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BackgroundTo support efforts to increase social prescribing and reduce levels of physical inactivity, parkrun UK and the Royal College of General Practitioners together developed the parkrun practice initiative to link general practices to local parkruns (free, weekly, timed, physical activity events). General practice staff are encouraged to take part in parkrun events themselves and to encourage patients to participate.AimTo provide insights for primary care clinicians about parkrun participants (parkrunners), especially those with characteristics of patients who might be signposted to physical activity.Design and settingSecondary analysis of an online survey of parkrunners in the UK.MethodResponders were ranked into 13 categories using mean parkrun finish time, allowing the following definitions: front runners; median runners; slower runners; runners/walkers; and walkers. Measures included demographics, health conditions, motives for first participating, and perceived impact on health and wellbeing.ResultsThe survey included 45 662 parkrunners. More than 9% of all participants and 45% of walkers were found to have at least one long-term health condition, including arthritis, obesity, depression, hypertension, chronic pain, anxiety, type 2 diabetes, and asthma. Walkers were less likely to be motivated by fitness or competition, and were more likely to be motivated by physical health. Despite these differences, perceived improvements to wellbeing were broadly similar for all parkrunners, regardless of their finishing time.ConclusionParkrunners are a diverse population in terms of their physical health. Information provided by this study could be combined with other research on the barriers to participation and successful brief interventions to help address the key issues of primary care clinicians’ knowledge and confidence about social prescribing to increase patients’ physical activity levels.

PurposeThe use of online focus groups to explore children and young people's (CYP) perspectives of inequalities in health and associated “sensitive” topics raises important ethical and methodological issues to consider. The purpose of the paper is to discuss lessons learnt from navigating the authors' way through some of the key challenges the authors encountered when researching inequalities in health with CYP through online focus groups.Design/methodology/approachIn the paper, the authors draw on reflections and notes from the fieldwork design, public involvement and engagement (PIE) activities and data collection for their research project.FindingsCollecting data online influenced the authors' ability to develop rapport and relationships with CYP and to provide effective support when discussing sensitive topics. The authors note that building activities to develop rapport with participants during recruitment and data collection and establishing clear support and safeguarding protocols helped navigate challenges of online approaches around effective and supportive participant engagement.Originality/valueThe paper highlights that despite ethical and methodological challenges of conducting online focus groups with CYP on potentially sensitive topics, the adoption of practical steps and strategies before, during and following data collection can facilitate the safe participation of CYP and generate useful and valid data in meaningful and appropriate ways.

Aims\ud \ud To explore the qualitative literature on the perceived factors, positive and negative, affecting participation by children and adolescents with type 1 diabetes in physical activity, from the perspective of children and adolescents with type 1 diabetes, their family members, teachers or sports coaches, and healthcare professionals.\ud \ud \ud Methods\ud \ud MEDLINE, SPORTDiscus, PsycINFO, CINAHL and Scopus were systematically searched in July 2019. Eligible studies included any that reported qualitative findings on the perceived factors that affect participation in physical activity from either the perspective of children or adolescents with type 1 diabetes, their family members, teachers or coaches, and healthcare professionals.\ud \ud \ud Results\ud \ud The literature search yielded a total of 7859 studies, of which 14 (13 qualitative studies and one mixed‐methods study) met the review inclusion criteria. In total there were 12 unique populations containing 270 individuals, 105 children or adolescents with type 1 diabetes,108 family members, 37 teachers and 20 healthcare professionals. The main factors thought to influence physical activity for this population were the individual characteristics of children and adolescents, the requirement for self‐blood glucose regulation, support systems including friends, family, teachers and professionals, education and knowledge, and communication.\ud \ud \ud Conclusions\ud \ud This review synthesizes views on the perceived factors from several different perspectives. The findings suggest that it is important to consider the needs of the wider support network, as well as the child's or adolescent’s concerns and preferences, when developing new or existing strategies and programmes to promote physical activity in children and adolescents with type 1 diabetes.

Summary Lockdown restrictions imposed across the UK in response to the coronavirus disease 2019 (COVID-19) pandemic had a profound impact on many people’s health and wellbeing. People were encouraged to be active, but population surveys suggest some groups found this easier than others. We explored the changes in health, wellbeing and physical activity levels among a sample in the UK who experienced the sudden loss of a weekly community-based physical activity opportunity, parkrun. A sample of UK parkrun participants responded to two surveys: pre-COVID-19 in January/February 2019 and during the COVID-19 pandemic in September 2020. Outcomes were happiness, life satisfaction, connections with others, physical health, mental health and physical activity. The sample was stratified by gender, age, deprivation status, physical activity and number of parkruns completed. Demographics were reported using descriptive statistics; distributions between sub-groups were compared using Chi-square tests while differences in outcomes were determined using the Mann–Whitney U test. Open text responses were also analysed. Happiness, life satisfaction, connections with others, physical health and mental health of 450 parkrun participants were negatively impacted for all sub-groups, although the impact was not experienced equally. Physical activity fell by 6% while happiness and life satisfaction fell by 12%. People experienced the worst negative impact on their connections with others. The COVID-19 pandemic negatively impacted the wellbeing of a greater proportion of females, younger adults, inactive people, those from higher deprivation areas, and those who had completed fewer parkruns. There is evidence that the wellbeing of those who were more active, and those more involved in a community-based physical activity initiative pre-pandemic, was less negatively affected during the COVID-19 lockdown.

