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Promotion of physical activity by health professionals can increase physical activity participation among patients, however, implementing physical activity promotion within hospital systems is lacking. The Promotion of Physical Activity by Health Professionals (PROMOTE-PA) study is a hybrid type I effectiveness-implementation cluster randomised controlled trial evaluating the effectiveness of support for physical activity promotion by health professionals on physical activity participation of patients. Health professionals delivering outpatient healthcare services within four local health districts and one specialty health network in New South Wales, Australia will be included. The target patient population is children (5–17 years) and adults (18+ years) who are willing to receive additional support to be more physically active. The evidence-based intervention is brief physical activity promotion informed by the ‘5As’ physical activity counselling model and behavioural theory, embedded into routine clinical practice. Our multi-faceted strategy to support implementation of physical activity promotion was developed based on preliminary research and consultation with key stakeholders. The implementation strategy includes education and training as well as a selection of the following (tailored to each clinical team): community referral strategies, experts and clinical mentors, and clinical champions. 30 outpatient clinical teams will be randomised to receive the implementation strategy immediately or after a 3-month delay (waitlist control). Each team will seek to recruit 10–30 patients (n=approx. 720) to report moderate-vigorous physical activity (minutes per week, primary outcome), frequency of balance and strength exercise, mobility, and quality of life at baseline, 3-month and 6-month post patient recruitment. This study aims to address the increasing burden of physical inactivity in a high-risk population using the existing health workforce.

Few studies have examined trends in inequalities related to lifestyle risk behaviours. This study examined 1) 16-year (2004-2019) trends of individual lifestyle risk factors and a combined lifestyle risk index and 2) trends in socioeconomic inequalities in these risk factors, in New South Wales (NSW; Australia) adults. Data was sourced from the NSW Adult Population Health Survey, an annual telephone survey of NSW residents aged ≥16 years, totalling 191,905 completed surveys. Excessive alcohol consumption, current smoking, insufficient physical activity, insufficient fruit and/or vegetable consumption, sugar-sweetened beverage [SSB] consumption, and a combined lifestyle risk index (overall high-risk lifestyle defined as total number of lifestyle risk behaviours ≥2) were examined. Socioeconomic status was assessed using education attainment, postal area-level disadvantage measured by Index of Relative Socioeconomic Disadvantage (IRSD), and remoteness based on Accessibility-Remoteness Index of Australia Plus (ARIA+). Socioeconomic inequalities were examined as prevalence difference for absolute inequalities and prevalence ratio for relative inequalities. The prevalence of lifestyle behaviours by levels of each socioeconomic status variable were estimated using predicted probabilities from logistic regression models. After adjusting for covariates, there was a decrease in prevalence over time for most lifestyle risk behaviours. Between 2004 and 2019, the prevalence decreased for current smoking from 21.8% to 17.1%, insufficient physical activity from 39.1% to 30.9%, excessive alcohol consumption from 15.4% to 13.7%, daily SSB consumption from 29.9% to 21.2%, and overall high-risk lifestyle from 50.4% to 43.7%. Socioeconomic inequalities, based on one or more of the socioeconomic variables, increased over time for current smoking, insufficient physical activity, daily SSB consumption, and an overall high-risk lifestyle. Overall, the health behaviours of the NSW populatio

BACKGROUND: Poor physical activity and excessive sedentary behaviour are well-established risk factors for morbidity and mortality. In the presence of emerging social problems, including loneliness and social isolation, these risks may be even greater. We aimed to investigate the joint effects of social health and movement behaviours on mortality and cardiovascular disease (CVD). METHODS: 497,544 UK Biobank participants were followed for an average of 11 years. Loneliness and social isolation were measured via self-report. Physical activity was categorised around current World Health Organisation (WHO) guidelines as low (< 600 metabolic equivalent of task [MET]-mins/week), moderate (600 < 1200) and high (≥ 1200). Sedentary behaviour was classified as low (≤ 3.5 h/day), moderate (3.5 ≤ 5) and high (> 5.5). We derived 24 social health-movement behaviour combinations, accordingly. Mortality and hospitalisations were ascertained to May 2020 for all-cause and CVD mortality, and non-fatal cardiovascular events. RESULTS: Social isolation amplified the risk of both all-cause and CVD death across all physical activity and sedentary levels (hazard ratio, 95% confidence interval [HR, 95% CIs] for all-cause mortality; 1.58 [1.49 to 1.68] for low active-isolated vs. 1.26 [1.22 to 1.30] for low active-not isolated). Loneliness was only found to amplify the risk of death from cardiovascular disease among the high active and low sedentary participants. Loneliness and social isolation did not add to the risk of non-fatal cardiovascular events across most activity levels. CONCLUSION: The detrimental associations of poor physical activity and sedentary behaviour with mortality were consistently amplified by social isolation. Our study supports the need to target the socially isolated as a priority group in preventive public health strategies.

