Professor Ronald Plotnikoff

Participating in physical activity is beneficial for health. Whilst Aboriginal children possess high levels of physical activity, this declines rapidly by early adolescence. Low physical activity participation is a behavioral risk factor for chronic disease, which is present at much higher rates in Australian Aboriginal communities compared to non-Aboriginal communities. Through photos and ¿yarning¿, the Australian Aboriginal cultural form of conversation, this photovoice study explored the barriers and facilitators of sport and physical activity participation perceived by Aboriginal children (n = 17) in New South Wales rural communities in Australia for the first time and extended the limited research undertaken nationally. Seven key themes emerged from thematic analysis. Four themes described physical activity barriers, which largely exist at the community and interpersonal level of children¿s social and cultural context: The physical environment, high costs related to sport and transport, and reliance on parents, along with individual risk factors such as unhealthy eating. Three themes identified physical activity facilitators that exist at the personal, interpersonal, and institutional level: Enjoyment from being active, supportive social and family connections, and schools. Findings highlight the need for ongoing maintenance of community facilities to enable physical activity opportunities and ensure safety. Children held strong aspirations for improved and accessible facilities. The strength of friendships and the family unit should be utilized in co-designed and Aboriginal community-led campaigns.

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.

Objectives Some online, personally tailored, text-based physical activity interventions have proven effective. However, people tend to ¿ skim' and ¿ scan' web-based text rather than thoroughly read their contents. In contrast, online videos are more engaging and popular. We examined whether web-based personally tailored physical activity videos were more effective in promoting physical activity than personally tailored text and generic information. Methods 501 adults were randomised into a video-tailored intervention, text-tailored intervention or control. Over a 3-month period, intervention groups received access to eight sessions of web-based personally tailored physical activity advice. Only the delivery method differed between intervention groups: tailored video versus tailored text. The primary outcome was 7-day ActiGraph-GT3X+ measured moderate-to-vigorous physical activity (MVPA) assessed at 0, 3 and 9 months. Secondary outcomes included self-reported MVPA and website engagement. Differences were examined using generalised linear mixed models with intention-to-treat and multiple imputation. Results Accelerometer-assessed MVPA increased 23% in the control (1.23 (1.06, 1.43)), 12% in the text-tailored (1.12 (0.95, 1.32)) and 28% in the video-tailored (1.28 (1.06, 1.53)) groups at the 3-month follow-up only, though there were no significant between-group differences. Both text-tailored (1.77 (1.37, 2.28]) and video-tailored (1.37 (1.04, 1.79)) groups significantly increased self-reported MVPA more than the control group at 3 months only, but there were no differences between video-tailored and text-tailored groups. The video-tailored group spent significantly more time on the website compared with text-tailored participants (90 vs 77 min, p=0.02). Conclusions The personally tailored videos were not more effective than personally tailored text in increasing MVPA. The findings from this study conflict with pilot study outcomes and previous literature. Process evaluation and mediation analyses will provide further insights. Trial registration number ACTRN12615000057583

Understanding for whom behaviour change interventions work is important, however there is a lack of studies examining potential moderators in such interventions. This study investigated potential moderators on the effectiveness of a computer-tailored intervention to increase physical activity among Australian adults. People who had <150 min of moderate-vigorous physical activity (MVPA) a week, able to speak and read English, aged =18 years, lived in Australia, and had internet access were eligible to participate. Participants recruited through social media, emails, and third-party databases, were randomly assigned to either the control (n = 167) or intervention groups (n = 334). Physical activity was measured objectively by ActiGraph GT3X and also by self-report at baseline and three months. Three-way interaction terms were tested to identify moderators (i.e., demographic characteristics, BMI, and perceived neighbourhood walkability). The results showed that the three-way interaction was marginally significant for sex on accelerometer measured MVPA/week (p = 0.061) and steps/day (p = 0.047). The intervention appeared to be more effective for women compared to men. No significant three-way interactions were found for the other potential moderators. Strategies to improve levels of personalisation may be needed so that physical activity interventions can be better tailored to different subgroups, especially sex, and therefore improve intervention effectiveness.

Importance: Cardiorespiratory fitness is an important marker of childhood health and low fitness levels are a risk factor for disease later in life. Levels of children's fitness have declined in recent decades. Whether school-based physical activity interventions can increase fitness at the population level remains unclear. Objective: To evaluate the effect of an internet-based intervention on children's cardiorespiratory fitness across a large number of schools. Design, Setting, and Participants: In this cluster randomized clinical trial, 22 government-funded elementary schools (from 137 providing consent) including 1188 students stratified from grades 3 and 4 in New South Wales, Australia, were randomized. The other schools received the intervention but were not included in the analysis. Eleven schools received the internet-based intervention and 11 received the control intervention. Recruitment and baseline testing began in 2016 and ended in 2017. Research assistants, blinded to treatment allocation, completed follow-up outcome assessments at 12 and 24 months. Data were analyzed from July to August 2020. Interventions: The internet-based intervention included standardized online learning for teachers and minimal in-person support from a project mentor (9-10 months). Main Outcomes and Measures: Multistage 20-m shuttle run test for cardiorespiratory fitness. Results: Of 1219 participants (49% girls; mean [SD] age, 8.85 [0.71] years) from 22 schools, 1188 students provided baseline primary outcome data. At 12 months, the number of 20-m shuttle runs increased by 3.32 laps (95% CI, 2.44-4.20 laps) in the intervention schools and 2.11 laps (95% CI, 1.38-2.85 laps) in the control schools (adjusted difference = 1.20 laps; 95% CI, 0.17-2.24 laps). By 24 months, the adjusted difference was 2.22 laps (95% CI, 0.89-3.55 laps). The cost per student was AUD33 (USD26). Conclusions and Relevance: In this study, a school-based intervention improved children's cardiorespiratory fitness when delivered in a large number of schools. The low cost and sustained effect over 24 months of the intervention suggests that it may have potential to be scaled at the population level. Trial Registration: http://anzctr.org.au Identifier: ACTRN12616000731493.

Background: To examine if a composite activity-sleep behaviour index (ASI) mediates the effects of a combined physical activity and sleep intervention on symptoms of depression, anxiety, or stress, quality of life (QOL), energy and fatigue in adults. Methods: This analysis used data pooled from two studies: Synergy and Refresh. Synergy: Physically inactive adults (18¿65 years) who reported poor sleep quality were recruited for a two-arm Randomised Controlled Trial (RCT) (Physical Activity and Sleep Health (PAS; n = 80), or Wait-list Control (CON; n = 80) groups). Refresh: Physically inactive adults (40¿65 years) who reported poor sleep quality were recruited for a three-arm RCT (PAS (n = 110), Sleep Health-Only (SO; n = 110) or CON (n = 55) groups). The SO group was omitted from this study. The PAS groups received a pedometer, and accessed a smartphone/tablet ¿app¿ using behaviour change strategies (e.g., self-monitoring, goal setting, action planning), with additional email/SMS support. The ASI score comprised self-reported moderate-to-vigorous-intensity physical activity, resistance training, sitting time, sleep duration, efficiency, quality and timing. Outcomes were assessed using DASS-21 (depression, anxiety, stress), SF-12 (QOL-physical, QOL-mental) and SF-36 (Energy & Fatigue). Assessments were conducted at baseline, 3 months (primary time-point), and 6 months. Mediation effects were examined using Structural Equation Modelling and the product of coefficients approach (AB), with significance set at 0.05. Results: At 3 months there were no direct intervention effects on mental health, QOL or energy and fatigue (all p > 0.05), and the intervention significantly improved the ASI (all p < 0.05). A more favourable ASI score was associated with improved symptoms of depression, anxiety, stress, QOL-mental and of energy and fatigue (all p < 0.05). The intervention effects on symptoms of depression ([AB; 95%CI] -0.31; - 0.60,-0.11), anxiety (- 0.11; - 0.27,-0.01), stress (- 0.37; - 0.65,-0.174), QOL-mental (0.53; 0.22, 1.01) and ratings of energy and fatigue (0.85; 0.33, 1.63) were mediated by ASI. At 6 months the magnitude of association was larger although the overall pattern of results remained similar. Conclusions: Improvements in the overall physical activity and sleep behaviours of adults partially mediated the intervention effects on mental health and quality of life outcomes. This highlights the potential benefit of improving the overall pattern of physical activity and sleep on these outcomes. Trial registration: Australian New Zealand Clinical Trial Registry: ACTRN12617000680369; ACTRN12617000376347. Universal Trial number: U1111¿1194-2680; U1111¿1186-6588. Human Research Ethics Committee Approval: H-2016-0267; H-2016¿0181.

Background Cardiorespiratory fitness (CRF) is an important marker of current and future health status. The primary aim of our study was to evaluate the impact of a time-efficient school-based intervention on older adolescents' CRF. Methods Two-arm cluster randomised controlled trial conducted in two cohorts (February 2018 to February 2019 and February 2019 to February 2020) in New South Wales, Australia. Participants (N=670, 44.6% women, 16.0±0.43 years) from 20 secondary schools: 10 schools (337 participants) were randomised to the Burn 2 Learn (B2L) intervention and 10 schools (333 participants) to the control. Teachers in schools allocated to the B2L intervention were provided with training, resources, and support to facilitate the delivery of high-intensity interval training (HIIT) activity breaks during curriculum time. Teachers and students in the control group continued their usual practice. The primary outcome was CRF (20 m multi-stage fitness test). Secondary outcomes were muscular fitness, physical activity, hair cortisol concentrations, mental health and cognitive function. Outcomes were assessed at baseline, 6 months (primary end-point) and 12 months. Effects were estimated using mixed models accounting for clustering. Results We observed a group-by-time effect for CRF (difference=4.1 laps, 95% CI 1.8 to 6.4) at the primary end-point (6 months), but not at 12 months. At 6 months, group-by-time effects were found for muscular fitness, steps during school hours and cortisol. Conclusions Implementing HIIT during curricular time improved adolescents' CRF and several secondary outcomes. Our findings suggest B2L is unlikely to be an effective approach unless teachers embed sessions within the school day. Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN12618000293268).

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.

Background: Substantial evidence links activity domains with health and well-being; however, research has typically examined time-use behaviors independently, rather than considering daily activity as a 24-hour time-use composition. This study used compositional data analysis to estimate the difference in physical and mental well-being associated with reallocating time between behaviors. Methods: Participants (n = 430; 74% female; 41 [12] y) wore an accelerometer for 7 days and reported their body mass index; health-related quality of life (QoL); and symptoms of depression, anxiety, and stress. Regression models determined whether time-use composition, comprising sleep, sedentary behavior, light physical activity (LPA), and moderate to vigorous physical activity (MVPA), was associated with well-being. Compositional isotemporal substitution models estimated the difference in well-being associated with reallocating time between behaviors. Results: Time-use composition was associated with body mass index and physical health-related QoL. Reallocating time to MVPA from sleep, sedentary behavior, and LPA showed favorable associations with body mass index and physical health-related QoL, whereas reallocations from MVPA to other behaviors showed unfavorable associations. Reallocations from LPA to sedentary behavior were associated with better physical health¿related QoL and vice versa. Conclusion: Results reinforce the importance of MVPA for physical health but do not suggest that replacing sedentary behavior with LPA is beneficial for health and well-being.

Objectives: Examining mediators of intervention efficacy in an m-health intervention targeting physical activity and sleep in 160 Australian adults. Design: Nationwide randomised controlled trial. Main outcome measures: Moderate- and vigorous-intensity physical activity (MVPA), assessed using the Active Australia Questionnaire; sleep quality (Pittsburgh Sleep Quality Index); and sleep hygiene practices (Sleep Hygiene Index). Hypothesised psychosocial (e.g. self-efficacy) and behavioural (i.e. MVPA, sleep quality, sleep hygiene) mediators were tested on primary endpoint data at 3 months using bias-corrected bootstrapping (PROCESS 2 for SPSS). All outcomes and mediators were assessed using self-report. Results: At three months, the intervention had significantly improved sleep quality (d = 0.48, 95% CI: -2.26, -0.33, p = 0.009) and sleep hygiene (d = 0.40, 95% CI: -3.10, -0.19, p = 0.027). Differences in MVPA were not significant (d = 0.24, 95% CI: -35.53, 254.67, p = 0.139). Changes in MVPA were mediated by self-efficacy, perceived capability, environment, social support, intentions and planning, some of which showed inconsistent mediation (suppression). None of the hypothesised psychosocial factors mediated sleep outcomes. Changes in sleep hygiene mediated changes in sleep quality. Conclusions: Several psychosocial factors mediated changes in physical activity but not in sleep outcomes. Mediation effects of sleep hygiene on sleep quality highlight the importance of providing evidence-based strategies to improve sleep quality.

Background Poor sleep health is highly prevalent. Physical activity is known to improve sleep quality but not specifically targeted in sleep interventions. Purpose To compare the efficacy of a combined physical activity and sleep intervention with a sleep-only intervention and a wait-list control, for improving sleep quality in middle-aged adults without a diagnosed sleep disorder. Methods Three-arm randomized controlled trial (Physical Activity and Sleep Health (PAS), Sleep Health Only (SO), Wait-list Control (CON) groups; 3-month primary time-point, 6-month follow-up) of 275 (PAS = 110, SO = 110, CON = 55) inactive adults (40¿65 years) reporting poor sleep quality. The main intervention component was a smartphone/tablet ¿app¿ to aid goal setting and self-monitoring physical activity and/or sleep hygiene behaviors (including stress management), and a pedometer for PAS group. Primary outcome was Pittsburgh Sleep Quality Index (PSQI) global score. Secondary outcomes included several self-reported physical activity measures and PSQI subcomponents. Group differences were examined stepwise, first between pooled intervention (PI = PAS + SO) and CON groups, then between PAS and SO groups. Results Compared with CON, PI groups significantly improved PSQI global and subcomponents scores at 3 and 6 months. There were no differences in sleep quality between PAS and SO groups. The PAS group reported significantly less daily sitting time at 3 months and was significantly more likely to report =2 days/week resistance training and meeting physical activity guidelines at 6 months than the SO group. Conclusions PIs had statistically significantly improved sleep quality among middle-aged adults with poor sleep quality without a diagnosed sleep disorder. The adjunctive physical activity intervention did not additionally improve sleep quality.