Background: Regular physical activity (PA) may bring symptomatic improvements and enhance wellbeing among people living with serious mental illness (SMI), especially when undertaken in community-based group settings. Initiating PA can be difficult for people with SMI and so PA engagement is commonly low. Purpose: To use a meta-ethnography approach to review qualitative studies exploring the experience of PA initiation in community, group settings among adults with SMI. Methods: Eligible studies used qualitative methodology; involved adults (���18 years) with schizophrenia, bipolar affective disorder, major depressive disorder, or psychosis; reported community-based group PA; and captured the experience of PA initiation. Study selection and quality assessment were performed by four reviewers. Results: Sixteen qualitative studies were included for review. We identified a ���journey' of PA initiation, including thought processes, expectations, barriers and support needs. Support from a trusted source was particularly important for getting people to the activity, both physically and emotionally. Conclusions: The journey illustrated that initiation of PA for people with SMI is a long complex transition. This complex process needs to be understood before ongoing participation in PA can be addressed. We provide recommendations for the design and delivery of supportive PA programmes for people with SMI. Funding: This review was funded by Sheffield Health and Social Care NHS Foundation Trust., The Health & Fitness Journal of Canada, Vol. 14 No. 3 (2021): Proceedings from the 8th International Society for Physical Activity and Health Congress

Participation in regular physical activity is a well-established strategy to support good mental wellbeing in adults with, and without, mental health conditions. The physical activity initiative parkrun is a free, weekly, timed, running and walking event which is attended by people from the local community of all abilities. The purpose of this study was to investigate the mental wellbeing of UK parkrun participants along with their motives for taking part and the impact of participation. Mental health conditions were self-reported in 2.5% of 60,000 respondents to an online survey of parkrunners, with the most prevalent being depression and anxiety. Those with mental health conditions were more motivated than those without to first participate in parkrun to manage their health conditions and improve their mental health. Those with mental health conditions were equally motivated to improve their physical health when compared to those without, and reported similar levels of improvement. Mental wellbeing scores for those with mental health conditions were close to the normal range, suggesting that engagement in parkrun may have had a role in limiting the effect of their illness. Community initiatives could replicate parkrun’s model, and use the potential for both mental and physical health improvement, as well as health condition management, as a motivation for participation.

Adults aged 55+ are most likely to be inactive, despite research suggesting older adults experience multiple benefits when participating in physical activity and sport. Limited research focuses on long-term continuation of sport participation in this population, especially in 'adapted sports' like walking football. This study explored experiences of walking football maintenance in 55- to 75- year-old players. Semi-structured interviews were conducted with 17 older adults maintaining walking football play over six months. Inductive analysis revealed five higher-order themes representing maintenance influences, and two higher-order themes relating to maintenance mechanisms (i.e., the conscious process by which players maintain). Influences when maintaining walking football included individual-level and culture-level influences (e.g. perceived benefits of maintenance and ability acceptance). Maintenance mechanisms included cognitions and behaviours (e.g., scheduling sessions and redefining physical activity expectations). Findings highlight novel implications for policy and practice, which are important to consider when delivering walking football to older adults. Keywords: older adults, football, soccer, behaviour change, maintenance, qualitative methods, interviews

IntroductionLockdown restrictions imposed across the UK in response to the COVID-19 pandemic had a profound impact on many people’s health and wellbeing. People were encouraged to be active, but population surveys suggest some groups found this easier than others. We explored the changes in health, wellbeing and physical activity levels among a sample in the UK who experienced the sudden loss of a weekly community-based physical activity opportunity, parkrun.MethodsA sample of UK parkrun participants responded to two surveys; pre-COVID-19 in January/February 2019 and during the COVID-19 pandemic in September 2020. Outcomes were happiness, life satisfaction, connections with others, physical health, mental health and physical activity. The sample was stratified by gender, age, deprivation status, physical activity and number of parkruns completed. Demographics were reported using descriptive statistics. Distributions between sub-groups were compared using Chi-square tests while differences in outcomes were determined using the Mann-Whitney U test. Open text responses were also analysed. FindingsHappiness, life satisfaction, connections with others, physical health and mental health of 450 parkrun participants were negatively impacted for all sub-groups, although the impact was not experienced equally. The COVID-19 pandemic negatively impacted the mental wellbeing of a greater proportion of females, younger adults, inactive people, those from higher deprivation areas, and those who had completed fewer parkruns.ConclusionsThere is evidence that the wellbeing of those who were more active, and those more involved in a community-based physical activity initiative pre-pandemic, was less negatively affected during the COVID-19 lockdown.

