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While integrated behavioral health (IBH) is growing as a primary care practice paradigm, there are gaps in developing the workforce needed. In particular, there are few examples of cotraining curricula in IBH for family medicine residents with postdoctoral psychology fellows. Furthermore, even fewer programs incorporate a colearning primary care practice environment featuring a targeted approach to care for patients with chronic illness using panel management and integrated care.In this article, the authors describe a cotraining experience in an urban federally qualified health center supported by a 5-year Health Resources and Services Administration Title VII grant, within a social justice mission-driven academic department to prepare both family medicine (FM) residents and primary care psychology (PCP) postdoctoral fellows for IBH practice. The article will discuss the specific components of the shared/parallel curriculum, integration of social justice and population health principles and practices, and a structured approach for resident/fellow partnership.The authors share the clinical and educational impacts of this integrated cotraining curriculum model as described by the FM residents and PCP fellows. The article describes workforce results measuring the diversity of the trainees and their postprogram jobs serving vulnerable populations.The interdisciplinary cotraining between FM residents and PCP fellows presents an innovative approach to developing workforce capacity for integrated practice in medically underserved settings. This article describes the creation and implementation of a cotraining curriculum and provides recommendations for other programs and residencies preparing their residents and future PCP psychologists to practice and teach skills in integrated care. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Evidence-based guidelines represent the highest level of scientific evidence to identify best practices for clinical/public health. However, the availability of guidelines do not guarantee their use, targeted knowledge translation strategies and tools are necessary to help promote uptake. Following publication of the 2019 Canadian Guideline for Physical Activity throughout Pregnancy, the Get Active Questionnaire for Pregnancy, and an associated Health Care Provider Consultation Form for Prenatal Physical Activity were developed to promote guideline adoption and use amongst pregnant individuals and health care providers. This paper describes the process of developing these tools. First, a survey was administered to qualified exercise professionals to identify the barriers and facilitators in using existing prenatal exercise screening tools. A Working Group of researchers and stakeholders then convened to develop an evidence-informed exercise pre-participation screening tool for pregnant individuals, building from previous tool and survey findings. Finally, end-user feedback was solicited through a survey and key informant interviews to ensure tools are feasible and acceptable to use in practice. The uptake and use of these documents by pregnant individuals, exercise, and health care professionals will be assessed in future studies. Novelty: Evidence supports the safety/benefits of exercise for most pregnant individuals; however, exercise is not recommended for a small number of individuals with specific medical conditions. The Get Active Questionnaire for Pregnancy and Health Care Provider Consultation Form for Physical Activity during Pregnancy identify individuals where prenatal exercise may pose a risk, while reducing barriers to physical activity participation for the majority of pregnant individuals.

BACKGROUND The Canadian 24-Hour Movement Guidelines for adults provide specific recommendations for levels of physical activity, sedentary behavior, and sleep (ie, the movement behaviors) required for optimal health. Performance of the movement behaviors is associated with improved mental well-being. However, most postsecondary students do not meet the movement behavior recommendations within the Canadian 24-Hour Movement Guidelines and experience increased stress and declining well-being, suggesting the need for an intervention targeting students’ movement behaviors. OBJECTIVE We aimed to develop and implement a theory-informed intervention intended to improve the movement behaviors and mental well-being of first-year postsecondary students. METHODS The Intervention Mapping protocol was applied in the development and implementation of the intervention. Intervention Mapping entailed performing a needs assessment, determining the intervention outcomes, selecting theory- and evidence-based change methods and applications, preparing and producing intervention plans and materials, developing the implementation plan, and finally developing an evaluation plan. The Theoretical Domains Framework and the Behavior Change Wheel were also used in conjunction with the Intervention Mapping protocol to ensure a solid theoretical basis for the intervention. This protocol led to the development and implementation of a 6-week, theory-informed ParticipACTION app–based intervention aimed at helping first-year postsecondary students improve their movement behaviors and mental well-being. The developed app content provided students with information on each of the movement behaviors and behavioral strategies (ie, goal setting, action planning, monitoring, and coping planning). The use of Intervention Mapping allowed for the continuous involvement of various multidisciplinary partners and end users, ensuring that the intervention design and implementation was appropriate for the target audience. The feasibility, acceptability, and potential impact of the intervention will be examined in a subsequent proof-of-concept study at 2 Canadian university campuses. RESULTS Participant recruitment occurred during September 2021, and the intervention was conducted from October to December 2021. The deadline for completion of the postintervention questionnaire by participants was mid-December 2021. The analysis of data examining the feasibility, acceptability, and potential impact of the intervention began in January 2022, with the publication of the proof-of-concept evaluation expected in 2023. CONCLUSIONS Intervention Mapping with the Theoretical Domains Framework and Behavior Change Wheel was a useful approach to combine evidence and theoretical concepts to guide the design and implementation of a ParticipACTION app–based intervention targeting postsecondary students’ movement behaviors and mental well-being. This process may serve as an example for other researchers developing multiple behavior change app–based interventions. Should the forthcoming evaluation demonstrate the intervention’s acceptability, feasibility, and potential impact, the intervention may provide a scalable method of improving postsecondary students’ movement behaviors and mental well-being. INTERNATIONAL REGISTERED REPORT RR1-10.2196/39977

BACKGROUND Health care providers have reported low knowledge, skill, and confidence for discussing movement behaviours (i.e., physical activity, sedentary behaviour, and sleep), which may be improved with the use of tools to guide movement behaviour discussions in their practice. Past reviews have examined the psychometric properties, scoring, and behavioural outcomes of physical activity discussion tools. However, the features, perceptions, and effectiveness of discussion tools for physical activity, sedentary behaviour, and/or sleep have not yet been synthesized. OBJECTIVE The aim of this review was to report and appraise tools for movement behaviour discussions between health care providers and adults 18+ years in a primary care context within Canada or analogous countries. METHODS An integrated knowledge translation approach guided this review, whereby a working group of key stakeholders was engaged from research question formation to interpretation of findings. Three search approaches were used (i.e., peer-reviewed, grey literature, and forward searches) to identify studies reporting on perceptions and/or effectiveness of tools for physical activity, sedentary behaviour, and/or sleep. The quality of included studies was assessed using the Mixed Methods Appraisal Tool. RESULTS In total, 135 studies reporting on 61 tools (i.e., 51 on physical activity, one on sleep, and nine combining two movement behaviours) met inclusion criteria. Included tools served the purposes of assessment (n=57), counselling (n=50), prescription (n=18), and/or referral (n=12) of one or more movement behaviour. Forty-nine tools were used or intended for use by physicians; 34 tools were used or intended for use among adults without chronic conditions aged 18-64 years. The quality of the 116 studies that evaluated tool effectiveness varied. CONCLUSIONS Many tools were positively perceived and were deemed effective at enhancing knowledge of, confidence for, ability in, and frequency of movement behaviour discussions. Future tools should guide discussions of all movement behaviours in an integrated manner in line with the 24-Hour Movement Guidelines. Practically, this review offers seven evidence-based recommendations that may guide future tool development and implementation.