Objectives: Supporting healthy ageing is a key priority worldwide. Physical activity, diet quality and sleep are all associated with health outcomes, but few studies have explored their independent associations with all-cause mortality in an older population in the same model. The study aim was to examine associations between step-count, self-reported diet quality, restless sleep, and all-cause mortality in adults aged 55¿85 years. Design: A prospective cohort study of adults in Newcastle, New South Wales, Australia. Method: Data were from 1697 participants (49.3% women; baseline mean age 65.4 ± 7.1 years). Daily steps (measured by pedometer), diet quality (from a modified Australian Recommended Food Score), and frequency of restless sleep (by self-report) were assessed in relation to all-cause mortality using Cox proportional hazard regression with adjustment for sex, age, household income and smoking. Baseline data were collected between January 2005 and April 2008, and last follow-up was in March 2017 (median follow-up 9.6 years). Results: Higher step count (HR: 0.93, 95%CI: 0.88¿0.98 per 1000-step increment) and higher diet quality (HR: 0.86, 95%CI: 0.74¿0.99 per 8-point increment in diet quality score) were associated with reduced mortality risk. Restless sleep for =3 nights/week was not associated with mortality risk (HR: 1.03, 95%CI: 0.78¿1.39). Sensitivity analyses, adjusting for chronic disease and excluding deaths <1 year after baseline, did not change these estimates. Conclusions: Increased daily steps and consumption of a greater variety of nutrient-dense foods every week would result in substantial health benefits for older people. Future research should include a greater variety of sleep measures.

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.

Introduction: Appealing approaches to increasing physical activity levels are needed. This study evaluated whether a social and gamified smartphone app (Active Team) could be one such approach. Study design: A 3-group cluster RCT compared the efficacy of Active Team with a basic self-monitoring app and waitlist control group. Setting/participants: Australian adults (N=444, mean age of 41 years, 74% female) were recruited in teams (n=121) and randomly assigned (1:1:1) to the Active Team (n=141, 39 teams), self-monitoring app (n=160, 42 teams), or waitlist group (n=143, 40 teams). Data were collected in 2016¿2017, and analysis was conducted in 2018¿2019. Intervention: Active Team is a 100-day app-based, gamified, online social networking physical activity intervention. Main outcome measures: The primary outcome was change in objective physical activity from baseline to 3-month follow-up. Secondary outcomes included objective physical activity at 9 months and self-reported physical activity, quality of life, depression, anxiety and stress, well-being, and engagement. Results: Mixed models indicated no significant differences in objective physical activity between groups at 3 (F=0.17, p=0.84; Cohen's d=0.03, 95% CI= -0.21, 0.26) or 9 months (F=0.23, p=0.92; d=0.06, 95% CI= -0.17, 0.29) and no significant differences for secondary outcomes of quality of life, depression, anxiety and stress, or well-being. Self-reported moderate-to-vigorous physical activity was significantly higher in the Active Team group at the 9-month follow-up (F=3.05, p=0.02; d=0.50, 95% CI=0.26, 0.73). Engagement was high; the Active Team group logged steps on an average of 72 (SD=35) days and used the social and gamified features an average of 89 (SD=118) times. Conclusions: A gamified, online social networking physical activity intervention did not change objective moderate-to-vigorous physical activity, though it did increase self-reported moderate-to-vigorous physical activity and achieve high levels of engagement. Future work is needed to understand if gamification, online social networks, and app-based approaches can be leveraged to achieve positive behavior change. Trial registration: This study is registered at Australian and New Zealand Clinical Trial Registry (protocol: ANZCTR12617000113358).

Humans in the industrialized world spend a large amount of daily time in sedentary behavior. Since sedentariness negatively impacts a variety of psychophysiological outcomes, the identification of antecedents that lead to sedentary behavior is an important public health issue. In this context, mood, a central indicator for both psychological well-being and mental health, is severely understudied. To investigate whether mood dimensions influence subsequent sedentary behavior, we assessed both constructs at baseline via questionnaires and via ambulatory assessment (AA) over 5¿days in 92 university employees. We continuously measured sedentary behavior using accelerometers and assessed mood repeatedly 10 times each day on smartphone diaries. We employed multiple regression analyses to analyze between-subject effects and multilevel modeling to analyze within-subject effects. Higher momentary ratings of valence (P¿<.05) and energetic arousal (P¿<.01) predicted lower amounts of subsequent sedentary behavior, whereas higher ratings of calmness (P¿<.01) predicted higher amounts of subsequent sedentary behavior. The context moderated the effect of energetic arousal and calmness on sedentary behavior with increased effects in the home compared to the work context. Mood significantly predicted sedentary behavior on a within-subject level but not on a between-subject level. Preliminary evidence suggests that mood regulates sedentary behavior in everyday life. Time-sensitive analyses, such as from moment to moment revealed an association between mood and sedentary behavior (within-subject), whereas analyses between different individuals revealed no associations (between-subject). These preliminary findings may inform multicomponent intervention strategies that target mood, to reduce sedentary behavior in daily life.

Background: This study examined the criterion validity of the online Active Australia Survey, using accelerometry as the criterion, and whether self-report bias was related to level of activity, age, sex, education, body mass index and health-related quality of life. Methods: The online Active Australia Survey was validated against the GENEActiv accelerometer as a direct measure of activity. Participants (n = 344) wore an accelerometer for 7 days, completed the Active Australia Survey, and reported their health and demographic characteristics. A Spearman's rank coefficient examined the association between minutes of moderate-to-vigorous physical activity recorded on the Active Australia Survey and GENEActiv accelerometer. A Bland-Altman plot illustrated self-report bias (the difference between methods). Linear mixed effects modelling was used to examine whether participant factors predicted self-report bias. Results: The association between moderate-to-vigorous physical activity reported on the online Active Australia Survey and accelerometer was significant (r s =.27, p <.001). Participants reported 4 fewer minutes per day on the Active Australia Survey than was recorded by accelerometry (95% limits of agreement -104 - 96 min) but the difference was not significant (t(343) = -1.40, p =.16). Self-report bias was negatively associated with minutes of accelerometer-recorded moderate-to-vigorous physical activity and positively associated with mental health-related quality of life. Conclusions: The online Active Australia Survey showed limited criterion validity against accelerometry. Self-report bias was related to activity level and mental health-related quality of life. Caution is recommended when interpreting studies using the online Active Australia Survey.

Background: Homophily is the tendency to associate with friends similar to ourselves. This study explored the effects of homophily on team formation in a physical activity challenge in which ¿captains¿ signed up their Facebook friends to form teams. Methods: This study assessed whether participants (n = 430) were more similar to their teammates than to nonteammates with regard to age, sex, education level, body mass index, self-reported and objectively measured physical activity, and negative emotional states; and whether captains were more similar to their own teammates than to nonteammates. Variability indices were calculated for each team, and a hypothetical variability index, representing that which would result from randomly assembled teams, was also calculated. Results: Within-team variability was less than that for random teams for all outcomes except education level and depression, with differences (SDs) ranging from +0.15 (self-reported physical activity) to +0.47 (age) (P < .001 to P = .001). Captains were similar to their teammates except in regard to age, with captains being 2.6 years younger (P = .003). Conclusions: Results support hypotheses that self-selected teams are likely to contain individuals with similar characteristics, highlighting potential to leverage team-based health interventions to target specific populations by instructing individuals with risk characteristics to form teams to help change behavior.

Empirical evidence shows that physical behavior positively impacts human health. Recently, researchers have started to differentiate between physical activity and sedentary behavior showing independent effects on somatic health. However, whether this differentiation is also relevant for mood dimensions is largely unknown. For investigating the dynamic relationships between sedentary behavior and mood dimensions in daily life, ambulatory assessment (AA) has become the state-of-the-art methodology. To investigate whether sedentary behaviors influence mood dimensions, we conducted an AA study in the everyday life of 92 university employees over 5¿days. We continuously measured sedentary behavior via accelerometers and assessed mood repeatedly 10 times each day on smartphone diaries. To optimize our sampling strategy, we used a sophisticated sedentary-triggered algorithm. We employed multilevel modeling to analyze the within-subject effects of sedentary behavior on mood. Sedentary time (15-minute intervals prior to each e-diary assessment) and sedentary bouts (30-minute intervals of uninterrupted sedentary behavior) negatively influenced valence and energetic arousal (all Ps¿<¿0.015). In particular, the more participants were sedentary in their everyday life, the less they felt well and energized. Exploratory analyses of the temporal course of these effects supported our findings. Sedentary behavior can be seen as a general risk factor because it impacts both somatic and mental health. Most importantly, physical activity and sedentary behavior showed independent effects on mood dimensions. Accordingly, future studies should consider the two sides of the physical behavior coin: How should physical activity be promoted? and How can sedentary behavior be reduced?.

Background: The study aim was to examine the mechanisms of physical activity behaviour change in the multi-component eCoFit randomised controlled trial (RCT) among adults diagnosed with, or at risk of, T2D. Method: The RCT included two phases: phase 1 (weeks 1¿10) integrated group sessions (outdoor physical activity and cognitive mentoring) and the use of the eCoFit smartphone application (app), and phase 2 (weeks 11¿20), which included the use of the eCoFit smartphone application only. Participants (n = 84) were assessed at baseline and 10 and 20¿weeks from baseline. Physical activity was assessed using pedometers, and the following mediators were tested: action self-efficacy, barrier self-efficacy, recovery self-efficacy, implementation intentions, intention to have regular physical activity, outcome expectations, risk perception and implicit associations related to physical activity. The PROCESS INDIRECT Macro was used to perform mediation analyses. Results: Significant mediation pathways were found for implementation intention measured at 10¿weeks, AB (95% CI = 486.04 [128.19, 1073.42]). No significant pathways were found for the other social¿cognitive and implicit attitudinal mediators. Conclusion: Increased daily steps among the intervention participants were explained by increased implementation intentions. The eCoFit study successfully operationalised implementation intentions in the smartphone app designed to promote outdoor physical activity. Trial Registration: The trial was approved by a University Human Research Committee and is registered with the Australian New Zealand Clinical Trial Registry (ACTRN12615000990527).

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.

Objective: To evaluate the effectiveness of interventions targeting alcohol consumption, drug use and smoking for college/university students.Participants: College/University students.Methods: Studies were eligible if: (1)included students attending universities/colleges; (2)implemented in a university/college setting; (3)aimed to improve at least one of the following behaviors: alcohol and/or drug use and/or smoking; (4)were RCTs. The effect of the interventions on behaviors was determined by the percentage of studies that reported an effect. Due to the heterogeneity of outcomes meta-analysis was not conducted.Results: 88 studies met criteria. University-based interventions were effective for reducing alcohol-related outcomes (drinking patterns, BAC, consequences, problem drinking). Inconsistent findings for drug and smoking were observed.Conclusions: University-based interventions have the potential to improve health for students. While there is a breadth of research examining the efficacy of interventions to reduce alcohol consumption, further research is needed to determine the best approach for addressing smoking and drug use among students.

Healthy Dads Healthy Kids (HDHK) was the first program internationally to specifically target overweight and obese fathers to improve their children's health. In previous randomized controlled trials, HDHK generated meaningful short-Term improvements in the adiposity, physical activity, and eating behaviors of both fathers and children. The aim of this dissemination trial was to evaluate the 12-month impact of HDHK when delivered by trained facilitators across four low socioeconomic and regional communities in the Hunter Region, Australia. The study was a nonrandomized, prospective trial with minimal eligibility criteria (i.e., father body mass index [BMI] ? 25 kg/m2 and children aged 4-12 years). HDHK included eight weekly practical and theoretical sessions. Assessments were baseline, 3 months (post-intervention), 6-months, and 12-months. The primary outcome was fathers' weight. Secondary outcomes included child BMI z-score and validated lifestyle behavior measures (e.g., physical activity, diet). Overall, 189 fathers (mean age: 40.2 years, BMI: 32.6 kg/m2) and 306 children (mean age: 8.1 years) participated in one of 10 HDHK programs in four areas. Intention-To-Treat linear mixed models revealed a significant mean reduction in fathers' weight at post-intervention (?3.6 kg, 95% confidence interval: ?4.3, ?2.9), which was maintained at 12 months (71% retention). Corresponding improvements were also detected in children's BMI z-score and a range of lifestyle behaviors for both fathers and children. Attendance and satisfaction levels were high. Positive intervention effects observed in previous randomized controlled trials were largely replicated and sustained for 12 months when HDHK was delivered by trained local facilitators in underserved communities. Further investigation into the key systems, processes, and contextual factors required to deliver HDHK at scale appears warranted.

High Intensity Interval Training (HIIT) may be effective for accumulating VPA. However, the contribution of HIIT to overall physical activity is unknown. Our primary aim was to explore the impact of school-based HIIT on physical activity. The secondary aim was to explore within-individual changes in physical activity after participating in HIIT. Participants [n = 65; 15.8(0.6)years] were randomized to a HIIT or control group. Intervention groups participated in three HIIT sessions/week. GENEActiv accelerometers assessed objective physical activity at baseline and week-one, to detect changes in MPA and VPA. Intervention effects were examined using linear mixed models and evidence of a change in physical activity (i.e., compensation) were examined using multilevel linear regression models. The group-by-time interaction effects for MPA and VPA were small and moderate, respectively. Adjusted difference between groups for VPA was 1.70 min/day, 95%CI ¿1.96 to 5.36; p = 0.354; d = 0.55). Embedding HIIT within the school-day had a moderate effect on VPA compared to controls. Compensation analyses (i.e., individual level) suggested that adolescents were more active on days when they participated in HIIT. Further studies are needed to test the effects of HIIT on adolescents¿ physical activity over extended time periods.