Background In 2017 Public Health England and Sport England commissioned a Consultant-led Sport and Exercise Medicine (SEM) pilot to test the feasibility and acceptability of embedding physical activity interventions in secondary care clinical pathways. The aim of this paper is to report qualitative findings exploring the experience of healthcare professionals (HCPs) and patients involved in the Active Hospital pilot. Methods Qualitative data was collected by semi-structured interviews with Active Hospital pilot SEM Consultants, and staff and patients involved in three clinical pathways. Interviews with SEM Consultants explored the experience of developing and implementing the pilot. Interviews with staff and patients explored the experience of delivering and receiving Active Hospital interventions. Data were analysed thematically. Results Interviews identified the importance of the Active Hospital pilot being Consultant-led for the following reasons; i) having trusting relationships with decision makers, ii) having sufficient influence to effect change, iii) identifying champions within the system, and iv) being adaptable to change and ensuring the programme fits within the wider strategic frameworks. HCPs emphasised the importance of the Active Hospital interventions fitting easily within existing work practices, the need for staff training and to tailor interventions for individual patient needs. The Active Hospital pilot was well received by patients, however a lack of dedicated resource and capacity to deliver the intervention was highlighted as a challenge by both patients and HCPs. Conclusion The SEM Consultants’ ability to navigate the political climate of a large National Health Service (NHS) Trust with competing agendas and limited resource was valuable. The interventions were well received and a valued addition to usual clinical care. However, implementation and ongoing delivery of the pilot encountered challenges including lack of capacity within the system and delays with recruiting to the delivery teams in each pathway.

Objectives To evaluate geographic access to free weekly outdoor physical activity events (‘parkrun’) in England, with a particular focus on deprived communities, and to identify optimal locations for future events to further maximise access. Study design This study is a cross-sectional ecological analysis of the socio-economic disparities in geographic access to parkrun events in England in late 2018. Methods We combined geolocation data on all English Lower Layer Super Output Areas and parkrun events to calculate geodesic distances to the nearest event for more than 32,000 communities in England. We use this measure of geographic access to summarise the relationship between access and socio-economic deprivation, measured using the index of multiple deprivation. We then used geographic coordinates of public green spaces in England to conduct a simple location-allocation analysis to identify 200 locations for future event locations that would maximise access. Results In England, 69% of the population live within 5 km of one of the 465 parkrun events. There is a small negative correlation between distance and deprivation, indicating that access is slightly better in more socio-economically deprived areas. Setting up an additional 200 events in optimal locations would improve access: the average distance to the nearest parkrun event would improve by 1.22 km, from 4.65 km to 3.43 km, and approximately 82% of the English population would live within 5 km of a parkrun event. Conclusion Over two-thirds of the English population live within 5 km of a parkrun event, and contrary to our expectation, we find that geographic access is slightly better for those living in more deprived communities. Creating additional events may improve geographic access, but effective strategies will still be needed to increase engagement in new and existing events by those living in socio-economically deprived areas., Highlights • Parkrun in a grass-roots movement that organises free weekly 5 km running and walking events. • In England, the median distance to the nearest parkrun event was 3.4 km; 69% of the population lived within 5 km of an event. • Access showed no negative socio-economic gradient. In fact, people in deprived communities had better geographic access. • Sport England provided funding to set up 200 new events. We identified optimal locations, to further maximise public access.

Around a third of people worldwide are physically inactive, causing 3.2 million deaths each year. People often use wearables and smartphone trackers to motivate them to be active, but there is evidence to show that use of these trackers declines quickly, often within weeks. One intervention that appears to successfully motivate people to be active is parkrun, a free, weekly timed 5 km run or walk every Saturday morning. The system used by parkrun is surprisingly low-tech: it uses printable barcodes, stopwatches and scanners, and the internet. A survey of 60,694 parkrun participants showed that levels of self-reported physical activity increased following participation in parkrun, especially for those with previously low levels of activity. Nine out of ten reported feeling a sense of personal achievement and improvements to fitness and physical health since starting parkrun. Based on a taxonomy of behaviour change interventions, the technology used by parkrun was shown to incorporate at least seven techniques that inform and encourage parkrunners. It is concluded that physical activity technologies should not be central to an intervention, rather, they should enhance interventions where behaviour change takes precedence.

