to intervention development. However, little research has examined the utility of psychological theory in the context of a WLM randomised controlled trial. What does this study add? A theory-based WL program improved men's physical activity and dietary behaviours and cognitions. Men who also received a theory-based WLM program did not show further improvements in physical activity or dietary cognitions and behaviours compared to those that did not. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background Physical inactivity is fourth in the list of risk factors for global mortality. General practitioners are well placed to offer physical activity counseling but insufficient time is a barrier. Although referral to an exercise specialist is an alternative, in Australia, these allied health professionals are only publicly funded to provide face-to-face counseling to patients who have an existing chronic illness. Accordingly, this trial aims to determine the efficacy of GP referral of insufficiently active patients (regardless of their chronic disease status) for physical activity counseling (either face-to-face or predominately via telephone) by exercise specialists, based on patients? objectively assessed physical activity levels, compared with usual care. If the trial is efficacious, the equivalence and cost-effectiveness of face-to-face counseling versus telephone counseling will be assessed. Methods This three arm pragmatic randomized trial will involve the recruitment of 261 patients from primary care clinics in metropolitan and regional areas of New South Wales, Australia. Insufficiently active (less than 7000 steps/day) consenting adult patients will be randomly assigned to: 1) five face-to-face counseling sessions, 2) one face-to-face counseling session followed by four telephone calls, or 3) a generic mailed physical activity brochure (usual care). The interventions will operationalize social cognitive theory via a behavior change counseling framework. Participants will complete a survey and seven days of pedometry at baseline, and at three and 12 months post-randomization. The primary analyses will be based on intention-to-treat principles and will compare: (i) mean change in average daily step counts between baseline and 12 months for the combined intervention group (Group 1: faceto- face, and Group 2: telephone) and usual care (Group 3); (ii) step counts at 3 months postrandomization. Secondary outcomes include: self-reported physical activity, sedentary behavior, quality of life, and depression. Discussion If referral of primary care patients to exercise specialists increases physical activity, this process offers the prospect of systematically and sustainably reaching a large proportion of insufficiently active adults. If shown to be efficacious this trial provides evidence to expand public funding beyond those with a chronic disease and for delivery via telephone as well as face-to-face consultations. [ABSTRACT FROM AUTHOR]

Objectives: A limited understanding of the mechanisms of behavior change has hindered the development of more effective interventions. The aim of this study was to identify potential mediators of objectively measured physical activity (PA) behavior change in women with type 2 diabetes (T2DM). Design: Mediation test of a randomized controlled trial. Method: Women with T2DM (n = 93) from the control group (standard PA materials, n = 44) and the full intervention group (control + stage-matched printed material and telephone counseling, n = 49) of a larger PA intervention trial were included. PA outcomes were minutes of MET weighted moderate and vigorous PA/week (self-report) and steps/3-days (objective) recorded at baseline and 12-months. Social-cognitive constructs were measured and tested in a mediating variable framework. Results: Perceived behavioral control and barrier self-efficacy mediated intervention effects on objective PA (proportion of intervention effect mediated = 18% and 24% respectively). Intention was a mediator of objective PA (23%). Conclusion: Perceived behavior control, barrier self-efficacy, and intention are effective mechanisms of PA behavior change in women with T2DM. [Copyright &y& Elsevier]

Background: While strong and consistent evidence supports the role of lifestyle modification in the prevention and management of type 2 diabetes (T2DM), the best strategies for program implementation to support lifestyle modification within primary care remain to be determined. The objective of the study is to evaluate the implementation of an evidence-based self- management program for patients with T2DM within a newly established primary care network (PCN) environment. Method: Using a non-randomized design, participants (total N = 110 per group) will be consecutively allocated in bi-monthly blocks to either a 6-month self-management program lead by an Exercise Specialist or to usual care. Our primary outcome is self-reported physical activity and pedometer steps. Discussion: The present study will assess whether a diabetes self-management program lead by an Exercise Specialist provided within a newly emerging model of primary care and linked to available community-based resources, can lead to positive changes in self-management behaviours for adults with T2DM. Ultimately, our work will serve as a platform upon which an emerging model of primary care can incorporate effective and efficient chronic disease management practices that are sustainable through partnerships with local community partners. Clinical Trials Registration: ClinicalTrials.gov identifier: NCT00991380 [ABSTRACT FROM AUTHOR]