Objective: Interventions to promote physical activity for sedentary patients seen in general practice may be a way to reduce the burden of chronic disease. Coaching by an exercise physiologist is publicly funded in Australia, but cost effectiveness has not been documented. Methods: In a three-arm randomised controlled trial, face-to-face coaching and telephone coaching over 12 weeks were compared with a control group using the outcome of step count for one week at baseline, three months and twelve months. Program costs and time-based costs were considered. Quality of life was measured as a secondary outcome. Results: At 12 months, the intervention groups were more active than controls by 1,002 steps per day (95%CI 244, 1,759). This was achieved at a cost of AUD$245 per person. There was no change in reported quality of life or utility values. Conclusion: Coaching achieved a modest increase in activity equivalent to 10 minutes walking per day, at a cost of AUD$245 per person. Face-to-face and telephone counselling were both effective. Implication for public health: Persistence of increases nine months after the end of coaching suggests it creates long-term change and is a good value health intervention.

Objective: To explore young people¿s perceptions of pedometers and investigate behaviours exhibited while being monitored. Design: Qualitative design using six focus groups with participants (mean age 14.7 years). Setting: Study participants (n = 24) were randomly selected from a previous study of 123 young people aged 14¿15 years from three secondary schools in New South Wales (NSW), Australia. Methods: Participants wore pedometers (Yamax CW700) and accelerometers (ActiGraph GT3X+) simultaneously for 7 days. Accelerometer output was used to categorise participants into one of six focus groups (three boys groups and three girls groups): (1) low active (<30 minutes moderate to vigorous physical activity [MVPA]/day), (2) medium active (30¿60 minutes MVPA/day), and (3) high active (=60 minutes MVPA/day). Participants were questioned on their perceptions of the monitoring process and the behaviours that they exhibited while wearing pedometers. A hybrid approach to data analysis identified key concepts, which were thematically analysed. Results: The two main themes identified were (1) participants¿ perceptions of the monitoring process and (2) behaviour exhibited while being monitored. Overall, participants¿ attitudes towards objective monitoring were positive. A large proportion reported changing their levels of physical activity during the monitoring process, and 87.5% of focus group participants reported shaking their pedometers to increase their step counts. The medium and high active groups reported changing their activity patterns more than the low active groups. Conclusion: Our findings are consistent with previous quantitative studies that suggest reactivity and tampering are commonplace among young people. Pedometers may have more utility as an intervention strategy for increasing activity rather than as a method for assessing habitual activity levels.

Purpose: Guidelines recommend that young people engage in muscle-strengthening activities on at least 3 dIwkj1. The purpose of this study was to examine the effect of a school-based intervention focused on resistance training (RT) for adolescents. Methods: The ''Resistance Training for Teens'' intervention was evaluated using a cluster-randomized, controlled trial with 607 adolescents (50.1% girls; 14.1 T 0.5 yr) from 16 secondary schools. Teachers were trained to deliver the intervention, which included the following: (i) an interactive student seminar; (ii) a structured physical activity program, focused on RT; (iii) lunchtime fitness sessions; and (iv) Web-based smartphone apps. The primary outcome was muscular fitness (MF) and secondary outcomes included body mass index, RT skill competency, flexibility, physical activity, self-efficacy, and motivation. Assessments were conducted at baseline, 6 months (postprogram; primary end point), and 12 months (follow-up). Outcomes were assessed using linear mixed models, with three potential moderators tested using interaction terms (and subgroup analyses where appropriate). Results: For the primary outcome (MF), a group-time effect was observed at 6 months for the upper body (2.0 repetitions; 95% confidence interval (CI), 0.8-3.2), but not the lower body (j1.4 cm; 95% CI, j4.7-1.9). At 6 months, there were intervention effects for RT skill competency and self-efficacy, but no other secondary outcomes. Effects for upper body MF and RT skill competency were sustained at 12 months. Despite overall no effect for body mass index, there was a group-time effect at 12 months among students whowere overweight/obese at baseline (j0.55 kgImj2; 95% CI, j1.01 toj0.08). Conclusions: The school-based RT intervention resulted in immediate and sustained improvements in upper body MF and RT skill competency, demonstrating an effective and scalable approach to delivering RT within secondary schools.

Introduction The primary aim was to examine longitudinal associations between changes in screen-time and mental health outcomes among adolescents. Methods Adolescents (N¿=¿322, 65.5% females, mean age¿=¿14.4¿±¿0.6 years) reported screen-time and mental health at two time points over a school year. Multi-level linear regression analyses were conducted after adjusting for covariates. Results Changes in total recreational screen-time (ß¿=¿-0.09 p¿=¿0.048) and tablet/mobile phone use (ß¿=¿-0.18, p¿<¿0.001) were negatively associated with physical self-concept. Changes in total recreational screen-time (ß¿=¿-0.20, p¿=¿0.001) and computer use (ß¿=¿-0.23, p¿=¿0.003) were negatively associated with psychological well-being. A positive association was found with television/DVD use and psychological difficulties (ß¿=¿0.16, p¿=¿0.015). No associations were found for non-recreational screen-time. Conclusion Changes in recreational screen-time were associated with changes in a range of mental health outcomes.

Objective To determine the comparability and feasibility of wrist- and hip-worn accelerometers among free-living adolescents. Design 89 adolescents (age = 13¿14 years old) from eight secondary schools in New South Wales (NSW), Australia wore wrist-worn GENEActiv and hip-worn ActiGraph (GT3X+) accelerometers simultaneously for seven days and completed an accelerometry behavior questionnaire. Methods Bivariate correlations between the wrist- and hip-worn out-put were used to determine concurrent validity. Paired samples t-test were used to compare minutes per day in moderate-to-vigorous physical activity (MVPA). Group means and paired sample t-tests were used to analyze participants¿ perceptions of the wrist- and hip-worn monitoring protocols to assist with determining the feasibility. Results Wrist-worn accelerometry compared favorably with the hip-worn in average activity (r = 0.88, p < 0.001) and MVPA (r = 0.84 p < 0.001, mean difference = 3.54 min/day, SD = 12.37). The wrist-worn accelerometer had 50% fewer non-valid days (75 days, 12%) than the hip-worn accelerometer (n = 152, 24.4%). Participants reported they liked to wear the device on the wrist (p < 0.01), and that it was less uncomfortable (p = 0.02) and less embarrassing to wear on the wrist (p < 0.01). Furthermore, that they would be more willing to wear the device again on the wrist over the hip (p < 0.01). Conclusions Our findings reveal there is a strong linear relationship between wrist- and hip-worn accelerometer out-put among adolescents in free-living conditions. Adolescent compliance was significantly higher with wrist placement, with participants reporting that it was more comfortable and less embarrassing to wear on the wrist.

The risk and prevalence of Type 2 Diabetes (T2D) has dramatically increased over the past decade. The aim of this study was to develop, implement and evaluate a physical activity intervention to improve aerobic and muscular fitness among adults at risk of, or diagnosed with T2D. A 20-week, assessor blinded, parallel-group randomized controlled trial (RCT) was conducted at the University of Newcastle (June¿December 2015). Adults were randomized to the intervention (n = 42) or wait-list control group (n = 42). The theory-based intervention included: Phase 1 (weeks 1¿10) integrated group sessions (outdoor physical activity and cognitive mentoring), and the eCoFit smartphone application (app). Phase 2 (weeks 11¿20) only included the eCoFit app. Participants were assessed at baseline, 10 weeks and 20 weeks. Linear mixed models (intention-to-treat) were used to determine group-by-time interactions at 10 weeks (primary time-point) and 20 weeks for the primary outcomes. Several secondary outcomes were also assessed. After 10 weeks, significant group-by-time effects were observed for aerobic fitness (4.5 mL/kg/min; 95% CI [1.3, 7.7], d = 0.68) and muscular fitness (lower body) (3.4 reps, 95% CI [2.7, 4.2], d = 1.45). Intervention effects for secondary outcomes included significant increased physical activity (1330 steps/week), improved upper body muscular fitness (5 reps; arm-curl test), improved functionality (- 1.8 s; timed-up and go test) reduced waist circumference (2.8 cm) and systolic blood pressure (- 10.4 mm Hg). After 20 weeks, significant effects were observed for lower body muscular fitness and health outcomes. eCoFit is an innovative lifestyle intervention which integrates smartphone technology, social support, and the outdoor environment to improve aerobic and muscular fitness.

Objective Regular participation in resistance training (RT) is critical to health and recommended in most international physical activity guidelines. Few people, however, participate in RT. The purpose of this review was to assess the demographic, behavioural, intrapersonal, interpersonal and environmental factors associated with participating in RT. Data sources Eligible studies were from English peer-reviewed published articles that examined correlates or determinants of RT in adult samples. Searches were performed from August 2015 to April 2016 in six databases. Results We identified 51 independent data sets, from nine countries, primarily of moderate to high quality, and 23 factors related to participating in RT. Education, perceived health status, quality of life, affective judgements, self-efficacy, intention, self-regulation behaviours, subjective norm and programme leadership were associated with RT. Conclusion Low education levels and poor health status were associated with low participation rates in RT. Intrapersonal factors including affective judgements, self-efficacy, and self-regulation behaviours, and interpersonal factors including subjective norms and programme leadership may be important for promoting RT behaviours.

Introduction Primary care physicians are well placed to offer physical activity counseling, but insufficient time is a barrier. Referral to an exercise specialist is an alternative. In Australia, exercise specialists are publicly funded to provide face-to-face counseling to patients who have an existing chronic illness. This trial aimed to (1) determine the efficacy of primary care physicians¿ referral of insufficiently active patients for counseling to increase physical activity, compared with usual care, and (2) compare the efficacy of face-to-face counseling with counseling predominantly via telephone. Study design Three-arm pragmatic RCT. Setting/participants Two hundred three insufficiently active (<7,000 steps/day) primary care practice patients (mean age 57 years; 70% female) recruited in New South Wales, Australia, in 2011¿2014. Intervention (1) Five face-to-face counseling sessions by an exercise specialist, (2) one face-to-face counseling session followed by four telephone calls by an exercise specialist, or (3) a generic mailed physical activity brochure (usual care). The counseling sessions operationalized social cognitive theory via a behavior change counseling framework. Main outcome measures Change in average daily step counts between baseline and 12 months. Data were analyzed in 2016. Results Forty (20%) participants formally withdrew; completion rates at 3 and 6 months were 64% and 58%, respectively. Intervention attendance was high (75% received five sessions). The estimated mean difference between usual care and the combined intervention groups at 12 months was 1,002 steps/day (95% CI=244, 1,759, p=0.01). When comparing face-to-face with predominantly telephone counseling, the telephone group had a non-significant higher mean daily step count (by 619 steps) at 12 months. Conclusions Provision of expert physical activity counseling to insufficiently active primary care patients resulted in a significant increase in physical activity (approximately 70 minutes of walking per week) at 12 months. Face-to-face only and counseling conducted predominantly via telephone were both effective. This trial provides evidence to expand public funding for expert physical activity counseling and for delivery via telephone in addition to face-to-face consultations. Trial registration This trial is registered at www.anzctr.org.au/ ACTRN12611000884909.

The mechanisms of behavior change in youth screen-time interventions are poorly understood. Participants were 361 adolescent boys (12¿14¿years) participating in the ATLAS obesity prevention trial, evaluated in 14 schools in low-income areas of New South Wales, Australia. Recreational screen-time was assessed at baseline, 8- and 18-months, whereas potential mediators (i.e., motivation to limit screen-time and parental rules) were assessed at baseline, 4- and 18-months. Multi-level mediation analyses followed the intention-to-treat principle and were conducted using a product-of-coefficients test. The intervention had a significant impact on screen-time at both time-points, and on autonomous motivation at 18-months. Changes in autonomous motivation partially mediated the effect on screen-time at 18-months in single and multi-mediator models [AB (95% CI)¿=¿-5.49 (-12.13, -.70)]. Enhancing autonomous motivation may be effective for limiting screen-time among adolescent males. Trial registration: Australian New Zealand Clinical Trials Registry No: ACTRN12612000978864.

Purpose: The aim of this study was to identify demographic, clinical, psychosocial, and environmental correlates of objectively assessed physical activity among breast cancer survivors. Methods: Baseline data were utilized from 574 female breast cancer survivors who participated in three different intervention studies: Resistance and Endurance exercise After ChemoTherapy (REACT), Exercise and Nutrition Routine Improving Cancer Health (ENRICH), and Move More for Life (MM4L). Participants were eligible if they were aged =18¿years and had completed primary cancer treatment. Physical activity was objectively assessed by accelerometers or pedometers. Participants completed self-reported questionnaires on demographic, psychosocial, and environmental factors. Information regarding clinical factors was obtained from medical records or patient self-report. Multivariable linear regression analyses were applied on the pooled dataset to identify factors that were significantly correlated with physical activity. In addition, the explained variance of the model was calculated. Results: The multivariable regression model revealed that older age, (ß¿=¿-0.01, 95¿%CI¿=¿-0.02; -0.003), higher body mass index (ß¿=¿-0.05, 95¿%CI¿=¿-0.06; -0.03), lower self-efficacy (ß¿=¿0.2, 95¿%CI¿=¿0.08; 0.2), and less social support (ß¿=¿0.1, 95¿%CI¿=¿0.05; 0.2) were significantly correlated with lower physical activity. This model explained 15¿% of the variance in physical activity. Conclusion: Age, body mass index, self-efficacy, and social support were significantly correlated with objectively assessed physical activity in breast cancer survivors. It may therefore be recommended that physical activity intervention studies in these women target those who are older, and have a higher body mass index, and should operationalize behavior change strategies designed to enhance self-efficacy and social support. Trial registration: The REACT study is registered at the Netherlands Trial Register [NTR2153]. The ENRICH study is registered at Australian New Zealand Clinical Trials Register [ANZCTRN12609001086257]. And the MM4L study is registered at Australian New Zealand Clinical Trials Register [ACTRN12611001061921]

Youth participation in organised sport and physical activity is important for healthy development, growth and wellbeing. In 2014, Active Healthy Kids Australia released its inaugural Report Card on Physical Activity for Children and Young People, which synthesised the best available national- and state-level data for children and young people (<18 years). This paper provides a more detailed examination of the evidence informing the grade for Organised Sport from the 2014 Report Card, compares Australia's Organised Sport grade with other countries, identifies future directions for research and surveillance, and explores possible beneficial strategies. The Report Card highlighted that between 64% and 85% of Australians aged 5-17 years participate in organised sports, a rate higher than alternate forms of physical activity such as active transportation, active play and school based physical activity. This finding reflects Australia's position as one of the global leaders for participating in organised sport. Future research and surveillance methodologies however, need to incorporate standardised metrics that aim to capture more detailed data regarding organised sport participation. Facilitating access for all children and preventing dropout from organised sports are important initiatives to improve current levels of sport participation. However, given that 80% of Australians aged 5-17 years are not sufficiently physically active to achieve the daily recommendation, participation in sport alone is not enough to ensure that children can accrue the health benefits associated with being physically active. As such, there is a pressing need to develop strategies that engage children in other forms of physical activity such as active transportation and active play.