Introduction: A severe surge of the COVID-19 pandemic in spring 2020 infected 33% of the population and caused more than 7000 deaths in the Bronx, NY. The Department of Family and Social Medicine at Montefiore Medical Center rapidly and strategically reconfigured clinical services to meet the needs of patients, communities, and the health system. Clinical Reconfiguration: Family medicine hospitalist services tripled in size within 2 weeks to cover 71 beds and cared for 447 patients between March 24 and June 10, 2020, of whom 279 (62.4%) had COVID-19. Community health centers reorganized to maintain primary care services, shifting abruptly to telemedicine while maintaining 95% of the previous year9s visit volume, and address intensified patient needs related to viral infection and mental health impacts. Core principles for redeployment included role flexibility, communication, responsiveness, and safety and wellness. Discussion: During a pandemic surge, academic family medicine departments have an important role in expanding hospitalist services and redesigning primary care services. The ability to reconfigure work to meet unprecedented demands on health care was facilitated by family medicine9s broad scope of practice including training in hospital medicine, interpersonal communication, behavioral health, care across settings, collaborative partnerships with specialists, and adaptability to communities9 needs.

Establishing a step-by-step process that provides practitioners with a blueprint for translating movement guidelines into action stands to optimize the investment in guideline development, improve guideline promotion and uptake, and ultimately enhance population health. The purpose of this paper is to describe how the Knowledge-to-Action framework and integrated knowledge translation were operationalized to systematically inform our knowledge translation (KT) efforts for the Canadian 24-Hour Movement Guidelines for Adults aged 18–64 years and Adults aged 65 years or older. In October 2018, the need for a KT Process, operating in tandem with the Guideline Development Process, led to the establishment of a KT team with a specific structure and terms of reference. The KT team collaboratively agreed on decision-making principles prior to selecting target audiences to focus their efforts. We undertook formative research to assess the local context and determinants of guideline dissemination and implementation efforts among target audiences. Plans for the subsequent steps and research are outlined. We highlight recommendations and lessons learned for applying the process in other settings.Novelty We outline a collaborative and systematic process and research program for the knowledge translation of movement guidelines. This paper provides an innovative and replicable blueprint to optimize future movement guideline knowledge translation efforts.

The Canadian Society for Exercise Physiology assembled a Consensus Panel representing national organizations, content experts, methodologists, stakeholders, and end-users and followed an established guideline development procedure to create the Canadian 24-Hour Movement Guidelines for Adults aged 18–64 years and Adults aged 65 years or older: An Integration of Physical Activity, Sedentary Behaviour, and Sleep. These guidelines underscore the importance of movement behaviours across the whole 24-h day. The development process followed the strategy outlined in the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. A large body of evidence was used to inform the guidelines including 2 de novo systematic reviews and 4 overviews of reviews examining the relationships among movement behaviours (physical activity, sedentary behaviour, sleep, and all behaviours together) and several health outcomes. Draft guideline recommendations were discussed at a 4-day in-person Consensus Panel meeting. Feedback from stakeholders was obtained by survey (n = 877) and the draft guidelines were revised accordingly. The final guidelines provide evidence-based recommendations for a healthy day (24-h), comprising a combination of sleep, sedentary behaviours, and light-intensity and moderate-to-vigorous-intensity physical activity. Dissemination and implementation efforts with corresponding evaluation plans are in place to help ensure that guideline awareness and use are optimized.Novelty First ever 24-Hour Movement Guidelines for Adults aged 18–64 years and Adults aged 65 years or older with consideration of a balanced approach to physical activity, sedentary behaviour, and sleep Finalizes the suite of 24-Hour Movement Guidelines for Canadians across the lifespan

The Canadian 24-Hour Movement Guidelines for Adults aged 18–64 years and Adults aged 65 years and older (“Guidelines”) integrate recommendations for physical activity, sedentary, and sleep behaviours. Given the novelty of these integrated Guidelines, it was important to consider messaging strategies that would be most effective in reaching Canadian adults. The purpose of this study was to examine optimal messaging of the Guidelines as it pertains to communication channels and messages. Representative samples of Guideline end-users (N = 1017) and stakeholders (N = 877) each completed a cross-sectional survey. Descriptive statistics were calculated along with tests of statistical significance. Inductive content analysis was used to code stakeholders’ comments (i.e., suggestions, concerns) on a draft version of the Guidelines. Most end-users had recently referred to online medical resources; family, friends, and co-workers; and physicians as communication channels for information regarding the movement behaviours. End-users and stakeholders felt that generic messages would foster self-efficacy to meet the Guidelines. Stakeholders highlighted a variety of considerations to ensure the Guidelines are inclusive towards diverse groups within the Canadian population. Findings will inform Guideline messaging. Novelty Most end-users referred to online medical resources; family, friends, and co-workers; and physicians as communication channels. End-users and stakeholders indicated that generic messages would foster self-efficacy to meet the Guidelines. Stakeholders expressed concerns about the inclusivity of the Guidelines for diverse socioeconomic groups.

