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Background: Physical activity (PA) levels are lower among some UK minority ethnic groups than the\ud majority White British population. Barriers to participation have been examined and a variety of\ud tailored interventions have emerged. This study documents the characteristics and logic of local\ud adaptations; a vital first step in evaluating such innovations.\ud Methods: 58 PA interventions from an English PA dataset were examined to establish the\ud characteristics of programmes focussed on minority ethnic populations. From these 58, three case\ud studies were examined to reveal the nature of tailoring and the logic underpinning it; employing\ud documentary analysis and qualitative interviews.\ud Results: Interventions typically aimed to improve both health and social outcomes, were largely\ud publically and charitably funded and sought to engage the most inactive groups. Tailoring was based\ud on six principles including using community resources to promote the intervention and\ud accommodating varying degrees of cultural identification. Additionally, tailoring interventions were\ud intended to build capacity for sustainability.\ud Conclusions: PA interventions tailored to the needs of minority ethnic groups reflect their largely\ud disadvantaged position in society and focus on addressing inactivity. Tailoring PA with the six\ud principles in mind could be used as a useful framework for developing, designing and evaluating\ud interventions for minority ethnic populations.

Aim Insufficient research examines the treatment effectiveness of real-world physical activity (PA) interventions. Purpose We investigated the effects of 3 interventions on directly measured cardiovascular variables. All treatments and measures were administered in community settings by fitness centre staff. Methods Participants were sedentary individuals receiving no medication to reduce cardiovascular disease (CVD) risk (n=369, age 43 ±5 years). In a semirandomised design, participants were allocated to a structured gym exercise programme (STRUC), unstructured gym exercise (FREE), physical activity counselling (PAC) or a measurement-only control condition (CONT). Measures were: predicted aerobic capacity (VO2: mL kg min), mean arterial blood pressure (MAP: mm Hg) and total cholesterol (TC: mmol/L), and were taken at baseline and 48 weeks. Results Data analysis indicated a statistically significant deterioration in TC in CONT (0.8%, SD=0.5, p=0.005), and a statistically significant improvement in MAP in STRUC (2.5%, SD=8.3, p=0.004). Following a median split by baseline VO2, paired-sample t tests indicated significant improvements in VO2 among low-fit participants in STRUC (3.5%, SD=4.8, p=0.003), PAC (3.3%, SD=7.7, p=0.050) and FREE (2.6%, SD=4.8, p=0.006), and significant deterioration of VO2 among high-fit participants in FREE (−2.0%, SD=5.6, p=0.037), and PAC (−3.2%, SD=6.4, p=0.031). Conclusions Several forms of PA may offset increased cholesterol resulting from inactivity. Structured PA (exercise) might be more effective than either unstructured PA or counselling in improving blood pressure, and community-based PA interventions might be more effective in improving VO2 among low-fit than among high-fit participants.

Slip-induced falls are among the most common cause of major occupational injuries in the UK as well as being a major public health concern in the elderly population. This study aimed to determine the optimal fall indicators for fall detection models which could be used to reduce the detrimental consequences of falls. A total of 264 kinematic variables covering three-dimensional full body model translation and rotational measures were analysed during normal walking, successful recovery from slips and falls on a cross-slope. Large effect sizes were found for three kinematic variables which were able to distinguish falls from normal walking and successful recovery. Further work should consider other types of daily living activities as results show that the optimal kinematic fall indicators can vary considerably between movement types. Practitioner Summary: Fall detection models are used to minimise the adverse consequences of slip-induced falls, a major public health concern. Optimal fall indicators were derived from a comprehensive set of kinematic variables for slips on a cross-slope. Results suggest robust detection of falls is possible on a cross-slope but may be more difficult than level walking.

Falls that occur as a result of a slip are one of the leading causes of injuries, particularly in the elderly population. Previous studies have focused on slips that occur on a flat surface. Slips on a laterally sloping surface are important and may be related to different mechanisms of balance recovery. This type of slip might result in different gait adaptations to those previously described on a flat surface, but these adaptations have not been investigated. The aim of this study was to assess whether, when walking on a cross-slope, young adults adapted their gait when made aware of a potential slip, and having experienced a slip. Gait parameters were compared for three conditions--(1) Normal walking; (2) Walking after being made aware of a potential slip (participants were told that a slip may occur); (3) Walking after experiencing a slip (Participants had already experienced at least one slip induced using a soapy contaminant). Gait parameters were only analysed for trials in which there was no slippery contaminant present on the walkway. Stride length and walking velocity were significantly reduced, and stance duration was significantly greater in the awareness and experience conditions compared to normal walking, with no significant differences in any gait parameters between the awareness and experience conditions. In addition, 46.7% of the slip trials resulted in a fall. This is higher than reported for slips induced on a flat surface, suggesting slips on a cross-slope are more hazardous. This would help explain the more cautious gait patterns observed in both the awareness and experience conditions.