Introduction The primary objective was to evaluate the impact of the ¿Switch-off 4 Healthy Minds¿ (S4HM) intervention on recreational screen-time in adolescents. Methods Cluster randomized controlled trial with study measures at baseline and 6-months (post-intervention). Eligible participants reported exceeding recreational screen-time recommendations (i.e., >¿2¿h/day). In total, 322 adolescents (mean age¿=¿14.4¿±¿0.6¿years) from eight secondary schools in New South Wales, Australia were recruited. The S4HM intervention was guided by Self-Determination Theory and included: an interactive seminar, eHealth messaging, a behavioral contract and parental newsletters. The primary outcome was recreational screen-time. Secondary outcomes included mental health (i.e., well-being, psychological distress, self-perceptions), objectively measured physical activity, and body mass index (BMI). Outcome analyses were conducted using linear mixed models and mediation was examined using a product-of-coefficients test. Results At post-intervention, significant reductions in screen-time were observed in both groups, with a greater reduction observed in the intervention group (-¿50¿min/day versus -¿29¿min, p¿<¿0.05 for both). However, the adjusted difference in change between groups was not statistically significant (mean¿=¿-¿21.3¿min/day, p¿=¿0.255). There were no significant intervention effects for mental health outcomes, physical activity or BMI. Significant mediation effects for autonomous motivation were found. Conclusions Participants in both the S4HM intervention and control groups significantly reduced their screen-time, with no group-by-time effects. Enhancing autonomous motivation might be a useful intervention target for trials aimed at reducing adolescents' recreational screen-time. Trial registration ACTRN12614000163606.

Physical inactivity is a leading contributor to the burden of disease in men. Social¿cognitive theories may improve physical activity (PA) interventions by identifying which variables to target to maximize intervention impact. This study tested the utility of Bandura¿s social cognitive theory (SCT) to explain men¿s PA during a 3-month weight loss program. Participants were 204 overweight/obese men (M [SD] age = 46.6 [11.3] years; body mass index = 33.1 [3.5] kg/m2). A longitudinal, latent variable structural equation model tested the associations between SCT constructs (i.e., self-efficacy, outcome expectations, intention, and social support) and self-reported moderate-to-vigorous PA (MVPA) and examined the total PA variance explained by SCT. After controlling for Time 1 cognitions and behavior, the model fit the data well (¿2= 73.9, degrees of freedom = 39, p < .001; normed ¿2= 1.9; comparative fit index = 0.96; standardized root mean residual = 0.059) and explained 65% of the variance in MVPA at Time 2. At Time 2, self-efficacy demonstrated the largest direct and total effects on MVPA (ßdirect= .45, p < .001; ßtotal= .67, p = .002). A small-to-medium effect was observed from intention to MVPA, but not from outcome expectations or social support. This study provides some evidence supporting the tenets of SCT when examining PA behavior in overweight and obese men. Future PA and weight loss interventions for men may benefit by targeting self-efficacy and intention, but the utility of targeting social support and outcome expectations requires further examination.

Background: Obesity prevention interventions targeting 'at-risk' adolescents are urgently needed. The aim of this study is to evaluate the sustained impact of the 'Active Teen Leaders Avoiding Screen-time' (ATLAS) obesity prevention program. Methods: Cluster RCT in 14 secondary schools in low-income communities of New South Wales, Australia. Participants were 361 adolescent boys (aged 12-14 years) 'at risk' of obesity. The intervention was based on Self-Determination Theory and Social Cognitive Theory and involved: professional development, fitness equipment for schools, teacher-delivered physical activity sessions, lunch-time activity sessions, researcher-led seminars, a smartphone application, and parental strategies. Assessments for the primary (body mass index [BMI], waist circumference) and secondary outcomes were conducted at baseline, 8- (post-intervention) and 18-months (follow-up). Analyses followed the intention-to-treat principle using linear mixed models. Results: After 18-months, there were no intervention effects for BMI or waist circumference. Sustained effects were found for screen-time, resistance training skill competency, and motivational regulations for school sport. Conclusions: There were no clinically meaningful intervention effects for the adiposity outcomes. However, the intervention resulted in sustained effects for secondary outcomes. Interventions that more intensively target the home environment, as well as other socio-ecological determinants of obesity may be needed to prevent unhealthy weight gain in adolescents from low-income communities. Trial registration: Australian Clinical Trial Registry ACTRN12612000978864.

Purpose Emerging literature suggests that physical activity and fitness may have a positive effect on cognitive and mental health in adolescents. The purpose of the current study was to evaluate the efficacy of two high-intensity interval training (HIIT) protocols for improving cognitive and mental health outcomes (executive function, psychological well-being, psychological distress, and physical self-concept) in adolescents. Methods Participants (n = 65; mean age = 15.8 ± 0.6 yr) were randomized to three conditions: aerobic exercise program (AEP; n = 21), resistance and aerobic program (RAP; n = 22), and control (n = 22). HIIT sessions (8-10 min per session) were delivered during physical education lessons or at lunchtime three times per week for 8 wk. Assessments were conducted at baseline and immediately postintervention to detect changes in executive function (trail making test), psychological well-being, psychological distress, and physical self-description by researchers blinded to treatment allocation. Intervention effects were examined using linear mixed models. Cohen's d effect sizes and clinical inference were also calculated. Results While results were not significant, small improvements in executive function (mean change (95% CI) -6.69 (-22.03, 8.64), d = -0.32) and psychological well-being (mean change (95% CI) 2.81 (-2.06, 7.68), d = 0.34) were evident in the AEP group; and moderate improvements in executive function (mean change (95% CI) -10.73 (-26.22, 4.76), d = -0.51), and small improvements in well-being (mean change (95% CI) 2.96 (-1.82, 7.75), d = 0.36) and perceived appearance (mean change (95% CI) 0.32 (-0.25, 0.86), d = 0.35), were observed for the RAP group. Mean feeling state scores improved from preworkout to postworkout in both HIIT conditions, with significant results for the AEP (P = 0.001). Conclusions This study highlights the potential of embedding HIIT within the school day for improving cognitive and mental health among adolescents.

Objective: More evidence from prospective studies is needed to determine ¿if¿ and ¿how¿ social cognitive constructs mediate behaviour change. In a longitudinal study, we aimed to examine potential social cognitive mediators of objectively measured physical activity (PA) behaviour among people with type 2 diabetes (T2D) who participated in a six-month PA intervention. Methods: All participants from the proven effective Healthy Eating and Active Living for Diabetes in Primary Care Networks trial were included for this secondary analysis. Change in pedometer-derived daily step counts (baseline to six months) was the outcome of interest. Primary constructs of interest were from Social Cognitive Theory, however constructs from and Theory of Planned Behaviour were also tested in a mediating variable framework using a product-of-coefficients test. Results: The sample (N¿=¿198) had a mean age of 59.5 (SD 8.3) years, haemoglobin A1c 6.8% (SD 1.1), 50% women, BMI 33.6¿kg/m2 (SD 6.5), systolic pressure 125.6¿mmHg (SD 16.2) and average daily steps were 5879 (SD 3130). Daily pedometer-determined steps increased for the intervention group compared to usual care control at six-months (1481 [SD 2631] vs. 336 [SD 2712]; adjusted p¿=¿.002). There was a significant action theory test effect for ¿planning¿ (A¿=¿.21, SE¿=¿.10, p¿=¿.037), and significant conceptual theory test results for ¿subjective norms¿ (B¿=¿657, SE¿=¿312, p¿=¿.037) and ¿cons¿ (B¿=¿-664, SE¿=¿270, p¿=¿.015). None of the constructs satisfied the criteria for mediation. Conclusions: We were unable to account for the effect of a pedometer-based PA intervention for people with T2D through our examination of mediators. Our findings are inconsistent with some literature concerning PA interventions in diabetes; this may be due to variability in measures used or in study populations.

Summary: Sedentary behaviour has emerged as a unique determinant of health in adults. Studies in children and adolescents have been less consistent. We reviewed the evidence to determine if the total volume and patterns (i.e. breaks and bouts) of objectively measured sedentary behaviour were associated with adverse health outcomes in young people, independent of moderate-intensity to vigorous-intensity physical activity. Four electronic databases (EMBASE MEDLINE, Ovid EMBASE, PubMed and Scopus) were searched (up to 12 November 2015) to retrieve studies among 2- to 18-year-olds, which used cross-sectional, longitudinal or experimental designs, and examined associations with health outcomes (adiposity, cardio-metabolic, fitness, respiratory, bone/musculoskeletal, psychosocial, cognition/academic achievement, gross motor development and other outcomes). Based on 88 eligible observational studies, level of evidence grading and quantitative meta-analyses indicated that there is limited available evidence that the total volume or patterns of sedentary behaviour are associated with health in children and adolescents when accounting for moderate-intensity to vigorous-intensity physical activity or focusing on studies with low risk of bias. Quality evidence from studies with robust designs and methods, objective measures of sitting, examining associations for various health outcomes, is needed to better understand if the overall volume or patterns of sedentary behaviour are independent determinants of health in children and adolescents.

Introduction Self-administered lifestyle interventions have been suggested as an alternative to face-to-face delivery modes, although their efficacy remains uncertain. The aim of this study was to evaluate the efficacy of the Type 2 diabetes mellitus Prevention Using LifeStyle Education (PULSE) Program, a self-administered and gender-tailored lifestyle intervention for men at high risk for developing Type 2 diabetes mellitus. Design/setting A 6-month, assessor-blinded, parallel-group RCT was conducted at the University of Newcastle, Australia in 2012-2013. Participants Men (aged 18-65 years, BMI 25-40 kg/m2, high risk for developing Type 2 diabetes mellitus) were stratified by age (<50 and >50 years) and BMI category (25.0-29.9, 30.0-35.9, and 35.0-40 kg/m2) and individually randomized (1:1 ratio) to the intervention (n=53) or waitlist control groups (n=48). Intervention The intervention group received the PULSE Program, which contained print and video resources on weight loss (Self-Help, Exercise and Diet using Internet Technology [SHED-IT] Weight Loss Program), diet modification, and exercise for Type 2 diabetes mellitus prevention. The waitlist control group received no information until 6 months. Main outcome measures Data were collected from September 2012 to September 2013 and analyzed in 2014-2015. Linear mixed models (intention-to-treat) were used to determine group X time interactions (differences between groups in changes over time) at 6 months for the primary outcome (weight), glycated hemoglobin, and several secondary outcomes (significance level, p<0.05). Results Differences between groups in mean changes from baseline to 6 months (group × time interaction) favored the intervention over control group for weight loss (-5.50 kg, 95% CI=-7.40 kg, -3.61 kg, p<0.001, Cohen's d=1.15), glycated hemoglobin (-0.2%, 95% CI=-0.3%, -0.1%, p=0.002, d=0.64), and BMI, waist circumference, body fat percentage, aerobic fitness, and lower body muscular fitness (all p<0.05). No group × time effects were observed for fasting plasma glucose, upper body muscular fitness, physical activity, or energy intake. Conclusions The PULSE Program improved several Type 2 diabetes mellitus risk factors in men, including weight and glycated hemoglobin. These findings provide evidence for a self-administered and gender-tailored lifestyle intervention, which has potential for dissemination in community settings.

The purpose of this study was to examine the mediating effect of resistance training skill competency on percentage of body fat, muscular fitness and physical activity among a sample of adolescent boys participating in a school-based obesity prevention intervention. Participants were 361 adolescent boys taking part in the Active Teen Leaders Avoiding Screen-time (ATLAS) cluster randomised controlled trial: a school-based program targeting the health behaviours of economically disadvantaged adolescent males considered ¿at-risk¿ of obesity. Body fat percentage (bioelectrical impedance), muscular fitness (hand grip dynamometry and push-ups), physical activity (accelerometry) and resistance training skill competency were assessed at baseline and post-intervention (i.e., 8 months). Three separate multi-level mediation models were analysed to investigate the potential mediating effects of resistance training skill competency on each of the study outcomes using a product-of-coefficients test. Analyses followed the intention-to-treat principle. The intervention had a significant impact on the resistance training skill competency of the boys, and improvements in skill competency significantly mediated the effect of the intervention on percentage of body fat and the combined muscular fitness score. No significant mediated effects were found for physical activity. Improving resistance training skill competency may be an effective strategy for achieving improvements in body composition and muscular fitness in adolescent boys.

