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Introduction: Nana Anokye, Brunel University London; ISPAH LMIC Research Chair of Council. Title: Setting the scene and introducing the speakers Speaker 1: Andrea Ramirez, Universidad de los Andes in Colombia; Coordinator, Global Observatory for Physical Activity ��� GoPA! Title: COVID and Physical Activity in LMIC. Description: Andrea will reflect on data in the past year on the correlations between physical inactivity and COVID-19 outcomes and vice versa, the effects of COVID-19 on physical activity, and the wider impacts of the pandemic on physical activity. Speaker 2: Deborah Salvo, Washington University and Prarthna Mukerjee, Public Health Foundation India Title: Roll call on Sustainable Development Goals and Physical Activity. Description: This session will provide up to date evidence on the linkages, supported by science, between SDGs and PA; focussing on the portions relevant to LMICs. This will include findings on simulated gains to SDGs due to different PA promotion strategies in cities of LMIC. Presenter 3: Prarthna Mukerjee, Public Health Foundation of India, Centre for Chronic Disease Control Title: Urban Forests, Parks in Delhi enhance Physical Activity, SDGs 3, 5, 10 Presenter 4: Alejandra Jauregui, Jefa del Departamento de Actividad F��sica y Estilos de Vida Saludable; Centro de Invesitgaci��n en Nurtici��n y Salud Title: Nexus between Obesity, Physical Activity and Diet in LMIC: The experiences in Mexico Speaker 5: Kingsley Agyemang, Brunel University London and Alejandra Jauregui, National Institute of Public Health of Mexico Title: Nexus between Obesity, Physical Activity and Diet in LMIC. Description: The speakers will present findings of recent empirical analyses using data from West Africa and Latin America. This will include an overview of the findings from the 2021 Ghana Obesity Survey, the first comprehensive survey on lifestyle behaviour in Ghana. Purpose: This symposium is organised by the LMIC Research council. The aim is to highlight the co-benefits of physical activity using evidence base in LMIC settings. The symposium will comprise three main parts; featuring research conducted in sub-Saharan Africa, Asia and the Americas., The Health & Fitness Journal of Canada, Vol. 14 No. 3 (2021): Proceedings from the 8th International Society for Physical Activity and Health Congress

Trial registration number ISRCTN15644451. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. Objective: To determine whether adding web-based support (e-coachER) to an exercise referral scheme (ERS) increases objectively assessed physical activity (PA). Design: Multicentre trial with participants randomised to usual ERS alone (control) or usual ERS plus e-coachER (intervention). Setting: Primary care and ERS in three UK sites from 2015 to 2018. Participants: 450 inactive ERS referees with chronic health conditions. Interventions: Participants received a pedometer, PA recording sheets and a user guide for the web-based support. e-coachER interactively encouraged the use of the ERS and other PA options. Main outcome measures: Primary and key secondary outcomes were: objective moderate-to-vigorous PA (MVPA) minutes (in ≥10 min bouts and without bouts), respectively, after 12 months. Secondary outcomes were: other accelerometer-derived and self-reported PA measures, ERS attendance, EQ-5D-5L, Hospital Anxiety and Depression Scale and beliefs about PA. All outcomes were collected at baseline, 4 and 12 months. Primary analysis was an intention to treat comparison between intervention and control arms at 12-month follow-up. Results: There was no significant effect of the intervention on weekly MVPA at 12 months between the groups recorded in ≥10 min bouts (mean difference 11.8 min of MVPA, 95% CI: -2.1 to 26.0; p=0.10) or without bouts (mean difference 13.7 min of MVPA, 95% CI: -26.8 to 54.2; p=0.51) for 232 participants with usable data. There was no difference in the primary or secondary PA outcomes at 4 or 12 months. Conclusion: Augmenting ERS referrals with web-based behavioural support had only a weak, non-significant effect on MVPA. Trial registration number: ISRCTN15644451. National Institute for Health Research (NIHR), Health Technology Assessment Programme (grant reference: 13/25/20).

Aim To compare mortality rates for cardiovascular disease, cancer, and respiratory disease between adults with cerebral palsy (CP) and the general population. Method A cohort study was conducted using data from adults with CP in England, identified through a primary care data set (the Clinical Practice Research Datalink), with linked data on death registrations from the Office for National Statistics. Cause of death was categorized according to International Classification of Diseases codes. Standardized mortality ratios (SMRs) were calculated to compare mortality rates between adults with CP and the general population, adjusted for age, sex, and calendar year. Results Nine hundred and fifty‐eight adults with CP were identified (52.5% males, 47.5% females; median age at start of follow‐up 31y [interquartile range 22–43y]) and followed for a total of 7693 person‐years. One hundred and forty‐two patients (15%) died during follow‐up. Adults with CP had an increased risk of death due to cardiovascular disease (SMR: 3.19, 95% confidence interval [CI] 2.20–4.62) and respiratory disease (SMR: 13.59, 95% CI 9.89–18.67), but not from malignant neoplasms (SMR: 1.42, 95% CI 0.83–2.45). Interpretation We found that adults with CP in England have increased risk of death due to diseases of the circulatory and respiratory systems, supporting findings from two studies that compared cause‐specific mortality rates between adults with CP in the USA and the general population. Further research is required into primary and secondary prevention of cardiovascular and respiratory disease in people with CP worldwide. What this paper adds Adults with cerebral palsy (CP) in England have 14‐fold increased risk of mortality due to diseases of the respiratory system.They have a 3‐fold increased risk of mortality due to diseases of the circulatory system.Adults with CP had an increased risk of death due to cerebrovascular disease and ischaemic heart disease.The elevated risk of ischaemic heart disease, however, did not reach statistical significance at the 5% per cent level., What this paper adds Adults with cerebral palsy (CP) in England have 14‐fold increased risk of mortality due to diseases of the respiratory system.They have a 3‐fold increased risk of mortality due to diseases of the circulatory system.Adults with CP had an increased risk of death due to cerebrovascular disease and ischaemic heart disease.The elevated risk of ischaemic heart disease, however, did not reach statistical significance at the 5% per cent level. This article is commented on by Landes on pages https://doi.org/10.1111/dmcn.14221 of this issue. This article's abstract has been translated into Spanish and Portuguese. Follow the links from the http://onlinelibrary.wiley.com/doi/10.1111/dmcn.14176/abstract to view the translations. Video Podcast: https://www.youtube.com/watch?v=7dF5aRog7KY&feature=youtu.be

