Getting a GRIP (getting research into practice) on movement integration in the school classroom

In adults prolonged sitting is detrimentally associated with a number of health sequela including type 2 diabetes, cardiovascular diseases and all-cause mortality, and it has been suggested these negative health consequences may not be fully protected against by participation in physical activity. Altering ubiquitous environments for children to increase their opportunities to break or reduce extended sitting is therefore of key public health interest. Emerging research shows that physical activity can be introduced into the school classroom, through short activity breaks and by integrating movement into the learning of core academic content. This may help to improve children’s time on task, enjoyment of learning, and in some cases academic outcomes. This discussion paper briefly highlights some of the key research on movement integration in the classroom, discusses potential challenges and facilitators of implementation at a variety of levels (e.g. teacher, school, external stakeholder) and presents an ongoing, innovative programme (CLASS PAL) as a case study of one approach to get research on classroom movement integration into routine teaching practice

Evaluation of the implementation of an intervention to improve the street environment and promote walking for transport in deprived neighbourhoods

Background Levels of physical activity remain low, particularly in deprived areas. Improving the street environment to promote walking for transport using a community engagement approach is a potential strategy to increase physical activity. An understanding of the implementation of this intervention approach is needed to facilitate further research, replication and scale-up. The aim of this study was to evaluate the implementation of the Fitter for Walking (FFW) intervention in deprived neighbourhoods. Methods FFW was delivered in five regions of England between August 2008 and March 2012 and aimed to use a community engagement approach to improve the street environment to promote walking for transport. Implementation was assessed in relation to reach; dosage; implementation processes and adaptation; and factors influencing implementation. Three data sources were used: focus groups and face-to-face interviews with coordinators; implementation logs; and participation records. Results Reach: 155 community groups participated in FFW engaging 30,230 local residents. Dosage: A wide variety of environmental improvements were implemented by local authorities (LAs) (42 projects) and by communities (46 projects). Examples of LA-led improvements included removal of encroaching vegetation, new/improved pedestrian signage, new dropped kerbs/kerb improvements and new, repaired or improved footpaths. Examples of community-led improvements include planting bulbs, shrubs or bedding plants, clean-up days and litter pick-ups. In 32 projects, no environmental improvements were implemented. Promotional and awareness-raising activities were undertaken in 81 projects. Examples included led walks, themed walks, development of maps/resources to promote improved routes and community events. Processes and adaptation: The need for a planning phase, a preparatory phase, and a delivery phase with a four step process were identified. Adaptability to local context was important. Factors influencing implementation: Five key themes were identified in relation to the barriers and facilitators of implementing FFW: local knowledge and contacts; intervention delivery; coordinator role; working with LAs and other partners; and working with communities. Conclusions FFW is one of few reported interventions which have used a community engagement approach to change the street environment to promote walking for transport in deprived neighbourhoods. Delivering these types of interventions is complex and requires considerable resource and time. A set of recommendations and an implementation framework are proposed for future delivery of this and similar types of programme

Evaluation of the implementation of an intervention to improve the street environment and promote walking for transport in deprived neighbourhoods

Background Levels of physical activity remain low, particularly in deprived areas. Improving the street environment to promote walking for transport using a community engagement approach is a potential strategy to increase physical activity. An understanding of the implementation of this intervention approach is needed to facilitate further research, replication and scale-up. The aim of this study was to evaluate the implementation of the Fitter for Walking (FFW) intervention in deprived neighbourhoods. Methods FFW was delivered in five regions of England between August 2008 and March 2012 and aimed to use a community engagement approach to improve the street environment to promote walking for transport. Implementation was assessed in relation to reach; dosage; implementation processes and adaptation; and factors influencing implementation. Three data sources were used: focus groups and face-to-face interviews with coordinators; implementation logs; and participation records. Results Reach: 155 community groups participated in FFW engaging 30,230 local residents. Dosage: A wide variety of environmental improvements were implemented by local authorities (LAs) (42 projects) and by communities (46 projects). Examples of LA-led improvements included removal of encroaching vegetation, new/improved pedestrian signage, new dropped kerbs/kerb improvements and new, repaired or improved footpaths. Examples of community-led improvements include planting bulbs, shrubs or bedding plants, clean-up days and litter pick-ups. In 32 projects, no environmental improvements were implemented. Promotional and awareness-raising activities were undertaken in 81 projects. Examples included led walks, themed walks, development of maps/resources to promote improved routes and community events. Processes and adaptation: The need for a planning phase, a preparatory phase, and a delivery phase with a four step process were identified. Adaptability to local context was important. Factors influencing implementation: Five key themes were identified in relation to the barriers and facilitators of implementing FFW: local knowledge and contacts; intervention delivery; coordinator role; working with LAs and other partners; and working with communities. Conclusions FFW is one of few reported interventions which have used a community engagement approach to change the street environment to promote walking for transport in deprived neighbourhoods. Delivering these types of interventions is complex and requires considerable resource and time. A set of recommendations and an implementation framework are proposed for future delivery of this and similar types of programme