Background: The primary aim of this study was to compare the efficacy of three physical activity (PA) behavioural intervention strategies in a sample of adults with type 2 diabetes. Method/Design: Participants (N = 287) were randomly assigned to one of three groups consisting of the following intervention strategies: (1) standard printed PA educational materials provided by the Canadian Diabetes Association [i.e., Group 1/control group)]; (2) standard printed PA educational materials as in Group 1, pedometers, a log book and printed PA information matched to individuals' PA stage of readiness provided every 3 months (i.e., Group 2); and (3) PA telephone counseling protocol matched to PA stage of readiness and tailored to personal characteristics, in addition to the materials provided in Groups 1 and 2 (i.e., Group 3). PA behaviour measured by the Godin Leisure Time Exercise Questionnaire and related social-cognitive measures were assessed at baseline, 3, 6, 9, 12 and 18-months (i.e., 6-month follow-up). Clinical (biomarkers) and health-related quality of life assessments were conducted at baseline, 12-months, and 18-months. Linear Mixed Model (LMM) analyses will be used to examine time-dependent changes from baseline across study time points for Groups 2 and 3 relative to Group 1. Discussion: ADAPT will determine whether tailored but low-cost interventions can lead to sustainable increases in PA behaviours. The results may have implications for practitioners in designing and implementing theory-based physical activity promotion programs for this population. Clinical Trials Registration: ClinicalTrials.gov identifier: NCT00221234 [ABSTRACT FROM AUTHOR]

Background: Attempts to demonstrate the efficacy of interventions aimed at increasing physical activity (PA) have been mixed. Further, studies are seldom designed in a manner that facilitates the understanding of how or why a treatment is effective or ineffective and PA intervention designs should be guided by a heavier reliance upon behavioral theory. The use of a mediating variable framework offers a systematic methodological approach to testing the role of theory, and could also identify the effectiveness of specific intervention components. The primary purpose of this paper was to test the mediating role that cognitive constructs may have played in regards to the positive effect that a workplace behavioral intervention had on leisure-time PA for women. A subsidiary purpose was to examine the cross-sectional relationships of these cognitive constructs with PA behavior. Methods: The Physical Activity Workplace Study was a randomized controlled trial which compared the effects of stage-matched and standard print materials upon self-reported leisure-time PA, within a workplace sample at 6 and 12-months. In this secondary analysis we examined the mediation effects of 14 psychosocial constructs across 3 major social-cognitive theories which were operationalized for the intervention materials and measured at baseline, 6 and 12-months. We examined change in PA and change in the psychological constructs employing a mediation strategy proposed by Baron and Kenny for: (1) the first 6-months (i.e., initial change), (2) the second 6-months (i.e., delayed change), and (3) the entire 12-months (overall change) of the study on 323 women (n = 213 control/standard materials group; n = 110 stage-matched materials group). Results: Of the 14 constructs and 42 tests (including initial, delayed and overall change) two positive results were identified (i.e., overall change in pros, initial change in experiential powerful intervention approaches processes), with very small effect sizes. However, these mediating results were eliminated after adjusting for the multiple statistical tests. Conclusions: The intervention did not change these mediators in any substantive way, and show a similar pattern to prior research where interventions generally do not result in a change in mediation of behavior change. It is important to report mediation results in randomized controlled trials whether the findings are null or positive. Future studies may wish to focus on more detailed dose-response issues between mediators and behavior, the inclusion of moderators that could affect individual change, or different mediator constructs at higher levels of measurement specificity. Continued work on innovative and more powerful PA intervention approaches are needed. [ABSTRACT FROM AUTHOR]