Objective The objective is to provide guidance for pregnant women, and obstetric care and exercise professionals, on prenatal physical activity. Outcomes The outcomes evaluated were maternal, fetal, or neonatal morbidity or fetal mortality during and following pregnancy. Evidence Literature was retrieved through searches of Medline, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Scopus and Web of Science Core Collection, CINAHL Plus with Full-text, Child Development & Adolescent Studies, ERIC, Sport Discus, ClinicalTrials.gov, and the Trip Database from database inception up to January 6, 2017. Primary studies of any design were eligible, except case studies. Results were limited to English, Spanish, or French language materials. Articles related to maternal physical activity during pregnancy reporting on maternal, fetal, or neonatal morbidity or fetal mortality were eligible for inclusion. The quality of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Values The Guidelines Consensus Panel solicited feedback from end-users (obstetric care providers, exercise professionals, researchers, policy organizations, and pregnant and postpartum women). The development of this guideline followed the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument. Benefits, harms, and costs The benefits of prenatal physical activity are moderate, and no harms were identified; therefore, the difference between desirable and undesirable consequences (net benefit) is expected to be moderate. The majority of stakeholders and end-users indicated that following these recommendations would be feasible, acceptable, and equitable. Following these recommendations is likely to require minimal resources from both individual and health systems perspectives. Preamble This guideline provide evidence-based recommendations regarding physical activity throughout pregnancy in the promotion of maternal, fetal, and neonatal health. In the absence of contraindications (see later for a detailed list), following this guideline is associated with: (1) fewer newborn complications (i.e., large for gestational age); and (2) maternal health benefits (i.e., decreased risk of preeclampsia, gestational hypertension, gestational diabetes, Caesarean section, instrumental delivery, urinary incontinence, excessive gestational weight gain, and depression; improved blood glucose; decreased total gestational weight gain; and decreased severity of depressive symptoms and lumbopelvic pain). Physical activity is not associated with miscarriage, stillbirth, neonatal death, preterm birth, preterm/prelabour rupture of membranes, neonatal hypoglycemia, low birth weight, birth defects, induction of labour, or birth complications. In general, more physical activity (frequency, duration, and/or volume) is associated with greater benefits. However, evidence was not identified regarding the safety or additional benefit of exercising at levels significantly above the recommendations. Prenatal physical activity should be considered a front-line therapy for reducing the risk of pregnancy complications and enhancing maternal physical and mental health. For pregnant women not currently meeting this guideline, a progressive adjustment toward them is recommended. Previously active women may continue physical activity throughout pregnancy. Women may need to modify physical activity as pregnancy progresses. There may be periods when following the guideline is not possible due to fatigue and/or discomforts of pregnancy; women are encouraged to do what they can and to return to following the recommendations when they are able. This guideline were informed by an extensive systematic review of the literature, expert opinion, end-user consultation and considerations of feasibility, acceptability, costs, and equity. Recommendations The specific recommendations in this 2019 Canadian Guideline for Physical Activity Throughout Pregnancy are provided below with corresponding statements indicating the quality of the evidence informing the recommendations and the strength of the recommendations (explanations follow). Contraindications All pregnant women can participate in physical activity throughout pregnancy with the exception of those who have contraindications (listed below). Women with absolute contraindications may continue their usual activities of daily living but should not participate in more strenuous activities. Women with relative contraindications should discuss the advantages and disadvantages of moderate-to-vigorous intensity physical activity with their obstetric care provider prior to participation. Absolute contraindications to exercise are the following: Relative contraindications to exercise are the following: STRENGTH OF THE RECOMMENDATIONS: The GRADE system was utilized to grade the strength of the recommendations. Recommendations are rated as strong or weak based on the: (1) balance between benefits and harms; (2) overall quality of the evidence; (3) importance of outcomes (i.e., values and preferences of pregnant women); (4) use of resources (i.e., cost); (5) impact on health equity; (6) feasibility, and (7) acceptability. Strong recommendation: Most or all pregnant women will be best served by the recommended course of action. Weak recommendation: Not all pregnant women will be best served by the recommended course of action; there is a need to consider other factors such as the individual's circumstances, preferences, values, resources available, or setting. Consultation with an obstetric care provider may assist in decision-making. Quality of the evidence The quality of the evidence refers to the level of confidence in the evidence and ranges from very low to high. High quality: The Guideline Consensus Panel is very confident that the estimated effect of physical activity on the health outcome is close to the true effect. Moderate quality: The Guideline Consensus Panel is moderately confident in the estimated effect of physical activity on the health outcome; the estimate of the effect is likely to be close to the true effect, but there is a possibility that it is substantially different. Low quality: The Guideline Consensus Panel's confidence in the estimated effect of physical activity on the health outcome is limited; the estimate of the effect may be substantially different from the true effect. Very low quality: The Guideline Consensus Panel has very little confidence in the estimated effect of physical activity on the health outcome; the estimate of the effect is likely to be substantially different from the true effect. aThis was a weak recommendation because the quality of evidence was low, and the net benefit between women who were physically active and those who were not was small. bThis was a strong recommendation because, despite low quality evidence supporting physical activity during pregnancy for women categorized as overweight or obese, there was evidence from randomized controlled trials demonstrating an improvement in gestational weight gain and blood glucose. cModerate-intensity physical activity is intense enough to noticeably increase heart rate; a person can talk but not sing during activities of this intensity. Examples of moderate-intensity physical activity include brisk walking, water aerobics, stationary cycling (moderate effort), resistance training, carrying moderate loads, and household chores (e.g., gardening, washing windows). dThis was a weak recommendation because urinary incontinence was was not rated as a "critical" outcome and the evidence was low quality. eThis was a weak recommendation because: (1) the quality of evidence was very low; and (2) although harms were investigated there was limited available information to inform the balance of benefits and harms. This recommendation was primarily based on expert opinion.