Chronic obstructive pulmonary disease (COPD), illness narratives and Elias's sociology of knowledge

This paper draws on Elias’s sociology of knowledge to provide a critical assessment of illness narratives. Focusing on a cohort of chronic obstructive pulmonary disease (COPD) patients (n=26), the paper employs a comparative analysis of mixed method data derived from qualitative interviews, quantitative questionnaires, and physiological and accelerometer testing. The article firstly compares four narratives conveyed in interviews with the broader paradigmatic approach to illness narratives and existing COPD-specific studies. It then explores the relationship between these ‘stories’ and COPD patients’ biographical contingencies (e.g. age, wealth, context of diagnosis) and embodied condition (e.g. co-morbidities, lung function), demonstrating how illness narratives are shaped by both broader social structural factors and embodied experience. Invoking Elias we further find that different narrative subthemes are varyingly affected by patients’ emotional engagement and ontological security and thus that people are differently enabled or constrained to present illness narratives that are consistent with their broader social and physical condition. Consequently, while narratives, social structure and embodied experience are interdependent, our reading of ‘truth’ must be sensitive to the social positioning of the ‘teller’ and the specific content being relayed. The paper therefore presents a more systematic, comparative, bio-psycho-social analysis than has hitherto been produced

Sitting time and obesity in a sample of adults from Europe and the USA

Obesity is a risk factor for many chronic diseases and the prevalence is increasing worldwide. Research suggests that sedentary behaviour (sitting) may be related to obesity.To examine the association between sitting time and obesity, while controlling for physical activity, in a large international sample.5338 adults from the UK, USA, Germany, Spain, Italy, France, Portugal, Austria and Switzerland self-reported their total daily sitting time, physical activity, age, height and weight. BMI (kg/m(2)), total physical activity (MET-minutes/week) and sitting time (hours/day) were derived. Participants were grouped into quartiles based on their daily sitting time (8 hours/day) and logistic regression models explored the odds of being obese versus normal weight for each sitting time quartile.Participants in the highest sitting time quartile (≥8 hours/day) had 62% higher odds of obesity compared to participants in the lowest quartile (<4 hours/day) after adjustment for physical activity and other confounding variables (OR = 1.62, 95% CI = 1.24-2.12, p<0.01).Sitting time is associated with obesity in adults, independent of physical activity. Future research should clarify this association using objective measures of sitting time and physical activity to further inform health guidelines

Evidence of moderation effects in predicting active transport to school

Distance from home to school is an important influence on the decision to use active transport (AT); however, ecological perspectives would suggest this relationship may be moderated by individual, interpersonal and environmental factors. This study investigates whether (i) gender, (ii) biological maturation, (iii) perceived family support for physical activity (PA) and (iv) multiple deprivation moderate the relationship between distance to school and AT.A total of 611 children (11-12 years old, 334 females) were recruited from schools in Leicestershire, UK. Gender, family support for PA, and AT were self-reported. Home and school postcodes were used to determine multiple deprivation and distance to school (km). Predicted age at peak height velocity was used to indicate biological maturation.Logistic regressions revealed the main effects explained 40.2% of the variance in AT; however; distance to school was the only significant predictor. Further analyses revealed that distance to school had a greater negative impact on the use of AT in late-maturing (OR: 3.60, CI: 1.45-8.96), less deprived (OR: 3.54, CI: 1.17-10.72) and children with low family support of PA (OR: 0.26, CI: 0.11-0.61).This study provides evidence that, although distance to school might be the strongest predictor of AT, this relationship is complex

Technologies that assess the location of physical activity and sedentary behavior: a systematic review

Background: The location in which physical activity and sedentary behavior are performed can provide valuable behavioral information, both in isolation and synergistically with other areas of physical activity and sedentary behavior research. Global positioning systems (GPS) have been used in physical activity research to identify outdoor location; however, while GPS can receive signals in certain indoor environments, it is not able to provide room- or subroom-level location. On average, adults spend a high proportion of their time indoors. A measure of indoor location would, therefore, provide valuable behavioral information. Objective: This systematic review sought to identify and critique technology which has been or could be used to assess the location of physical activity and sedentary behavior. Methods: To identify published research papers, four electronic databases were searched using key terms built around behavior, technology, and location. To be eligible for inclusion, papers were required to be published in English and describe a wearable or portable technology or device capable of measuring location. Searches were performed up to February 4, 2015. This was supplemented by backward and forward reference searching. In an attempt to include novel devices which may not yet have made their way into the published research, searches were also performed using three Internet search engines. Specialized software was used to download search results and thus mitigate the potential pitfalls of changing search algorithms. Results: A total of 188 research papers met the inclusion criteria. Global positioning systems were the most widely used location technology in the published research, followed by wearable cameras, and radio-frequency identification. Internet search engines identified 81 global positioning systems, 35 real-time locating systems, and 21 wearable cameras. Real-time locating systems determine the indoor location of a wearable tag via the known location of reference nodes. Although the type of reference node and location determination method varies between manufacturers, Wi-Fi appears to be the most popular method. Conclusions: The addition of location information to existing measures of physical activity and sedentary behavior will provide important behavioral information

