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Improving dietary reporting among people living with obesity is challenging as many factors influence reporting accuracy. Reactive Reporting may occur in response to dietary recording, but little is known about how image-based methods influence this process. Using a 4-d image-based mobile food record (mFRTM), this study aimed to identify demographic and psychosocial correlates of measurement error and reactivity bias, among adults with BMI 25–40 kg/m2. Participants (n 155, aged 18–65 years) completed psychosocial questionnaires and kept a 4-d mFRTM. Energy expenditure (EE) was estimated using ≥ 4 d of hip-worn accelerometer data, and energy intake (EI) was measured using mFRTM. EI:EE ratios were calculated, and participants in the highest tertile were considered to have Plausible Intakes. Negative changes in EI according to regression slopes indicated Reactive Reporting. Mean EI was 72 % (sd = 21) of estimated EE. Among participants with Plausible Intakes, mean EI was 96 % (sd = 13) of estimated EE. Higher BMI (OR 0·81, 95 % CI 0·72, 0·92) and greater need for social approval (OR 0·31, 95 % CI 0·10, 0·96) were associated with lower likelihood of Plausible Intakes. Estimated EI decreased by 3 % per d of recording (interquartile range − 14 %,6 %) among all participants. The EI of Reactive Reporters (n 52) decreased by 17 %/d (interquartile range − 23 %,–13 %). A history of weight loss (> 10 kg) (OR 3·4, 95 % CI 1·5, 7·8) and higher percentage of daily energy from protein (OR 1·1, 95 % CI 1·0, 1·2) were associated with greater odds of Reactive Reporting. Identification of reactivity to measurement, as well as Plausible Intakes, is recommended in community-dwelling studies to highlight and address sources of bias.

Purpose Cross-sectional studies have variably reported that poor sleep quality may be associated with myopia in children. Longitudinal data, collected over the ages when myopia develops and progresses, could provide new insights into the sleep-myopia paradigm. This study tested the hypothesis that 12-year trajectories of sleep behaviour from childhood to adolescence is associated with myopia during young adulthood. Methods At the 5-, 8-, 10-, 14- and 17-year follow-ups of the longitudinal Raine Study, which has been following a cohort since their birth in 1989-1992, participants' parents/guardians completed the Child Behaviour Checklist questionnaire (CBCL), which collected information on their child's sleep behaviour and quality. The CBCL includes six questions measuring sleep behaviour, which parents rated as 0 = not true, 1 = somewhat/sometimes true, or 2 = very/often true. Scores were summed at each follow-up to form a composite "sleep behaviour score". Latent Class Growth Analysis (LCGA) was used to classify participants according to their 12-year trajectory of sleep behaviour. At the 20-year follow-up, an eye examination was performed which included cycloplegic autorefraction and axial length measurement. Results The LCGA identified three clusters of participants based on their trajectory of sleep behaviour: those with minimal' (43.6% of the total Raine Study sample), 'declining' (48.9%), or 'persistent' (7.5%) sleep problems. A total of 1194 participants had ophthalmic data and longitudinal sleep data available for analysis (47.2% female, 85.6% Caucasian). No significant differences were observed in regards to age, sex, ethnicity or ocular parameters between trajectory groups. Unadjusted and fully adjusted analyses demonstrated that sleep problem behaviour was not significantly associated with changes in refractive error, axial length or corneal radius. Conclusions Our findings do not support the hypothesis that there is an association between sleep behaviour and myopia. Future longitudinal studies should explore sleep trajectory data pre- and post-myopia diagnosis to confirm our results.

To investigate whether participation in sport during the developmental stages of life is associated with cardiorespiratory fitness (CRF) in adulthood.Observational longitudinal study.Participants were Generation 2 of the Raine Study. Questionnaires related to participation in sport were administered at ages 5, 8, 10, 14 and 17 years. These data were used to develop sex-specific trajectories of sports participation: (for males) Consistent Participators, Drop-Outs and Joiners; and (females) Consistent Participators, Non-Participators and Drop-Outs. At age 28.3 ± 0.6 years, participants completed a graded maximal exercise test (i.e. V̇O402 participants n = 231 (57.5%) male, n = 171 (42.5%) female were included in the study. In males, Consistent Participators (all p 0.001) and Joiners (p 0.050) had greater fitness than Drop-Outs. In females, Consistent Participators had greater fitness than Non-Participators (p 0.050), but there were no significant differences in fitness between Consistent Participators and Drop-Outs (p 0.050) or Non-Participators and Drop-Outs (p 0.050).Participation in sport during childhood and adolescence is associated with greater fitness in adulthood, compared to individuals who never participate or those that cease participation in adolescence. A simple dichotomous question regarding sports participation over the childhood and adolescent period can be implemented to predict better fitness outcomes in young adulthood. Childhood and adolescence could be an opportune stage in life for parents, schools and governments to facilitate participation in sport and prevent drop out, as it may have an impact on long term risk reduction, with associated health and economic benefits.

PRECIS Higher physical working capacity (PWC) at age 17 was associated with thicker peripapillary retinal nerve fiber layer (pRNFL) at age 20, suggesting a mechanistic link between cardiovascular fitness and neuroretinal integrity. PURPOSE Physical activity and cardiovascular fitness have been linked with lower odds of developing glaucoma. We tested the hypothesis that early beneficial effects of physical activity and cardiovascular fitness can be observed by measuring the pRNFL thickness in young healthy adults. METHODS The Raine Study is a longitudinal study that has followed a cohort since before their births in 1989-1992. Parent-reported physical activity was collected between 8 and 17 years, and latent class analysis was used to identify the participants' physical activity trajectories. At the 20-year follow-up (participants' mean age=20.1±0.4 y), participants' metabolic equivalent of task-minutes/week was determined using self-reported physical activity data. Participants' PWC was assessed at the 14- and 17-year follow-ups to estimate their level of cardiovascular fitness. An eye examination, which included spectral-domain optical coherence tomography imaging, was conducted at the 20-year follow-up for 1344 participants. RESULTS Parent-reported or participant-reported physical activity was not associated with pRNFL thickness. However, higher PWC at 17 years was associated with thicker pRNFL globally [by 0.3 µm; 95% confidence interval (CI)=0.2-0.6; P

This study aimed to examine sedentary behaviour (SB), physical activity (PA) and their associations with health-related measures at the time of diagnosis in people with inoperable lung cancer. People newly diagnosed with inoperable lung cancer were invited to participate in the study and asked to wear an accelerometer for seven consecutive days. Variables analysed included time spent in SB, light intensity PA (LIPA) and moderate-to-vigorous intensity PA (MVPA). Daily steps were also recorded. Data on symptoms, health-related quality of life (HRQoL), hand grip force, comorbidities and lung function were collected. Of the 120 patients referred to the study, 89 (74%) consented to participate, and SB/PA data were available for 79 (age 71 +/- 11 years; 29 females). Participants spent 71% of their waking time in SB, 28% in LIPA and 1% in MVPA. Regression models demonstrated that increased SB was associated with more symptoms of fatigue and dyspnoea (p

Activity trackers provide real-time sedentary behavior (SB) and physical activity (PA) data enabling feedback to support behavior change. The validity of activity trackers in an obese population in a free-living environment is largely unknown. This study determined the convergent validity of the Fitbit Charge 2 in measuring SB and PA in overweight adults. The participants (n = 59; M ± SD: age = 48 ± 11 years; body mass index = 34 ± 4 kg/m2) concurrently wore a Charge 2 and ActiGraph GT3X+ accelerometer for 8 days. The same waking wear periods were analyzed, and standard cut points for GT3X+ and proprietary algorithms for the Charge 2, together with a daily step count, were used. Associations between outputs, mean difference (MD) and limits of agreement (LOA), and relative differences were assessed. There was substantial association between devices (intraclass correlation coefficients from .504, 95% confidence interval [.287, .672] for SB, to .925, 95% confidence interval [.877, .955] for step count). In comparison to the GT3X+, the Charge 2 overestimated SB (MD = 37, LOA = −129 to 204 min/day), moderate to vigorous PA (MD = 15, LOA = −49 to 79 min/day), and steps (MD = 1,813, LOA = −1,066 to 4,691 steps/day), and underestimated light PA (MD = −32, LOA = −123 to 58 min/day). The Charge 2 may be a useful tool for self-monitoring of SB and PA in an overweight population, as mostly good agreement was demonstrated with the GT3X+. However, there were mean and relative differences, and the implications of these need to be considered for overweight adult populations who are already at risk of being highly sedentary and insufficiently active.