The aim was to increase cardiac rehabilitation (CR) uptake using a novel intervention, Rehabilitation Support Via Postcard (RSVP), among patients with acute myocardial infarction discharged from two major hospitals in Hunter New England Local Health District (HNELHD), New South Wales, Australia. The RSVP trial was evaluated using a two-armed randomised controlled trial design. Participants (N=430) were recruited from the two main hospitals in HNELHD, and enrolled and randomised to either the intervention (n=216) or control (n=214) group over a six-month period. All participants received usual care; however, the intervention group received postcards promoting CR attendance between January and July 2020. The postcard was ostensibly written as an invitation from the patient's admitting medical officer to promote timely and early uptake of CR. The primary outcome was CR attendance at outpatient HNELHD CR services in the 30-days post-discharge. Fifty-four percent (54%) of participants who received RSVP attended CR, compared to 46% in the control group; however this difference was not statistically significant (odds ratio [OR]=1.4, 95% confidence interval [CI]=0.9–2.0, p =0.11). Exploratory post-hoc analysis among four sub-groups (i.e., Indigeneity, gender, age and rurality), found that the intervention significantly increased attendance in males (OR=1.6, 95%CI=1.0–2.6, p =0.03) but had no significant impact on attendance for other sub-groups. While not statistically significant, postcards increased overall CR attendance by 8%. This strategy may be useful to increase attendance, particularly in men. Alternative strategies are necessary to increase CR uptake among women, Indigenous people, older people and people from regional and remote locations. [ABSTRACT FROM AUTHOR]

Objectives This study examined mediation effects of socio-ecological variables on accelerometer-determined physical activity among children in the Supporting Children's Outcomes using Rewards, Exercise and Skills (SCORES) intervention. Design Randomized control trial mediation analysis. Methods Primary school children were randomly assigned the SCORES multi-component intervention or control group for the 12-month study. The outcome was accelerometer derived total moderate-to-vigorous physical activity (MVPA). Hypothesized mediators measured in children were physical activity enjoyment and perceived sport competence and social support. Hypothesized mediators measured in parents were family social support, access to physical activity facilities and equipment at home, and perceived access to physical activity opportunities in the local community. Mediation analyses were conducted using multi-level linear analysis in MPlus. Results There were significant intervention effects for social support from teachers (A = 1.73, SE = 0.88, p = 0.048) and parental perceived access to physical opportunities in the local community (A = 2.69, SE = 1.12, p = 0.016). There were significant associations between changes in perceived sport competence (B = 0.48, SE = 0.36, p = 0.027), parental perceived access to physical activity opportunities in the local community (B = 0.60, SE = 0.26, p = 0.021), and changes in total MVPA. Parental perceived access to physical activity opportunities in the local community was found to have a significant mediating effect on total MVPA (AB = 1.61, 95% CI = 0.06 to 3.95, proportion 13%). Conclusions Parental perceived access to physical activity opportunities in the local community is a potential mechanism of behavior change for children and mediated the effect of the SCORES intervention on objectively measured physical activity. [ABSTRACT FROM AUTHOR]

Purpose: Emerging literature suggests that physical activity and fitness may have a positive effect on cognitive and mental health in adolescents. The purpose of the current study was to evaluate the efficacy of two high-intensity interval training (HIIT) protocols for improving cognitive and mental health outcomes (executive function, psychological well-being, psychological distress, and physical self-concept) in adolescents. Methods: Participants (n = 65; mean age = 15.8 ± 0.6 yr) were randomized to three conditions: aerobic exercise program (AEP; n = 21), resistance and aerobic program (RAP; n = 22), and control (n = 22). HIIT sessions (8-10 min per session) were delivered during physical education lessons or at lunchtime three times per week for 8 wk. Assessments were conducted at baseline and immediately postintervention to detect changes in executive function (trail making test), psychological well-being, psychological distress, and physical self-description by researchers blinded to treatment allocation. Intervention effects were examined using linear mixed models. Cohen's d effect sizes and clinical inference were also calculated. Results: While results were not significant, small improvements in executive function (mean change (95% CI) -6.69 (-22.03, 8.64), d = -0.32) and psychological well-being (mean change (95% CI) 2.81 (-2.06, 7.68), d = 0.34) were evident in the AEP group; and moderate improvements in executive function (mean change (95% CI) -10.73 (-26.22, 4.76), d = -0.51), and small improvements in well-being (mean change (95% CI) 2.96 (-1.82, 7.75), d = 0.36) and perceived appearance (mean change (95% CI) 0.32 (-0.25, 0.86), d = 0.35), were observed for the RAP group. Mean feeling state scores improved from preworkout to postworkout in both HIIT conditions, with significant results for the AEP (P = 0.001). Conclusions: This study highlights the potential of embedding HIIT within the school day for improving cognitive and mental health among adolescents. [ABSTRACT FROM AUTHOR]

