Dr Anna Jansson

Background: Outdoor gym installations have become a popular initiative by local government agencies globally to increase community-based physical activity. Despite their rapid spread, usage rates and user characteristics are not well described, particularly the mode/type of activity performed. This study aims to investigate the proportion and timing of outdoor gym use, and demographic characteristics of gym users across seven locations. Method: The current study employed a cross-sectional research design with observational measures to examine outdoor gym use across seven locations in a large regional area in New South Wales, Australia. An outdoor gym audit including the number of pieces and names of the equipment, and type of outdoor gym was undertaken in the month prior to data collection. Results: A total of 56¿h of observation periods were conducted, during which 2950 individuals were observed moving through the observation target areas. Across all parks, 3.8% of individuals (n = 112) were observed using the outdoor gyms for exercise purposes. Males (65%) were more likely to be observed using the equipment than females (35%) and there were more young-to-middle aged adult (83.9%) users than seniors (6.3%), adolescents (4.5%) and children (3.6%). Conclusion: Outdoor gyms have the potential to influence community-based physical inactivity rates as they appear to be a popular strategy by many government jurisdictions globally. To increase usage, local government agencies would benefit from working collaboratively with researchers to determine effective education and promotion strategies and in developing interventions to increase usage of outdoor gym equipment, particularly among women and older adults.

Type 2 diabetes mellitus (T2DM) accounts for approximately 90% of diabetes cases globally. Regular physical activity is regarded as one of the key components in T2DM management. Aerobic exercise was traditionally recommended; however, there is a growing body of research examining the independent effect of resistance training (RT) on glycemic control. This systematic review and meta-analysis aimed to conduct an update on the effects of RT on glycosylated hemoglobin (HbA1c) in adults with T2DM and examine the moderating effects of training effect (ie, muscular strength improvements), risk of bias and intervention duration. Peer-reviewed articles published in English were searched across MEDLINE, Embase, CINAHL, Scopus and SPORTDiscus from database inception until January 19, 2021. Each online database was systematically searched for randomized controlled trials reporting on the effects of RT on HbA1c in individuals with T2DM. Twenty studies (n=1172) were included in the meta-analysis. RT significantly reduced HbA1c compared with controls (weighted mean difference=-0.39, 95% CI -0.60 to -0.18, p<0.001, I 2 =69.20). Training effect significantly (p<0.05) moderated the results, with larger improvements in muscular strength leading to greater reductions in HbA1c (ß=-0.99, CI -1.97 to -0.01). Intervention duration and risk of bias did not significantly moderate the effects. As a secondary analysis, this study found no significant differences in HbA1c when comparing RT and aerobic training (p=0.42). This study demonstrates that RT is an effective strategy to decrease HbA1c in individuals with T2DM. Importantly, RT interventions that had a larger training effect appeared more effective in reducing HbA1c, compared with interventions producing medium and small effects. PROSPERO registration number CRD42020134046.

Background: ecofit is an evidence-based multi-component physical activity intervention that integrates smartphone technology, the outdoor environment, and social support. In a previous efficacy trial, significant improvements were found across several clinical, fitness, and mental health outcomes among adults at risk of (or with) type 2 diabetes. Methods: The aim of the present pilot study was to evaluate a number of patient-centered and feasibility outcomes of the ecofit intervention in a "real-world" setting, using a scalable implementation model. ecofit was adapted and implemented by a rural municipal council in the Upper Hunter Shire, New South Wales, Australia, and evaluated using a single-group pre-post design. Inactive middle-aged and older adults (N=59) were recruited and assessed at 6 (primary time-point) and 20 weeks (follow-up). Results: Improvements were found in this predominantly overweight and obese sample for aerobic fitness, functional mobility, upper and lower body muscular fitness, systolic blood pressure, and waist circumference at 6 weeks. At 20 weeks, effects were found for aerobic fitness, functional mobility, upper and lower body muscular fitness, and systolic blood pressure. Overall, participants were satisfied with the ecofit program. Participants attended the 6-week primary time-point (66.1%) and follow-up at 20 weeks (41.6%). Conclusions: Our findings support the preliminary effectiveness and feasibility of the ecofit intervention delivered by municipal council staff following a brief training from the research team. This study provides valuable preliminary evidence to support a larger implementation trial.