In 2014 Public Health England (PHE) launched the national physical activity (PA) framework ‘Everybody Active, Everyday’. The framework included a key domain for action called ‘Moving Professionals’. The Moving Professionals Programme aimed to build expertise and leadership across key professional sectors and to raise awareness and understanding of the health benefits of PA among professionals and the wider public. The Moving Professionals Programme comprised a number of innovative work packages that are described elsewhere (See Brannan et al., 2019). The Physical Activity Clinical Advice Pad (PACAP) pilot was one element of the Moving Professionals Programme, and aimed to; increase the number of primary healthcare professionals (HCPs) in England who integrate brief advice on PA into their routine clinical practice.The PACAP provides advice about the amount and type of PA required to improve health and was designed to look like a prescription pad to aid compliance with the advice provided. It also provides tips on different ways to become more active and signposts users to the PHE Active 10 app and One You website. The purpose of the PACAP was to prompt and facilitate conversations about PA between HCPs and patients.In 2017, PHE and Sport England invited expressions of interest (EoIs) from Local Authority (LA) and Clinical Commissioning Group (CCG) partnerships across England to engage in the pilot. Twenty-five applications were returned and ten partnerships were invited to take part in the PACAP pilot.As part of the National Centre for Sport and Exercise Medicine (NCSEM) network, academics at Sheffield Hallam University (SHU) were commissioned to conduct an independent evaluation of the PACAP pilot. The NCSEM were not responsible for the implementation or delivery of the PACAP pilot. The evaluation adopted a mixed methods approach to explore the acceptability of the PACAP pilot. Data was collected from patients and HCPs using surveys, telephone interviews, focus groups and audits between April 2018 and February 2019. This report details the evaluation findings, provides recommendation for future iterations of the project and provides implications for scaling the PACAP across additional localities in England.

In 2014 Public Health England (PHE) launched the national physical activity (PA) framework ‘Everybody Active, Everyday’. The framework included a key domain for action called ‘Moving Professionals’. The Moving Professionals Programme aimed to build expertise and leadership across key professional sectors and to raise awareness and understanding of the health benefits of PA among professionals and the wider public. The Moving Professionals Programme comprised a number of innovative work packages that are described elsewhere (See Brannan et al., 2019). The Sport and Exercise Medicine (SEM) pilot was one element of the Moving Professionals Programme, and aimed to embed an SEM consultant led PA service within an NHS Trust to integrate PA in to the care plans of patients. This was termed creating an 'Active Hospital'.PHE and Sport England invited expressions of interest (EoIs) from NHS Trusts with the capacity to deliver the SEM pilot through a competitive process. Three Trusts were invited to interview and Oxford University Hospital NHS Foundation Trust (OUHFT) were selected to deliver the pilot. The successful Trust was tasked with developing an SEM pilot that strengthened existing core resources and expanded existing capacity to integrate specialist PA advice into the care pathways for adults in-patient care. This was tested across five clinical pathways within OUHFT where PA had not previously been targeted as a treatment intervention.Two lead SEM consultants were responsible for developing and implementing the SEM pilot, which targeted five clinical pathways and was underpinned by the COM-B model. These were; Maternity, Enablement, Renal, Complex Medical Unit (originally Critical Care), and Cardiology.As part of the National Centre for Sport and Exercise Medicine (NCSEM) network, academics at Sheffield Hallam University (SHU) were commissioned to conduct an independent evaluation of the SEM pilot. The NCSEM were not responsible for the implementation or delivery of the SEM pilot. The evaluation aimed to explore the acceptability and feasibility of the SEM pilot and followed a mixed methods approach. Data was collected from patients and healthcare professionals (HCPs) using surveys, face-to-face and telephone interviews and audits between June 2018 and March 2019. This report details the evaluation findings and provides implications for ongoing implementation of the pilot in OUHFT and for sharing learning with other Trusts across the UK.

Introduction\ud \ud The spontaneous, sporadic and sometimes unpredictable nature of children's physical activity causes fluctuations in blood glucose level and challenges for children with type 1 diabetes. Physical activity monitoring has potential utility. This study aimed to explore the perceptions of physical activity monitoring among healthcare professionals and assess the feasibility and acceptability of using it in the management of paediatric type 1 diabetes.\ud \ud \ud \ud Methods\ud \ud Seven healthcare professionals from one paediatric diabetes centre in the UK were involved in a focus group. Data were analysed thematically. Physical activity monitoring using a wrist-worn monitor was tested for feasibility with thirteen children aged 7-11 years with type 1 diabetes. The primary outcome was feasibility (i.e., recruitment, adherence, data completion, adverse events and acceptability). Secondary measures were glycaemic control, parental self-efficacy for diabetes management and parental fear of hypoglycaemia.\ud \ud \ud \ud Results\ud \ud Healthcare professionals valued having an awareness of the level, type and intensity of children’s physical activity. They identified unmet training and resource needs that would facilitate them being able to give physical activity advice to children and families. Recruitment rate was 20%, adherence to the activity monitoring was good and study completion rate was 62%. No adverse events were reported. Physical activity monitoring was deemed acceptable by parents.\ud \ud \ud \ud Conclusions\ud \ud Physical activity monitoring could be a feasible part of routine clinical practice, but further research is needed to understand whether healthcare professionals are best placed to implement it and what impact it has on health outcomes.