Background: In randomized controlled trials, participants cannot choose their preferred intervention delivery mode and thus might refuse to participate or not engage fully if assigned to a nonpreferred group. This might underestimate the true effectiveness of behavior-change interventions. Objective: To examine whether receiving interventions either matched or mismatched with participants' preferred delivery mode would influence effectiveness of a Web-based physical activity intervention. Methods: Adults (n = 863), recruited via email, were randomly assigned to one of three intervention delivery modes (text based, video based, or combined) and received fully automated, Internet-delivered personal advice about physical activity. Personalized intervention content, based on the theory of planned behavior and stages of change concept, was identical across groups. Online, self-assessed questionnaires measuring physical activity were completed at baseline, 1 week, and 1 month. Physical activity advice acceptability and website usability were assessed at 1 week. Before randomization, participants were asked which delivery mode they preferred, to categorize them as matched or mismatched. Time spent on the website was measured throughout the intervention. We applied intention-to-treat, repeated-measures analyses of covariance to assess group differences. Results: Attrition was high (575/863, 66.6%), though equal between groups (t[sub 863] =1.31, P =.19). At 1-month follow-up, 93 participants were categorized as matched and 195 as mismatched. They preferred text mode (493/803, 61.4%) over combined (216/803, 26.9%) and video modes (94/803, 11.7%). After the intervention, 20% (26/132) of matched-group participants and 34% (96/282) in the mismatched group changed their delivery mode preference. Time effects were significant for all physical activity outcomes (total physical activity: F[sub 2,801] = 5.07, P = .009; number of activity sessions: F[sub 2,801] = 7.52, P < .001; walking: F[sub 2,801] = 8.32, P < .001; moderate physical activity: F[sub 2,801] = 9.53, P < .001; and vigorous physical activity: F[sub 2,801] = 6.04, P = .002), indicating that physical activity increased over time for both matched and mismatched groups. Matched-group participants improved physical activity outcomes slightly more than those in the mismatched group, but interaction effects were not significant. Physical activity advice acceptability (content scale: t[sub 368] = .10, P = .92; layout scale: t[sub 368] = 1.53, P = .12) and website usability (layout scale: t[sub 426] = .05, P = .96; ease of use scale: t[sub 426] = .21, P = .83) were generally high and did not differ between the matched and mismatched groups. The only significant difference (t[sub 621] = 2.16, P = .03) was in relation to total time spent on the website: the mismatched group spent significantly more time on the website (14.4 minutes) than the matched group (12.1 minutes). Conclusion: Participants' preference regarding delivery mode may not significantly influence intervention outcomes. Consequently, allowing participants to choose their preferred delivery mode may not increase effectiveness of Web-based interventions. [ABSTRACT FROM AUTHOR]

Purpose: Physical activity (PA) declines dramatically during adolescence, and activity levels are consistently lower among children living in low-income communities. Competency in a range of fundamental movement skills (FMS) may serve as a protective factor against the decline in PA typically observed during adolescence. The purpose of this study was to evaluate the effect of a 12-month multicomponent PA and FMS intervention on children attending primary schools in low-income communities. Methods: The Supporting Children's Outcomes using Rewards, Exercise, and Skills intervention was evaluated using a cluster randomized controlled trial. The sample included 25 classes from eight primary schools located in low-income communities. Participants were 460 children (54.1% girls) age 8.5 ± 0.6 yr. Primary outcomes were objectively measured PA (ActiGraph GT3X and GT3X+ accelerometers), FMS competency (Test of Gross Motor Development 2, six locomotor and six object control skills), and cardiorespiratory fitness (20-m multistage fitness test) assessed at baseline, midprogram (6-months), and at posttest (12 months). Linear mixed models, adjusted for sex, age, body mass index z-score, socioeconomic status, ethnicity, and school class as a random factor, were used to assess the effect of the intervention. Results: At midprogram, there were no significant intervention effects for any of the outcomes. At posttest (study's primary time point), there were intervention effects for daily moderate-to-vigorous PA (MVPA) (adjusted mean difference, 12.7 min·d-1 of MVPA; 95% confidence interval (CI), 5.0-20.5), overall FMS competency (4.9 units; 95% CI, j0.04 to 9.8), and cardiorespiratory fitness (5.4 laps; 95% CI, 2.3-8.6). Conclusions: A school-based multicomponent PA and FMS intervention maintained daily MVPA, improved overall FMS competency, and increased cardiorespiratory fitness among children attending primary schools in low-income communities. [ABSTRACT FROM AUTHOR]