Research suggests dyadic interventions can increase physical activity; such interventions are untested within postpartum parent couples. A three-armed pilot randomised trial addressed this gap and tested which type of dyadic intervention is most effective. Inactive postpartum mothers and a significant other were recruited in Australia (n = 143 assessed for eligibility) and randomised in a single-blinded fashion (i.e., participants were blinded) to 1 of 3 dyadic conditions involving a single face-to-face session with access to web-based group support: a minimal treatment control (n = 34), collaborative planning group (n = 38), or collaborative planning + need supportive communication group (n = 30). Participants were asked to wear their accelerometers for 8 days and completed self-report measures at baseline, end of intervention (week 4), and follow-up (week 12). We expected dyads in the collaborative planning + need supportive communication group would have the greatest increases in Physical Activity (PA), autonomous motivation, and partners’ need supportive behaviours; and decreases in controlled motivation and controlling partner behaviours. Results from 51 dyads using Bayesian actor-partner interdependence models provided some evidence for a small positive effect on total physical activity at follow-up for postpartum mothers in the collaborative planning group and for partners in the collaborative planning + need supportive communication group. Furthermore, partners in the collaborative planning + need supportive communication group were more likely to engage in some vigorous PA. At follow-up, postpartum mothers in the collaborative planning + need supportive communication group scored lower on personal autonomous reasons. The impact of prior specification mean intervention effects need to be interpreted with caution. Progression to a full trial is warranted. Keywords: Postpartum, Mothers, Dyads, Randomized controlled trial, Physical activity. This project was funded by a Curtin International Postgraduate Research Scholarship/ Health Sciences Faculty International Research Scholarship. Andreas Stenling was supported by an international postdoc grant from the Swedish Research Council (dnr: 2017-00273).

Objectives To examine the longitudinal associations and differences between self-reported and device-assessed physical activity (PA) and sedentary behaviour (SB), using a multifaceted statistical approach. Design Longitudinal measurement burst. Methods In total, 52 university students (78% female) aged 18–38 years (mean = 21.94 ± 4.57 years) participated. The study consisted of three blocks of six days of measurement, during which participants wore an accelerometer on their wrist for the entire block, and self-reported their PA over the 6 days at the end of each block. Results Meaningful latent differences between methods were observed for moderate PA and SB across all three assessment periods, such that participants underreported the time spent in each activity. Bland–Altman plots revealed a positive mean difference for vigorous PA, with over-reporting increasing as mean levels increased. Negative mean differences were observed for all other intensities. Underreporting of moderate PA increased as the mean level increased, whereas for light PA and SB, underreporting decreased at high levels. Repeated measures correlations revealed a meaningful association for vigorous PA only, suggesting that as self-reported minutes increase so too do device-measured minutes. Conclusions We found evidence of cross-sectional and longitudinal differences and weak associations between self-reported and device-assessed PA and SB. Future work is needed to enhance the quality of self-reported methods to assess PA and SB (e.g., face and content validity), and consider improvements to the processing of device-based data.

Improving dietary reporting among people living with obesity is challenging as many factors influence reporting accuracy. Reactive reporting may occur in response to dietary recording but little is known about how image-based methods influence this process. Using a 4-day image-based mobile food record (mFRTM), this study aimed to identify demographic and psychosocial correlates of measurement error and reactivity bias, among adults with BMI 25-40kg/m2. Participants (n=155, aged 18-65y) completed psychosocial questionnaires, and kept a 4-day mFRTM. Energy expenditure (EE) was estimated using ≥4 days of hip-worn accelerometer data, and energy intake (EI) was measured using mFRTM. Energy intake: energy expenditure ratios were calculated, and participants in the highest tertile were considered to have Plausible Intakes. Negative changes in EI according to regression slopes indicated Reactive Reporting. Mean EI was 72% (SD=21) of estimated EE. Among participants with Plausible Intakes, mean EI was 96% (SD=13) of estimated EE. Higher BMI (OR 0.81, 95%CI 0.72-0.92) and greater need for social approval (OR 0.31, 95% CI 0.10-0.96), were associated with lower likelihood of Plausible Intakes. Estimated EI decreased by 3% per day of recording (IQR -14%,6%) among all participants. The EI of Reactive Reporters (n=52) decreased by 17%/day (IQR -23%,-13%). A history of weight loss (10kg) (OR 3.4, 95% CI 1.5-7.8), and higher percentage of daily energy from protein (OR 1.1, 95%CI 1.0-1.2) were associated with greater odds of Reactive Reporting. Identification of reactivity to measurement, as well as Plausible Intakes, is recommended in community-dwelling studies to highlight and address sources of bias.

This project is funded by the National Health and Medical Research Council (NHMRC) (Investigator Grant--APP1174739) and Curtin University., Introduction Exercise and physical activity have been shown to improve cognition for people living with mild cognitive impairment (MCI). There is strong evidence for the benefits of aerobic exercise and medium evidence for participating in regular strength training for people with MCI. However, people living with MCI fall two times as often as those without cognitive impairment and the evidence is currently unknown as to whether balance training for people with MCI is beneficial, as has been demonstrated for older people without cognitive impairment. The aim of this study is to determine whether a balance-focused multimodal exercise intervention improves balance and reduces falls for people with MCI, compared with a control group receiving usual care. Methods and analysis This single blind randomised controlled trial (Balance on the Brain) will be offered to 396 people with MCI living in the community. The multimodal exercise intervention consists of two balance programmes and a walking programme to be delivered by physiotherapists over a 6-month intervention period. All participants will be followed up over 12 months (for the intervention group, this involves 6-month intervention and 6-month maintenance). The primary outcomes are (1) balance performance and (2) rate of falls. Physical performance, levels of physical activity and sedentary behaviour, quality of life and cognition are secondary outcomes. A health economic analysis will be undertaken to evaluate the cost-effectiveness of the intervention compared with usual care. Ethics and dissemination Ethics approval has been received from the South Metropolitan Health Service Human Research Ethics Committee (HREC), Curtin University HREC and the Western Australia Department of Health HREC; and approval has been received to obtain data for health costings from Services Australia. The results will be disseminated through peer-review publications, conference presentations and online platforms., National Health and Medical Research Council (NHMRC) of Australia APP1174739, Curtin University

Background: Limited research reports on the relationship between body mass index (BMI) and physical activity (PA), sedentary behavior (SB), sleep, and gross motor skills (GMS) in low- and middle-income countries. The aim of this study was to (1) describe BMI, PA, SB, sleep duration, and GMS proficiency in South African preschool children and (2) identify relationships between variables. Methods: BMI, including z scores for height, weight, and BMI were determined. Seven-day PA, SB, and sleep were measured using accelerometry. GMS were assessed using the Test of Gross Motor Development (second edition). Associations were explored by comparing sleep, PA, SB, and GMS between BMI tertiles using the Kruskal–Wallis test. Results: Most (86%) children (n = 78, 50% boys) had a healthy BMI (15.7 [1.3] kg/m2). Children spent 560.5 (52.9) minutes per day in light- to vigorous-intensity PA and 90.9 (30.0) minutes per day in moderate- to vigorous-intensity PA; most (83%) met the current PA guideline. Nocturnal sleep duration was low (9.28 [0.80] h/d). Although daytime naps increased 24-hour sleep duration (10.17 [0.71] h/d), 38% were classified as short sleepers. Around half (54.9%) of participants complied with both PA and sleep guidelines. No associations between variables were found. Conclusion: Despite being lean, sufficiently active, and having adequate GMS, many children were short sleepers, highlighting a possible area for intervention.