Objectif L'objectif est de guider les femmes enceintes et les professionnels de l'obstetrique et de l'exercice en ce qui concerne l'activite physique prenatale. ReSULTATS: Les issues evaluees etaient la morbidite maternelle, fœtale ou neonatale et la mortalite fœtale pendant et apres la grossesse. DONNeES: Nous avons interroge MEDLINE, Embase, PsycINFO, la Cochrane Database of Systematic Reviews, le Cochrane Central Register of Controlled Trials, Scopus et la Web of Science Core Collection, CINAHL Plus with Full Text, Child Development & Adolescent Studies, ERIC, SPORTDiscus, ClinicalTrials.gov de leur creation jusqu'au 6 janvier 2017. Les etudes primaires de tous types etaient admissibles, a l'exception des etudes de cas. Seules les publications en anglais, en espagnol et en francais ont ete retenues. Les articles lies a l'activite physique durant la grossesse qui abordaient la morbidite maternelle, fœtale ou neonatale ou la mortalite fœtale etaient admissibles. La qualite des donnees probantes a ete evaluee au moyen de l'approche GRADE (Grading of Recommendations Assessment, Development and Evaluation). Valeurs Le groupe d'experts responsable des lignes directrices a recueilli les commentaires d'utilisateurs finaux (fournisseurs de soins obstetricaux, professionnels de l'exercice, chercheurs, organismes responsables de politiques, et femmes enceintes et en periode postpartum). La directive clinique a ete elaboree au moyen de l'outil Appraisal of Guidelines for Research Evaluation (AGREE) II. AVANTAGES, INCONVeNIENTS, ET COuTS: Les avantages de l'activite physique prenatale sont moderes, et aucun inconvenient n'a ete releve; la difference entre les consequences desirables et indesirables (avantage net) devrait donc etre moderee. La majorite des intervenants et des utilisateurs finaux ont indique qu'il serait faisable, acceptable et equitable de suivre ces recommandations, qui necessitent generalement des ressources minimes de la part des personnes et des systemes de sante. PREAMBULE: Les presentes lignes directrices contiennent des recommandations fondees sur des donnees probantes au sujet de l'activite physique durant la grossesse visant a favoriser la sante maternelle, fœtale et neonatale. En l'absence de contre-indications (voir la liste detaillee plus loin), le fait de suivre ces lignes directrices est associe a : 1) moins de complications pour le nouveau-ne (p. ex., gros par rapport a l'âge gestationnel); et 2) des bienfaits pour la sante maternelle (p. ex., diminution du risque de preeclampsie, d'hypertension gravidique, de diabete gestationnel, de cesarienne, d'accouchement operatoire, d'incontinence urinaire, de gain de poids excessif durant la grossesse et de depression; amelioration de la glycemie; diminution du gain de poids total durant la grossesse; et diminution de la gravite des symptomes depressifs et de la douleur lombo-pelvienne). L'activite physique n'est pas associee a la fausse couche, a la mortinaissance, au deces neonatal, a l'accouchement premature, a la rupture prematuree preterme des membranes, a l'hypoglycemie neonatale, au poids insuffisant a la naissance, aux anomalies congenitales, au declenchement du travail, ou aux complications a la naissance. En general, une augmentation de l'activite physique (frequence, duree ou volume) est liee a une augmentation des bienfaits. Cependant, nous n'avons pas trouve de donnees probantes concernant l'innocuite ou l'avantage accru de l'exercice a des niveaux considerablement superieurs aux recommandations. L'activite physique prenatale devrait etre vue comme un traitement de premiere ligne pour reduire le risque de complications de la grossesse et ameliorer la sante physique et mentale de la mere. Pour les femmes enceintes qui n'atteignent actuellement pas le niveau recommande, nous recommandons une augmentation progressive pour l'atteindre. Les femmes deja actives peuvent continuer de l'etre tout au long de la grossesse. Elles pourraient devoir modifier le type d'activite a mesure que leur grossesse avance. Il peut devenir impossible de suivre les lignes directrices pendant certaines periodes en raison de la fatigue ou des inconforts de la grossesse; nous encourageons les femmes a faire ce qu'elles peuvent et a revenir aux recommandations lorsqu'elles en sont capables. Les recommandations qui suivent reposent sur une revue systematique approfondie de la litterature, l'opinion d'experts, la consultation d'utilisateurs finaux et des considerations de faisabilite, d'acceptabilite, de cout et d'equite. Recommandations Les recommandations des Lignes directrices canadiennes sur l'activite physique durant la grossesse 2019 sont fournies ci-dessous avec des enonces indiquant la qualite des donnees probantes utilisees et la force des recommandations (des explications suivent). Contre-indications Toutes les femmes enceintes peuvent faire de l'activite physique durant la grossesse, sauf celles qui presentent des contre-indications (voir ci-dessous). Celles presentant des contre-indications absolues peuvent poursuivre leurs activites quotidiennes habituelles, mais ne devraient pas faire d'activites plus vigoureuses. Celles presentant des contre-indications relatives devraient discuter des avantages et des inconvenients de l'activite physique d'intensite moderee a vigoureuse avec leur fournisseur de soins obstetricaux avant d'y prendre part. Contre-indications absolues Contre-indications relatives FORCE DES RECOMMANDATIONS: Nous avons utilise le systeme GRADE pour evaluer la force des recommandations. Les recommandations sont jugees fortes ou faibles en fonction de : 1) l'equilibre entre les avantages et les inconvenients; 2) la qualite globale des donnees probantes; 3) l'importance des issues (valeurs et preferences des femmes enceintes); 4) l'utilisation de ressources (cout); 5) l'incidence sur l'equite en matiere de sante; 6) la faisabilite et 7) l'acceptabilite. Recommandation forte : La majorite ou la totalite des femmes enceintes auraient avantage a suivre la recommandation. Recommandation faible : Les femmes enceintes n'auraient pas toutes avantage a suivre la recommandation; il faut tenir compte d'autres facteurs comme la situation, les preferences, les valeurs, les ressources et le milieu de chaque personne. La consultation d'un fournisseur de soins obstetricaux peut faciliter la prise de decisions. QUALITe DES DONNeES PROBANTES: La qualite des donnees probantes fait reference au degre de confiance dans les donnees et va de tres faible a elevee. Qualite elevee : Le groupe d'experts responsable des lignes directrices est tres convaincu que l'effet estime de l'activite physique sur l'issue de sante est pres de l'effet reel. Qualite moyenne : Le groupe d'experts responsable des lignes directrices a moyennement confiance en l'effet estime de l'activite physique sur l'issue de sante; l'effet estime est probablement pres de l'effet reel, mais il est possible qu'il soit tres different. Qualite faible : Le groupe d'experts responsable des lignes directrices a peu confiance en l'effet estime de l'activite physique sur l'issue de sante; l'effet estime pourrait etre tres different de l'effet reel. Qualite tres faible : Le groupe d'experts responsable des lignes directrices a tres peu confiance en l'effet estime de l'activite physique sur l'issue de sante; l'effet estime est probablement tres different de l'effet reel. a Il s'agit d'une recommandation faible parce que la qualite des donnees probantes etait faible et que l'avantage net entre les femmes qui etaient physiquement actives et celles qui ne l'etaient pas etait petit. b Il s'agit d'une recommandation forte parce que, malgre le fait que les donnees probantes appuyant l'activite physique durant la grossesse pour les femmes en surpoids ou obeses etaient de qualite faible, des donnees tirees d'essais cliniques randomises demontraient une diminution du gain de poids durant la grossesse et une amelioration de la glycemie. c On parle d'intensite moderee lorsque l'activite est assez intense pour augmenter la frequence cardiaque de facon perceptible; une personne peut parler, mais pas chanter durant les activites de cette intensite. Pensons par exemple a la marche rapide, a la gymnastique aquatique, au velo stationnaire (effort modere), a l'entrainement musculaire, au port de charges moderees et aux travaux menagers (p. ex., jardinage, lavage de fenetres). d Il s'agit d'une recommandation faible parce que l'incontinence urinaire n'etait pas jugee comme etant une issue « critique » et que les donnees etaient de qualite faible. e Il s'agit d'une recommandation faible parce que : 1) la qualite des donnees probantes etait tres faible; et 2) bien que nous ayons etudie les inconvenients, il y avait peu de renseignements disponibles sur l'equilibre entre les avantages et les inconvenients. Cette recommandation etait principalement fondee sur l'opinion d'experts.

