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Background: TransformUs was a four-arm school-based intervention to increase physical activity and reduce sedentary behaviour among primary school children. Pedagogical and environmental strategies targeted the classroom, school grounds and family setting. The aims of this study were to evaluate program fidelity, dose, appropriateness, satisfaction and sustainability, and associations between implementation level and outcomes among the three intervention arms., Methods: At baseline, 18-months (mid-intervention) and 30-months (post-intervention), teachers, parents and children completed surveys, and children wore GT3X ActiGraph accelerometers for 8 days at each time point to determine physical activity and sedentary time. Implementation data were pooled across the three intervention groups and teachers were categorised by level of implementation: (i) 'Low' (< 33% delivered); (ii) 'Moderate' (33-67% delivered); and (iii) 'High' (> 67% delivered). Linear and logistic mixed models examined between group differences in implementation, and the association with children's physical activity and sedentary time outcomes. Qualitative survey data were analysed thematically., Results: Among intervention recipients, 52% (n = 85) of teachers, 29% (n = 331) of parents and 92% (n = 407) of children completed baseline evaluation surveys. At 18-months, teachers delivered on average 70% of the key messages, 65% set active/standing homework, 30% reported delivering > 1 standing lesson/day, and 56% delivered active breaks per day. The majority of teachers (96%) made activity/sports equipment available during recess and lunch, and also used this equipment in class (81%). Fidelity and dose of key messages and active homework reduced over time, whilst fidelity of standing lessons, active breaks and equipment use increased. TransformUs was deemed appropriate for the school setting and positively received. Implementation level and child behavioural outcomes were not associated. Integration of TransformUs into existing practices, children's enjoyment, and teachers' awareness of program benefits all facilitated delivery and sustainability., Conclusions: This study demonstrated that intervention dose and fidelity increased over time, and that children's enjoyment, senior school leadership and effective integration of interventions into school practices facilitated improved intervention delivery and sustainability. Teacher implementation level and child behavioural outcomes were unrelated, suggesting intervention efficacy was achieved irrespective of implementation variability. The potential translatability of TransformUs into practice contexts may therefore be increased. Findings have informed scale-up of TransformUs across Victoria, Australia., Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN83725066; Australian New Zealand Clinical Trials Registry Number ACTRN12609000715279. Registered 19 August 2009. Available at: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=308387&isReview=true., (© 2022. The Author(s).)

Background: Strong evidence indicates that excessive time spent sitting (sedentary behaviour) is detrimentally associated with multiple chronic diseases. Sedentary behaviour is prevalent among adults in Australia and has increased during the COVID-19 pandemic. Estimating the potential health benefits and healthcare cost saving associated with reductions in population sitting time could be useful for the development of public health initiatives., Methods: A sedentary behaviour model was developed and incorporated into an existing proportional, multi-state, life table Markov model (ACE-Obesity Policy model). This model simulates the 2019 Australian population (age 18 years and above) and estimates the incidence, prevalence and mortality of five diseases associated with sedentary behaviour (type 2 diabetes, stroke, endometrial, breast and colorectal cancer). Key model inputs included population sitting time estimates from the Australian National Health Survey 2014-2015, healthcare cost data from the Australian Institute of Health and Welfare (2015) and relative risk estimates assessed by conducting literature reviews and meta-analyses. Scenario analyses estimated the potential change in disease incidence as a result of changes in population sitting time. This, in turn, resulted in estimated improvements in long term health outcomes (Health-adjusted life years (HALYs)) and healthcare cost-savings., Results: According to the model, if all Australian adults sat no more than 4 h per day, the total HALYs gained would be approximately 17,211 with health care cost savings of approximately A$185 million over one year. Under a more feasible scenario, where sitting time was reduced in adults who sit 4 or more hours per day by approximately 36 min per person per day (based on the results of the Stand Up Victoria randomised controlled trial), potential HALYs gained were estimated to be 3,670 and healthcare cost saving could reach A$39 million over one year., Conclusions: Excessive sedentary time results in considerable population health burden in Australia. This paper describes the development of the first Australian sedentary behaviour model that can be used to predict the long term consequences of interventions targeted at reducing sedentary behaviour through reductions in sitting time. These estimates may be used by decision makers when prioritising healthcare resources and investing in preventative public health initiatives., (© 2022. The Author(s).)