Objectives The purpose of this study was to identify early life factors that were associated with childhood and adolescent organized sport participation trajectories. Design Participants were in the Raine Study, a pregnancy cohort in Western Australia recruited from 1989 to 1991. Methods Three organized sport trajectories over ages 5–17 years were previously identified for girls (n = 824: consistent participators, dropouts, and non-participators in sport) and boys (n = 855: consistent participators, dropouts, joiners — those who joined sport in adolescence). Physical, psychological and social factors were measured from birth to age 5. Results For girls and boys, children who were breastfed, were taller, did not have behavior problems, and attended childcare were more likely to consistently participate. Girls who had a previous injury (Relative risk ratio 1.55: 95% confidence interval 1.05, 2.29 vs never been injured) or who had parents who had worries about their child’s health (1.56: 1.00, 2.42 vs no worries) were more likely to be in the dropout trajectory. Boys born preterm (2.00, 2.06, 3.76 vs full-term), did not have a previous injury (0.72, 0.53, 0.97 those with injury vs never been injured), had more difficult temperament (1.63, 1.02, 2.60 vs easy temperament), and higher family dysfunction (1.49, 1.06, 2.08) were more likely to be in the dropout trajectory. Conclusions Early life factors were associated with membership in sport trajectories. Physical, psychological, and social factors may serve as early warning signs for parents and practitioners that children may be at higher risk of dropping out of sports.

Aim Sleep behaviour is correlated and causally related to physical and mental health. Limited longitudinal data exist on the associations of poor sleep behaviour in childhood and adolescence with adult health. Parent-reported sleep behaviours from 1993 participants of the Raine Study (at ages 5, 8, 10, 14, 17) were used to determine sleep trajectories (using latent class growth analysis). Methods Measures of physical and mental health were compared between sleep trajectories using generalised linear models (at age 20). Results Three sleep trajectories were identified as follows: 43% of participants belonged to a trajectory with 'consistently minimal' sleep problems, 49% showed some 'declining' in reporting of sleep problems incidence and 8% had 'persistent' sleep problems. Participants in the 'consistently minimal' trajectory had better physical and mental health outcomes at age 20 compared to those in the 'declining' and 'persistent' trajectories. For example, 'consistently minimal' participants had significantly lower body fat percentage (mean difference: -3.89% (95% CI: -7.41 to -0.38)) and a higher (better) SF-12 mental component score (mean difference: 4.78 (95% CI: 2.35-7.21)) compared to participants in the 'persistent' trajectory. Conclusion Poor sleep behaviour across childhood and adolescent years is related to poorer physical and mental health in young adulthood.

Introduction There are limited data on the association of chronotype and hypertension and on their interaction on hypertension. This study aimed to investigate the independent and combined effects of chronotype and OSA on risk for prevalent hypertension in a middle-aged community population. Methods Baseline data on adult participants (n=1098, female=58%; age mean [range]=56.7[40.8–80.6] years) from an Australian community cohort study were analysed. Shift workers and individuals with incomplete data were excluded. Prevalent hypertension was defined as ‘doctor diagnosed’ and/or an elevated average systolic blood pressure (BP; ≥140mmHg) or diastolic BP (≥90mmHg). OSA was diagnosed when apnoea hypopnoea index (AHI) ≥10 events/hour from in-laboratory polysomnography. Chronotype was determined from actigraphy mid-sleep time on work free days. Tertiles of mid-sleep time were used to categorise morning, intermediate and evening chronotypes. Logistic regression (adjusted for sex, body mass index, age, alcohol consumption and sleep duration) were used to assess the cross-sectional relationship between chronotype, OSA and hypertension. Results After applying exclusion criteria 496 participants were analysed (female=58%; age mean[range]=57.0[42.1–81.6] years). All those with OSA had greater odds of hypertension than those without and there was no difference in risk of hypertension according to chronotype. Compared to morning chronotypes with no OSA (n=84), evening chronotypes with OSA (n=79) had non-significantly increased odds (OR 2.15, 95% CI 1.00–4.76; P=0.054) for hypertension while morning chronotypes with OSA (n=82) had significantly increased odds (OR 3.02, 95% CI 1.44–6.58; P=0.004). Discussion Morning chronotypes with OSA might be at increased risk of hypertension compared to evening chronotypes with OSA.

UNSTRUCTURED Excess weight is a major risk factor for chronic diseases. In Australia, over 60% of adults are overweight or obese. The overconsumption of energy-dense nutrient-poor (EDNP) foods and low physical activity (PA) levels are key factors contributing to population obesity. New cost-effective approaches to improve population diet and PA behaviors are needed. This 1-year randomized controlled trial (6-month intervention and 6-month follow-up) aims to investigate whether a tailored intervention using mobile technology can improve diet and PA behaviors leading to weight loss in adults (aged 18-65 years) who are overweight or obese and recruited through a social marketing campaign (LiveLighter). All eligible participants will provide data on demographics and lifestyle behaviors online at baseline, 6 months, and 12 months. Using two-stage randomization, participants will be allocated into one of three conditions (n=200 per group): tailored feedback delivered via email at seven time points, informed by objective dietary (mobile food record app) and activity (wearable activity monitor) assessment; active control receiving no tailored feedback, but undergoing the same objective assessments as tailored feedback; and online control receiving no tailored feedback or objective assessments. Primary outcome measures at 6 and 12 months are changes in body mass, EDNP food and beverage consumption, and daily moderate-to-vigorous PA (measured via accelerometry). Secondary outcomes include change in fruit and vegetable consumption, daily sedentary behaviors, and cost effectiveness. Enrolment commenced in August 2017. Primary outcomes at 12 months will be available for analysis from September 2019. Tailored email feedback provided to individuals may deliver a cost-effective strategy to overcome existing barriers to improving diet and PA. If found to be successful and cost effective, upscaling this intervention for inclusion in larger-scale interventions is highly feasible. Australian New Zealand Clinical Trials Registry ACTRN12617000554369; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=371325&isReview=true.

Introduction: Data on device-measured physical activity (PA) and sedentary behaviour (SB) in the period before treatment commencement in people with inoperable lung cancer could help guide PA goals during and after treatment. However, the feasibility of collecting these data during such a stressful (and often short) period has not been reported. Aim: In people with inoperable lung cancer, to (i) examine compliance to accelerometry in the period before treatment; and (ii) describe their time spent in PA and SB. Method: People diagnosed with inoperable lung cancer, with Eastern Cooperative Oncology Group (ECOG) performance status 0-2, without brain metastases, wore an accelerometer (Actigraph GT9X) on their waist for 7 days before treatment. Compliance was measured as the percent of people who had ≥4 valid days (i.e. 10 h/day of wear-time). Results: Sixty-eight participants consented (44 males; 71±11yr), 62 were provided with the accelerometer, and 60 of them (97%) returned the device. No complications were reported on accelerometer use. Fifty-seven (95%) had ≥4 valid days of wear-time. Participants mean step count was 7,633±3,569 steps/day and they spent 600±116 min/day in SB. Compared to those with better performance status (ECOG 0/1; n=47), participants with poorer performance status (ECOG 2; n=10) had a lower step count (mean difference [95% CI] 2,480 [112; 4847] steps/day) and spent more time in SB (61 [7; 115] min/day). Conclusion: Compliance to accelerometry before lung cancer treatment was high. Participants with poorer performance status were less active and 1 h/day more sedentary than those with better performance status. Such data could guide PA and SB goal setting during and after treatment.

Context Vitamin D plays a role in the differentiation and metabolism of skeletal muscle and, possibly, adipose tissue; however, the relationship between vitamin D status during growth and body composition in early adulthood is unclear. Objective We examined associations between vitamin D status in childhood, adolescence, and early adulthood with body composition at age 20 years. Design, Setting, Participants We studied 821 offspring (385 females) of the Western Australian Pregnancy Cohort Study who had ≥3 serum 25-hydroxyvitamin D [25(OH)D] at age 6, 14, 17, and 20 years and body composition assessed at age 20 using dual-energy x-ray absorptiometry. The participants were grouped into four vitamin D status trajectories: consistently lower, decreasing, increasing, and consistently higher. Results The mean serum 25(OH)D at the study visits was 72.7 to 86.8 nmol/L. In males, serum 25(OH)D at 17 and 20 years was positively associated with lean body mass (LBM), and 25(OH)D at age 20 correlated negatively with fat body mass (FBM). Males with a consistently higher 25(OH)D trajectory had a 2.3- to 3.7-kg greater LBM and 4.1- to 6.0-kg lower FBM at 20 years compared with those with consistently lower or decreasing trajectories (P < 0.05 for all). In females, 25(OH)D at 14, 17, and 20 years was negatively associated with FBM. Females with increasing or consistently higher 25(OH)D trajectories had a 5.2- to 6.8-kg lower FBM at age 20 compared with those with a consistently lower trajectory (P < 0.05 for all). Conclusions In the present predominantly white, relatively vitamin D-replete cohort, a higher vitamin D status trajectory from childhood to early adulthood was associated with a greater LBM in males and lower FBM in both sexes at age 20.