ISSUE ADDRESSED: Understanding community support for obesity prevention policy is important for developing effective preventive health action. This study assessed support for a range of obesity prevention interventions, including food environment policies designed to improve healthy food and drink availability and promotion within public institutions. METHODS: An online cross-sectional survey was completed by 2006 NSW adults. Questions explored attitudes and beliefs about obesity, the importance of government-led prevention and support for eight obesity prevention interventions. Regression analyses examined associations between intervention support and sociodemographic, attitudinal and behavioural characteristics. RESULTS: Most respondents (80%) believed obesity was a large problem and that poor individual choices (86%) and the widespread availability of unhealthy food and drink (78%) contributed to the issue. There was moderate to high support for most (n = 7) initiatives. Support for food environment policies was highest for schools (76%-82%) and hospitals (67%-79%). Supporters and opponents rationalised opinions based on perceived effectiveness, the government's role and cost benefits. Opponents were a minority, but principles of autonomy were predominant. Attributing obesity to environment-related factors, and personal lower SSB consumption strongly predicted support. CONCLUSION: There is a significant recognition of the obesity issue and strong support for policies designed to improve the availability and promotion of healthy food and drink in public institutions, particularly in schools and hospitals. SO WHAT?: Substantial community support for healthy food environment policies in schools and hospitals warrants continued implementation in NSW. This may foster further acceptance for wider implementation. Our findings could inform the framing of policy advocacy messages.

BACKGROUND: Physical activity has many physical and mental health benefits and can delay the development of disability in older age. However, uptake of this health behaviour is sub-optimal in women in their middle and older age. This trial aims to establish the acceptability and feasibility of the Active Women over 50 programme involving online information, telephone health coaching and email or SMS support to promote physical activity behaviour change among women aged 50 years and over. METHODS: Sixty community-dwelling women who are insufficiently active according to national guidelines, will be recruited and randomised to 1) receive the Active Women over 50 programme or 2) a wait-list control. Active Women over 50 is a 3-month physical activity programme guided by behaviour change science, providing access to a website, one telephone-delivered health coaching session from a physiotherapist and 8 email or 24 SMS messages. The primary outcome is the proportion of participants at 3 months post-randomisation who would recommend participation in the programme to another person like themselves. Secondary outcomes are feasibility measures: rates of recruitment, retention, completeness of outcome data and uptake of telephone support; and intervention impact measures: accelerometer-assessed average steps/day, proportion of participants meeting national guidelines on moderate to vigorous physical activity; and questionnaire-assessed quality of life, exercise perceptions, mood, physical functioning and self-reported physical activity. Intervention participants will also complete a follow-up survey to assess impressions of the intervention and adoption of strategies for physical activity participation. Data will be analysed descriptively to guide the design of a larger trial. Between-group differences in secondary outcomes will be used to estimate effect sizes for sample size calculations for a fully powered randomised controlled trial. DISCUSSION: This feasibility pilot tri

Background Nine per cent of Australian adults report dieting to lose weight, and 49% of these describe their diets as ‘low calorie’.1 An online search for ‘low calorie/energy diet products’ reveals many advertisements for commercially available low- and very low-energy meal-replacement (MR) products, including promotions for ‘soups and shakes’. Evidence supports low- and very low-energy MRs as a successful strategy for weight loss in overweight and obese individuals.2,3 Australian clinical practice guidelines for overweight and obesity management include changing lifestyle behaviours and the use of very low-energy diets as effective in supporting weight loss for overweight and obese adults.4 Considering the evidence supporting their use to reduce energy intake, MRs may be underutilised in weight loss management.5 Further, the role of their use in public health is unclear. Although many studies have investigated the efficacy of MRs, few have explored participant perceptions of using these options for weight-loss management. In those studies that have explored this, MRs were positively perceived, and considered convenient and easy to use.6,7 The Healthy Weight for Life (HWFL) program is an 18-week weight-loss lifestyle-modification program for overweight or obese adults with chronic disease who have private health insurance.8 The program includes physical activity and dietary recommendations, incorporating a portion-controlled eating plan including MRs under the brand name KicStart, in the form of a shake or soup. Past participants of the program have lost on average, approximately 7–8% of their baseline weight.9,10 We undertook qualitative research to investigate an additional maintenance phase for HWFL participants. Six focus groups were conducted during November 2016, with 28 English-speaking participants who had completed HWFL within the past year (53.6% of participants were male, 46.4% female, 85.7% aged 55 years and older, 82.1% from most advantaged areas, 96.4%