Purpose: Previous studies in cancer survivors have examined behavioral correlates of physical activity (PA), but no study to date has adopted a broader social-ecological framework in understanding PA. This study examined the associations among demographic, medical, social-cognitive, and environmental correlates of meeting PA guidelines among kidney cancer survivors (KCS). Methods: All 1985 KCS diagnosed between 1996 and 2010 identified through a Canadian provincial registry were mailed a survey that consisted of medical, demographic, and social-cognitive measures, as well as PA as measured by the Godin Leisure Time Exercise Questionnaire. Environmental constructs were also assessed for both self-report and objective measures using geographic information systems (GIS). A series of binary logistic regression analyses were conducted in this cross-sectional study. Results: Completed surveys with geographical information were received from 432 KCS with Mage = 64.4 ± 11.1¿years, 63.2¿% male, and 82.2¿% having localized kidney cancer. In the final multivariate model, meeting PA guidelines was associated with disease stage (OR = 0.25, p =.005), having drug therapy (OR = 3.98, p =.009), higher levels of instrumental attitudes (OR = 1.66, p =.053), higher levels of intention (OR = 1.72, p =.002), and the perceived presence of many retail shops in the neighborhood (OR = 1.37, p =.032). Conclusions: Meeting PA guidelines in KCS were associated with various aspects of the social-ecological model. Implications for Cancer Survivors: Understanding the social-ecological correlates for PA can provide insight into future interventions designed to increase PA in KCS. Prime targets for PA promotion should consider treatment-related factors, promote the benefits of PA, and enhance positive perceptions of the built environment.

Objectives: Given the low levels of physical activity in girls, improving our understanding of the factors associated with girls¿ physical activity is important. In particular, exploring maternal correlates of girls¿ physical activity for both generations is important, given the paucity of research in this area. The primary aim of this study was to assess maternal correlates of objectively-measured physical activity in girls. Methods: A cross-sectional design was used to assess 40 girls [mean age 8.8¿years; mean body mass index (BMI) z-score¿=¿0.7] and their mothers (mean age 39.1¿years; mean BMI¿=¿27.6) prior to an intervention. Maternal correlates of daughters¿ accelerometer-assessed physical activity were evaluated. Daughters¿ outcomes included: % moderate-to-vigorous physical activity (MVPA), counts per minute (CPM) and % sedentary behavior (SED), screen time (mother-proxy) and BMI z-score (objectively measured). Maternal correlates included demographic, anthropometric, behavioral, activity-related parenting practices, and physical activity cognitions. Correlates were examined using regression models. Results: For daughters¿ % MVPA, mothers¿ beliefs was significant in the final model (R2¿=¿0.14; P¿=¿0.01). For daughters¿ CPM, mothers¿ logistic support (P¿=¿0.03), mothers¿ CPM (P¿=¿0.02) and outcome expectations (P¿=¿0.01) were all significant (R2¿=¿0.24). For daughters¿ % SED, mothers¿ logistic support (P¿=¿0.02) was significant (R2¿=¿0.11). Conclusions for Practice: A number of maternal behaviors, social¿cognitive and parenting correlates were found to be significantly associated with daughters¿ physical activity. Experimental studies are warranted, targeting mothers as the primary agents of change to increase physical activity among girls.

Current physical activity and fitness levels among adolescents are low, increasing the risk of chronic disease. Although the efficacy of high intensity interval training (HIIT) for improving metabolic health is now well established, it is not known if this type of activity can be effective to improve adolescent health. The primary aim of this study is to assess the effectiveness and feasibility of embedding HIIT into the school day. A 3-arm pilot randomized controlled trial was conducted in one secondary school in Newcastle, Australia. Participants (n= 65; mean age = 15.8(0.6) years) were randomized into one of three conditions: aerobic exercise program (AEP) (n = 21), resistance and aerobic exercise program (RAP) (n = 22) and control (n = 22). The 8-week intervention consisted of three HIIT sessions per week (8-10. min/session), delivered during physical education (PE) lessons or at lunchtime. Assessments were conducted at baseline and post-intervention to detect changes in cardiorespiratory fitness (multi-stage shuttle-run), muscular fitness (push-up, standing long jump tests), body composition (Body Mass Index (BMI), BMI-z scores, waist circumference) and physical activity motivation (questionnaire), by researchers blinded to treatment allocation. Intervention effects for outcomes were examined using linear mixed models, and Cohen's d effect sizes were reported. Participants in the AEP and RAP groups had moderate intervention effects for waist circumference (p = 0.024), BMI-z (p = 0.037) and BMI (not significant) in comparison to the control group. A small intervention effect was also evident for cardiorespiratory fitness in the RAP group.

Background Participation in physical activity can improve the health outcomes of breast cancer survivors. To impact public health, broad-reaching sustainable interventions that promote physical activity are needed. Purpose To evaluate the efficacy of two distance-based interventions for promoting physical activity among breast cancer survivors compared with a standard recommendation control. Methods Breast cancer survivors who had finished 'active' cancer treatment were eligible to participate. Participants (n = 330) were randomly assigned to receive one of the following mail-delivered interventions: three computer-tailored newsletters, a previously developed breast cancer-specific physical activity booklet or a pamphlet detailing the public health recommendations for physical activity (control). Primary outcomes were self-reported moderate to vigorous aerobic activity and participant's self-reported resistance training activity at 4 months post-baseline. Secondary outcomes were pedometer step counts, whether or not participants were meeting the physical activity guidelines, time spent in sedentary behaviour, fatigue and health-related quality of life. Results Participants randomised into the tailored-print intervention group were three times more likely to commence resistance training and meet the resistance-training guidelines immediately after the intervention than participants allocated to the control group. There were no other significant intervention effects. Conclusion Computer-tailored newsletters may be an effective strategy for enhancing resistance-based physical activity among breast cancer survivors. The null findings relating to other outcomes may be due to ceiling effects (in the case of aerobic activity, fatigue and health-related quality of life) or the sensitivity of the measure used (in the case of sitting time). These issues require further exploration.

This study examined factors associated with higher sitting time in general, chronic disease, and psychologically-distressed, adult populations (aged =45 years). A series of logistic regression models examined potential socio-demographic and health factors associated with higher sitting (=6hrs/day) in adults from the 45 and Up Study (n = 227,187), including four separate subsamples for analysis comprising those who had ever had heart disease (n = 26,599), cancer (n = 36,381), diabetes (n = 19,550) or psychological distress (n = 48,334). Odds of higher sitting were significantly (p<.01) associated with a number of factors across these groups, with an effect size of ORs=1.5 observed for the high-income =$70,000AUD, employed full-time and severe physical limitations demographics. Identification of key factors associated with higher sitting time in this population-based sample will assist development of broad-based, public health and targeted strategies to reduce sitting-time. In particular, those categorized as being high-income earners, full-time workers, as well as those with severe physical limitations need to be of priority, as higher sitting appears to be substantial across these groups.

Background: Little is known about which behavioral strategies are most important to target in weight loss interventions for men. Purpose: The aim of the current study was to identify behavioral mediators of weight loss in the male-only Self-Help, Exercise, and Diet using Information Technology (SHED-IT) community weight loss study. Methods: A randomized controlled trial with 159 overweight/obese men [mean (SD) age = 47.5 (11.0) years; body mass index = 32.7 (3.5) kg/m2] assessed at baseline, 3¿months (post-test) and 6¿months (follow-up). Results: In an intention-to-treat, multiple-mediator model, the significant intervention effect on weight at 6¿months (-3.70¿kg; p < 0.001) was mediated by increases in physical activity (steps/day) and decreases in takeaway meals (kJ/day) and portion size at 3¿months. The largest mediation effect was for physical activity (-0.6¿kg; 95¿% confidence interval -1.4, -0.1). Overall, the targeted mediators accounted for 47.0¿% of the intervention¿s effect on weight. Conclusion: Step counts, takeaway food consumption, and portion sizes may be key areas to target in future weight loss programs for men (ACTRN12610000699066).

Background: Physical inactivity levels are unacceptably high and effective interventions that can increase physical activity in large populations at low cost are urgently needed. Web-based interventions that use computer-tailoring have shown to be effective, though people tend to 'skim' and 'scan' text on the Internet rather than thoroughly read it. The use of online videos is, however, popular and engaging. Therefore, the aim of this 3-group randomised controlled trial is to examine whether a web-based physical activity intervention that provides personally-tailored videos is more effective when compared with traditional personally-tailored text-based intervention and a control group. Methods/design: In total 510 Australians will be recruited through social media advertisements, e-mail and third party databases. Participants will be randomised to one of three groups: text-tailored, video-tailored, or control. All groups will gain access to the same web-based platform and a library containing brief physical activity articles. The text-tailored group will additionally have access to 8 sessions of personalised physical activity advice that is instantaneously generated based on responses to brief online surveys. The theory-based advice will be provided over a period of 3 months and address constructs such as self-efficacy, motivation, goal setting, intentions, social support, attitudes, barriers, outcome expectancies, relapse prevention and feedback on performance. Text-tailored participants will also be able to complete 7 action plans to help them plan what, when, where, who with, and how they will become more active. Participants in the video-tailored group will gain access to the same intervention content as those in the text-tailored group, however all sessions will be provided as personalised videos rather than text on a webpage. The control group will only gain access to the library with generic physical activity articles. The primary outcome is objectively measured physical activity. Secondary outcomes include website engagement and retention, quality of life, depression, anxiety, stress, sitting time, sleep and psychosocial correlates of physical activity. Outcomes will be measured at baseline, 3, and 9 months. Discussion: This study presents an ideal opportunity to study the effectiveness of an isolated feature within a web-based physical activity intervention and the knowledge generated from this study will help to increase intervention effectiveness. Trial registration: Australian New-Zealand Clinical Trial Registry: ACTRN12615000057583. Registered 22 January 2015.

Aim: The aim of this analysis is to establish if dietitians have the knowledge, skills and attitude to provide support to other health professional (HP) groups in the provision of weight management advice to overweight/obese patients. Methods: A secondary data analysis of a cross-sectional survey of HPs was undertaken to perform a gap analysis with regard to practices, knowledge, confidence and attitudes in the provision of weight management advice. Survey responses and additional measures (practice, knowledge, confidence and attitude scores) were compared between dietitians and other HPs. Descriptive statistics were undertaken, and differences between group ¿2 tests were performed for nominal data and the Wilcoxon rank sum test for ordinal and non-parametric data. Results: About 100% of dietitians had received initial weight management training and 85% had participated in professional development training, compared with 18 and 19% of HPs, respectively, although 70% believed it was within their scope of practice to provide evidence-based advice. Dietitian respondents achieved a higher median score (maximum 10) in the following areas (practice = 6.5, knowledge = 8.0, confidence = 8.3) when compared with HP respondents (practice = 4.2, knowledge = 7.0, confidence = 5.4). The median attitude score for both groups was 6.0. Conclusions: HPs are receptive to providing evidence-based weight loss messages to overweight/obese clients in their current practice. However, weight management training is required to enhance HPs' knowledge and skills in order to increase confidence and improve practice skills. Dietitians can assist HPs to ensure that clear, consistent, evidence-based messages are delivered to overweight clients throughout the health-care system.

Background: High-intensity interval training (HIIT) may be a feasible and efficacious strategy for improving health-related fitness in young people. The objective of this systematic review and meta-analysis was to evaluate the utility of HIIT to improve health-related fitness in adolescents and to identify potential moderators of training effects. Methods: Studies were considered eligible if they: (1) examined adolescents (13-18 years); (2) examined health-related fitness outcomes; (3) involved an intervention of =4 weeks in duration; (4) included a control or moderate intensity comparison group; and (5) prescribed high-intensity activity for the HIIT condition. Meta-analyses were conducted to determine the effect of HIIT on health-related fitness components using Comprehensive Meta-analysis software and potential moderators were explored (ie, study duration, risk of bias and type of comparison group). Results: The effects of HIIT on cardiorespiratory fitness and body composition were large, and medium, respectively. Study duration was a moderator for the effect of HIIT on body fat percentage. Intervention effects for waist circumference and muscular fitness were not statistically significant. Conclusions: HIIT is a feasible and time-efficient approach for improving cardiorespiratory fitness and body composition in adolescent populations.

A cross-sectional survey was conducted in a regional area in Australia to measure nurses' perceptions, practices, and knowledge in regard to providing healthy lifestyle advice to people who are overweight or obese. Responses were compared between geographic regions. Participation was voluntary and anonymous. Of the 79 nurse participants, 68% considered that provision of healthy lifestyle advice was within their scope of practice. Only 28% reported frequently estimating body mass index in the practice setting. Nurses often recommended increasing activity levels (44%), but recommended reducing daily caloric intake less often (25%). Nurses' knowledge about weight management was variable and the proportion of correct answers to knowledge items ranged from 33-99%. Nurses have many opportunities to deliver healthy lifestyle advice in a range of practice settings. The variation in practices and knowledge of nurses indicates a need for improved healthy lifestyle education for undergraduate and practicing nurses.

Objective: To determine the effectiveness of an exercise specialist led lifestyle program for adults with type 2 diabetes in primary care. Methods: Eligible participants from 4 primary care networks in Alberta, Canada were assigned to either a lifestyle program or a control group. The program targeted increased daily walking through individualized daily pedometer step goals for the first 3 months and brisk walking speed, along with substitution of low-relative to high-glycemic index foods over the next 3 months. The outcomes were daily steps, diet, and clinical markers, and were compared using random effects models. Results: 198 participants were enrolled (102 in the intervention and 96 in the control). For all participants, (51% were women), mean age 59.5 (SD 8.3) years, A1c 6.8% (SD 1.1), BMI 33.6 kg/m2 (SD 6.5), systolic BP 125.6 mmHg (SD 16.2), glycemic index 51.7 (4.6), daily steps 5879 (SD 3130). Daily steps increased for the intervention compared with the control at 3-months (1292 [SD 2698] vs. 418 [SD 2458] and 6-months (1481 [SD 2631] vs. 336 [SD 2712]; adjusted P = .002). No significant differences were observed for diet or clinical outcomes. Conclusions: A 6-month lifestyle program delivered in primary care by an exercise specialist can be effective for increasing daily walking among adults with recently diagnosed type 2 diabetes. This short-term increase in daily steps requires longer follow-up to estimate the potential impact on health outcomes.