Objective: The Residents in Action Trial (RiAT; ACTRN12616001177448) was a 16-week motivationally-embellished peer-led walking intervention designed to increase walking, reduce sitting, and improve mental health and well-being in insufficiently active residents in retirement villages. In this paper we report on 1) trial feasibility and acceptability, and 2) evaluate the processes involved in the implementation of the intervention using the RE-AIM framework. Method: A mixed methods design was employed, consisting of data from accelerometers, surveys, (individual, pair-based and focus group) interviews, and participant logbooks. Participants included 116 walkers (M(SD) age = 78.37(8.30); 92% female), 8 peer leaders (i.e. ambassadors) and 3 retirement village managers from 14 retirement villages. Descriptives and linear mixed modelling were used to analyse the quantitative data and inductive thematic analyses were employed to analyse the interview data. Results: The intended cluster randomised controlled design became quasi-experimental due to insufficient numbers of recruited ambassadors. The perceived burden of the number and frequency of research assessments was a frequently mentioned reason for a poor recruitment. Facilitators to walking maintenance were the use of self-monitoring, goal setting, social support, and having a routine. Reach was modest (about 14% of eligible participants were recruited from each village), but retention was excellent (92%). The motivational strategies taught appeared to have been implemented, at least in part, by the ambassadors. The walkers in the main experimental condition increased marginally their step counts, but there were no group differences on mental health and well-being outcomes, partly because of low statistical power. Conclusions: Walkers and ambassadors who did take part in the study suggested that they enjoyed the programme and found it useful in terms of becoming more active and making social connections. However, the group format was not appealing to some participants, hence, other delivery options should be explored in the future.

Physical activity has been associated with physical and mental health across the life course, yet few studies have used group-based trajectory modeling to examine the effect of longitudinal patterns of physical activity during childhood and adolescence on adult health outcomes. The Raine Study data from Gen2 follow-ups at 8, 10, 14, 17, 20, and 22 years collected between 1998 and 2014 were used. Latent class analysis identified trajectories using parent-reported physical activity for ages 8 to 17. Associations between trajectories and physical and mental health outcomes at ages 20 and 22 were explored, adjusting for current physical activity and considering sex interactions. Analysis in 2019 identified three trajectories: low (13%), mid (65%) and high (22%) physical activity (n = 1628). Compared to the low-activity trajectory, those in the high-activity trajectory had lower adiposity, insulin, HOMA-IR and fewer diagnosed disorders, higher HDL-cholesterol, and faster cognitive processing. For example, those in the high-activity trajectory had lower percent body fat at age 20 compared to those in the mid-activity (−4.2%, 95%CI: −5.8, −2.7) and low-activity (−9.5%, 95%CI: −11.7, −7.2) trajectories. Physical activity trajectories showed different associations between sexes for self-reported physical and mental health, BMI, systolic blood pressure, and depression symptoms. Being in the high- or mid-activity trajectory was associated with a more favorable cardiometabolic and mental health profile in young adulthood. Strategies are needed to help less active children to increase physical activity throughout childhood and adolescence to improve young adult health outcomes.

Objective: The aim of this study was to determine whether mobile phone text messages could modify objectively measured sedentary behavior and cardiometabolic health in office workers. Methods: Nine males and 12 females [mean (SD): 27.5 (5.7) years, 23.8 (2.8) kg/m2] were assigned to a control (CON) or intervention (PROMPT) group. PROMPT received an activity-promoting text message during office hours. Participants wore an actiGraph and activPAL accelerometer for 7 days during and after the intervention. Blood pressure, lipid, and metabolic profiles were measured before and after the intervention. Results: PROMPT sat less [mean (95% confidence interval, 95% CI): 4.9 (4.4 to 5.4) hours/day] than CON [6.0 (5.5 to 6.4) hours/day; P = 0.04] during the message-receiving period. There was no difference between groups after the intervention and for the other activity variables. There were no changes in cardiometabolic health markers following the intervention. Conclusion: Sitting time was lower during the message-receiving period, but the difference between groups was no longer apparent after the intervention.

To identify “activity phenotypes” from accelerometer-derived activity characteristics among young adults. Participants were young adults (n = 628, mean age, 22.1, SD 0.6) in the Raine Study in Western Australia. Sex-specific latent class analyses identified sub-groups using eight indicators derived from 7-day hip-worn Actigraph GT3X+ accelerometers: daily steps, total daily moderate-to-vigorous physical activity (MVPA), MVPA variation, MVPA intensity, MVPA bout duration, sedentary-to-light ratio, sedentary-to-light ratio variation, and sedentary bout duration. Five activity phenotypes were identified for women (n = 324) and men (n = 304). Activity phenotype 1 for both women (35%) and men (30%) represented average activity characteristics. Phenotype 2 for women (17%) and men (16%) was characterized by below average total activity and MVPA (10.6 and 16.7 min of MVPA/day, women and men respectively). Phenotype 3 for women (15%) and men (23%) was characterized by below average total physical activity, average MVPA (32.6 and 36.5 min/day), high sedentary-light ratio and long sedentary bouts. Phenotype 4 differed between women (29%) and men (18%) but both had low sedentary-to-light ratios and shorter sedentary bouts. Finally, phenotype 5 in both women (4%) and men (12%) was characterized by extreme MVPA metrics (81.3 and 96.1 min/day). Five activity phenotypes were identified for each gender in this population of young adults which can help design targeted interventions to enhance or modulate activity phenotypes.

ObjectivesOvarian cancer (OC) survivors experience many disease and treatment adverse effects. However, the impact of OC and its treatment on objective activity behaviors and physiological status have not been examined. The purpose of this study was to compare objectively measured activity behaviors and physiological characteristics of advanced-stage OC survivors to age-matched controls.MethodsTwenty stage III–IV OC survivors and 20 controls completed assessments of activity behaviors (7-day accelerometry), physical function (400-meter walk as indicator of cardiorespiratory fitness, repeated chair rise, 6-meter walking tests), muscle strength (1-repetition maximum and handgrip), body composition (dual-energy x-ray absorptiometry), and musculoskeletal morphology (peripheral quantitative computed tomography).ResultsCompared with controls, OC survivors spent more time/day in prolonged sedentary bouts (P= 0.039,r= 0.32), had lower cardiorespiratory fitness (P= 0.041,r= 0.33) and upper body strength (P= 0.023,r= 0.37), had higher areal bone mineral content (P= 0.047,r= 0.33) and volumetric trabecular density (P= 0.048,r= 0.31), but were not different in other measures of body composition nor in muscle morphology (P> 0.050). Only 20% (n = 4) of OC survivors accrued 150 minutes/week or greater moderate and vigorous physical activity (MVPA) time in 10-minute bouts or greater. Moderate and vigorous physical activity time/day in 10-minute bouts or greater was strongly associated with cardiorespiratory fitness (P= 0.001, ρ = −0.702) and lower extremity function (P= 0.019, ρ = −0.519) and moderately associated with muscle cross-sectional area (P= 0.035, ρ = 0.473).ConclusionsPosttreatment OC survivors spent more time in prolonged sedentary bouts and had lower cardiorespiratory fitness and upper body strength compared with controls. Moderate and vigorous physical activity was associated with physical function and muscle cross-sectional area. Future studies should test the efficacy of exercise interventions to increase MVPA, reduce sedentary behavior, and increase cardiorespiratory fitness and muscle strength in OC survivors.