that many studies examining the treatment effectiveness of exercise in the real world adopt laboratory style methods and controls that would be impractical and uneconomic in real-world interventions. Data resulting from such studies merely add to the efficacy data set. We argue that despite metaphorically drowning in evidence of efficacy and implementation effectiveness, SEM is yet to provide sufficient evidence of treatment effectiveness. Furthermore, while it is a mistake to confuse efficacy with effectiveness, 9 in lobbying for exercise as a public health tool, we often do just that.

A sedentary lifestyle is associated with cardiovascular disease (CVD). Blood pressure (BP) and blood lipids (cholesterols) are key mediators of CVD. A substantial body of evidence demonstrates reduced CVD risk following systematic physical activity (PA). Despite this evidence, CVD continues to rise, and public health PA initiatives often fail to demonstrate clinically relevant effects. In short, laboratory efficacy often fails to translate into real-world effectiveness.PURPOSE: We investigated the effectiveness of three physical activity interventions. We did so using a Phase-IV clinical trial model, in which all treatments were administered in uncontrolled community settings, and in which all interventions and measures were delivered by, and conducted by, community health centre staff.METHODS: Participants were sedentary individuals receiving no medication to reduce CVD risk (n=238, age 43±5 years). Participants selected a PA or exercise (EX) pathway. Those who selected PA were randomised to either fitness centre based PA counselling delivered by an exercise professional (PAC) or a wait-list control condition (CONT). Those who selected EX were randomised to either a structured exercise program (STRUC) or unstructured fitness centre use (FREE). Measures were mean arterial pressure (MAP: mmHg) estimated using the formula Diastolic Blood Pressure (BP) + (0.33 x (Systolic BP – Diastolic BP)), and total cholesterol (TC: mmol/L). Measures were taken at baseline and 48 weeks. Data were analysed using paired-sample t-tests.RESULTS: Data analysis for cholesterol indicated a small but statistically significant increase in TC in CONT (M=0.8%, SD=0.5, p = .005). TC was however approximately equivalent to baseline in PAC and FREE and reduced, although not significantly, in STRUC. Data for blood pressure indicated a statistically significant decrease in MAP in STRUC (M=2.5%, SD=8.3, P = .004). MAP was reduced, although not significantly, in all other treatments and CONT.CONCLUSIONS: Data suggest that over 48 weeks, all forms of exercise might be effective in offsetting increases in total cholesterol associated with inactivity. Furthermore, a structured exercise programme might be more effective than either unstructured exercise or physical activity counselling in reducing mean arterial blood pressure.

PURPOSE: Evidence for the effectiveness of GP Exercise Referral is weak (1, 2). We examined traditional supervised exercise (TRAD), physical activity counselling (PAC), combined TRAD/PAC (CMB) and wait-list controls (CON) in a community exercise referral programme in South East London, UK.METHODS: PPs (n=141) were identified by their doctors as overweight and at increased risk of Type 2 Diabetes. PPs were randomly assigned to treatment. Measures were blood pressure and body composition at baseline and 12 weeks. RESULTS: One-way ANOVA of absolute change in dependant variables between treatments indicated that body fat mass, body fat % and systolic blood pressure were reduced at 12 weeks for all groups including CONT. No statistically significant between-group effects were observed. Paired sample t-tests indicated that lean mass was significantly increased at 12 weeks for all groups including CON; diastolic blood pressure was significantly decreased for all groups at 12 weeks except PAC. Retention was highest to CMB (75%), followed by CON (68%), with PAC and TRAD both at 55%. CONCLUSIONS: Treatment groups and CON appeared to benefit from the programme, with likely measurement effects partially explaining improvement in CON. High retention to CMB is of significance to future GP Referral programmes.