BACKGROUND: Physical activity has many physical and mental health benefits and can delay the development of disability in older age. However, uptake of this health behaviour is sub-optimal in women in their middle and older age. This trial aims to establish the acceptability and feasibility of the Active Women over 50 programme involving online information, telephone health coaching and email or SMS support to promote physical activity behaviour change among women aged 50 years and over. METHODS: Sixty community-dwelling women who are insufficiently active according to national guidelines, will be recruited and randomised to 1) receive the Active Women over 50 programme or 2) a wait-list control. Active Women over 50 is a 3-month physical activity programme guided by behaviour change science, providing access to a website, one telephone-delivered health coaching session from a physiotherapist and 8 email or 24 SMS messages. The primary outcome is the proportion of participants at 3 months post-randomisation who would recommend participation in the programme to another person like themselves. Secondary outcomes are feasibility measures: rates of recruitment, retention, completeness of outcome data and uptake of telephone support; and intervention impact measures: accelerometer-assessed average steps/day, proportion of participants meeting national guidelines on moderate to vigorous physical activity; and questionnaire-assessed quality of life, exercise perceptions, mood, physical functioning and self-reported physical activity. Intervention participants will also complete a follow-up survey to assess impressions of the intervention and adoption of strategies for physical activity participation. Data will be analysed descriptively to guide the design of a larger trial. Between-group differences in secondary outcomes will be used to estimate effect sizes for sample size calculations for a fully powered randomised controlled trial. DISCUSSION: This feasibility pilot tri

Qualitative evidence of participants’ experiences of real-life weight loss maintenance programs is important for ongoing participant engagement and can inform program improvements. The purpose of this study was to understand how participants account for their engagement with a weight loss maintenance program and the role of the program in their weight management. A qualitative study using semi-structured interviews with 17 participants of a weight loss maintenance program was conducted; common themes were identified using a thematic inductive approach. Many participant narratives incorporated recurrent descriptions of their program experiences as a weight management journey. Our analysis generated four themes: returning to real life as a threat, the personal responsibility imperative, the program supporting agency and the program supporting self-regulation. The program, which provides external support and strategies, overlapped with the context of returning to real life and the personal responsibility imperative. Participant accounts of their journey at this intersection include the program supporting both agency and self-regulation which influences ongoing weight management. The interplay between themes identified and the maintenance program services allows compatibility between participants’ sense of personal responsibility and the program components to help participants to ‘stay on track’ or ‘get back on track’. In providing sufficient structure, opportunities to revisit successful strategies, and accountability, participants are empowered to overcome real-life threats and make positive health choices.

Objective Identifying who participates in chronic disease management programs yields insights into program reach and appeal. This study investigated sustained participation in a remotely delivered weight loss maintenance program offered to Australian private health insurance members. Methods All participants completing an initial 18-week weight loss program were eligible for a maintenance phase. A pre-post test design was used and sociodemographic and anthropometric characteristics of those who did and did not opt in to the maintenance phase were compared using binary logistic regression. Results Maintenance phase participants lost more weight during the initial weight loss program (−2.2 kg (P < 0.001); body mass index −0.8 kg/m2 (P < 0.001)) than those who did not opt in. Participants who were obese (v. overweight) upon completion of the initial weight loss program were less likely to opt in to the maintenance phase (adjusted odds ratio (aOR) 1.76, 95% confidence interval (CI) 1.35–2.30, P < 0.001) and participants aged ≥55 years were more likely to opt in (aOR 0.59, 95% CI 0.44–0.80, P < 0.001) than those aged <55 years. Conclusions Understanding why health insurance members opt in to maintenance programs can assist the development of strategies to improve program reach. Younger participants and those who remain obese following a weight loss program may be targeted by private health insurers and service providers to increase weight loss maintenance program participation. What is known about the topic? Australian private health insurers offer chronic disease management programs to support members to manage obesity-related chronic disease. An 18-week weight loss and lifestyle modification program was extended to assist participants maintain weight loss and health benefits resulting from the initial program. This weight loss maintenance phase is novel in the private health insurance setting and is thought to be important to sustained health improvement. Although prog

Background Health insurers worldwide implement financial incentive schemes to encourage health-related behaviours, including to facilitate weight loss. The maintenance of weight loss is a public health challenge, and as non-communicable diseases become more prevalent with increasing age, mid-older adults could benefit from programs which motivate weight loss maintenance. However, little is understood about their perceptions of using financial incentives to maintain weight loss. Methods We used mixed methods to explore the attitudes and views of participants who had completed an Australian weight loss and lifestyle modification program offered to overweight and obese health insurance members with weight-related chronic diseases, about the acceptability and usefulness of different types of financial incentives to support weight loss maintenance. An online survey was completed by 130 respondents (mean age = 64 years); and a further 28 participants (mean age = 65 years) attended six focus groups. Results Both independent samples of participants supported a formalised maintenance program. Online survey respondents reported that non-cash (85.2%) and cash (77%) incentives would be potentially motivating; but only 40.5% reported that deposit contracts would motivate weight loss maintenance. Results of in-depth discussions found overall low support for any type of financial incentive, but particularly deposit contracts and lotteries. Some participants expressed that improved health was of more value than a monetary incentive and that they felt personally responsible for their own health, which was at odds with the idea of financial incentives. Others suggested ongoing program and peer support as potentially useful for weight loss maintenance. Conclusions If financial incentives are considered for mid-older Australian adults in the health insurance setting, program planners will need to balance the discordance between participant beliefs about the individual responsibility fo