Malignant pleural effusion (MPE) affects 1 million people worldwide annually and can significantly impair physical activity. Accelerometry is a validated method of objectively assessing physical activity. The purpose of this study was to determine the compliance in patients with MPE to accelerometry and describe their activity.Patients with MPE wore an Actigraph GT3X accelerometer over a 7-day continuous wear protocol. Compliance was measured as the percent of patients who had ≥4 valid days (i.e., 8-h/day of waking wear-time). Eastern Cooperative Oncology Group performance status was documented the day of actigraphy initialization.Forty-six patients with MPE received accelerometers; 44 (95.7%) returned their device. No complications were reported on their use. Forty subjects (90.9%) had ≥4 valid days of wear-time. Patients spent most of their waking hours sedentary [mean 11.0 h (SD 1.95)], with limited participation in moderate and vigorous physical activity [mean 9.5 min (SD 14.16)]. Compared to patients with better performance status (n = 32), patients with poorer performance status (n = 11) spent significantly more hours/day sedentary [mean difference 2.1 (CI 0.86-3.32); p = 0.001], as did those who survived3 months (n = 5) compared to12 months (n = 27) [mean difference 2.6 (CI 0.49-4.77); p = 0.013).Accelerometry was applied successfully in patients with MPE with high compliance and no adverse events. This is the first reported objectively measured physical activity in patients with MPE and revealed high sedentary behavior and low physical activity. The data reflected patient performance status and discriminated between survival groups. Accelerometry can provide a useful measure for future interventional studies in patients with MPE.

Walking interventions can be effective in increasing physical activity amongst physically inactive employees. However, despite their promising potential regarding sustainability and scalability, peer-led workplace walking interventions have not been tested. We evaluated a peer-led workplace group walking intervention designed to engage physically inactive employees. A 16-week pilot cluster randomized controlled trial consisted of enhanced (5 worksites; n = 50 participants) and minimal treatment (3 worksites; n = 47) conditions. All participants were provided with a Fitbit Zip and information on health benefits of walking. Enhanced treatment participants had access to a mobile phone app incorporating behavior change techniques, were trained on principles of autonomous motivation, and had a peer leader trained in a motivationally supportive communication style. Feasibility assessments included recruitment and drop-out rates, assessment completion rates, training acceptability (walkers and peer leaders), and intervention acceptability (walkers only). Outcomes assessed included movement-related behaviors (assessed via activPAL devices), cardio-metabolic risk factors, motivation to walk, and well-being, and these measures were taken at baseline and post-intervention. The results supported intervention feasibility. Preliminary efficacy evidence was mixed. Markers of cardio-metabolic risk improved in the enhanced treatment only. Autonomous motivation increased in both conditions. There were no changes in step counts, standing, and sitting time, or well-being. Further fine tuning is needed before a definitive RCT. Australian and New Zealand Clinical Trials Registry: ACTRN12618000807257.

Pet ownership is associated with increased levels of physical activity (PA) in older adults. Studies have mainly focused on the association between PA and dog walking; however, broader aspects of pet ownership may influence PA. The purpose of this study was to explore the association between pet ownership and incidental and purposeful PA using a mixed methods approach. Participants’ (N = 15) PA was measured for 7 days using accelerometers and diaries. Semistructured interviews explored participants’ perspectives regarding pet-related activities. Participants’ mean (SD) daily step count was 14,204 (5,061) steps, and mean (SD) sedentary time per day was 8.76 (1.18) hr. Participants strongly concurred that their pets were an integral part of their daily lives. Incidental and purposeful PA resulted from participants undertaking pet care and socially interacting with their pets. Pets may interrupt sedentary behaviors by nudging older adults to engage in PA as part of their daily lived experience.

Background Recent evidence shows that sport settings can act as a powerful draw to engage men in weight loss. The primary objective of this pilot study was to test the feasibility of delivering and to evaluate preliminary efficacy of Aussie-FIT, a weight-loss program for men with overweight/obesity delivered in Australian Football League (AFL) settings, in preparation for a future definitive trial. Methods and findings This 6-month pilot trial took place in Perth, Australia. Participants were overweight/obese (Body Mass Index [BMI] ≥ 28 kg/m2), middle-aged (35–65 years old) men. Participants were recruited in May 2018, and the intervention took place between June and December 2018. The intervention involved 12 weekly 90-min face-to-face sessions, incorporating physical activity, nutrition, and behaviour change information and practical activities delivered by coaches at 2 clubs. Data were collected at baseline and immediately postintervention. For trial feasibility purposes, 6-month follow-ups were completed. Outcomes were differences in weight loss (primary outcome) and recruitment and retention rates, self-reported measures (for example, psychological well-being), device-measured physical activity, waist size, and blood pressure at 3 months. Within 3 days of advertising at each club, 426 men registered interest; 306 (72%) were eligible. Men were selected on a first-come first-served basis (n = 130; M age = 45.8, SD = 8; M BMI = 34.48 kg/m2, SD = 4.87) and randomised by a blinded researcher. Trial retention was 86% and 63% at 3- and 6-month follow-ups (respectively). No adverse events were reported. At 3 months, mean difference in weight between groups, adjusted for baseline weight and group, was 3.3 kg (95% CI 1.9, 4.8) in favour of the intervention group (p < 0.001). The intervention group’s moderate-to-vigorous physical activity (MVPA) was higher than the control group by 8.54 min/day (95% CI 1.37, 15.71, p = 0.02). MVPA among men attracted to Aussie-FIT was high at baseline (intervention arm 35.61 min/day, control arm 38.38 min/day), which may have limited the scope for improvement. Conclusions Aussie-FIT was feasible to deliver; participants increased physical activity, decreased weight, and reported improvements in other outcomes. Issues with retention were a limitation of this trial. In a future, fully powered randomised controlled trial (RCT), retention could be improved by conducting assessments outside of holiday seasons. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12617000515392., Eleanor Quested and colleagues report the findings from a pilot, football-based randomised controlled trial aimed at men with overweight/obesity., Author summary Why was this study done? The prevalence of overweight and obesity is higher in men than in women in Australia (71% versus 56%). Provision of weight-loss programs suitable for men is limited, and men are less likely than women to take part in weight-loss programs. Use of sport settings, such as Australian Football League (AFL) club facilities, can be used as a powerful way to encourage men to participate in weight-loss programs. What did the researchers do and find? 130 men took part in the Aussie-FIT program. This men-only weight-loss program included 12 weekly 90-min sessions that included weight-loss education and coach-led physical activity. The AFL themed program was delivered in 2 Australian football club settings. After all of the men’s initial weight and health measures were taken, half of the group received the program, and the other half waited for 3 months to receive it. At 3 months, the measurements were repeated so that we could compare differences in weight (and other indicators of health) between men who had already completed the program and the men who were waiting to receive the program. We found that the men who had participated in the program lost on average 3.33 kg more than the men who had not. Men who had completed Aussie-FIT did, on average, 8.54 min more moderate-to vigorous physical activity per day than their counterparts who had not yet received the program. What do these findings mean? Aussie-FIT is feasible to deliver in Australian football settings. This study provides some initial evidence that Aussie-FIT may be appealing and effective as a weight-loss program for men with overweight and obesity in Australia. This study was relatively small (130 men took part). In order to make definitive policy recommendations regarding program scale out, a follow-up study involving more participants and more football clubs is needed. Also, studies with longer follow-up are needed. A limitation of this study was that the program did not attract men from culturally or linguistically diverse backgrounds or indigenous Australians; future studies should explore how the program can be made more appealing and acceptable to men from more diverse backgrounds.

School-aged children are spending increasingly long periods of time engaged in sedentary activities such as sitting. Recent school-based studies have examined the intervention effects of introducing standing desks into the classroom in the short and medium term. The aim of this repeated-measures crossover design study was to assess the sit-stand behaviour, waking sedentary time and physical activity, and musculoskeletal discomfort at the start and the end of a full school year following the provision of standing desks into a Grade 4 classroom. Accelerometry and musculoskeletal discomfort were measured in both standing and traditional desk conditions at the start and at the end of the school year. At both time points, when students used a standing desk, there was an increase in standing time (17&ndash, 26 min/school day) and a reduction in sitting time (17&ndash, 40 min/school day). There was no significant difference in sit-stand behaviour during school hours or sedentary time and physical activity during waking hours between the start and the end of the school year. Students were less likely to report discomfort in the neck and shoulders when using a standing desk and this finding was consistent over the full school year. The beneficial effects of using a standing desk were maintained over the full school year, after the novelty of using a standing desk had worn off.