In the last decade, an abundance of new research from Canada and internationally has provided substantial evidence for the efficacy of exercise in preventing pregnancy complications and improving long-term maternal and fetal outcomes. Indeed, guidelines for exercise during pregnancy are available from several countries. This includes the expert consensus-based 2003 Joint SOGC and Canadian Society for Exercise Physiology Clinical Practice Guidelines: Exercise in Pregnancy and the Postpartum Period. With the plethora of new scientific evidence, it was vital to re-examine the literature by using the rigorous process followed by previous Canadian health behaviour guidelines.The purpose of this document is to outline the process and outcomes for the re-development of the 2019 Canadian Guideline for Physical Activity Throughout Pregnancy, herein referred to as the Guidelines. The target users for these Guidelines are obstetric care providers, policymakers, and exercise professionals who provide guidance for pregnant women regarding prenatal physical activity.

Leaders from the Canadian Society for Exercise Physiology convened representatives of national organizations, content experts, methodologists, stakeholders, and end-users who followed rigorous and transparent guideline development procedures to create the Canadian 24-Hour Movement Guidelines for Children and Youth: An Integration of Physical Activity, Sedentary Behaviour, and Sleep. These novel guidelines for children and youth aged 5-17 years respect the natural and intuitive integration of movement behaviours across the whole day (24-h period). The development process was guided by the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument and systematic reviews of evidence informing the guidelines were assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Four systematic reviews (physical activity, sedentary behaviour, sleep, integrated behaviours) examining the relationships between and among movement behaviours and several health indicators were completed and interpreted by expert consensus. Complementary compositional analyses were performed using Canadian Health Measures Survey data to examine the relationships between movement behaviours and health indicators. A stakeholder survey was employed (n = 590) and 28 focus groups/stakeholder interviews (n = 104) were completed to gather feedback on draft guidelines. Following an introductory preamble, the guidelines provide evidence-informed recommendations for a healthy day (24 h), comprising a combination of sleep, sedentary behaviours, light-, moderate-, and vigorous-intensity physical activity. Proactive dissemination, promotion, implementation, and evaluation plans have been prepared in an effort to optimize uptake and activation of the new guidelines. Future research should consider the integrated relationships among movement behaviours, and similar integrated guidelines for other age groups should be developed. Refereed/Peer-reviewed

The objective is to provide guidance for pregnant women and obstetric care and exercise professionals on prenatal physical activity. The outcomes evaluated were maternal, fetal or neonatal morbidity, or fetal mortality during and following pregnancy. Literature was retrieved through searches of MEDLINE, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Scopus and Web of Science Core Collection, CINAHL Plus with Full Text, Child Development & Adolescent Studies, Education Resources Information Center, SPORTDiscus, ClinicalTrials.gov and the Trip Database from inception up to 6 January 2017. Primary studies of any design were eligible, except case studies. Results were limited to English-language, Spanish-language or French-language materials. Articles related to maternal physical activity during pregnancy reporting on maternal, fetal or neonatal morbidity, or fetal mortality were eligible for inclusion. The quality of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation methodology. The Guidelines Consensus Panel solicited feedback from end users (obstetric care providers, exercise professionals, researchers, policy organisations, and pregnant and postpartum women). The development of these guidelines followed the Appraisal of Guidelines for Research and Evaluation II instrument. The benefits of prenatal physical activity are moderate and no harms were identified; therefore, the difference between desirable and undesirable consequences (net benefit) is expected to be moderate. The majority of stakeholders and end users indicated that following these recommendations would be feasible, acceptable and equitable. Following these recommendations is likely to require minimal resources from both individual and health systems perspectives.

The impairment of short-term memory experienced in the early stages of dementia may lead to forgetting the names of familiar people. The Model of Human Occupation is founded on the belief that meaningful occupation is central to people well-being and that human occupation can best be understood as a dynamic system that involves: physical and social environments, skills, habituation, personal causation (motivation). The Assessment of Motor and Process Skills is designed to assess how an individual’s motor and process skills affect their ability to carry out activities of daily living. The chapter explores the impact of dementia on engagement in activity, the assessment of occupational performance and occupational therapy interventions. The Pool Activity Level Instrument closes the loop, as it were, by enabling the identification of the developmental level that a person with dementia is at and suggesting how activity can be structured to support continuing engagement in that activity.

Background: The Canadian Society for Exercise Physiology convened representatives of national organizations, research experts, methodologists, stakeholders, and end-users who followed rigorous and transparent guideline development procedures to create the Canadian 24-Hour Movement Guidelines for the Early Years (0–4 years): An Integration of Physical Activity, Sedentary Behaviour, and Sleep. These novel guidelines for children of the early years embrace the natural and intuitive integration of movement behaviours across the whole day (24-h period). Methods: The development process was guided by the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Four systematic reviews (physical activity, sedentary behaviour, sleep, combined behaviours) examining the relationships within and among movement behaviours and several health indicators were completed and interpreted by a Guideline Development Panel. The systematic reviews that were conducted to inform the development of the guidelines, and the framework that was applied to develop the recommendations, followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Complementary compositional analyses were performed using data from the Canadian Health Measures Survey to examine the relationships between movement behaviours and indicators of adiposity. A review of the evidence on the cost effectiveness and resource use associated with the implementation of the proposed guidelines was also undertaken. A stakeholder survey (n = 546), 10 key informant interviews, and 14 focus groups (n = 92 participants) were completed to gather feedback on draft guidelines and their dissemination. Results: The guidelines provide evidence-informed recommendations as to the combinations of light-, moderate- and vigorous-intensity physical activity, sedentary behaviours, and sleep that infants (

Background Arguably the uptake and usability of the physical activity (PA) guidelines for older adults has not been effective with only 12% of this population meeting the minimum guidelines to maintain health. Health promoters must consider innovative ways to increase PA adoption and long-term sustainability. Physical literacy (PL) is emerging as a promising strategy to increase lifelong PA participation in younger age-groups, yet there is relatively little evidence of PL being used to support older adults in achieving the PA guidelines. Methods An iterative and mixed-methods consensus development process was utilized over a series of six informed processes and meetings to develop a model of physical literacy for adults aged 65 years and older. Results A multi-disciplinary collaborative working group (n = 9) from diverse practice settings across Canada, and representative and reflective of the full range of key elements of PL, was assembled. Three consensus meetings and two Delphi surveys, using an international cohort of 65 expert researchers, practitioners, non-government organizations and older adults, was conducted. 45% responded on the first round and consensus was achieved; however, we elected to run a second survey to support our results. With 79% response rate, there was consensus to support the new PL model for older adults. Conclusion Older adults are a unique group who have yet to be exposed to PL as a means to promote long-term PA participation. This new PL model uses an ecological approach to integrate PL into the lifestyles of most older adults. Understanding the interactions between components and elements that facilitate PL will ultimately provide a new and effective tool to target PA promotion and adherence for all older Canadians.