Purpose: To explore whether there was a difference in objectively measured physical activity and study participation between people who received their preferred study group allocation (matched) and those who did not receive their preferred study group (mismatched). Design: Secondary data from the NewCOACH randomized controlled trial. Setting: Insufficiently active patients in the primary care settings in Sydney and Newcastle, Australia. Participants: One hundred seventy-two adults aged 20 to 81 years. Intervention: Participants indicated their intervention preference at baseline for (1) five face-to-face visits with an exercise specialist, (2) one face-to-face visit and 4 telephone follow-ups with an exercise specialist, (3) written material, or (4) slight-to-no preference. Participants were then allocated to an intervention group and categorized as either "matched" or "mismatched" based on their indications. Participants who reported a slight-to-no preference was categorized as "matched." Measures: Daily step count as measured by pedometers and study participation. Analysis: Mean differences between groups in daily step count at 3 and 12 months (multiple linear regression models) and study participation at baseline, 3 months, and 12 months (¿2 tests). Results: Preference for an intervention group prior to randomization did not significantly (all P's >.05 using 95% confidence interval) impact step counts (differences of <600 steps/day between groups) or study participation. Conclusion: Future research should continue to address whether the strength of preferences influence study outcome and participation and whether the study preferences change over time.

Objectives: While outdoor gyms are being rapidly installed around the globe, little is known about their implications on physical activity, and fitness and other health-related outcomes. The primary objective of this systematic review was to examine the effects of outdoor gyms on physical activity, fitness and other health-related outcomes. Secondary objectives were to describe outdoor gym characteristics, user characteristics, and outdoor gym usage. Design: Systematic review. Methods: Peer-reviewed papers published in English were obtained through online database searches of the following databases; EBSCO, SPORTdiscus, Medline, PsycINFO, Web of Science, Scopus and Informit. Searches covered the periods from database inception to January 2019. Studies that reported on the efficacy of outdoor gym use for physical activity, health-related outcomes or descriptive aspects of outdoor gyms and their users were eligible for inclusion. Results: There was some support that outdoor gyms may improve physical activity, fitness and other health-related outcomes, however few experimental studies have been conducted. There was no consistency between outdoor gyms in terms types and number of installed equipment for each facility. Further, this review found discrepancies of whom were the most likely users of outdoor gyms and when they were mainly used. Conclusions: This review contributes to the limited evidence on the impact and characteristics of outdoor gyms on physical activity and fitness and health-related outcomes.

A robust finding in recognition memory is that performance declines monotonically across test trials. Despite the prevalence of this decline, there is a lack of consensus on the mechanism responsible. Three hypotheses have been put forward: (1) interference is caused by learning of test items (2) the test items cause a shift in the context representation used to cue memory and (3) participants change their speed-accuracy thresholds through the course of testing. We implemented all three possibilities in a combined model of recognition memory and decision making, which inherits the memory retrieval elements of the Osth and Dennis (2015) model and uses the diffusion decision model (DDM: Ratcliff, 1978) to generate choice and response times. We applied the model to four datasets that represent three challenges, the findings that: (1) the number of test items plays a larger role in determining performance than the number of studied items, (2) performance decreases less for strong items than weak items in pure lists but not in mixed lists, and (3) lexical decision trials interspersed between recognition test trials do not increase the rate at which performance declines. Analysis of the model's parameter estimates suggests that item interference plays a weak role in explaining the effects of recognition testing, while context drift plays a very large role. These results are consistent with prior work showing a weak role for item noise in recognition memory and that retrieval is a strong cause of context change in episodic memory.