Background and Objectives Peer-led interventions are promising for the promotion of physical activity behavior in older adults. However, little is known about the attributes of effective older peer leaders in such intervention programs. The objective was to determine what older adults perceive to be effective peer leader attributes. Research Design and Methods A mixed-methods concurrent triangulation design was used. Participants, aged 60 years and older, were recruited from retirement villages and existing walking groups in Western Australia. They were predominantly white, Australian-born, female, healthy retirees. The sample consisted of four groups of older adults: those who had taken part in past peer-led walking programs (experienced walkers; n = 18), those interested in joining as walkers in a peer-led walking intervention (inexperienced walkers; n = 43), those interested to take on a peer leader role (inexperienced peer leaders; n = 25), and those who had already served as peer leaders (experienced peer leaders; n = 15). Questionnaires measured perceived effective leadership attributes, and physical activity was measured using ActivPAL devices (N = 101; Mage [SD] = 75.36 [7.59]). Semistructured interviews were conducted with the majority of participants (N = 68; Mage [SD] = 74.68 [7.78]). Results Overall, participants described an effective peer leader as optimistic, compassionate, and friendly, but differences in perceptions were apparent between the groups. Discussion and Implications Our findings advance knowledge about important characteristics of an effective older peer leader, which can inform peer leader training, recruitment of peer leaders, and future scale development.

Background and aims Currently there is a lack of large population studies that have investigated pain sensitivity distributions in healthy pain free people. The aims of this study were: (1) to provide sex-specific reference values of pressure and cold pain thresholds in young pain-free adults; (2) to examine the association of potential correlates of pain sensitivity with pain threshold values. Methods This study investigated sex specific pressure and cold pain threshold estimates for young pain free adults aged 21–24 years. A cross-sectional design was utilised using participants (n =617) from the Western Australian Pregnancy Cohort (Raine) Study at the 22-year follow-up. The association of site, sex, height, weight, smoking, health related quality oflife, psychological measures and activity with pain threshold values was examined. Pressure pain threshold (lumbar spine, tibialis anterior, neck and dorsal wrist) and cold pain threshold (dorsal wrist) were assessed using standardised quantitative sensory testing protocols. Results Reference values for pressure pain threshold (four body sites) stratified by sex and site, and cold pain threshold (dorsal wrist) stratified by sex are provided. Statistically significant, independent correlates of increased pressure pain sensitivity measures were site (neck, dorsal wrist), sex (female), higher waist-hip ratio and poorer mental health. Statistically significant, independent correlates of increased cold pain sensitivity measures were, sex (female), poorer mental health and smoking. Conclusions These data provide the most comprehensive and robust sex specific reference values for pressure pain threshold specific to four body sites and cold pain threshold at the dorsal wrist for young adults aged 21–24 years. Establishing normative values in this young age group is important given that the transition from adolescence to adulthood is a critical temporal period during which trajectories for persistent pain can be established. Implications These data will provide an important research resource to enable more accurate profiling and interpretation of pain sensitivity in clinical pain disorders in young adults. The robust and comprehensive data can assist interpretation of future clinical pain studies and provide further insight into the complex associations of pain sensitivity that can be used in future research.

Researchers are increasingly using 24 h accelerometer wear protocols. No automated method has been published that accurately distinguishes 'waking' wear time from other data ('in-bed', non-wear, invalid days) in young adults. This study examined the validity of an automated algorithm developed to achieve this for hip-worn Actigraph GT3X + 60 s epoch data. We compared the algorithm against a referent method ('into-bed' and 'out-of-bed' times visually identified by two independent raters) and benchmarked against two published algorithms. All methods used the same non-wear rules. The development sample (n = 11) and validation sample (n = 95) were Australian young adults from the Raine pregnancy cohort (54% female), all aged approximately 22 years. The agreement with Rater 1 in each minute's classification (yes/no) of waking wear time was examined as kappa (κ), limited to valid days (≥10 h waking wear time per day) according to the algorithm and Rater 1. Bland–Altman methods assessed agreement in daily totals of waking wear and in-bed wear time. Excellent agreement (κ > 0.75) was obtained between the raters for 80% of participants (median κ = 0.94). The algorithm showed excellent agreement with Rater 1 (κ > 0.75) for 89% of participants and poor agreement (κ < 0.40) for 1%. In this sample, the algorithm (median κ = 0.86) performed better than algorithms validated in children (median κ = 0.77) and adolescents (median κ = 0.66). The mean difference (95% limits of agreement) between Rater 1 and the algorithm was 7 (−220, 234) min d−1 for waking wear time on valid days and −41 (−309, 228) min d−1 for in-bed wear time. In this population, the automated algorithm's validity for identifying waking wear time was mostly good, not worse than inter-rater agreement, and better than the evaluated published alternatives. However, the algorithm requires improvement to better identify in-bed wear time.

Sedentary behaviors such as watching television (TV) are associated with increased risk of cardiometabolic disease. The effects of TV watching during key developmental stages on skeletal health are uncertain. Hours of TV watching/week were recorded by parental or self-report at 5, 8, 10, 14, 17, and 20 years of age in 1181 members (48% female) of a pregnancy cohort (the Raine Study). Participants were classified into one of three TV-watching trajectories (using latent class analysis): low (consistently

Background Excess weight is a major risk factor for chronic diseases. In Australia, over 60% of adults are overweight or obese. The overconsumption of energy-dense nutrient-poor (EDNP) foods and low physical activity (PA) levels are key factors contributing to population obesity. New cost-effective approaches to improve population diet and PA behaviors are needed. Objective This 1-year randomized controlled trial (6-month intervention and 6-month follow-up) aims to investigate whether a tailored intervention using mobile technology can improve diet and PA behaviors leading to weight loss in adults (aged 18-65 years) who are overweight or obese and recruited through a social marketing campaign (LiveLighter). Methods All eligible participants will provide data on demographics and lifestyle behaviors online at baseline, 6 months, and 12 months. Using two-stage randomization, participants will be allocated into one of three conditions (n=200 per group): tailored feedback delivered via email at seven time points, informed by objective dietary (mobile food record app) and activity (wearable activity monitor) assessment; active control receiving no tailored feedback, but undergoing the same objective assessments as tailored feedback; and online control receiving no tailored feedback or objective assessments. Primary outcome measures at 6 and 12 months are changes in body mass, EDNP food and beverage consumption, and daily moderate-to-vigorous PA (measured via accelerometry). Secondary outcomes include change in fruit and vegetable consumption, daily sedentary behaviors, and cost effectiveness. Results Enrolment commenced in August 2017. Primary outcomes at 12 months will be available for analysis from September 2019. Conclusions Tailored email feedback provided to individuals may deliver a cost-effective strategy to overcome existing barriers to improving diet and PA. If found to be successful and cost effective, upscaling this intervention for inclusion in larger-scale interventions is highly feasible. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12617000554369; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=371325&isReview=true International Registered Report Identifier (IRRID) DERR1-10.2196/12782

Background/Objectives: Malignant pleural mesothelioma (MPM) is an incurable cancer and optimizing daily physical activity and quality of life are key goals of patient management. Little is known about the prevalence of pre-sarcopenia and malnutrition in MPM or their associations with patient outcomes. This study aimed to determine the prevalence of pre-sarcopenia and malnutrition in MPM and investigate if activity levels and quality of life differed according to body composition and nutritional status. Subjects/Methods: Patients with a diagnosis of MPM were recruited. Pre-sarcopenia was defined as low appendicular skeletal muscle mass (≤ 7.26 kg/m2 for men and ≤ 5.45 kg/m2 for women), measured by dual energy X-ray absorptiometry. Malnutrition was defined as a rating of B or C on the Patient-Generated Subjective Global Assessment. Outcome measures included objective activity levels (Actigraph GT3X) and health-related quality of life (HRQoL; Functional Assessment of Cancer Therapy General). Results: Sixty-one people participated (79% male, median age 69 [IQR 62–74] years and median BMI 25.8 [IQR 24.3–28.4] kg/m2). Fifty-four percent were pre-sarcopenic and 38% were malnourished. Percent of time spent in light activity/day was lower in participants with pre-sarcopenia compared with non-sarcopenic participants (median 25.4 [IQR 19.8–32.1]% vs. 32.3 [27.1–35.6]%; p = 0.008). Participants with malnutrition had poorer HRQoL than well-nourished participants (mean 69.0 (16.3) vs. 84.4 (13.3); p