Introduction Excessive recreational screen time (i.e., screen use for entertainment) is a global public health issue associated with adverse mental and physical health outcomes. Considering the growing popularity of screen-based recreation in adolescents, there is a need to identify effective strategies for reducing screen time among adolescents. The aim of this paper is to report the rationale and study protocol for the ‘Switch-off 4 Healthy Minds’ (S4HM) study, an intervention designed to reduce recreational screen time among adolescents. Methods The S4HM intervention will be evaluated using a cluster randomized controlled trial in eight secondary schools ( N = 322 students) in New South Wales, Australia. The 6-month multi-component intervention will encourage adolescents to manage their recreational screen time using a range of evidence-based strategies. The intervention is grounded in Self-Determination Theory (SDT) and includes the following components: an interactive seminar for students, eHealth messaging, behavioral contract and parental newsletters. All outcomes will be assessed at baseline and at 6-months (i.e., immediate post-test). The primary outcome is recreational screen time measured by the Adolescent Sedentary Activity Questionnaire (ASAQ). Secondary outcomes include: self-reported psychological well-being, psychological distress, global physical self-concept, resilience, pathological video gaming and aggression, and objectively measured physical activity (accelerometry) and body mass index (BMI). Hypothesized mediators of behavior change will also be explored. Discussion The S4HM study will involve the evaluation of an innovative, theory-driven, multi-component intervention that targets students and their parents and is designed to reduce recreational screen time in adolescents. The intervention has been designed for scalability and dissemination across Australian secondary schools. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the effectiveness of the ‘Healthy Dads, Healthy Kids (HDHK)’ program when delivered by trained facilitators in community settings. Method: A two-arm randomized controlled trial of 93 overweight/obese fathers (mean [SD] age=40.3 [5.3] years; BMI=32.5 [3.8] kg/m2) and their primary school-aged children (n=132) from the Hunter Region, Australia. In 2010–2011, families were randomized to either: (i) HDHK intervention (n=48 fathers, n=72 children) or (ii) wait-list control group. The 7-week intervention included seven sessions and resources (booklets, pedometers). Assessments were held at baseline and 14-weeks with fathers' weight (kg) as the primary outcome. Secondary outcomes for fathers and children included waist, BMI, blood pressure, resting heart rate, physical activity (pedometry), and self-reported dietary intake and sedentary behaviors. Results: Linear mixed models (intention-to-treat) revealed significant between-group differences for fathers' weight (P <.001, d =0.24), with HDHK fathers losing more weight (−3.3kg; 95%CI, −4.3, −2.4) than control fathers (0.1kg; 95%CI, −0.9,1.0). Significant treatment effects (P <.05) were also found for fathers' waist (d =0.41), BMI (d =0.26), resting heart rate (d =0.59), energy intake (d =0.49) and physical activity (d =0.46) and for children's physical activity (d =0.50) and adiposity (d =0.07). Discussion: HDHK significantly improved health outcomes and behaviors in fathers and children, providing evidence for program effectiveness when delivered in a community setting. [Copyright &y& Elsevier]

Abstract: 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 &y& Elsevier]