Objective: This cross-sectional study examined the interrelationships between workplace movement (sitting, standing, and stepping), availability of discussion space, and face-to-face (FTF) interactions between workers., Methods: Desk-based workers (n = 221) wore an activity monitor for 7 days and self-reported their weekly frequency of FTF interactions and discussion space availability. Negative binomial regression models examined behavioral and spatial factors associated with the frequency of FTF interactions., Results: Adjusted for potential confounders, each one standard deviation increment in time spent sitting, standing, stepping, and discussion space availability was associated with 20% lower (P = 0.004), 19% higher (P = 0.003), 6% higher (P = 0.16), and 11% higher (P = 0.26) frequency of FTF interactions, respectively CONCLUSIONS:: Lower workplace sitting was often linked to reduced risk of chronic diseases. Our findings suggest that less sitting at work may have additional benefits of increasing informal interactions between office workers.

Background and Aims: Modern Western lifestyles are characterized by consumption of approximately 45% of total daily energy intake at the evening meal, followed by prolonged sitting while watching television (TV), which may deleteriously impact glycemic control. After a high-energy evening meal (dinner), we examined whether regular, brief activity bouts during TV commercial breaks could acutely lower postprandial glucose and insulin responses in overweight/obese adults, compared to prolonged uninterrupted sitting., Methods and Results: Nine overweight/obese adults (29.7 ± 4.06 kg m -2 ; aged 32 ± 3 years; 5 male) completed two laboratory-based conditions of three and a half hours: prolonged sitting during TV viewing (SIT); and, prolonged sitting interrupted every 20 min with 3 min of light-intensity body-weight resistance activities (active commercial breaks; ACBs). Venous postprandial glucose and insulin responses to dinner were calculated as positive incremental area under the curve (iAUC) from baseline. Interstitial glucose was measured using a continuous glucose monitor and quantified as total AUC (tAUC). Compared to SIT, plasma glucose iAUC was reduced by 33% [3.4 ± 1.0 vs 5.1 ± 1.0 (mean ± SEM) mmol h·L -1 , p = 0.019] and plasma insulin iAUC by 41% (813 ± 224 vs 1373 ± 224, p = 0.033 pmol h·L -1 ) for the ACB condition. During the ACB condition there was a significant reduction in interstitial glucose tAUC (24.4 ± 5.2 vs 26.9 ± 5.2 mmol h·L -1 , p < 0.001), but this did not persist beyond the laboratory observation period., Conclusions: Regular brief light-intensity activity bouts can attenuate glycemic responses during television viewing time following a high-energy evening meal in overweight/obese adults., (Copyright © 2018 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Background: The Stand Up Victoria multi-component intervention successfully reduced workplace sitting time in both the short (three months) and long (12 months) term. To further understand how this intervention worked, we aimed to assess the impact of the intervention on four social-cognitive constructs, and examined whether these constructs mediated intervention effects on workplace sitting time at 3 and 12 months post-baseline., Methods: Two hundred and thirty one office-based workers (14 worksites, single government employer) were randomised to intervention or control conditions by worksite. The intervention comprised organisational, environmental, and individual level elements. Participant characteristics and social-cognitive constructs (perceived behavioural control, barrier self-efficacy, perceived organisational norms and knowledge) were measured through a self-administered online survey at baseline, 3 months and 12 months. Workplace sitting time (min/8 h day) was measured with the activPAL3 device. Single multi-level mediation models were performed for each construct at both time points., Results: There were significant intervention effects at 3 months on perceived behavioural control, barrier self-efficacy and perceived organisational norms. Effects on perceived organisational norms were not significant at 12 months. Perceived behavioural control significantly mediated intervention effects at 3 months, accounting for a small portion of the total effect (indirect effect: -8.6 min/8 h day, 95% CI: -18.5, -3.6 min; 7.5% of total effect). At 12 months, barrier self-efficacy significantly mediated the intervention effects on workplace sitting time (indirect effect: -10.3 min/8 h day, 95% CI: -27.3, -2.2; 13.9% of total effect). No significant effects were observed for knowledge at either time point., Conclusions: Strategies that aim to increase workers' perceived control and self-efficacy over their sitting time may be helpful components of sedentary behaviour interventions in the workplace. However, social-cognitive factors only partially explain variation in workplace sitting reduction. Understanding the importance of other levels of influence (particularly interpersonal and environmental) for initiating and maintaining workplace sedentary behaviour change will be informative for intervention development and refinement., Trial Registration: This study was prospectively registered with the Australian New Zealand Clinical Trials register ( ACTRN12611000742976 ) on 15 July 2011.