La Societe canadienne de physiologie de l’exercice (SCPE) en collaboration avec plusieurs partenaires, intervenants concernes et chercheurs a elabore les premieres directives canadiennes en matiere...

La Societe canadienne de physiologie de l’exercice (SCPE) en collaboration avec plusieurs partenaires, parties prenantes et chercheurs a elabore de nouvelles Directives canadiennes en matiere d’act...

La Société canadienne de physiologie de l’exercice (SCPE) en collaboration avec le groupe de recherche Healthy Active Living and Obesity Research Group (HALO) de l’Institut de recherche du Centre hospitalier pour enfants de l’est de l’Ontario, de ParticipACTION et d’autres organismes a élaboré les Directives canadiennes en matière de comportement sédentaire à l’intention des enfants âgés de 5 à 11 ans et des jeunes âgés de 12 à 17 ans. Les directives comprennent un préambule situant le contexte et des recommandations spécifiques en matière de comportement sédentaire. L’élaboration complète des directives a respecté la Grille II d’évaluation de la qualité des recommandations pour la pratique clinique (AGREE), un outil reconnu internationalement pour l’élaboration des lignes directrices en pratique clinique. L’élaboration des directives est donc le résultat d’un processus rigoureux et transparent, et les recommandations présentées dans cet article sont basées sur l’interprétation des données probantes relevées dans une analyse documentaire systématique. Les directives finales sont le fruit d’une vaste consultation en ligne auprès de 230 intervenants concernés et de sources de premier plan sur la scène nationale et internationale. Les directives finales énoncent ce qui suit : Afin de profiter des bienfaits pour leur santé, les enfants âgés de 5 à 11 ans et les jeunes âgés de 12 à 17 ans doivent diminuer chaque jour le temps consacré à des activités sédentaires. Ceci peut être accompli (i) en limitant le temps de loisir passé devant l’écran à moins de 2 h par jour; moins de temps passé devant l’écran est associé à des bienfaits supplémentaires pour la santé; (ii) en diminuant les déplacements en véhicule motorisé et en réduisant le temps passé assis à l’intérieur pendant la journée. Ces directives sont les premières Directives canadiennes en matière de comportement sédentaire à l’intention des enfants et des jeunes; elles résultent de la synthèse, de l’interprétation et de l’application des données probantes les plus récentes à ce jour et comportent des recommandations importantes qui arrivent à un moment opportun dans la promotion de la santé publique.

La Société canadienne de physiologie de l’exercice (SCPE) en collaboration avec ParticipACTION et des parties prenantes et avec l’appui de l’Agence de santé publique du Canada (ASPC) a élaboré de nouvelles Directives canadiennes en matière d’activité physique à l’intention des enfants (âgés de 5 à 11 ans), des jeunes (âgés de 12 à 17 ans), des adultes (âgés de 18 à 64 ans) et des aînés (âgés de 65 ans et plus). Les nouvelles directives sont composées d’un préambule situant le contexte et de directives spécifiques à chaque tranche d’âge. L’élaboration complète des directives a respecté la Grille II d’évaluation de la qualité des recommandations pour la pratique clinique (AGREE), un outil reconnu internationalement pour l’élaboration des lignes directrices en pratique clinique. L’élaboration des directives résulte d’un processus rigoureux et transparent. Les recommandations présentées dans cet article sont basées sur les données probantes relevées dans trois analyses documentaires systématiques, et les directives finales ont bénéficié des fruits d’une vaste consultation en ligne et en personne auprès de centaines d’intervenants concernés et de sources de premier plan, sur la scène nationale et internationale. Depuis 2006, les résultats de nos efforts se retrouvent entre autres dans 21 articles (dont 5 analyses documentaires systématiques) sanctionnés par des pairs. La démarche entreprise par les chercheurs canadiens pour la mise à jour des directives en matière d’activité physique a abouti à la synthèse, l’interprétation et l’application des données probantes les plus récentes à ce jour.

Cet article resume les principales observations rapportees dans les articles de ce numero special de la revue. Il confirme les resultats des etudes repertoriees sur la communication et l'amelioration des directives concernant la pratique de l'activite physique a l'intention des Canadiennes et des Canadiens; il souligne egalement le besoin de procurer des directives specifiques a des sous-groupes de la population. Cet article insiste aussi sur la necessite de transformer les directives en messages efficaces et convaincants, de mener des campagnes de promotion et de faire l'evaluation de ces dernieres. Les recommandations sur la facon de proceder s'appuient sur les donnees presentees dans ces diverses etudes. On y presente aussi les prochaines etapes a realiser et les besoins en termes de recherche a effectuer.

Physical inactivity is a pressing public health concern. In this commentary we argue that Canada’s approach to increasing physical activity (PA) has been fragmented and has lacked coordination, funding and a strategic approach. We then describe a potential solution in Active Canada 20/20 (AC 20/20), which provides both a national plan and a commitment to action from non-government and public sectors with a view to engaging corporate Canada and the general public. It outlines a road map for initiating, coordinating and implementing proactive initiatives to address this prominent health risk factor. The identified actions are based on the best available evidence and have been endorsed by the majority of representatives in the relevant sectors. The next crucial steps are to engage all those involved in public health promotion, service provision and advocacy at the municipal, provincial and national levels in order to incorporate AC 20/20 principles into practice and planning and thus increase the PA level of every person in Canada. Further, governments, as well as the private, not-for-profit and philanthropic sectors, should demonstrate leadership and continue their efforts toward providing the substantial and sustained resources needed to recalibrate Canadians’ habitual PA patterns; this will ultimately improve the overall health of our citizens.