Adults aged 55 and older are least likely to play sport. Despite research suggesting this population experiences physical and psychological benefits when doing so, limited research focuses on older adult sport initiation, especially in “adapted sports” such as walking football. The aim of this study was to explore initiation experiences of walking football players between 55 and 75 years old. Semistructured interviews took place with 17 older adults playing walking football for 6 months minimum (Mage = 64). Inductive analysis revealed six higher order themes representing preinitiation influences. Eight further higher order themes were found, relating to positive and negative experiences during initiation. Fundamental influences preinitiation included previous sporting experiences and values and perceptions. Emergent positive experiences during initiation included mental development and social connections. Findings highlight important individual and social influences when initiating walking football, which should be considered when encouraging 55- to 75-year-old adults to play adapted sport. Policy and practice recommendations are discussed.

Background This study describes the development and feasibility evaluation of a physical activity intervention for children with type 1 diabetes called ‘Steps to Active Kids with Diabetes’ (STAK-D). It aims to explore the feasibility and acceptability of the intervention and study design. Methods Thirteen children aged 9–11 years and their parents were recruited from one paediatric diabetes clinic. A process evaluation was conducted alongside a two-arm randomised feasibility trial, including assessment of rate of recruitment, adherence, retention, data completion and burden, implementation fidelity and adverse events. Qualitative interviews with children (n = 9), parents (n = 8), healthcare professionals (n = 3) and STAK-D volunteers (n = 8) explored intervention acceptability. Interviews were analysed thematically. Results Rate of recruitment was 25%, with 77% retention at 3-month follow-up. Study burden was low, data completion was high and the intervention was delivered as per protocol. No serious adverse event was reported. Engagement with intervention materials was generally good, but attendance at group activity sessions was low due to logistical barriers. Interview analysis identified preferred methods of recruitment, motivations for recruitment, barriers and facilitators to adherence, the experience of data collection, experience of the STAK-D programme and its perceived benefits. Conclusions STAK-D was feasible and acceptable to children, their parents and healthcare professionals, but group sessions may present logistical issues. Recruitment and retention may be improved with a clinic-wide approach to recruitment. Trial registration This trial was registered on ClinicalTrials.gov: NCT02144337 (16/01/2014). Electronic supplementary material The online version of this article (10.1186/s12887-018-1036-8) contains supplementary material, which is available to authorized users.

Background: This is an updated version of the original Cochrane Review published in the Cochrane Liibrary 2013, Issue 9. Despite good evidence for the health benefits of regular exercise for people living with or beyond cancer, understanding how to promote sustainable exercise behaviour change in sedentary cancer survivors, particularly over the long term, is not as well understood. A large majority of people living with or recovering from cancer do not meet current exercise recommendations. Hence, reviewing the evidence on how to promote and sustain exercise behaviour is important for understanding the most effective strategies to ensure benefit in the patient population and identify research gaps. Objectives: To assess the effects of interventions designed to promote exercise behaviour in sedentary people living with and beyond cancer and to address the following secondary questions: Which interventions are most effective in improving aerobic fitness and skeletal muscle strength and endurance? Which interventions are most effective in improving exercise behaviour amongst patients with different cancers? Which interventions are most likely to promote long-term (12 months or longer) exercise behaviour? What frequency of contact with exercise professionals and/or healthcare professionals is associated with increased exercise behaviour? What theoretical basis is most often associated with better behavioural outcomes? What behaviour change techniques (BCTs) are most often associated with increased exercise behaviour? What adverse effects are attributed to different exercise interventions? Search methods: We used standard methodological procedures expected by Cochrane. We updated our 2013 Cochrane systematic review by updating the searches of the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, Embase, AMED, CINAHL, PsycLIT/PsycINFO, SportDiscus and PEDro up to May 2018. We also searched the grey literature, trial registries, wrote to leading experts in the field and searched reference lists of included studies and other related recent systematic reviews. Selection criteria: We included only randomised controlled trials (RCTs) that compared an exercise intervention with usual care or 'waiting list' control in sedentary people over the age of 18 with a homogenous primary cancer diagnosis. Data collection and analysis: In the update, review authors independently screened all titles and abstracts to identify studies that might meet the inclusion criteria, or that could not be safely excluded without assessment of the full text (e.g. when no abstract is available). We extracted data from all eligible papers with at least two members of the author team working independently (RT, LS and RG). We coded BCTs according to the CALO-RE taxonomy. Risk of bias was assessed using the Cochrane's tool for assessing risk of bias. When possible, and if appropriate, we performed a fixed-effect meta-analysis of study outcomes. If statistical heterogeneity was noted, a meta-analysis was performed using a random-effects model. For continuous outcomes (e.g. cardiorespiratory fitness), we extracted the final value, the standard deviation (SD) of the outcome of interest and the number of participants assessed at follow-up in each treatment arm, to estimate the standardised mean difference (SMD) between treatment arms. SMD was used, as investigators used heterogeneous methods to assess individual outcomes. If a meta-analysis was not possible or was not appropriate, we narratively synthesised studies. The quality of the evidence was assessed using the GRADE approach with the GRADE profiler. Main results: We included 23 studies in this review, involving a total of 1372 participants (an addition of 10 studies, 724 participants from the original review); 227 full texts were screened in the update and 377 full texts were screened in the original review leaving 35 publications from a total of 23 unique studies included in the review. We planned to include all cancers, but only studies involving breast, prostate, colorectal and lung cancer met the inclusion criteria. Thirteen studies incorporated a target level of exercise that could meet current recommendations for moderate-intensity aerobic exercise (i.e.150 minutes per week); or resistance exercise (i.e. strength training exercises at least two days per week). Adherence to exercise interventions, which is crucial for understanding treatment dose, is still reported inconsistently. Eight studies reported intervention adherence of 75% or greater to an exercise prescription that met current guidelines. These studies all included a component of supervision: in our analysis of BCTs we designated these studies as 'Tier 1 trials'. Six studies reported intervention adherence of 75% or greater to an aerobic exercise goal that was less than the current guideline recommendations: in our analysis of BCTs we designated these studies as 'Tier 2 trials.' A hierarchy of BCTs was developed for Tier 1 and Tier 2 trials, with programme goal setting, setting of graded tasks and instruction of how to perform behaviour being amongst the most frequent BCTs. Despite the uncertainty surrounding adherence in some of the included studies, interventions resulted in improvements in aerobic exercise tolerance at eight to 12 weeks (SMD 0.54, 95% CI 0.37 to 0.70; 604 participants, 10 studies; low-quality evidence) versus usual care. At six months, aerobic exercise tolerance was also improved (SMD 0.56, 95% CI 0.39 to 0.72; 591 participants; 7 studies; low-quality evidence). Authors' conclusions: Since the last version of this review, none of the new relevant studies have provided additional information to change the conclusions. We have found some improved understanding of how to encourage previously inactive cancer survivors to achieve international physical activity guidelines. Goal setting, setting of graded tasks and instruction of how to perform behaviour, feature in interventions that meet recommendations targets and report adherence of 75% or more. However, long-term follow-up data are still limited, and the majority of studies are in white women with breast cancer. There are still a considerable number of published studies with numerous and varied issues related to high risk of bias and poor reporting standards. Additionally, the meta-analyses were often graded as consisting of low- to very low-certainty evidence. A very small number of serious adverse effects were reported amongst the studies, providing reassurance exercise is safe for this population. © 2018 The Cochrane Collaboration.