Background: Obesity prevention among youth of low SES is a public health priority given the higher prevalence of youth obesity in this population subgroup. Purpose: To evaluate the 24-month impact of a school-based obesity prevention program among adolescent girls living in low-income communities. Design: The study was a school-based group RCT, the Nutrition and Enjoyable Activity for Teen Girls (NEAT Girls) intervention. Setting/participants: The study involved 12 secondary schools located in low-income communities in New South Wales, Australia. Participants were 357 adolescent girls (aged 13.2±0.5 years). Intervention: The 12-month multicomponent intervention was guided by social cognitive theory and involved strategies to promote physical activity, reduce sedentary behaviors, and improve dietary outcomes. Main outcome measures: The primary outcome was BMI, and secondary outcomes were BMI z-score; percentage body fat (bioelectrical impedance analysis); physical activity (accelerometers); dietary intake; and recreational screen-time (self-report). Data were collected in 2010–2012 and analyzed in 2012. Results: After 24 months, there were no intervention effects on BMI (adjusted mean difference −0.33, 95% CI= −0.97, 0.28, p=0.353) and BMI z-score (−0.12, 95% CI= −0.27, 0.04, p=0.178). However, there was a group-by-time interaction for percentage body fat (−1.96%, 95% CI= −3.02, −0.89, p=0.006). Intervention effects for physical activity, screen time, and dietary intake were not significant. Conclusions: The NEAT Girls intervention did not result in effects on the primary outcome. Further study of youth who are “at risk” of obesity should focus on strategies to improve retention and adherence in prevention programs. Trial registration: This study is registered at Australian New Zealand Clinical Trials ACTRN1261000033004. [ABSTRACT FROM AUTHOR]

Introduction: Appealing approaches to increasing physical activity levels are needed. This study evaluated whether a social and gamified smartphone app (Active Team) could be one such approach.Study Design: A 3-group cluster RCT compared the efficacy of Active Team with a basic self-monitoring app and waitlist control group.Setting/participants: Australian adults (N=444, mean age of 41 years, 74% female) were recruited in teams (n=121) and randomly assigned (1:1:1) to the Active Team (n=141, 39 teams), self-monitoring app (n=160, 42 teams), or waitlist group (n=143, 40 teams). Data were collected in 2016-2017, and analysis was conducted in 2018-2019.Intervention: Active Team is a 100-day app-based, gamified, online social networking physical activity intervention.Main Outcome Measures: The primary outcome was change in objective physical activity from baseline to 3-month follow-up. Secondary outcomes included objective physical activity at 9 months and self-reported physical activity, quality of life, depression, anxiety and stress, well-being, and engagement.Results: Mixed models indicated no significant differences in objective physical activity between groups at 3 (F=0.17, p=0.84; Cohen's d=0.03, 95% CI= -0.21, 0.26) or 9 months (F=0.23, p=0.92; d=0.06, 95% CI= -0.17, 0.29) and no significant differences for secondary outcomes of quality of life, depression, anxiety and stress, or well-being. Self-reported moderate-to-vigorous physical activity was significantly higher in the Active Team group at the 9-month follow-up (F=3.05, p=0.02; d=0.50, 95% CI=0.26, 0.73). Engagement was high; the Active Team group logged steps on an average of 72 (SD=35) days and used the social and gamified features an average of 89 (SD=118) times.Conclusions: A gamified, online social networking physical activity intervention did not change objective moderate-to-vigorous physical activity, though it did increase self-reported moderate-to-vigorous physical activity and achieve high levels of engagement. Future work is needed to understand if gamification, online social networks, and app-based approaches can be leveraged to achieve positive behavior change.Trial Registration: This study is registered at Australian and New Zealand Clinical Trial Registry (protocol: ANZCTR12617000113358). [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: Primary care physicians are well placed to offer physical activity counseling, but insufficient time is a barrier. Referral to an exercise specialist is an alternative. In Australia, exercise specialists are publicly funded to provide face-to-face counseling to patients who have an existing chronic illness. This trial aimed to (1) determine the efficacy of primary care physicians' referral of insufficiently active patients for counseling to increase physical activity, compared with usual care, and (2) compare the efficacy of face-to-face counseling with counseling predominantly via telephone.Study Design: Three-arm pragmatic RCT.Setting/participants: Two hundred three insufficiently active (<7,000 steps/day) primary care practice patients (mean age 57 years; 70% female) recruited in New South Wales, Australia, in 2011-2014.Intervention: (1) Five face-to-face counseling sessions by an exercise specialist, (2) one face-to-face counseling session followed by four telephone calls by an exercise specialist, or (3) a generic mailed physical activity brochure (usual care). The counseling sessions operationalized social cognitive theory via a behavior change counseling framework.Main Outcome Measures: Change in average daily step counts between baseline and 12 months. Data were analyzed in 2016.Results: Forty (20%) participants formally withdrew; completion rates at 3 and 6 months were 64% and 58%, respectively. Intervention attendance was high (75% received five sessions). The estimated mean difference between usual care and the combined intervention groups at 12 months was 1,002 steps/day (95% CI=244, 1,759, p=0.01). When comparing face-to-face with predominantly telephone counseling, the telephone group had a non-significant higher mean daily step count (by 619 steps) at 12 months.Conclusions: Provision of expert physical activity counseling to insufficiently active primary care patients resulted in a significant increase in physical activity (approximately 70 minutes of walking per week) at 12 months. Face-to-face only and counseling conducted predominantly via telephone were both effective. This trial provides evidence to expand public funding for expert physical activity counseling and for delivery via telephone in addition to face-to-face consultations.Trial Registration: This trial is registered at www.anzctr.org.au/ ACTRN12611000884909. [ABSTRACT FROM AUTHOR]