The science and practice of step counting in children (typically aged 6-11 years) and adolescents (typically aged 12-19 years) has evolved rapidly over a relatively brief period with the commercial availability of research-grade pedometers and accelerometers. Recent reviews have summarized considerations for assessing physical activity using pedometers in young people (both children and adolescents), but 3 areas have received little attention: pedometer monitoring protocols, minimal (as opposed to optimal) step counts necessary for maintaining basal levels of health, and appropriate pedometer-based interventions for young people. Therefore, the objective of this review was to evaluate the current evidence and identify future research directions in these areas. The challenges of objective monitoring of physical activity in children and adolescents reinforce the importance of using protocols that minimize participant burden and the potential for tampering/reactivity. Evidence for a sedentary lifestyle cut point is limited; researchers are therefore encouraged to investigate several cut points (ie, <5000, <6000, <7000 steps/d) in children and adolescents to identify the health consequences of very low levels of ambulatory activity. Personalized messages may be necessary for health behavior change in pedometer-based interventions, but there is a need for more high-quality studies to develop the existing evidence base.

Aims: The primary aim was to describe characteristics of men identified at high-risk for Type 2 diabetes mellitus (T2DM) using the Australian diabetes risk assessment (AUSDRISK) tool. Secondary aims were to determine the prevalence of pre-diabetes and metabolic syndrome in these men. Methods: Men (n = 209) completed the AUSDRISK tool, with 165 identified as high-risk for T2DM (score = 12, maximum 38). Demographic, anthropometric, physiological and behavioural outcomes were assessed for 101 men. Comparisons (one-way ANOVA) among three AUSDRISK score groups (12-15, 16-19, = 20) were performed (significance level, P < 0.05). Results: Common risk factors (percentages) among high-risk men were waist circumference (>90cm; 93%), age (>44 years; 79%), physical activity level (<150minwk-1; 59%), family history of diabetes (39%) and previously high blood glucose levels (32%). Men with AUSDRISK scores =20 had higher (mean±SD) HbA1C (6.0±0.4% [42±4.4mmol.mol-1], P<0.001), FPG (5.3±0.6mmol.L-1, P=0.001) and waist circumference (113.2±9.8cm, P=0.026) than men with scores of 12-15. Mean FPG for the sample was 5.0±0.6mmol.L-1, whereas mean HbA1C was 5.8±0.5% [40±5.5mmol.mol-1]. Pre-diabetes prevalence was 70% and metabolic syndrome prevalence was 62%. Conclusions: The AUSDRISK tool identified men who were mostly older than 44, and had large waist circumferences and elevated HbA1C. These findings provide evidence supporting the usefulness of the AUSDRISK screening tool for T2DM screening in clinical and research settings.

Office workers are commonly targeted in interventions to modify their sitting behaviour, yet there is limited evidence of the correlates of breaks in sitting to inform intervention development. This study identifies the individual, workplace and spatial configuration correlates of the frequency of breaks in sitting (number/hour) in office workers (n = 5531) stratified by office type (private-enclosed, shared, open plan). All behaviours and potential correlates were measured via self-report using an online cross-sectional survey. Regression analyses revealed age was the only socio-demographic characteristic associated with frequency of breaks in sitting in all office types. Greater job autonomy and local connectivity were positively associated with frequency of breaks in sitting in shared and open-plan offices. In open-plan offices co-worker proximity was negatively associated with frequency of breaks in sitting. Co-worker visibility was positively associated with frequency of breaks in sitting in all office types. This study demonstrates that individual, workplace and spatial configuration factors are all associated with the frequency of breaks in sitting and that these relationships differ by office type. These observations extend prior studies that have only examined correlates at a single level (e.g. the individual). This evidence could be useful to guide future interventions in the design of workplaces to increase breaks in sitting and workers physical activity.

Objectives: To examine potential mediators of adolescent girls' dietary behavior change in the Nutrition and Enjoyable Activity for Teen Girls (NEAT Girls) intervention for obesity prevention. Methods: Participants were 294 adolescent girls attending 12 secondary schools located in low-income communities of New South Wales, Australia. Hypothesized social cognitive mediators of dietary behavior change were assessed using valid and reliable scales. Results: The intervention effects on dietary outcomes and hypothesized mediators were not statistically significant. However, changes in hypothesized mediators were associated with changes in key dietary behaviors. Conclusions: Continued research is needed to examine effective strategies for improving dietary outcomes in youth, and to explore alternative theoretical mechanisms of dietary behavior change.

Introduction: Excessive recreational screen time (i.e., screen use for entertainment) is a global public health issue associated with adverse mental and physical health outcomes. Considering the growing popularity of screen-based recreation in adolescents, there is a need to identify effective strategies for reducing screen time among adolescents. The aim of this paper is to report the rationale and study protocol for the 'Switch-off 4 Healthy Minds' (S4HM) study, an intervention designed to reduce recreational screen time among adolescents. Methods: The S4HM intervention will be evaluated using a cluster randomized controlled trial in eight secondary schools (. N=. 322 students) in New South Wales, Australia. The 6-month multi-component intervention will encourage adolescents to manage their recreational screen time using a range of evidence-based strategies. The intervention is grounded in Self-Determination Theory (SDT) and includes the following components: an interactive seminar for students, eHealth messaging, behavioral contract and parental newsletters. All outcomes will be assessed at baseline and at 6-months (i.e., immediate post-test). The primary outcome is recreational screen time measured by the Adolescent Sedentary Activity Questionnaire (ASAQ). Secondary outcomes include: self-reported psychological well-being, psychological distress, global physical self-concept, resilience, pathological video gaming and aggression, and objectively measured physical activity (accelerometry) and body mass index (BMI). Hypothesized mediators of behavior change will also be explored. Discussion: The S4HM study will involve the evaluation of an innovative, theory-driven, multi-component intervention that targets students and their parents and is designed to reduce recreational screen time in adolescents. The intervention has been designed for scalability and dissemination across Australian secondary schools.

To examine the effectiveness of interventions aimed at improving physical activity, diet, and/or weight-related behaviors amongst university/college students. Five online databases were searched (January 1970 to April 2014). Experimental study designs were eligible for inclusion. Data extraction was performed by one reviewer using a standardized form developed by the researchers and checked by a second reviewer. Data were described in a narrative synthesis and meta-analyses were conducted when appropriate. Study quality was also established. Forty-one studies were included; of these, 34 reported significant improvements in one of the key outcomes. Of the studies examining physical activity 18/29 yielded significant results, with meta-analysis demonstrating significant increases in moderate physical activity in intervention groups compared to control. Of the studies examining nutrition, 12/24 reported significantly improved outcomes; only 4/12 assessing weight loss outcomes found significant weight reduction. This appears to be the first systematic review of physical activity, diet and weight loss interventions targeting university and college students. Tertiary institutions are appropriate settings for implementing and evaluating lifestyle interventions, however more research is needed to improve such strategies.

Background: This study examined potential parenting-related mediators of children's physical activity and dietary behavior change in the Healthy Dads, Healthy Kids (HDHK) community program. Methods: A randomized controlled trial was conducted with 45 overweight/obese (mean [SD] age = 39.8 [5.4] years; BMI = 32.4 [3.8]) fathers and their children (n = 77; 58% boys; mean [SD] age = 7.7 [2.5] years). Families were randomized to either the HDHK program or wait-list control group. The program involved 7 sessions. Fathers and their children were assessed at baseline and at 14 weeks for physical activity (pedometery) and core food intake (Questionnaire). Fathers' lifestyle-related parenting practices included; self-efficacy, beliefs, modeling, logistic support, rules, cophysical activity, shared mealtime frequency and intentions. Results: Significant intervention effects were found for cophysical activity and modeling physical activity. Cophysical activity mediated children's physical activity in the intervention ('mediated effect,' AB = 653, 95% CI = 4-2050) and was responsible for 59.5% of the intervention effect. Fathers' beliefs mediated children's percent energy from core foods (AB = 1.51, 95% CI = 0.05-5.55) and accounted for 72.9% of the intervention effect. Conclusions: Participation in the HDHK program positively impacted on fathers' cophysical activity with their child and beliefs about healthy eating which mediated changes in children's diet and physical activity behaviors.

Background Evidence suggests that physical self-concept is associated with physical activity in children and adolescents, but no systematic review of this literature has been conducted. Objective The primary aim of this systematic review and meta-analysis was to determine the strength of associations between physical activity and physical self-concept (general and sub-domains) in children and adolescents. The secondary aim was to examine potential moderators of the association between physical activity and physical self-concept. Methods A systematic search of six electronic databases (MEDLINE, CINAHL, SPORTDiscus, ERIC, Web of Science and Scopus) with no date restrictions was conducted. Random effects meta-analyses with correction for measurement were employed. The associations between physical activity and general physical self-concept and sub-domains were explored. A risk of bias assessment was conducted by two reviewers. Results The search identified 64 studies to be included in the meta-analysis. Thirty-three studies addressed multiple outcomes of general physical self-concept: 28 studies examined general physical self-concept, 59 examined perceived competence, 25 examined perceived fitness, and 55 examined perceived appearance. Perceived competence was most strongly associated with physical activity (r = 0.30, 95 % CI 0.24-0.35, p < 0.001), followed by perceived fitness (r = 0.26, 95 % CI 0.20-0.32, p < 0.001), general physical self-concept (r = 0.25, 95 % CI 0.16-0.34, p < 0.001) and perceived physical appearance (r = 0.12, 95 % CI 0.08-0.16, p < 0.001). Sex was a significant moderator for general physical self-concept (p < 0.05), and age was a significant moderator for perceived appearance (p = 0.01) and perceived competence (p < 0.05). No significant moderators were found for perceived fitness. Conclusion Overall, a significant association has been consistently demonstrated between physical activity and physical self-concept and its various sub-domains in children and adolescents. Age and sex are key moderators of the association between physical activity and physical self-concept. © 2014 Springer International Publishing Switzerland.

Objective To determine whether time spent outdoors was associated with increased moderate-to-vigorous physical activity (MVPA) and related health benefits in youth. Study design We performed a cross-sectional study of 306 youth aged 13.6 ± 1.4 years. The exposure of interest was self-reported time spent outdoors after school, stratified into three categories: none, some, and most/all of the time. The main outcome of interest was accelerometer-derived MVPA (Actical: 1500 to >6500 counts/min). Secondary outcomes included sedentary behavior, cardiorespiratory fitness, overweight status, and blood pressure. Results Among the 306 youth studied, those who reported spending most/all of their after-school time outdoors (n = 120) participated in more MVPA (61.0 ± 24.3 vs 39.9 ± 19.1 min/day; adjusted P <.001), were more likely to achieve the recommended minimum 60 min/day of MVPA (aOR 2.8; 95% CI, 1.3-6.4), spent less time in sedentary activities (539 ± 97 min/day vs 610 ± 146 min/day; adjusted P <.001), and had higher cardiorespiratory fitness (49 ± 5 vs 45 ± 6 mL/kg/min; adjusted P <.001) than youth who reported no time outdoors (n = 52). No differences in overweight/obesity or blood pressure were observed across the groups. Conclusions Time spent outdoors is positively associated with MVPA and cardiorespiratory fitness in youth and negatively associated with sedentary behavior. Experimental trials are needed to determine whether strategies designed to increase time spent outdoors exert a positive influence on physical activity and fitness levels in youth. Copyright © 2014 Elsevier Inc. All rights reserved.

BACKGROUND:: Supervised physical activity (PA) improves short-term health outcomes in cancer survivors, but longer-term adherence is rarely achieved. OBJECTIVE:: The aim of this study was to evaluate the feasibility and preliminary efficacy of adding behavioral counseling to supervised PA in kidney cancer survivors (KCSs). METHODS:: Thirty-two KCSs were randomized to a 4-week supervised PA program plus standard exercise counseling (SPA + EC group; n = 16) or a 4-week supervised PA plus behavioral counseling based on the Theory of Planned Behavior (SPA + BC group; n = 16). The primary outcome was self-reported PA at 12 weeks. Secondary outcomes were quality of life, anthropometric measures, cardiorespiratory fitness, and physical function. RESULTS:: Follow-up rates for outcomes at 12 weeks were 88% and 94% for fitness testing and questionnaires, respectively. Adherence to the interventions was 94% in both groups with a 6% attrition rate. Analyses of covariance revealed that PA minutes at 12 weeks favored the SPA + BC group by +34 minutes (95% confidence interval, -62 to 129), which was a small effect size (d = 0.21) not reaching statistical significance (P = .47). Moreover, the SPA + BC group increased their 6-minute walk by 48 m more than the SPA + EC group (95% confidence interval, 1-95; d = +0.64; P = .046). There were no significant changes in quality of life measures. CONCLUSIONS:: This pilot study provides preliminary evidence that adding behavioral counseling to supervised PA in KCSs is feasible and may improve PA and fitness in the short-term. Larger and longer-term trials are needed. IMPLICATIONS FOR PRACTICE:: Oncology nurses may consider adopting behavioral counseling strategies in addition to supervised PA to motivate KCSs to maintain PA. © 2014 Wolters Kluwer Health Lippincott Williams & Wilkins.