Background: Physical inactivity, inadequate dietary protein, and low-grade systemic inflammation contribute to age-related muscle loss, impaired function, and disability., Objective: We assessed the effects of progressive resistance training (PRT) combined with a protein-enriched diet facilitated through lean red meat on lean tissue mass (LTM), muscle size, strength and function, circulating inflammatory markers, blood pressure, and lipids in elderly women., Design: In a 4-mo cluster randomized controlled trial, 100 women aged 60-90 y who were residing in 15 retirement villages were allocated to receive PRT with lean red meat (∼160 g cooked) to be consumed 6 d/wk [resistance training plus lean red meat (RT+Meat) group; n = 53] or control PRT [1 serving pasta or rice/d; control resistance training (CRT) group; n = 47)]. All women undertook PRT 2 times/wk and received 1000 IU vitamin D3/d., Results: The mean (± SD) protein intake was greater in the RT+Meat group than in the CRT group throughout the study (1.3 ± 0.3 compared with 1.1 ± 0.3 g · kg⁻¹ · d⁻¹, respectively; P < 0.05). The RT+Meat group experienced greater gains in total body LTM (0.45 kg; 95% CI: 0.07, 0.84 kg), leg LTM (0.22 kg; 95% CI: 0.02, 0.42 kg), and muscle strength (18%; 95% CI: 0.03, 0.34) than did the CRT group (all P < 0.05). The RT+Meat group also experienced a 10% greater increase in serum insulin-like growth factor I (P < 0.05) and a 16% greater reduction in the proinflammatory marker interleukin-6 (IL-6) (P < 0.05) after 4 mo. There were no between-group differences for the change in blood lipids or blood pressure., Conclusion: A protein-enriched diet equivalent to ∼1.3 g · kg⁻¹ · d⁻¹ achieved through lean red meat is safe and effective for enhancing the effects of PRT on LTM and muscle strength and reducing circulating IL-6 concentrations in elderly women. This trial was registered at the Australian Clinical Trials Registry as ACTRN12609000223235.