Introduction: The primary objective was to evaluate the impact of the 'Switch-off 4 Healthy Minds' (S4HM) intervention on recreational screen-time in adolescents.Methods: Cluster randomized controlled trial with study measures at baseline and 6-months (post-intervention). Eligible participants reported exceeding recreational screen-time recommendations (i.e., >2h/day). In total, 322 adolescents (mean age=14.4±0.6years) from eight secondary schools in New South Wales, Australia were recruited. The S4HM intervention was guided by Self-Determination Theory and included: an interactive seminar, eHealth messaging, a behavioral contract and parental newsletters. The primary outcome was recreational screen-time. Secondary outcomes included mental health (i.e., well-being, psychological distress, self-perceptions), objectively measured physical activity, and body mass index (BMI). Outcome analyses were conducted using linear mixed models and mediation was examined using a product-of-coefficients test.Results: At post-intervention, significant reductions in screen-time were observed in both groups, with a greater reduction observed in the intervention group (-50min/day versus -29min, p<0.05 for both). However, the adjusted difference in change between groups was not statistically significant (mean=-21.3min/day, p=0.255). There were no significant intervention effects for mental health outcomes, physical activity or BMI. Significant mediation effects for autonomous motivation were found.Conclusions: Participants in both the S4HM intervention and control groups significantly reduced their screen-time, with no group-by-time effects. Enhancing autonomous motivation might be a useful intervention target for trials aimed at reducing adolescents' recreational screen-time.Trial Registration: ACTRN12614000163606. [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]

Introduction: Self-administered lifestyle interventions have been suggested as an alternative to face-to-face delivery modes, although their efficacy remains uncertain. The aim of this study was to evaluate the efficacy of the Type 2 diabetes mellitus Prevention Using LifeStyle Education (PULSE) Program, a self-administered and gender-tailored lifestyle intervention for men at high risk for developing Type 2 diabetes mellitus.Design/setting: A 6-month, assessor-blinded, parallel-group RCT was conducted at the University of Newcastle, Australia in 2012-2013.Participants: Men (aged 18-65 years, BMI 25-40 kg/m(2), high risk for developing Type 2 diabetes mellitus) were stratified by age (<50 and >50 years) and BMI category (25.0-29.9, 30.0-35.9, and 35.0-40 kg/m(2)) and individually randomized (1:1 ratio) to the intervention (n=53) or waitlist control groups (n=48).Intervention: The intervention group received the PULSE Program, which contained print and video resources on weight loss (Self-Help, Exercise and Diet using Internet Technology [SHED-IT] Weight Loss Program), diet modification, and exercise for Type 2 diabetes mellitus prevention. The waitlist control group received no information until 6 months.Main Outcome Measures: Data were collected from September 2012 to September 2013 and analyzed in 2014-2015. Linear mixed models (intention-to-treat) were used to determine group X time interactions (differences between groups in changes over time) at 6 months for the primary outcome (weight), glycated hemoglobin, and several secondary outcomes (significance level, p<0.05).Results: Differences between groups in mean changes from baseline to 6 months (group × time interaction) favored the intervention over control group for weight loss (-5.50 kg, 95% CI=-7.40 kg, -3.61 kg, p<0.001, Cohen's d=1.15), glycated hemoglobin (-0.2%, 95% CI=-0.3%, -0.1%, p=0.002, d=0.64), and BMI, waist circumference, body fat percentage, aerobic fitness, and lower body muscular fitness (all p<0.05). No group × time effects were observed for fasting plasma glucose, upper body muscular fitness, physical activity, or energy intake.Conclusions: The PULSE Program improved several Type 2 diabetes mellitus risk factors in men, including weight and glycated hemoglobin. These findings provide evidence for a self-administered and gender-tailored lifestyle intervention, which has potential for dissemination in community settings. [ABSTRACT FROM AUTHOR]