Protocol for a feasibility trial to inform the development of a breathlessness rehabilitation programme for chronic obstructive pulmonary disease and chronic heart failure (the COHERE trial)

© 2019 Author(s). Introduction Adults with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) commonly suffer from exertional dyspnoea and fatigue. Exercise training is recommended in the management of both diseases, yet many of the outcome measures traditionally reported are disease specific and may not fully acknowledge the multimorbid older adult. Based on our previous research, a breathlessness rehabilitation programme for patients with COPD/CHF or combined disease has been introduced as a service improvement within University Hospital Leicester National Health Service Trust and has amalgamated aspects of cardiac and pulmonary rehabilitation. This has created an opportunity to expand the outcome measures assessed and introduce a holistic approach in a population that share common symptoms. Therefore, this multisite trial will explore the feasibility of collecting novel outcome markers as part of a comprehensive assessment prior to enrolment in a breathlessness rehabilitation programme for participants with COPD and/or CHF. Methods and analysis The rehabilitation programme consists of 12 sessions, twice weekly, over a 6-week period. In addition to usual rehabilitation outcome measures, the trial will collect measures of future cardiometabolic risk including arterial stiffness, body composition, physical activity/sedentary time, frailty and symptom burden in a comprehensive rehabilitation assessment. The primary outcome measures will centre around feasibility (eg, acceptability of the comprehensive rehabilitation assessment, intervention delivery and the experiences and attitudes of healthcare professionals and participants). Focus groups and interviews will be conducted to further explore barriers and facilitators to the operation and participation in a breathlessness rehabilitation programme and the trial. Thematic analysis will be used for the interpretation of all qualitative data. Ethics and dissemination The research ethics committee East Midlands Leicester-Central has provided ethical approval for the conduct of this trial. The results of the trial will be disseminated through appropriate conference proceedings and peer-reviewed journals. Trial registration number ISRCTN1163630

Novel technology to help understand the context of physical activity and sedentary behaviour.

When used in large, national surveillance programmes, objective measurement tools provide prevalence estimates of low physical activity guideline compliance and high amounts of sedentary time. There are undoubtedly a plethora of reasons for this but one possible contributing factor is the current lack of behavioural context offered by accelerometers and posture sensors. Context includes information such as where the behaviour occurs, the type of activity being performed and is vital in allowing greater refinement of intervention strategies. Novel technologies are emerging with the potential to provide this information. Example data from three ongoing studies is used to illustrate the utility of these technologies. Study one assesses the concurrent validity of electrical energy monitoring and wearable cameras as measures of television viewing. This study found that on average the television is switched on for 202 min d(-1) but is visible in just 90 min of wearable camera images with a further 52 min where the participant is in their living room but the television is not visible in the image. Study two utilises indoor location monitoring to assess where older adult care home residents accumulate their sedentary time. This study found that residents were highly sedentary (sitting for an average of 720 min d(-1)) and spent the majority of their time in their own rooms with more time spent in communal areas in the morning than in the afternoon. Lastly, study three discusses the use of proximity sensors to quantify exposure to a height adjustable desk. These studies are example applications of this technology, with many other technologies available and applications possible. The adoption of these technologies will provide researchers with a more complete understanding of the behaviour than has previously been available

Can functional magnetic resonance imaging studies help with the optimization of health messaging for lifestyle behavior change? A systematic review

Unhealthy behaviours, including smoking, poor nutrition, excessive alcohol consumption, physical inactivity and sedentary lifestyles, are global risk factors for non-communicable diseases and premature death. Functional magnetic resonance imaging (fMRI) offers a unique approach to optimize health messages by examining how the brain responds to information relating to health. Our aim was to systematically review fMRI studies that have investigated variations in brain activation in response to health messages relating to (i) smoking; (ii) alcohol consumption; (iii) physical activity; (iv) diet; and (v) sedentary behaviour. The electronic databases used were Medline/PubMed, Web of Science (Core Collection), PsychINFO, SPORTDiscuss, Cochrane Library and Open Grey. Studies were included if they investigated subjects aged ≥10 years and were published before January 2017. Of the 13,836 studies identified in the database search, 18 studies (smoking k=15; diet k=2; physical activity/sedentary behavior k=1) were included in the review. The prefrontal cortex was activated in seven (47%) of the smoking-related studies and the physical activity study. Results suggest that activation of the ventromedial, dorsolateral and medial prefrontal cortex regions were predictive of subsequent behavior change following exposure to aversive anti-smoking stimuli. Studies investigating the neurological responses to anti-smoking material were most abundant. Of note, the prefrontal cortex and amygdala were most commonly activated in response to health messages across lifestyle behaviors. The review highlights an important disparity between research focusing on different lifestyle behaviors. Insights from smoking literature suggests fMRI may help to optimize health messaging in relation to other lifestyle behaviors