Purpose: To examine the association of strength training (ST) activity with impaired glucose metabolism (IGM) in Australian adults., Methods: On the basis of an oral glucose tolerance test, IGM (which includes impaired fasting glucose, impaired glucose tolerance, or newly diagnosed type 2 diabetes), was assessed in 5831 adults (mean age = 56.0 +/- 12.7 yr) without clinically diagnosed diabetes who participated in the 2004–2005 Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Meeting the current ST guideline was based on reporting ST at least two times per week (frequency) or > or = 40 min x wk(-1) in total (duration). Multiple logistic regression analyses examined associations of self-reported ST frequency and duration with IGM., Results: After adjustment for known confounding factors and total moderate- to vigorous-intensity leisure time exercise, the odds ratio (OR) of IGM was 0.73 (95% confidence interval [CI] = 0.59–0.91, P < or = 0.005) in those who met the ST frequency guideline (two or more times per week) and 0.69 (95% CI = 0.55–0.87, P < or = 0.01) in those who met the ST duration guideline (> or =40 min x wk(-1)). Those who achieved both the recommended frequency and duration of ST had 24% lower odds of IGM. There was also evidence that a moderate frequency (once a week) and duration (10–39 min x wk(-1)) of ST reduced the odds of IGM (OR frequency = 0.53, 95% CI = 0.51–0.81, P e 0.01; OR duration = 0.72, 95% CI = 0.52–1.00, P < or = 0.05)., Conclusions: These findings support the importance of including ST activity, at a frequency of at least once per week, within exercise management recommendations for the maintenance of favorable metabolic health, particularly as it may contribute to reducing the risk of developing type 2 diabetes mellitus.

Background: Physical activity (PA) is associated with positive cardio-metabolic health and emerging evidence suggests sedentary behavior (SB) may be detrimental to children's health independent of PA. The primary aim of the Transform-Us! study is to determine whether an 18-month, behavioral and environmental intervention in the school and family settings results in higher levels of PA and lower rates of SB among 8-9 year old children compared with usual practice (post-intervention and 12-months follow-up). The secondary aims are to determine the independent and combined effects of PA and SB on children's cardio-metabolic health risk factors; identify the factors that mediate the success of the intervention; and determine whether the intervention is cost-effective., Methods/design: A four-arm cluster-randomized controlled trial (RCT) with a 2 × 2 factorial design, with schools as the unit of randomization. Twenty schools will be allocated to one of four intervention groups, sedentary behavior (SB-I), physical activity (PA-I), combined SB and PA (SB+PA-I) or current practice control (C), which will be evaluated among approximately 600 children aged 8-9 years in school year 3 living in Melbourne, Australia. All children in year 3 at intervention schools in 2010 (8-9 years) will receive the intervention over an 18-month period with a maintenance 'booster' delivered in 2012 and children at all schools will be invited to participate in the evaluation assessments. To maximize the sample and to capture new students arriving at intervention and control schools, recruitment will be on-going up to the post-intervention time point. Primary outcomes are time spent sitting and in PA assessed via accelerometers and inclinometers and survey., Discussion: To our knowledge, Transform-Us! is the first RCT to examine the effectiveness of intervention strategies for reducing children's overall sedentary time, promoting PA and optimizing health outcomes. The integration of consistent strategies and messages to children from teachers and parents in both school and family settings is a critical component of this study, and if shown to be effective, may have a significant impact on educational policies as well as on pedagogical and parenting practices., Trial Registration: ACTRN12609000715279; Current Controlled Trials ISRCTN83725066.

Background: Television (TV) viewing time is associated with abnormal glucose metabolism, the metabolic syndrome, and risk of type 2 diabetes; associations are stronger and more consistent in women. One explanation of this difference may be that TV viewing is a marker of an overall pattern of sedentary behavior in women., Purpose: We sought to examine associations of TV viewing time with other sedentary behaviors and with leisure-time physical activity in a large sample of Australian adults., Methods: Adults aged between 20 and 65 years (n = 2,046) completed a self-administered questionnaire on TV viewing, five other leisure-time sedentary behaviors, and leisure-time physical activity. Mean adjusted time spent in other sedentary behaviors and in physical activity was compared across TV-time categories previously shown to be associated with abnormal glucose metabolism., Results: After adjustment for body mass index and socio-demographic variables, women's time spent watching TV was associated positively with time in other sedentary behaviors and negatively with leisure-time physical activity, but no such associations were observed in men., Conclusions: TV viewing time may be a robust marker of a sedentary lifestyle in women but not in men. Gender differences in the pattern of sedentary behaviors may explain at least in part the gender differences in the previously reported associations of TV viewing time with biological attributes related to type 2 diabetes.