Background Our understanding of effective perioperative supportive interventions for patients undergoing cystectomy procedures and how these may affect short and long-term health outcomes is limited. Methods Randomised controlled trials involving any non-surgical, perioperative interventions designed to support or improve the patient experience for patients undergoing cystectomy procedures were reviewed. Comparison groups included those exposed to usual clinical care or standard procedure. Studies were excluded if they involved surgical procedure only, involved bowel preparation only or involved an alternative therapy such as aromatherapy. Any short and long-term outcomes reflecting the patient experience or related urological health outcomes were considered. Results Nineteen articles (representing 15 individual studies) were included for review. Heterogeneity in interventions and outcomes across studies meant meta-analyses were not possible. Participants were all patients with bladder cancer and interventions were delivered over different stages of the perioperative period. The overall quality of evidence and reporting was low and outcomes were predominantly measured in the short-term. However, the findings show potential for exercise therapy, pharmaceuticals, ERAS protocols, psychological/educational programmes, chewing gum and nutrition to benefit a broad range of physiological and psychological health outcomes. Conclusions Supportive interventions to date have taken many different forms with a range of potentially meaningful physiological and psychological health outcomes for cystectomy patients. Questions remain as to what magnitude of short-term health improvements would lead to clinically relevant changes in the overall patient experience of surgery and long-term recovery. Electronic supplementary material The online version of this article (10.1186/s12894-018-0382-z) contains supplementary material, which is available to authorized users.