A sedentary lifestyle is associated with cardiovascular disease (CVD). A substantial and compelling body of evidence demonstrates reduced CVD risk following systematic physical activity (PA). Despite this evidence, CVD continues to rise, and public health PA initiatives appear to be failing to demonstrate clinically relevant effects.PURPOSE: A core component of cardiovascular health is the ability to utilise oxygen, termed ‘oxygen uptake’ or VO2. We investigated the effectiveness of three physical activity interventions on oxygen uptake. We did so using a Phase-IV clinical trial model, in which all treatments were administered in uncontrolled community settings, and in which all interventions and measures were delivered by, and conducted by, community health centre staff.METHODS: Participants were sedentary individuals receiving no medication to reduce CVD risk (n=238, age 43±5 years). Participants selected a PA or exercise (EX) pathway. Those who selected PA were randomised to either fitness centre based physical activity counselling delivered by an exercise professional (PAC) or a wait-list control condition (CON). Those who selected EX were randomised to either a structured exercise program (STRUC) or unstructured fitness centre use (FREE). The dependent measure was predicted maximum oxygen uptake (VO2 max; ml/kg/min), measured using the COSMED Fitmate. Measures were taken at baseline and 48 weeks.RESULTS: Repeated measures ANOVA indicated no statistically significant difference between treatments (F [3,215] = 1.173, p = .321), and paired-sample t-tests indicated no significant pre-post effects for any treatment. When data were grouped using a quartile split by baseline VO2 max however, repeated measures ANOVA indicated significant differences between groups (F [3,215] = −6.1, p < .001), specifically that whilst in the highest two quartiles VO2 max was reduced (M = -2.7, SD = 7.0, p=.05 and M = -2.6, SD = 6.0, p=.008 respectively), and no significant change was observed in the third quartile (M = -0.1, SD = 5.0, p = .89), in the lowest quartile, VO2 max was significantly increased (M = 4.1, SD = 6.6, p < .001). CONCLUSIONS: Data suggest that in terms of VO2, treatments in the current study were more effective with the least fit participants at baseline, and actually counter-productive for the most fit.

Purpose. Many sedentary adults possess not only a high body fat percentage (BFP), but also low lean body mass (LBM). The latter may predispose metabolic disease such as Type-2 Diabetes. The majority of public health messaging around physical activity centers on habitual (e.g., walking) or purposeful (e.g., jogging) aerobic activity. However, few positive effects on muscle mass result from such activities. Whilst resistance training (RT) is an obvious solution, its effectiveness in public health settings is not demonstrated. We report two community-based RT studies, Study 1 delivered to a sedentary population, Study 2 to overweight and pre-diabetic patients.METHODS: In Study 1 (48-weeks), participants (n=364) were allocated to either programed-exercise (PROG), un-programmed use of a community gym (FREE), or monthly physical activity counseling (PAC). A wait-list control (CONT) was employed. In Study 2 (12-weeks), overweight and pre-diabetic patients (n=141) were randomly assigned to 12 sessions of either supervised exercise (SUP), PAC, or the two combined (COMB). A wait list control was employed.RESULTS: In Study 1, ANOVA indicated significant differences between treatments. PROG performed significantly better than CONT on strength (p= .048) and LBM (p= .009). FREE performed significantly better than CONT on strength (p= .029). Paired-sample t-tests indicated that PROG improved significantly pre-post on strength (p= .001), LBM (p= .036) and BFP (p= .006), whilst improvements in strength only were observed in FREE (p= .01) and PAC (p= .014). In Study 2 ANOVA indicated no significant differences between treatments. However paired-sample t-tests indicated that SUP improved significantly pre-post on strength (p= .01) and BFP (p= .027), with a clear trend also in LBM (p= .074), whilst significantly improved strength only was observed in COMB (p= .026) and PAC (p= .016).CONCLUSIONS: In both studies, whilst statistically significant increases in strength were observed across all treatments, significant improvements in both strength and body composition were observed only in programmed and/or supervised conditions. Collectively data suggest that the programming and supervision of resistance training is beneficial in community settings when improvements in body composition are desired.