This study aimed to describe the influence of social support on participants' self-efficacy and motivation to perform physical activity before, during and after the Healthy Eating and Active Living for Diabetes in primary care networks (HEALD) programme. HEALD was a controlled trial of a 24-week primary care-based walking programme for people with type 2 diabetes, proven effective in increasing physical activity. Data used in this qualitative sub-study were derived from semi-structured interviews with purposefully selected HEALD completers (n = 13) six months after the programme ended. Qualitative data were analysed using content analysis. Prior to HEALD, participants reported feeling a lack of social support for diabetes management and fear of diabetes consequences. During the programme, they reported feeling supported by exercise specialists and peers in general and specifically to do physical activity; they reported weakening social support after HEALD ended. Accordingly, participants reported having self-efficacy and motivation to increase their physical activity during HEALD, but these did not persist after HEALD ended; many relapsed into former behaviours. Participants recommended a longer programme, with more contacts. Our findings are congruent with Social Cognitive Theory. Participants' reported self-efficacy and motivation to adopt physical activity during HEALD were tied to feeling supported by the exercise specialists who led the programme and peers participating in the programme. However, these perceived improvements were compromised when social support was no longer available through HEALD. Periodic contacts with a health care provider post-programme may promote maintenance of positive behaviour changes following diabetes self-management programmes. Furthermore, an optimal mode of peer support requires study.

Objective: To evaluate the effectiveness of the 'Healthy Dads, Healthy Kids (HDHK)' program when delivered by trained facilitators in community settings. Method: A two-arm randomized controlled trial of 93 overweight/obese fathers (mean [SD] age=40.3 [5.3] years; BMI=32.5 [3.8] kg/m2) and their primary school-aged children (n=132) from the Hunter Region, Australia. In 2010-2011, families were randomized to either: (i) HDHK intervention (n=48 fathers, n=72 children) or (ii) wait-list control group. The 7-week intervention included seven sessions and resources (booklets, pedometers). Assessments were held at baseline and 14-weeks with fathers' weight (kg) as the primary outcome. Secondary outcomes for fathers and children included waist, BMI, blood pressure, resting heart rate, physical activity (pedometry), and self-reported dietary intake and sedentary behaviors. Results: Linear mixed models (intention-to-treat) revealed significant between-group differences for fathers' weight (P < .001, d= 0.24), with HDHK fathers losing more weight (- 3.3. kg; 95%CI, - 4.3, - 2.4) than control fathers (0.1. kg; 95%CI, - 0.9,1.0). Significant treatment effects (P < .05) were also found for fathers' waist (d= 0.41), BMI (d= 0.26), resting heart rate (d= 0.59), energy intake (d= 0.49) and physical activity (d= 0.46) and for children's physical activity (d= 0.50) and adiposity (d= 0.07). Discussion: HDHK significantly improved health outcomes and behaviors in fathers and children, providing evidence for program effectiveness when delivered in a community setting. © 2014 Published by Elsevier Inc.

The primary aim of this study was to examine a range of potential behavioral and maternal/paternal correlates of adiposity in children. Secondary aims were to examine (a) correlates of screen-time, diet and physical activity and (b) if there were differences in maternal and paternal physical activity- and dietary-related parenting practices. Cross-sectional analysis was conducted using 70 families with children (59% boys (41/70), mean age 8.4 (±2.4) years). Parenting practices were measured using the Parenting Strategies for Eating and Activity Scale. Children's outcomes included: 7-day pedometry (physical activity), screen-time, percent energy from core foods (Food frequency questionnaire) and BMI z-score. Multiple regression models were generated to examine the associations between maternal and paternal parenting practices and children's variables. In the regression analyses, fathers' BMI (p < .01) and mothers' control (p < .001) were significantly associated with child weight status. Fathers' reinforcement (p < .01) was significantly associated with child physical activity. For screen-time, mothers' monitoring (p < .001) and child characteristics [age (p = .01), sex (p = .01), BMI z-score (p = .03)] were significant predictors. Mothers' parenting practices [limit setting (p = .01), reinforcement (p = .02)] and child screen-time (p = .02) were significantly associated with intake of core foods. Despite some similarities within families, three out of five parenting constructs were significantly different between mothers and fathers. Mothers and fathers have different parental influences on their children's weight status and lifestyle behaviors and both should be included in lifestyle interventions targeting children. A focus on maternal parenting specifically relating to screen-time and diet, and father's physical activity parenting and weight status may support their children in developing more healthy behaviors. © 2014 Elsevier Ltd.

Objectives The aim was to evaluate the impact of the 'Healthy Dads, Healthy Kids' programme on fathers' and mothers' activity- and diet-related parenting practices. Methods Overweight/obese fathers (n = 87) and their primary school-aged children (56% boys) were randomized to either (i) 7-week programme (n = 45) or (ii) control group (n = 42). The programme involved four sessions for fathers only and three for fathers/children. Mothers were not directly involved. Parenting practices of both fathers and mothers were measured using the parenting strategies for eating and activity scale at baseline and 14-week follow-up. Results Intention-to-treat analysis using linear mixed models revealed significant group-by-time effects for fathers' limit setting (P = 0.048, d = 0.36) and reinforcement for multiple lifestyle behaviours (P = 0.001, d = 0.79). No significant intervention effects were found for fathers' control, monitoring, discipline or mothers' parenting practices (P > 0.05). Conclusions The Healthy Dads, Healthy Kids programme had a positive impact on some parenting practices for fathers but not mothers.

Objective: The Health Action Process Approach (HAPA) proposes principles that can be translated into testable hypotheses. This is one of the first studies to have explicitly tested HAPA's first 2 principles, which are (1) health behavior change process can be subdivided into motivation and volition, and (2) volition can be grouped into intentional and action stages. The 3 stage groups are labeled preintenders, intenders, and actors. Method: The hypotheses of the HAPA model were investigated in a sample of 1,193 individuals with Type 2 diabetes. Study participants completed a questionnaire assessing the HAPA variables. The hypotheses were evaluated by examining mean differences of test variables and by the use of multigroup structural equation modeling (MSEM). Results: Findings support the HAPA's 2 principles and 3 distinct stages. The 3 HAPA stages were significantly different in several stage-specific variables, and discontinuity patterns were found in terms of nonlinear trends across means. In terms of predicting goals, action planning, and behavior, differences transpired between the 2 motivational stages (preintenders and intenders), and between the 2 volitional stages (intenders and actors). Conclusions: Results indicate implications for supporting behavior change processes, depending on in which stage a person is at: All individuals should be helped to increase self-efficacy. Preintenders and intenders require interventions targeting outcome expectancies. Actors benefit from an improvement in action planning to maintain and increase their previous behavior. Overall, the first 2 principles of the HAPA were supported and some evidence for the other principles was found. Future research should experimentally test these conclusions. © 2012 American Psychological Association.

Objective:To examine the longitudinal associations between different physical activity (PA) intensities and cardiometabolic risk factors among a sample of Canadian youth.Methods:The findings are based on a 2-year prospective cohort study in a convenience sample of 315 youth aged 9-15 years at baseline from rural and urban schools in Alberta, Canada. Different intensities (light, moderate and vigorous) of PA were objectively assessed with Actical accelerometers. The main outcome measures were body mass index (BMI) z-score, waist circumference, cardiorespiratory fitness and systolic blood pressure at 2-year-follow-up and conditional BMI z-score velocity. A series of linear regression models were conducted to investigate the associations after adjusting for potential confounders.Results:At follow-up, cardiorespiratory fitness increased (quartile 1 vs quartile 4=43.3 vs 50.2; Ptrend <0.01) and waist circumference decreased (quartile 1 vs quartile 4=79.0 vs 72.6; P trend =0.04; boys only) in a dose-response manner across quartiles of baseline vigorous-intensity PA. A similar trend was observed for systolic blood pressure (quartile 1 vs quartile 4=121.8 vs 115.3; Ptrend =0.07; boys only). Compared with quartile 1 of vigorous-intensity PA, BMI z-score at follow-up and conditional BMI z-score velocity were significantly lower in the quartile 2 and 3 (P<0.05). Waist circumference at follow-up also decreased (quartile 1 vs quartile 4=75.3 vs 73.8; Ptrend =0.04) across quartiles of baseline moderate-intensity PA.Conclusions:Time spent in vigorous-intensity PA was associated with several positive health outcomes 2 years later. These findings suggest that high-intensity activities in youth help to reduce the risk for several chronic diseases. © 2014 Macmillan Publishers Limited.

Objective Theory-based interventions to promote physical activity (PA) are more effective than atheoretical approaches; however, the comparative utility of theoretical models is rarely tested in longitudinal designs with multiple time points. Further, there is limited research that has simultaneously tested social-cognitive models with self-report and objective PA measures. The primary aim of this study was to test the predictive ability of three theoretical models (social cognitive theory, theory of planned behaviour, and protection motivation theory) in explaining PA behaviour. Methods Participants were adults with type 2 diabetes (n = 287, 53.8% males, mean age = 61.6 ± 11.8 years). Theoretical constructs across the three theories were tested to prospectively predict PA behaviour (objective and self-report) across three 6-month time intervals (baseline-6, 6-12, 12-18 months) using structural equation modelling. PA outcomes were steps/3 days (objective) and minutes of MET-weighted PA/week (self-report). Results The mean proportion of variance in PA explained by these models was 6.5% for objective PA and 8.8% for self-report PA. Direct pathways to PA outcomes were stronger for self-report compared with objective PA. Conclusions These theories explained a small proportion of the variance in longitudinal PA studies. Theory development to guide interventions for increasing and maintaining PA in adults with type 2 diabetes requires further research with objective measures. Theory integration across social-cognitive models and the inclusion of ecological levels are recommended to further explain PA behaviour change in this population. Statement of contribution What is already known on this subject? Social-cognitive theories are able to explain partial variance for physical activity (PA) behaviour. What does this study add? The testing of three theories in a longitudinal design over 3, 6-month time intervals. The parallel use and comparison of both objective and self-report PA measures in testing these theories. © 2013 The British Psychological Society.

Objective: To evaluate the impact of a 12-month school-based multi-component program on adolescent girls' physical activity and sedentary behaviors, and hypothesized mediators of physical activity behavior change. Design: Group randomized controlled trial with 12-month follow-up. Methods: The intervention, guided by Social Cognitive Theory, involved 357 adolescent girls (13.2. ±. 0.5 years) from 12 secondary schools (6 intervention schools, 6 control schools) in low-income communities in the Hunter and Central Coast regions of New South Wales, Australia.The intervention included enhanced school sport, lunchtime physical activity sessions, interactive seminars, student handbooks, nutrition workshops, pedometers, parent newsletters and text messages to encourage physical activity and healthy eating, and a decrease in sedentary behavior. Outcomes were assessed at baseline and 12-months and included: physical activity (accelerometers), sedentary behaviors (questionnaire and accelerometers), and social-cognitive mediators of physical activity (questionnaire). Results: There were significant between group differences in favor of the intervention group for self-reported recreational computer use (-26.0. min; 95% CI, -46.9 to -5.1), and sedentary activities summed (-56.4. min; 95% CI, -110.1 to -2.7), however objective sedentary behavior showed no differences. There were no group-by-time effects for any of the physical activity outcomes or hypothesized mediators. Conclusions: A school-based intervention tailored for adolescent girls from schools located in low-income communities significantly reduced time spent in sedentary activities. However, improvements in physical activity and hypothesized mediators of physical activity behavior were not observed. Future studies are encouraged to explore alternative mechanisms of behavior change derived from integrated and socio-ecological theories. © 2013 Sports Medicine Australia.

This review investigated three research questions (i) What is the utility of social cognitive theory (SCT) to explain physical activity (PA)?; (ii) Is the effectiveness of SCT moderated by sample or methodological characteristics? and (iii) What is the frequency of significant associations between the core SCT constructs and PA? Ten electronic databases were searched with no date or sample restrictions. Forty-four studies were retrieved containing 55 SCT models of PA. Methodological quality was assessed using a standardized tool. A random-effects meta-analysis revealed that SCT accounted for 31% of the variance in PA. However, methodological quality was mostly poor for these models. Methodological quality and sample age moderated the PA effect size, with increases in both associated with greater variance explained. Although self-efficacy and goals were consistently associated with PA, outcome expectations and socio-structural factors were not. This review determined that SCT is a useful framework to explain PA behaviour. Higher quality models explained more PA variance, but overall methodological quality was poor. As such, high-quality studies examining the utility of SCT to explain PA are warranted.

Introduction: The negative consequences of unhealthy weight gain and the high likelihood of pediatric obesity tracking into adulthood highlight the importance of targeting youth who are 'at risk' of obesity. The aim of this paper is to report the rationale and study protocol for the 'Active Teen Leaders Avoiding Screen-time' (ATLAS) obesity prevention intervention for adolescent boys living in low-income communities. Methods/design: The ATLAS intervention will be evaluated using a cluster randomized controlled trial in 14 secondary schools in the state of New South Wales (NSW), Australia (2012 to 2014). ATLAS is an 8-month multi-component, school-based program informed by self-determination theory and social cognitive theory. The intervention consists of teacher professional development, enhanced school-sport sessions, researcher-led seminars, lunch-time physical activity mentoring sessions, pedometers for self-monitoring, provision of equipment to schools, parental newsletters, and a smartphone application and website. Assessments were conducted at baseline and will be completed again at 9- and 18-months from baseline. Primary outcomes are body mass index (BMI) and waist circumference. Secondary outcomes include BMI z-scores, body fat (bioelectrical impedance analysis), physical activity (accelerometers), muscular fitness (grip strength and push-ups), screen-time, sugar-sweetened beverage consumption, resistance training skill competency, daytime sleepiness, subjective well-being, physical self-perception, pathological video gaming, and aggression. Hypothesized mediators of behavior change will also be explored. Discussion: ATLAS is an innovative school-based intervention designed to improve the health behaviors and related outcomes of adolescent males in low-income communities. © 2013 Elsevier Inc.

OBJECTIVE: The goal of this study was to evaluate the impact of the Active Teen Leaders Avoiding Screen-time (ATLAS) intervention for adolescent boys, an obesity prevention intervention using smartphone technology.