Background\ud People with long-term serious mental illness live with severe and debilitating symptoms that can negatively influence their health and quality of life, leading to outcomes such as premature mortality, morbidity and obesity. An interplay of social, behavioural, biological and psychological factors is likely to contribute to their poor physical health. Participating in regular physical activity could bring symptomatic improvements, weight loss benefits, enhanced wellbeing and when undertaken in a community-based group setting can yield additional, important social support benefits. Yet poor uptake of physical activity by people with serious mental illness is a problem. This review will systematically search, appraise and synthesise the existing evidence that has explored the experience of community-based physical activity initiation and key features of social support within these contexts by adults with schizophrenia, bipolar affective disorder, major depressive disorder or psychosis using the meta-ethnography approach. This new understanding may be key in designing more acceptable and effective community-based group PA programmes that meet patients’ need and expectations.\ud Methods\ud This will be a systematic review of qualitative studies using the meta-ethnography approach. The following databases will be searched: ASSIA, CINAHL, Cochrane Central Register of Controlled Trials, EMBASE, Health Technology Assessment Database, MEDLINE, PsycINFO, Sociological Abstracts, SPORTDiscus and Web of Science. Grey literature will also be sought. Eligible studies will use qualitative methodology; involve adults (≥18 years) with schizophrenia, bipolar affective disorder, major depressive disorder or psychosis; will report community-based group physical activity; and capture the experience of physical activity initiation and key features of social support from the perspective of the participant. Study selection and assessment of quality will be performed by two reviewers. Data will be extracted by one reviewer, tabled, and checked for accuracy by the second reviewer. The meta-ethnography approach by Noblit and Hare [1] will be used to synthesise the data.\ud Discussion\ud This systematic review is expected to provide new insights into the experience of community-based group physical activity initiation for adults who have a serious mental illness to inform person-centred improvements to the management of serious mental illness through physical activity.\ud Registration\ud The protocol has been registered on the International Prospective Register of Systematic Reviews (PROSPERO) on 22/03/2017; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42017059948 (registration number CRD42017059948).\ud Keywords\ud Serious mental illness - Physical activity - Community - Social support - Exercise - Sport - Adults - Patient experience - Qualitative research - Meta-ethnography - Systematic review

1. The success of grassland biodiversity restoration schemes is determined by many factors; as such their outcomes can be unpredictable. There is a need for improved understanding of the relative importance of belowground factors to restoration success, such as contrasting soil type and management intensities, as well as plant community composition and order of assembly.2. We carried out an eight-year mesocosm experiment across three locations in the UK to explore the relative and interactive roles of various aboveground and belowground factors in the establishment of target species, to determine general constraints on grassland restoration. Each location had a series of mesocosms with contrasting soil types and management status, which were initially sown with six grasses typical of species-poor grasslands targeted for restoration. 3. Over five years, sets of plant species were added, to test how different vegetation treatments, including early-coloniser species and the hemiparasite Rhinanthus minor, and soil type and management, influenced the establishment of target plant species and community diversity.4. The addition of early-coloniser species to model grasslands suppressed the establishment of target species, indicating a strong priority effect. Soil type was also an important factor, but effects varied considerably across locations. In the absence of early-coloniser species, low soil nutrient availability improved establishment of target species across locations, although R. minor had no beneficial effect. 5. Synthesis and applications. Our long-term, multi-site study indicates that successful restoration of species rich grassland is dependent primarily on priority effects, especially in the form of early-coloniser species that suppress establishment of slow-growing target species. We also show that priority effects vary with soil conditions, being stronger in clay than sandy soils, and on soils of high nutrient availability. As such, our work emphasises the importance of considering priority effects and local soil conditions in developing management strategies for restoring plant species diversity in grassland.

Background Regular physical activity has important health benefits for children with type 1 diabetes mellitus (T1DM), yet children and their parents face barriers to participation such as lack of self-efficacy or concerns around hypoglycaemia. Multimedia interventions are useful for educating children about their health and demonstrate potential to improve children’s health-related self-efficacy, but few paediatric clinics offer web-based resources as part of routine care. The Steps to Active Kids with Diabetes (STAK-D) programme is an online intervention grounded in psychological theory (social cognitive theory) and informed by extensive preliminary research. The aim of the programme is to encourage and support safe engagement with physical activity for children with T1DM. The aim of this research is to explore the feasibility of delivering the STAK-D programme to children aged 9–12 years with T1DM, and to assess the feasibility of further research to demonstrate its clinical and cost-effectiveness. Methods Up to 50 children aged 9–12 years with T1DM and their parents will be recruited from two paediatric diabetes clinics in the UK. Child-parent dyads randomised to the intervention group will have access to the intervention website (STAK-D) and a wrist-worn activity monitor for 6 months. The feasibility of intervention and further research will be assessed by rate of recruitment, adherence, retention, data completion and adverse events. Qualitative interviews will be undertaken with a subsample of children and parents (up to 25 dyads) and health care professionals (up to 10). Health outcomes and the feasibility of outcome measurement tools will be assessed. These include self-efficacy (CSAPPA), objective physical activity, self-reported physical activity (PAQ), fear of hypoglycaemia (CHFS; PHFS), glycaemic control (HbA1c), insulin dose, Body Mass Index (BMI), health-related quality of life (CHU9D; CHQ-PF28), health service use and patient-clinician communication. Assessments will be taken at baseline (T0), 8 weeks (T1) and at 6-month follow-up (T2). Discussion The goal of this feasibility trial is to assess the delivery of STAK-D to promote physical activity among children with T1DM, and to assess the potential for further, definitive research to demonstrate its effectiveness. Results will provide the information necessary to design a larger randomised controlled trial and maximise the recruitment rate, intervention delivery and trial retention. Trial registration ISRCTN, ISRCTN48994721. Registered on 28 October 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1719-0) contains supplementary material, which is available to authorized users.