PURPOSE: Ensuring that at-risk groups are sufficiently physically active is a major public health challenge. Physical activity counselling (PAC) has shown some promise. However many programmes require multiple PAC sessions that are resource intensive and costly. We report a study of PAC – in this case the UK-based programme ‘Let’s Get Moving’ – built around just one PAC session and delivered from general medical practitioner (GP) surgeries.METHODS: Participants (n=1601, M±SD age = 41.4±21.8) were identified by their local GP surgeries as meeting one or more of the following: age 18-74, currently sedentary, BMI 28-35, and/or hypertensive, and/or first medication for hypertension in last 6 months, and/or first medication for weight management in last 6 months. Participants attended a PAC session with a local community exercise professional (CEP) who was based at the surgery. At this session participants were encouraged to increase their physical activity and to attend community exercise sessions provided by local authorities. All participants received a telephone call at 6-weeks and attended a follow-up PAC session with the CEP at 12-weeks. Measures at 0 and 12 weeks were self-reported physical activity (MET-min/week) using the International Physical activity Questionnaire short-form (IPAQ) and an additional question regarding sport participation.RESULTS: Paired sample t-tests indicated significant increases in MET-min/week in Walking (M±SD = 404.6±1622.0, p < 0.001), Moderate Activity (M±SD = 151.8±1365.2, p = 0.006), Vigorous Activity (M±SD = 193.8±1439.7, p = 0.001), Total Activity (M±SD = 659.6±2742.3, p < 0.001), and Sport Participation (M±SD = 35.5±105.5, p < 0.001). Repeated measures ANOVA revealed a significant interaction suggesting that Vigorous Activity increased significantly more for females than males (F[1,533] = 3.981, p = .047). Reasons for this are unclear and warrant further investigation.CONCLUSIONS: Whilst the absence of controls and the self-report of physical activity are limitations, data suggest that brief PAC is an effective intervention when delivered to at risk individuals, and might be especially effective in encouraging females to adopt more vigorous activity. We also speculate that PAC’s effectiveness is enhanced through being located at a GP surgery.

PURPOSE: The physical activity (PA) levels and fitness of schoolchildren is increasingly a public health issue. Cardiorespiratory fitness (CRF) is a validated marker of PA levels, however there is little systematic measurement of this variable in school children. Systematic measurement would allow all stakeholders, from parents and schools to activity providers and public health agencies, to monitor changes in CRF over time and to evaluate the effectiveness of interventions. The primary purpose of this investigation was to examine the CRF of children at a number of UK primary schools over one academic year. Measures were CRF and body mass index (BMI). Secondary aims were to test the feasibility of CRF testing in primary schools more generally (previous studies have been administered by research teams, and whilst providing useful data relating to validity and reliability, provide little insight into the practicality and scalability of testing).METHODS: Participants from 14 schools (n=463) aged between 8-9 (M±SD BMI 17.61±61) completed a 20 meter shuttle run test (20-mSRT) four times during a calendar year (Oct, Feb, June, Sep). This included data collection either side of the school summer break from July-Sep. CRF (VO2max ml kg-1min-1) was calculated using standardised prediction equations for children. To demonstrate both practicality and scalability of the protocol, testing sessions and data collection were conducted by appropriately trained and qualified personnel already operating in the schools and not by the research team, although the latter vetted this process.RESULTS: Paired sample t-tests indicated a significant increase in CRF during the 1st quarter of the academic year (VO2max 49.58±4.06-51.58±5.09 p 0.01).CONCLUSIONS: Significant negative changes in CRF and BMI suggest children are less active in the summer break, a finding that should be used to inform future activity provision. Data also indicate that the delivery of CRF testing in primary schools is feasible and scalable.

Previous research has reported the validity and reliability of a range of field-based tests of children’s cardiorespiratory fitness. These two criteria are critical in ensuring the integrity and credibility of data derived through such tests. However, the criterion of scalability has received little attention. Scalability determines the degree to which tests developed on small samples in controlled settings might demonstrate real-world value, and is of increasing interest to policymakers and practitioners. The present paper proposes a method by which the scalability of cardiorespiratory field-based tests suitable for school-aged children might be assessed. We developed an algorithm to estimate scalability based on a six-component model; delivery, evidence of operating at scale, effectiveness, costs, resource requirements and practical implementation. We tested the algorithm on data derived through a systematic review of research that has used relevant fitness tests. A total of 229 studies that had used field based cardiorespiratory fitness tests to measure children’s fitness were identified. Initial analyses indicated that the 5-min run test did not meet accepted criteria for reliability, whilst the 6-min walk test likewise failed to meet the criteria for validity. Of the remainder, a total of 28 studies met the inclusion criteria, 22 reporting the 20-m shuttle-run and seven the 1-mile walk/run. Using the scalability algorithm we demonstrate that the 20-m shuttle run test is substantially more scalable than the 1-mile walk/run test, with tests scoring 34/48 and 25/48, respectively. A comprehensive analysis of scalability was prohibited by the widespread non-reporting of data, for example, those relating to cost-effectiveness. Of all sufficiently valid and reliable candidate tests identified, using our algorithm the 20-m shuttle run test was identified as the most scalable. We hope that the algorithm will prove useful in the examination of scalability in either new data relating to existing tests or in data pertaining to new tests.