IntroductionOverweight and obesity are highly prevalent among Australian men. Professional sports settings can act as a powerful ‘hook’ to engage men in weight loss programmes; the Football Fans in Training programme delivered in professional UK soccer clubs was successful and cost-effective in helping men lose weight. The Australian Football League (AFL) is a potentially attractive setting to engage men in a weight loss programme. We aim to develop, pilot and evaluate the feasibility of a weight loss intervention for overweight/obese middle-aged men, delivered in AFL settings, to promote weight loss and healthier lifestyles and determine its suitability for a future randomised control trial.Methods and analysis120 overweight/obese male fans will complete baseline physical and psychological health measures and objective measures of physical activity (PA), weight, waist size and blood pressure prior to randomisation into the intervention or waitlist comparison group. The intervention group will receive 12 weekly 90 min workshops incorporating PA, nutrition education, behaviour change techniques and principles of effective motivation. Four community coaches will be trained to deliver Aussie-FIT at two AFL clubs in Western Australia. Measurements will be repeated in both groups at 3 months (post-intervention) and 6 months (follow-up). Outcomes will include programme uptake, attendance, changes in lifestyle and weight variables to inform power calculations for a future definitive trial, fidelity of programme delivery, acceptability, satisfaction with the programme and perceptions of effectiveness. We will also determine trial feasibility and potential to gather cost-effectiveness data.Ethics and disseminationEthics approval was granted by Curtin University’s Human Research Ethics Committee (HREC2017-0458). Results will be disseminated via peer-reviewed publications, conference presentations and reports. A multicomponent dissemination strategy will include targeted translation and stakeholder engagement events to establish strategies for sustainability and policy change.Trial registration numberACTRN12617000515392; Pre-results.

It is unclear what effect habitual physical activity or ethnicity has on annual changes in bone size and strength in pre-pubertal children.To determine whether the annual relative change in bone size and strength differed between high and low bone loaders and also between black and white pre-pubertal children.Peripheral quantitative computed tomography (pQCT) scans of the 65% radius and tibia were completed on 41 black and white children (15 boys, 26 girls) between the ages of 8-11 years, at baseline and 1 year later. Children were categorised into either a high or low bone loading group from a peak bone strain score obtained from a bone-specific physical activity questionnaire. Total area (ToA), cortical area (CoA), cortical density (CoD), strength-strain index (SSI), periosteal circumference (PC), endosteal circumference (EC) and cortical thickness (CT) were assessed.There was no difference in annual relative change in radial or tibia bone size and strength between the low and high bone loaders. Black children had a greater annual relative change in CoD (p = 0.03) and SSI (p = 0.05) compared to the white children.Children who performed high bone loading activities over a 1-year period had similar bone growth to children who did low bone loading activities over the same period. Rapid maturational growth over this period may have resulted in bone adapting to the strains of habitual physical activity placed on it. Black children may have greater tibial bone strength compared to white children due to a greater annual increase in cortical density.

Background: In the cancer survivorship context, physical activity and sedentary behavior have been measured using different methods. Purpose: To conduct a narrative review of published research in cancer survivor populations to summarize the quality and identify gaps in reporting on accelerometer data collection, data processing, and outcome measures in cancer survivors. Methods: An initial PubMed® search of articles published in English was conducted in January 2017, and a final search was conducted in May 2017. Variables extracted included study characteristics, methods for accelerometry data collection (e.g., device used), data processing (e.g., cut points used), and data reporting (e.g., time spent in different activity intensities). Results: A total of 46 articles were eligible for inclusion in the review. The majority of studies (34 of 46) targeted a single cancer group and 18 of these 34 studies were in survivors of breast cancer. Half (54%) of the studies used an ActiGraph® accelerometer. Methods of accelerometer data processing varied across studies. Definitions of non–wear time, vectors used during processing, and filters applied during processing were reported by 51%, 60%, and 8% of studies, respectively. Most studies reported moderate and vigorous physical activity (78%), 50% reported sedentary time, and 43% reported light-intensity activity. Cut points to categorize these activities varied between studies. Conclusions: This narrative review highlights inconsistency in the methods used to collect, process, and report accelerometry data across cancer survivor studies. Accelerometry has potential to add detailed knowledge of the levels and patterns of physical activities and sedentary behaviors across the cancer spectrum. Recommendations are made to improve data processing and reporting methods to maximize the scientific validity of future accelerometer research in this field. Refereed/Peer-reviewed

Objective:The objective of this systematic review is to integrate the available evidence on changes in sedentary behavior (SB) in patients with knee osteoarthritis after total knee arthroplasty (TKA).Methods:A systematic literature search from January 2002 to October 31, 2017, was performed for studies assessing objectively and/or subjectively measured SB following TKA. The Scottish Intercollegiate Guidelines Network Methodology appraisal tool was used to critically appraise the methodological quality of the included studies.Results:Ten studies reporting on SB with a total of 1,028 participants were included in the review. Three studies reported changes in SB with two showing a reduction in SB and one (with high risk of bias) an increase in SB after TKA. Seven studies showed no change in SB following TKA.Conclusion:Currently, there is insufficient evidence which suggests that SB time improves following TKA. Detailed assessments of SB after TKA are needed.

To describe objectively measured changes in the volume and pattern of physical activity and sedentary behavior in patients undergoing total knee arthroplasty for osteoarthritis. Physical activity and sedentary behavior were measured in patients (13 males, 76 females) with a mean age of 64 years (range 55–80) and end-stage osteoarthritis of the knee, using an accelerometer (ActiGraph GT3X+) for seven consecutive days (24 h/day) prior to, 6 weeks and 6 months after total knee arthroplasty. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), University of California Los Angeles (UCLA) Activity index and range of motion (ROM) were also assessed. Proportion of time spent in sedentary behavior decreased from baseline to 6 months (mean 70.1 vs. 64.0%; p = 0.009) and the interruptions to sedentary behavior improved between baseline and 6 months after total knee arthroplasty (mean 85.0–93.0 breaks/day, p = 0.014). Proportion of time spent in light physical activity increased from baseline to 6 months after total knee arthroplasty (29.0 vs. 34.8%; p = 0.008). There was no change in time spent in moderate to vigorous physical activity after total knee arthroplasty. WOMAC (median 71.0 vs. 4.0, p

Little is known about the relationship between health-related quality of life (HRQoL), pelvic floor dysfunction (PFD), and modifiable lifestyle and physiological factors for ovarian cancer survivors (OCS). The primary aim of the study was to compare post-treatment advanced-stage OCS with age-matched controls on measures of HRQoL and PFD. The secondary aim was to examine associations between HRQoL, PFD, objective activity behaviors, physical function, and body composition in OCS. Twenty advanced-stage OCS and 20 controls completed questionnaires assessing HRQoL (SF-36) and PFD (Australian Pelvic Floor Questionnaire), and underwent objective assessments of activity behavior (7-day accelerometry), physical function (400-m walk, repeated chair rise, 6-m usual-pace walk, one-repetition maximum chest press, and single-leg extension), and body composition (dual-energy x-ray absorptiometry). Compared to controls, OCS had worse physical HRQoL (− 4.3 median difference, p = 0.013), but equivalent self-reported PFD, indicated by combined bladder, bowel, and pelvic organ prolapse symptoms (0.89 mean difference, p = 0.277). In OCS, physical HRQoL was significantly negatively associated with PFD (r = 0.468, p = 0.043). Decreased physical HRQoL and increased PFD were significantly associated with less moderate-to-vigorous physical activity in ≥ 10-min bouts (ρ = 0.627, p = 0.003; ρ = − 0.457, p = 0.049), more sedentary time (r = − 0.449, p = 0.047; r = 0.479, p = 0.038), and slower 400-m walk time (ρ = − 0.565, p = 0.022; ρ = 0.504, p = 0.028). Post-treatment advanced-stage OCS have decreased physical HRQoL, which is associated with modifiable factors such as worse PFD, less moderate-to-vigorous physical activity, more sedentary time, and decreased objective physical function. This highlights the need for ongoing supportive care and multidisciplinary interventions after first-line ovarian cancer treatment.