BACKGROUND: There is modest evidence that exercise referral schemes increase physical activity in inactive individuals with chronic health conditions. There is a need to identify additional ways to improve the effects of exercise referral schemes on long-term physical activity. OBJECTIVES: To determine if adding the e-coachER intervention to exercise referral schemes is more clinically effective and cost-effective in increasing physical activity after 1 year than usual exercise referral schemes. DESIGN: A pragmatic, multicentre, two-arm randomised controlled trial, with a mixed-methods process evaluation and health economic analysis. Participants were allocated in a 1 : 1 ratio to either exercise referral schemes plus e-coachER (intervention) or exercise referral schemes alone (control). SETTING: Patients were referred to exercise referral schemes in Plymouth, Birmingham and Glasgow. PARTICIPANTS: There were 450 participants aged 16-74 years, with a body mass index of 30-40 kg/m2, with hypertension, prediabetes, type 2 diabetes, lower limb osteoarthritis or a current/recent history of treatment for depression, who were also inactive, contactable via e-mail and internet users. INTERVENTION: e-coachER was designed to augment exercise referral schemes. Participants received a pedometer and fridge magnet with physical activity recording sheets, and a user guide to access the web-based support in the form of seven 'steps to health'. e-coachER aimed to build the use of behavioural skills (e.g. self-monitoring) while strengthening favourable beliefs in the importance of physical activity, competence, autonomy in physical activity choices and relatedness. All participants were referred to a standard exercise referral scheme. PRIMARY OUTCOME MEASURE: Minutes of moderate and vigorous physical activity in ≥ 10-minute bouts measured by an accelerometer over 1 week at 12 months, worn ≥ 16 hours per day for ≥ 4 days including ≥ 1 weekend day. SECONDARY OUTCOMES: Other accelerometer-derived physical activity measures, self-reported physical activity, exercise referral scheme attendance and EuroQol-5 Dimensions, five-level version, and Hospital Anxiety and Depression Scale scores were collected at 4 and 12 months post randomisation. RESULTS: Participants had a mean body mass index of 32.6 (standard deviation) 4.4 kg/m2, were referred primarily for weight loss and were mostly confident self-rated information technology users. Primary outcome analysis involving those with usable data showed a weak indicative effect in favour of the intervention group (n = 108) compared with the control group (n = 124); 11.8 weekly minutes of moderate and vigorous physical activity (95% confidence interval -2.1 to 26.0 minutes; p = 0.10). Sixty-four per cent of intervention participants logged on at least once; they gave generally positive feedback on the web-based support. The intervention had no effect on other physical activity outcomes, exercise referral scheme attendance (78% in the control group vs. 75% in the intervention group) or EuroQol-5 Dimensions, five-level version, or Hospital Anxiety and Depression Scale scores, but did enhance a number of process outcomes (i.e. confidence, importance and competence) compared with the control group at 4 months, but not at 12 months. At 12 months, the intervention group incurred an additional mean cost of £439 (95% confidence interval -£182 to £1060) compared with the control group, but generated more quality-adjusted life-years (mean 0.026, 95% confidence interval 0.013 to 0.040), with an incremental cost-effectiveness ratio of an additional £16,885 per quality-adjusted life-year. LIMITATIONS: A significant proportion (46%) of participants were not included in the primary analysis because of study withdrawal and insufficient device wear-time, so the results must be interpreted with caution. The regression model fit for the primary outcome was poor because of the considerable proportion of participants [142/243 (58%)] who recorded no instances of ≥ 10-minute bouts of moderate and vigorous physical activity at 12 months post randomisation. FUTURE WORK: The design and rigorous evaluation of cost-effective and scalable ways to increase exercise referral scheme uptake and maintenance of moderate and vigorous physical activity are needed among patients with chronic conditions. CONCLUSIONS: Adding e-coachER to usual exercise referral schemes had only a weak indicative effect on long-term rigorously defined, objectively assessed moderate and vigorous physical activity. The provision of the e-coachER support package led to an additional cost and has a 63% probability of being cost-effective based on the UK threshold of £30,000 per quality-adjusted life-year. The intervention did improve some process outcomes as specified in our logic model. TRIAL REGISTRATION: Current Controlled Trials ISRCTN15644451. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 63. See the NIHR Journals Library website for further project information.