The aim of this review was to consolidate and synthesize existing evidence regarding current knowledge and awareness of the Canadian Physical Activity (PA) and Sedentary Behaviour (SB) Guidelines. MEDLINE, Embase, and PsycINFO were searched for peer-reviewed publications pertaining to the guidelines. Content experts, key organizations (i.e., ParticipACTION and the Canadian Fitness and Lifestyle Research Institute), journal Web sites, and service organizations (i.e., the Canadian Society for Exercise Physiology (CSEP) and the Public Health Agency of Canada) were consulted for additional evidence. Scientific publications (n = 6) and research from ParticipACTION and the Canadian Fitness and Lifestyle Research Institute reported that awareness of the guidelines is low, especially with respect to the SB guidelines. Less than 10% of survey respondents from the Canadian population were aware of the PA guidelines, and less than 5% were aware of the SB guidelines. Information on the guidelines was available on 51% of public health unit and CSEP partner Web sites. Online metrics (e.g., downloads, site accessions) from CSEP, the Public Health Agency of Canada, and journal Web sites showed that online accession of the guidelines was high (e.g., all “highly accessed” on journal Web sites). This review showed that awareness of the Canadian PA and SB Guidelines is low among the general population but higher among the scientific and stakeholder communities. Governmental, nongovernmental, and stakeholder organizations should collaborate in creating sustained, long-term, and well-resourced communication plans to reach the Canadian population to raise awareness of PA and SB guidelines and should implement programs to facilitate their uptake.

source and purpose. Constraints in the healthcare delivery system are resulting in unprecedented challenges to quality nursing care. In response to concerns expressed by readers in a JSPN survey, we solicited input from prominent SPN members. conclusions. Quality care can be sustained through nurses' creativity, flexibility, leadership, and collaboration. The context for quality care is an organizatinal environment with attention to critical analysis, careful resource utilization, and improved outcomes. practice implications. Nurses can not only maintain premium standards of quality care but, by assuming leadership, help shape the future of health care.

The Canadian Society for Exercise Physiology (CSEP), with assistance from multiple partners, stakeholders, and researchers, developed the first Canadian Physical Activity Guidelines for the Early Years (aged 0-4 years). These national guidelines were created in response to an urgent call from public health, health care, child care, and fitness practitioners for healthy active living guidance for the early years. The guideline development process was informed by the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument and the evidence assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The recommendations are informed by evidence from a systematic review that examined the relationships between physical activity and health indicators (healthy body weight, bone and skeletal health, motor skill development, psychosocial health, cognitive development, and cardio-metabolic disease risk factors) for three age groups (infants aged1 year; toddlers aged 1-2 years; preschoolers aged 3-4 years). The new guidelines include a preamble to provide context, followed by the specific recommendations. The final guidelines benefitted from an extensive on-line consultation process with input from over 900 domestic and international stakeholders, end-users, and key informants. The final guideline recommendations state that for healthy growth and development, infants (aged1 year) should be physically active several times daily - particularly through interactive floor-based play. Toddlers (aged 1-2 years) and preschoolers (aged 3-4 years) should accumulate at least 180 min of physical activity at any intensity spread throughout the day, including a variety of activities in different environments, activities that develop movement skills, and progression toward at least 60 min of energetic play by 5 years of age. More daily physical activity provides greater benefits.

The Canadian Society for Exercise Physiology (CSEP), with assistance from multiple partners, stakeholders, and researchers, developed the first Canadian Sedentary Behaviour Guidelines for the Early Years (aged 0-4 years). These national guidelines are in response to a call from health and health care professionals, child care providers, and fitness practitioners for guidance on sedentary behaviour in the early years. The guideline development process followed the Appraisal of Guidelines for Research Evaluation (AGREE) II framework. The recommendations are informed by evidence from a systematic review that examined the relationships between sedentary behaviour (predominantly screen time) and health indicators (healthy body weight, bone and skeletal health, motor skill development, psychosocial health, cognitive development, and cardio-metabolic disease risk factors) for three age groups (infants aged1 year; toddlers aged 1-2 years; preschoolers aged 3-4 years). Evidence from the review was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The new guidelines include a preamble to provide context, followed by the specific recommendations. The final guidelines benefitted from extensive on-line consultations with input from900 domestic and international stakeholders, end-users, and key informants. The final guidelines state: for healthy growth and development, caregivers should minimize the time infants (aged1 year), toddlers (aged 1-2 years), and preschoolers (aged 3-4 years) spend being sedentary during waking hours. This includes prolonged sitting or being restrained (e.g., stroller, high chair) for more than 1 h at a time. For those under 2 years, screen time (e.g., TV, computer, electronic games) is not recommended. For children 2-4 years, screen time should be limited to under 1 h per day; less is better.

The Canadian Society for Exercise Physiology (CSEP), in partnership with the Healthy Active Living and Obesity Research Group (HALO) at the Children’s Hospital of Eastern Ontario Research Institute, and in collaboration with ParticipACTION, and others, has developed the Canadian Sedentary Behaviour Guidelines for Children (aged 5–11 years) and Youth (aged 12–17 years). The guidelines include a preamble to provide context, followed by the specific recommendations for sedentary behaviour. The entire development process was guided by the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument, which is the international standard for clinical practice guideline development. Thus, the guidelines have gone through a rigorous and transparent developmental process and the recommendations are based on evidence from a systematic review and interpretation of the research evidence. The final guidelines benefitted from an extensive online consultation process with 230 domestic and international stakeholders and key informants. The final guideline recommendations state that for health benefits, children (aged 5–11 years) and youth (aged 12–17 years) should minimize the time that they spend being sedentary each day. This may be achieved by (i) limiting recreational screen time to no more than 2 h per day — lower levels are associated with additional health benefits; and (ii) limiting sedentary (motorized) transport, extended sitting time, and time spent indoors throughout the day. These are the first evidence-based Canadian Sedentary Behaviour Guidelines for Children and Youth and provide important and timely recommendations for the advancement of public health based on a systematic synthesis, interpretation, and application of the current scientific evidence.