There is a critical need for longitudinal cohort studies to consider the association of the cumulative exposure of physical activity during childhood and adolescence and bone mass. The aim of this study was to investigate the relationship between organized sports trajectories (that capture distinct and potentially meaningful patterns over critical developmental periods) and bone mass at age 20 years. Participation in organized sport was recorded by parental report at ages 5, 8, 10, 14, and 17 years in 984 offspring (48% female) of a pregnancy cohort (Raine Study). Latent class analysis identified three trajectory classes in each sex. In females, these were "consistent sport participators" (48%), "dropouts" (34%), and "non-participators" (18%); in males, "consistent sport participators" (55%), "dropouts" (37%), and "sport joiners" (8%). Whole-body bone mineral content (BMC) at age 20 years was assessed by dual-energy X-ray absorptiometry (DXA). At age 20 years, after adjustment for covariates measured at age 20 years, including height, lean mass, physical activity, calcium intake, serum 25-hydroxyvitamin D, alcohol, and smoking, males who were "consistent sport participators" had significantly greater whole-body and leg BMC than those who dropped out of sport (p < 0.001), whereas males who joined sports had significantly greater leg BMC than those who dropped out of sport (p = 0.002). Females in the "consistent sport participator" trajectory had significantly greater leg BMC than those who dropped out (all p = 0.004). Participation in organized sport during childhood and adolescence is associated with bone mass at age 20 years. Because attainment of optimal peak bone mass in young adulthood is protective against osteoporosis in later life, this may have long-term skeletal benefits. © 2018 American Society for Bone and Mineral Research.

Background The prominence of sedentary behavior research in health science has grown rapidly. With this growth there is increasing urgency for clear, common and accepted terminology and definitions. Such standardization is difficult to achieve, especially across multi-disciplinary researchers, practitioners, and industries. The Sedentary Behavior Research Network (SBRN) undertook a Terminology Consensus Project to address this need. Method First, a literature review was completed to identify key terms in sedentary behavior research. These key terms were then reviewed and modified by a Steering Committee formed by SBRN. Next, SBRN members were invited to contribute to this project and interested participants reviewed and provided feedback on the proposed list of terms and draft definitions through an online survey. Finally, a conceptual model and consensus definitions (including caveats and examples for all age groups and functional abilities) were finalized based on the feedback received from the 87 SBRN member participants who responded to the original invitation and survey. Results Consensus definitions for the terms physical inactivity, stationary behavior, sedentary behavior, standing, screen time, non-screen-based sedentary time, sitting, reclining, lying, sedentary behavior pattern, as well as how the terms bouts, breaks, and interruptions should be used in this context are provided. Conclusion It is hoped that the definitions resulting from this comprehensive, transparent, and broad-based participatory process will result in standardized terminology that is widely supported and adopted, thereby advancing future research, interventions, policies, and practices related to sedentary behaviors. Electronic supplementary material The online version of this article (doi:10.1186/s12966-017-0525-8) contains supplementary material, which is available to authorized users.

Activity monitors have added a new dimension to our ability to objectively measure physical activity in patients undergoing total knee arthroplasty (TKA). The aim of the study is to assess whether changes in the time spent sitting, standing, and stepping were associated with changes in patient-reported outcome measures (PROMs) before and after TKA.Valid activPAL data (3 days) and PROMs were obtained from 49 men and women (mean [SD] age, 62.8 [8.6] years; body mass index, 33.8 [7.1] kg/mMean (SD) Knee injury and Osteoarthritis Outcome Score (80.1 [16.3] to 41.6 [6.5], P.001) and Oxford Knee Score (12.0 [9.8] to 17.7 [22.8], P.001) scores improved 6 months after TKA. Walking time (mean [95% confidence interval]; min/d) increased from before (79 [67-91]) to 6 months after TKA (101 [88-114], P = .006). Standing time (318 [276-360] to 321 [291-352], P = .782) and sitting time (545 [491-599] to 509.0 [459.7-558.3], P = .285) did not change from before to 6 months after TKA. Participants took more steps (2559 [2128-2991] to 3515 [2983-4048] steps/day, P = .001) and accumulated more steps (31 [30-34] to 34 [33-35] steps/min, P.001) after TKA compared to before. There were no associations between changes in activity behaviors and changes in PROMs (P.05).Despite improvements in self-reported knee pain and functional ability, these changes do not correlate with improvements in objectively measured light-intensity and sedentary activity behaviors.

We examined the interplay between ethnicity and weight-bearing physical activity on the content and volumetric properties of bone in a pre- to early pubertal South African Black and White population. Sixty six children [Black boys, 10.4 (1.4) yrs, n = 15; Black girls, 10.1 (1.2) yrs, n = 27; White boys, 10.1 (1.1) yrs, n = 7; White girls, 9.6 (1.3) yrs, n = 17] reported on all their physical activities over the past two years in an interviewer administered physical activity questionnaire (PAQ). All participants underwent a whole body and site-specific DXA scan and we also assessed bone structure and estimated bone strength with pQCT. Children were classified as being either high or low bone loaders based on the cohort's median peak bone strain score estimated from the PAQ. In the low bone loading group, Black children had greater femoral neck bone mineral content (BMC) (2.9 (0.08) g) than White children (2.4 (0.11) g; p = 0.05). There were no ethnic differences in the high bone loaders for femoral neck BMC. At the cortical site, the Black low bone loaders had a greater radius area (97.3 (1.3) vs 88.8 (2.6) mm 2 ; p = 0.05) and a greater tibia total area (475.5 (8.7) vs. 397.3 (14.0) mm 2 ; p = 0.001) and strength (1633.7 (60.1) vs. 1271.8 (98.6) mm 3 ; p = 0.04) compared to the White low bone loaders. These measures were not different between the Black low and high bone loaders or between the Black and White high bone loaders. In conclusion, the present study shows that there may be ethnic and physical activity associations in the bone health of Black and White pre-pubertal children and further prospective studies are required to determine the possible ethnic specific response to mechanical loading.

Low magnitude bone-loading sports may benefit bone structure and strength in the exercised limbs. This study compared peripheral quantitative computed tomography measures of radial and tibial diaphyseal strength (strength-strain index, SSI), structure (total area (ToA) and cortical area (CoA), density (CoD) and thickness (CT), and circumferences), muscle cross-sectional area (MCSA) and strength (one-repetition maximum, 1-RM) in male endurance athletes taking part in (i) non-weight-bearing and non-impact sports: swimmers (SWIM, n = 13) and road cyclists (RC, n = 10), (ii) non-weight-bearing, impact sport: mountain bikers (MB, n = 10), (iii) weight bearing and impact sport: runners (RUN, n = 9). All athlete groups were also compared to sedentary controls (CON, n = 10). Arm MCSA, 1-RM and radial bone size and strength tended to be greater in SWIM than CON and/or RC (ToA, %difference ± 95%CI, SWIM-CON: 14.6% ± 12.7%; SWIM-RC: 12.9% ± 10.7%) but not different to MB and RUN. RUN had bigger tibial CoA than CON, SWIM and RC (CoA, RUN-CON: 12.1% ± 10.7%; RUN-SWIM: 10.9% ± 9.4%; RUN-RC: 15.8% ± 9.5%) without marked changes in tibial strength indices, lower-limb MCSA or 1-RM. Both MB and RC failed to display any difference in tibial indices, lower-limb MCSA and 1-RM compared to CON. In swimmers, the bone structure and strength of the primary exercised limbs, the arms, is greater than controls and road cyclists. Conversely, although runners experience impact and weight-bearing loading, tibial structure is greater without a substantial difference in tibial strength compared to controls and non-impact sports. Failure to observe a difference in tibial indices in MB and RC compared to controls is unexpected.