Background Intensive lifestyle interventions have been successful in reducing type 2 diabetes incidence. Whether intensive programmes requiring face-to-face contact, trained staff and access to facilities are feasible, on a larger scale, has been debated. Objectives The aim of this study is to determine the feasibility and efficacy of a lifestyle intervention for type 2 diabetes prevention in men using an assessor-blinded, parallel-group, randomised controlled trial. The ‘ Type 2 Diabetes PULSE ( Prevention Using LifeStyle Education ) Programme for Men ’ is a 6-month, self-administered, gender-tailored lifestyle intervention, with a multicomponent approach (weight loss, dietary modification, aerobic exercise and resistance training). Eligible men were aged 18–65 years, overweight/obese (BMI 25–40 kg·m − 2 ) and at high-risk for type 2 diabetes (score ≥ 12, Australian diabetes risk tool). Men with diagnosed prediabetes were eligible, but those with type 1 and 2 diabetes were ineligible. Randomisation was stratified by age (< 50 or ≥ 50 years) and BMI category (kg·m − 2 : 25–29.9; 30–34.9; 35–40) to the intervention or wait-list control group. Data are collected at study entry (baseline), 3 and 6 months. The primary outcome is weight change at 6 months. Secondary outcomes include: fasting plasma glucose, HbA 1C , waist circumference, body composition, blood pressure, diet quality, aerobic fitness, muscular fitness and physical activity. Generalised linear mixed models (intention-to-treat) will assess outcomes for treatment (intervention vs. control), time (baseline, 3 and 6-months) and the treatment-by-time interaction. Conclusion The results will determine the efficacy of a type 2 diabetes prevention programme for men with potential for wide reach and dissemination. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12612000721808). [ABSTRACT FROM AUTHOR]

Abstract: Despite short-term efficacy, many weight loss studies demonstrate poor long-term results and have difficulty recruiting men. Cost-effective treatments that help men achieve long-term weight loss are required. Using a two-phase, assessor-blinded, parallel-group randomised controlled trial design this study will test the effectiveness and cost-effectiveness of a male-only weight loss maintenance intervention. In Phase I (3months) 209 men received the SHED-IT Weight Loss Program. In Phase II (12months) 92 men who lost 4kg or more were randomised to either (i) a maintenance group who received the 6-month, gender-tailored SHED-IT Weight Loss Maintenance Program, which included no face-to-face contact (n=47), or (ii) a self-help control group (n=45). Randomisation was stratified by weight loss (4kg–7.4kg, ≥7.5kg) and BMI (<30kg/m2, ≥30kg/m2). Assessments occurred at 'study entry' (start of Phase I), 'baseline' (start of Phase II), '6 months' (post-test) and will occur at '12 months' (follow-up; primary endpoint). The primary outcome is weight change in Phase II (i.e. from 'baseline' at 12months after randomization). Secondary outcomes include waist circumference (umbilicus and narrowest), blood pressure, body composition, objectively measured physical activity, sedentary time, portion size, dietary intake, quality of life, depressive symptoms, and behavioural cognitions. Costing data will be collected for cost-effectiveness analysis. Generalised linear mixed models (intention-to-treat) will assess outcomes for treatment (maintenance vs. control), time (baseline, 6-month and 12-month) and the treatment-by-time interaction. This will be the first study to evaluate a male-only, gender-targeted weight loss maintenance program. Results will provide evidence regarding feasible and theoretically-driven obesity treatments for men with potential for long-term impact and widespread dissemination. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12612000749808). [Copyright &y& Elsevier]