The Canadian Society for Exercise Physiology (CSEP), in cooperation with ParticipACTION and other stakeholders, and with support from the Public Health Agency of Canada (PHAC), has developed the new Canadian Physical Activity Guidelines for Children (aged 5–11 years), Youth (aged 12–17 years), Adults (aged 18–64 years), and Older Adults (aged ≥65 years). The new guidelines include a preamble to provide context and specific guidelines for each age group. The entire guideline development process was guided by the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument, which is the international standard for clinical practice guideline development. Thus, the guidelines have gone through a rigorous and transparent developmental process; we based the recommendations herein on evidence from 3 systematic reviews, and the final guidelines benefitted from an extensive online and in-person consultation process with hundreds of stakeholders and key informants, both domestic and international. Since 2006, the products of our efforts resulted in the completion of 21 peer-reviewed journal articles (including 5 systematic reviews) that collectively guided this work. The process that Canadian researchers undertook to update the national physical activity guidelines represents the most current synthesis, interpretation, and application of the scientific evidence to date.

This article summarizes the main findings from the papers included in this journal supplement. It consolidates the evidence currently available to inform and advance the development of physical activity guidelines for Canadians, and it highlights the specific needs of various population subgroups. The challenges of translating guideline information into effective and persuasive physical activity messages, of campaigns to disseminate messages and of related evaluations are underlined. Recommendations on how to proceed are based on the evidence base provided by this series of papers; the immediate next steps mandated by this initiative are outlined and priorities for future research are indicated.

Determining D-dimer levels remains important in the diagnostic algorithms for venous thromboembolism (VTE). The present study aimed to identify factors influencing D-dimer utility in diagnosing VTE. Consecutive symptomatic medical patients, who attended our emergency department from 1 November 2006 to 31 December 2006, had D-dimer levels measured as fibrinogen equivalent units (FEU), following clinical risk assessment. Diagnosis of VTE was established by venous compression ultrasonography and computed tomographic pulmonary angiography. VTE-negative patients were followed for 2 months to detect future occurrence of thromboembolism. Impact of various factors on D-dimer levels was analyzed. Four thousand and twenty-six patients attended our emergency department, and 525 patients (median age 52 years) had D-dimer assessed. Final diagnosis of VTE was established in 25 (4.7%) patients on radiological investigations. Median D-dimer levels for VTE-negative patients less than 60 years old, with normal renal function and chest radiology were 0.38 microgFEU/ml (range 0.19-2.3), 0.39 microgFEU/ml (range 0.17-3.5) and 0.39 microgFEU/ml (range 0.1-4.3), respectively. Similar figures for those at least 60 years, with renal impairment and abnormal chest radiology, were 0.75 microgFEU/ml (range 0.22-4.3), 0.52 microgFEU/ml (range 0.17-4.4) and 0.92 microgFEU/ml (range 0.26-5.6), respectively. Factors including patient age, renal function and chest radiology had significant influence on D-dimer levels (P < 0.01). A triad of patient age at least 60 years, renal impairment (modification of diet in renal disease stage 2-5) and abnormal chest radiology had a false positive D-dimer in 96% of patients (n = 72). Use of D-dimer in patients with a triad of advanced age, renal impairment and abnormal chest radiology has no practical diagnostic value in VTE.

Meeting the educational needs and requirements of surgical resident physicians while achieving optimal patient care is a challenge for program directors. Midlevel practitioners (MLPs) were employed by a large community teaching hospital to augment the surgical teaching service, to improve continuity of patient care, and to provide resident physicians with greater flexibility to participate in classroom, operative, and clinical educational experiences. The MLPs were carefully integrated into the surgical program by creating the necessary buy-in, developing positive relationships, decreasing resistance, and reinforcing acceptance when demonstrated. MLPs function at the level of junior resident physicians and are active participants in the teaching and evaluation process. Structurally, MLPs receive their assignments from and report to the chief resident physician, but are ultimately responsible to the program director. Instituting the program required providing financial justification to administration and flexibility in meeting the diverse needs of the four teams. As a result, surgical resident physicians have been sufficiently freed from service activities to be able to capitalize on learning activities that range from surgeries to conferences. MLPs can be integrated into a surgical teaching program and become a positive force in the education of resident physicians.

Most adults with multiple sclerosis (MS) are physically inactive. Physical activity guidelines are an important tool for exercise prescription, promotion, and monitoring. This article describes the application of international standards for guideline development in the creation of evidence-based physical activity guidelines for people with MS. The development process was informed by the Appraisal of Guidelines Research and Evaluation II instrument. The evidence base for the guidelines consisted of a systematic review of research examining the effects of exercise on fitness, fatigue, mobility, and health-related quality of life among people with MS. A multidisciplinary consensus panel deliberated the evidence and generated the guidelines and a preamble. Expert and stakeholder reviews of the materials led to refinement of the wording of both components of the guidelines. The resulting guidelines state that to achieve important fitness benefits, adults with MS who have mild to moderate disability need at least 30 minutes of moderate intensity aerobic activity 2 times per week and strength training exercises for major muscle groups 2 times per week. Meeting these guidelines may also reduce fatigue, improve mobility, and enhance elements of health-related quality of life. People with MS and health professionals are encouraged to adopt these rigorously developed guidelines.

Background: Few validated guidelines exist for developing messages in health promotion practice. In clinical practice, the Appraisal of Guidelines, Research, and Evaluation II (AGREE II) Instrument is the international gold standard for guideline assessment, development, and reporting. In a case study format, this paper describes the application of the AGREE II principles to guide the development of health promotion guidelines for constructing messages to supplement the new Canadian Physical Activity Guidelines (CPAG) released in 2011. Methods: The AGREE II items were modified to suit the objectives of developing messages that (1) clarify key components of the new CPAG and (2) motivate Canadians to meet the CPAG. The adapted AGREE II Instrument was used as a systematic guide for the recommendation development process. Over a two-day meeting, five workgroups (one for each CPAG – child, youth, adult, older adult – and one overarching group) of five to six experts (including behavior change, messaging, and exercise physiology researchers, key stakeholders, and end users) reviewed and discussed evidence for creating and targeting messages to supplement the new CPAG. Recommendations were summarized and reviewed by workgroup experts. The recommendations were pilot tested among end users and then finalized by the workgroup. Results: The AGREE II was a useful tool in guiding the development of evidence-based specific recommendations for constructing and disseminating messages that supplement and increase awareness of the new CPAG (child, youth, adults, and older adults). The process also led to the development of sample messages and provision of a rationale alongside the recommendations. Conclusions: To our knowledge, these are the first set of evidence-informed recommendations for constructing and disseminating messages supplementing physical activity guidelines. This project also represents the first application of international standards for guideline development (i.e., AGREE II) to the creation of practical recommendations specifically aimed to inform health promotion and public health practice. The messaging recommendations have the potential to increase the public health impact of evidence-based guidelines.