Background: There is a need for effective population-based physical activity interventions. The internet provides a good platform to deliver physical activity interventions and reach large numbers of people at low cost. Personalised advice in web-based physical activity interventions has shown to improve engagement and behavioural outcomes, though it is unclear if the effectiveness of such interventions may further be improved when providing brief video-based coaching sessions with participants. The purpose of this study is to determine the effectiveness, in terms of engagement, retention, satisfaction and physical activity changes, of a web-based and computer-tailored physical activity intervention with and without the addition of a brief video-based coaching session in comparison to a control group. Methods/Design. Participants will be randomly assigned to one of three groups (tailoring + online video-coaching, tailoring-only and wait-list control). The tailoring + video-coaching participants will receive a computer-tailored web-based physical activity intervention ('My Activity Coach') with brief coaching sessions with a physical activity expert over an online video calling program (e.g. Skype). The tailoring-only participants will receive the intervention but not the counselling sessions. The primary time point's for outcome assessment will be immediately post intervention (week 9). The secondary time points will be at 6 and 12 months post-baseline. The primary outcome, physical activity change, will be assessed via the Active Australia Questionnaire (AAQ). Secondary outcome measures include correlates of physical activity (mediators and moderators), quality of life (measured via the SF-12v2), participant satisfaction, engagement (using web-site user statistics) and study retention. Discussion. Study findings will inform researchers and practitioners about the feasibility and effectiveness of brief online video-coaching sessions in combination with computer-tailored physical activity advice. This may increase intervention effectiveness at an acceptable cost and will inform the development of future web-based physical activity interventions. Trial registration. ACTRN12614000339651 Date: 31/03/2014. © 2014 Alley et al.; licensee BioMed Central Ltd.

Background: According to social-cognitive theory (SCT), self-efficacy affects health behavior both directly and indirectly by influencing how individuals perceive their environment. This study examines whether perceptions of home and school environment mediate the association between self-efficacy and physical activity (PA) and sedentary behavior in adolescent girls. Methods: Baseline data from the Nutrition and Enjoyable Activity for Teen Girls (NEAT) was used for this study. Grade 8 female students (n = 357) were recruited from 12 secondary schools located in low-income communities in the Hunter Region, New South Wales, Australia. PA was assessed using accelerometers, and sedentary behavior by self-report and accelerometers. Self-reported measures were used for perceived home and school environment and self-efficacy. Multilevel regression models were calculated to determine if the perceived environment mediated the relationship between self-efficacy with both PA and sedentary behavior. Results: The perceptions of the school and home environment did not mediate the relationship between PA self-efficacy and PA behavior or sedentary behavior. Conclusion: The mediated models were not supported for PA or sedentary behavior. However, other results of this paper may be helpful for future theory development and practice. More research is needed to understand behaviors in unique populations such as this.

Current recommendations for the prevention of type 2 diabetes advise modification of diet and exercise behaviors including both aerobic and resistance training. However, the efficacy of multi-component interventions involving a combination of these three components has not been established. The aims of this review were to systematically review and meta-analyze the evidence on multi-component (diet + aerobic exercise + resistance training) lifestyle interventions for type 2 diabetes prevention. Eight electronic databases (Medline, Embase, SportDiscus, Web of Science, CINAHL, Informit health collection, Cochrane library and Scopus) were searched up to June 2013. Eligible studies 1) recruited prediabetic adults or individuals at risk of type 2 diabetes; 2) conducted diet and exercise [including both physical activity/aerobic and resistance training] programs; and 3) reported weight and plasma glucose outcomes. In total, 23 articles from eight studies were eligible including five randomized controlled trials, one quasi-experimental, one two-group comparison and one single-group pre-post study. Four studies had a low risk of bias (score = 6/10). Median intervention length was 12 months (range 4-48 months) with a follow-up of 18 months (range 6.5 - 48 months). The diet and exercise interventions varied slightly in terms of their specific prescriptions. Meta-analysis favored interventions over controls for weight loss (-3.79 kg [-6.13, -1.46; 95% CI], Z = 3.19, P = 0.001) and fasting plasma glucose (-0.13 mmol.L-1 [-0.24, -0.02; 95% CI], Z = 2.42, P = 0.02). Diabetes incidence was only reported in two studies, with reductions of 58% and 56% versus control groups. In summary, multi-component lifestyle type 2 diabetes prevention interventions that include diet and both aerobic and resistance exercise training are modestly effective in inducing weight loss and improving impaired fasting glucose, glucose tolerance, dietary and exercise outcomes in at risk and prediabetic adult populations. These results support the current exercise guidelines for the inclusion of resistance training in type 2 diabetes prevention, however there remains a need for more rigorous studies, with long-term follow-up evaluating program efficacy, muscular fitness outcomes, diabetes incidence and risk reduction. © 2014 Aguiar et al.; licensee BioMed Central Ltd.

Background: Although previous studies have demonstrated that children with high levels of fundamental movement skill competency are more active throughout the day, little is known regarding children's fundamental movement skill competency and their physical activity during key time periods of the school day (i.e., lunchtime, recess and after-school). The purpose of this study was to examine the associations between fundamental movement skill competency and objectively measured moderate-to-vigorous physical activity (MVPA) throughout the school day among children attending primary schools in low-income communities.Methods: Eight primary schools from low-income communities and 460 children (8.5 ± 0.6 years, 54% girls) were involved in the study. Children's fundamental movement skill competency (TGMD-2; 6 locomotor and 6 object-control skills), objectively measured physical activity (ActiGraph GT3X and GT3X + accelerometers), height, weight and demographics were assessed. Multilevel linear mixed models were used to assess the cross-sectional associations between fundamental movement skills and MVPA.Results: After adjusting for age, sex, BMI and socio-economic status, locomotor skill competency was positively associated with total (P = 0.002, r = 0.15) and after-school (P = 0.014, r = 0.13) MVPA. Object-control skill competency was positively associated with total (P < 0.001, r = 0.20), lunchtime (P = 0.03, r = 0.10), recess (P = 0.006, r = 0.11) and after-school (P = 0.022, r = 0.13) MVPA.Conclusions: Object-control skill competency appears to be a better predictor of children's MVPA during school-based physical activity opportunities than locomotor skill competency. Improving fundamental movement skill competency, particularly object-control skills, may contribute to increased levels of children's MVPA throughout the day.Trial registration: Australian New Zealand Clinical Trials Registry No: ACTRN12611001080910. © 2014 Cohen et al.; licensee BioMed Central Ltd.

Background/aim: Obesity affects more than half the Australian population and has become epidemic throughout the world. Little is known regarding occupational therapy interventions with clients who are overweight or obese. This study aimed to identify occupational therapy practice in relation to the provision of weight management. This was part of a larger study investigating health professional practice. Methods: A cross-sectional study design using a self-administered, purpose-designed survey was employed to identify the current practices of occupational therapists working in a regional area of New South Wales, Australia. Participants were recruited via email or mail as publically available. Results: Fifty-one occupational therapists anonymously completed the survey. Results revealed that 53% (n = 26) of respondents did not consider weight management to be within their scope of practice or their workplace role description. The most common intervention was the provision of physical activity advice (65.2%; n = 30). Dietary advice was provided by 20.8% (n = 10), while 77% (n = 32) referred onto dietitian services. During entry-level occupational therapy education, only 7.8% (n = 4) had received weight management advice education. Completion of postgraduate professional development training in this area was reported by 14% (n = 7) of respondents. Conclusion: This study provides insight into the current practices of Australian occupational therapists in relation to the provision of weight management advice. This research displays a need to acknowledge both a generic and a discipline-specific role for the provision of healthy lifestyle interventions. This may be achieved through better access to education during entry-level programmes and in the workplace. © 2013 Occupational Therapy Australia.

Objective: To assess the impact of a 3. year (2006-2009) community-based intervention for obesity and chronic disease prevention in four diverse "Healthy Alberta Communities" (HAC). Methods: Targeted intervention development incorporated the ANGELO conceptual framework to help community stakeholders identify environmental determinants of obesity amenable to intervention. Several inter-related initiatives were implemented. To evaluate, we surveyed separate samples of adults in HAC communities before and after the interventions and compared responses to identical survey questions asked of adults living in Alberta in two waves of the Canadian Community Health Survey (CCHS). Results: The HAC sample included 4761 (2006) and 4733 (2009) people. The comparison sample included 9775 and 9784 respondents in 2005 and 2009-10 respectively. Self-reported body mass index showed no change, and neither were there significant changes in behaviors relative to secular trends. Most significant outcomes were relevant to social conditions, specifically sense of belonging to community in the intervention communities. Conclusion: Health outcome indicators at the community level may not be sufficiently sensitive to capture changes which, over a relatively short term, would only be expected to be incremental, given that interventions were directed primarily to creating environmental conditions supportive of changes in behavioral outcomes rather than toward health outcome change directly. © 2013 Elsevier Inc.

Background Obesity prevention among youth of low SES is a public health priority given the higher prevalence of youth obesity in this population subgroup. Purpose To evaluate the 24-month impact of a school-based obesity prevention program among adolescent girls living in low-income communities. Design The study was a school-based group RCT, the Nutrition and Enjoyable Activity for Teen Girls (NEAT Girls) intervention. Setting/participants The study involved 12 secondary schools located in low-income communities in New South Wales, Australia. Participants were 357 adolescent girls (aged 13.2±0.5 years). Intervention The 12-month multicomponent intervention was guided by social cognitive theory and involved strategies to promote physical activity, reduce sedentary behaviors, and improve dietary outcomes. Main outcome measures The primary outcome was BMI, and secondary outcomes were BMI z-score; percentage body fat (bioelectrical impedance analysis); physical activity (accelerometers); dietary intake; and recreational screen-time (self-report). Data were collected in 2010-2012 and analyzed in 2012. Results After 24 months, there were no intervention effects on BMI (adjusted mean difference -0.33, 95% CI= -0.97, 0.28, p=0.353) and BMI z-score (-0.12, 95% CI= -0.27, 0.04, p=0.178). However, there was a group-by-time interaction for percentage body fat (-1.96%, 95% CI= -3.02, -0.89, p=0.006). Intervention effects for physical activity, screen time, and dietary intake were not significant. Conclusions The NEAT Girls intervention did not result in effects on the primary outcome. Further study of youth who are "at risk" of obesity should focus on strategies to improve retention and adherence in prevention programs. Trial registration This study is registered at Australian New Zealand Clinical Trials ACTRN1261000033004. © 2013 American Journal of Preventive Medicine.

Background: This study aimed to develop and evaluate the construct validity and reliability of modernized social cognitive measures relating to physical activity behaviors in adolescents. Methods: An instrument was developed based on constructs from Bandura's Social Cognitive Theory and included the following scales: self-efficacy, situation (perceived physical environment), social support, behavioral strategies, and outcome expectations and expectancies. The questionnaire was administered in a sample of 171 adolescents (age = 13.6 ± 1.2 years, females = 61%). Confirmatory factor analysis was employed to examine model-fit for each scale using multiple indices, including chi-square index, comparative-fit index (CFI), goodness-of-fit index (GFI), and the root mean square error of approximation (RMSEA). Reliability properties were also examined (ICC and Cronbach's alpha). Results: Each scale represented a statistically sound measure: fit indices indicated each model to be an adequate-to-exact fit to the data; internal consistency was acceptable to good (a = 0.63-0.79); rank order repeatability was strong (ICC = 0.82-0.91). Conclusions: Results support the validity and reliability of social cognitive scales relating to physical activity among adolescents. As such, the developed scales have utility for the identification of potential social cognitive correlates of youth physical activity, mediators of physical activity behavior changes and the testing of theoretical models based on Social Cognitive Theory. © 2013 Human Kinetics, Inc..

Background: Adverse health effects of sedentary behaviour on cancer risk and health outcomes in cancer survivors have been reported but few studies have examined quality of life (QoL) and no study has focused on kidney cancer survivors (KCS). The purpose of this study was to estimate the prevalence of sitting time among KCS and to determine any associations with QoL. Methods: All 1985 KCS diagnosed between 1996 and 2010 identified through a Canadian provincial Registry were mailed a survey that consisted of the modified domain-specific sitting time questionnaire, the Godin Leisure Time Exercise Questionnaire and several Functional Assessment of Cancer Therapy (FACT) QoL scales. Standard demographic and medical variables were also reported. Results: Completed surveys were received from 540 KCS. The mean hours of sitting time were 8.0 ± 4.7 for a work-day and 6.5 ± 3.8 for a non-work day. After adjustment for key covariates, analyses of covariance indicated that the only significant relationship was an unexpected positive association between sitting time on a work day and emotional well-being (p = 0.019). Moreover, the only variable to moderate these associations was age, with younger KCS under age 60 showing the expected negative associations between sitting time and physical and functional aspects of QoL. Conclusion: KCS sit for a significant amount of time on work days and non-work days, however, there were few associations with QoL. Future observational studies and randomized controlled trials are warranted to examine sitting time and health outcomes among KCS. Crown Copyright © 2012 Published by Elsevier Ltd. All rights reserved.

Background: Excessive time spent in sedentary behavior is associated with a range of physiological, psychosocial and behavioral health concerns in youth. Objective: The primary aim of this study was to examine the association between sedentary behavior and self-esteem among adolescent girls living in low-income communities. Methods: Participants were 357 girls [mean age (standard deviation) = 13.2 (0.5) years] from 12 secondary schools located in low-income communities in New South Wales, Australia. Height, weight, body fat (bio-electrical impedance analysis) and physical activity (accelerometers), self-esteem were assessed. Results: Significant inverse associations were found between self-esteem and time spent watching DVDs and using the computer for non-school purposes, but no relationship was found between TV viewing and self-esteem. The relationship between sedentary time (%) from accelerometers and self-esteem was not significant. Conclusions: Sedentary behavior is a pervasive public health concern and time spent in specific screen-based recreation was associated with self-esteem in adolescent girls living in low-income communities. Our findings are indicative of the complex nature of these relationships and reveal a need for further longitudinal and intervention-based research in the field. Copyright © 2012 Published by Elsevier Ltd. All rights reserved.