Background: Despite the health benefits of physical activity, children across the population are\ud insufficiently active. Physical activity is essential in the management of Type 1 Diabetes Mellitus (T1DM),\ud therefore its promotion should be a priority, yet little research has explored the experience of physical\ud activity from the viewpoint of children with this condition. This study sought to provide insight into how\ud children with T1DM perceive and participate in physical activity to further the design of initiatives and\ud clinical interventions that promote active lifestyles in this population.\ud \ud Methods: Researchers collected data through in-depth interviews with twelve children aged 9-11 years with\ud T1DM in the UK. Interviews were recorded, transcribed verbatim and data were analysed using thematic\ud analysis.\ud \ud Results: The overarching themes captured: children’s understanding of physical activity; children’s physical\ud activity is motivated by friendship and social interaction; children’s physical activity is motivated by positive\ud perceptions, fun and enjoyment; children describe how their family helps them to be active; school provides\ud children with an opportunity to be active; children’s access to facilities and outdoor space encourages\ud physical activity; children refer to personal mastery and competence in physical activity and; children\ud perceive difficulties that make physical activity harder.\ud \ud Conclusions: This study is the first to distinguish children’s perceptions toward physical activity from other\ud key stakeholders. Listening to children has identified what they believe is important, for example enjoyment\ud and socialisation, which should be considered when developing strategies to promote physical activity in this\ud population.

The importance of managing land to optimize carbon sequestration for climate change mitigation is widely recognized, with grasslands being identified as having the potential to sequester additional carbon. However, most soil carbon inventories only consider surface soils, and most large-scale surveys group ecosystems into broad habitats without considering management intensity. Consequently, little is known about the quantity of deep soil carbon and its sensitivity to management. From a nationwide survey of grassland soils to 1 m depth, we show that carbon in grassland soils is vulnerable to management and that these management effects can be detected to considerable depth down the soil profile, albeit at decreasing significance with depth. Carbon concentrations in soil decreased as management intensity increased, but greatest soil carbon stocks (accounting for bulk density differences), were at intermediate levels of management. Our study also highlights the considerable amounts of carbon in subsurface soil below 30 cm, which is missed by standard carbon inventories. We estimate grassland soil carbon in Great Britain to be 2097 Tg C to a depth of 1 m, with ~60% of this carbon being below 30 cm. Total stocks of soil carbon (t ha(-1) ) to 1 m depth were 10.7% greater at intermediate relative to intensive management, which equates to 10.1 t ha(-1) in surface soils (0-30 cm), and 13.7 t ha(-1) in soils from 30 to 100 cm depth. Our findings highlight the existence of substantial carbon stocks at depth in grassland soils that are sensitive to management. This is of high relevance globally, given the extent of land cover and large stocks of carbon held in temperate managed grasslands. Our findings have implications for the future management of grasslands for carbon storage and climate mitigation, and for global carbon models which do not currently account for changes in soil carbon to depth with management.

Northern peatlands are recognized as globally important stores of terrestrial carbon (C), yet we have limited understanding of how global changes, including land use, affect C cycling processes in these ecosystems. Making use of a long-term (>50 year old) peatland land management experiment in the UK, we investigated, using a 13CO2 pulse chase approach, how managed burning and grazing influenced the short-term uptake and cycling of C through the plant–soil system. We found that burning affected the composition and growth stage of the plant community, by substantially reducing the abundance of mature ericoid dwarf-shrubs. Burning also affected the structure of the soil microbial community, measured using phospholipid fatty acid analysis, by reducing fungal biomass. There was no difference in net ecosystem exchange of CO2, but burning was associated with an increase in photosynthetic uptake of 13CO2 and increased transfer of 13C to the soil microbial community relative to unburned areas. In contrast, grazing had no detectable effects on any measured C cycling process. Our study provides new insight into how changes in vegetation and soil microbial communities arising from managed burning affect peatland C cycling processes, by enhancing the uptake of photosynthetic C and the transfer of C belowground, whilst maintaining net ecosystem exchange of CO2 at pre-burn levels.

The controls on aboveground community composition and diversity have been extensively studied, but our understanding of the drivers of belowground microbial communities is relatively lacking, despite their importance for ecosystem functioning. In this study, we fitted statistical models to explain landscape-scale variation in soil microbial community composition using data from 180 sites covering a broad range of grassland types, soil and climatic conditions in England. We found that variation in soil microbial communities was explained by abiotic factors like climate, pH and soil properties. Biotic factors, namely community-weighted means (CWM) of plant functional traits, also explained variation in soil microbial communities. In particular, more bacterial-dominated microbial communities were associated with exploitative plant traits versus fungal-dominated communities with resource-conservative traits, showing that plant functional traits and soil microbial communities are closely related at the landscape scale. © 2012 Blackwell Publishing Ltd/CNRS.