What interventions increase commuter cycling? A systematic review.

OBJECTIVE: To identify interventions that will increase commuter cycling. SETTING: All settings where commuter cycling might take place. PARTICIPANTS: Adults (aged 18+) in any country. INTERVENTIONS: Individual, group or environmental interventions including policies and infrastructure. PRIMARY AND SECONDARY OUTCOME MEASURES: A wide range of 'changes in commuter cycling' indicators, including frequency of cycling, change in workforce commuting mode, change in commuting population transport mode, use of infrastructure by defined populations and population modal shift. RESULTS: 12 studies from 6 countries (6 from the UK, 2 from Australia, 1 each from Sweden, Ireland, New Zealand and the USA) met the inclusion criteria. Of those, 2 studies were randomised control trials and the remainder preintervention and postintervention studies. The majority of studies (n=7) evaluated individual-based or group-based interventions and the rest environmental interventions. Individual-based or group-based interventions in 6/7 studies were found to increase commuter cycling of which the effect was significant in only 3/6 studies. Environmental interventions, however, had small but positive effects in much larger but more difficult to define populations. Almost all studies had substantial loss to follow-up. CONCLUSIONS: Despite commuter cycling prevalence varying widely between countries, robust evidence of what interventions will increase commuter cycling in low cycling prevalence nations is sparse. Wider environmental interventions that make cycling conducive appear to reach out to hard to define but larger populations. This could mean that environmental interventions, despite their small positive effects, have greater public health significance than individual-based or group-based measures because those interventions encourage a larger number of people to integrate physical activity into their everyday lives

Measuring the effect of opportunity cost of time on participation in sports and exercise

This article has been made available through the Brunel Open Access Publishing Fund.Background: There is limited research on the association between opportunity cost of time and sports and exercise due to lack of data on opportunity cost of time. Using a sample of 14142 adults from Health Survey for England (2006), we develop and test a composite index of op-portunity cost of time (to address the current issues with data constraint on opportunity cost of time) in order to explore the relationship between opportunity cost of time and sports participation. Methods: Probit regression models are fitted adjusting for a range of covariates. Opportunity cost of time is measured with two proxy measures: a) composite index (consisting of various indicators of wage earnings) con-structed using principal component analysis; and b) education and employment, approach in the literature. We estimate the relative impact of the composite index compared with current proxy measures, on prediction of sports participation. Findings: Findings suggest that higher opportunity cost of time is associated with increased likelihood of sports participation, regardless of the time intensity of activity or the measure of opportunity cost of time used. The relative impacts of the two proxy measures are comparable. Sports and exercise was found to be positively correlated with income. Another important positive correlate of sports and exercise is participation in voluntary activity. The research and policy implications of our findings are discussed

Behaviour Change in Public Health: Evidence and Implications

Article ID 598672The evidence on the role of particular lifestyles, smoking, binge drinking, lack of physical activity, and poor health care seeking, in increased risks for mortality and morbidity is compelling [1]. Understanding the pathways through which these various “unhealthy” behaviours affect health is complicated by the broader ecological context in which they occur. The complexity is further enhanced because behaviours do not occur in isolation and there is often a convergence of associations. Interventions to achieve changes in either single or multiple behaviours have therefore often been limited in their effectiveness and longer term sustainability. In order to develop and implement a meaningful behaviour change agenda we need to establish innovative ways of operationalizing and understanding the complexity of behavioural factors and their dynamic interrelationships and how these collectively affect health. The Behaviour Change Research Cycle (BCRC) (Figure 1) provides a simple illustration of the life cycle of evidence required

Physical activity in England: Who is meeting the recommended level of participation through sports and exercise?

This article is available through the Brunel Open Access Publishing Fund. Copyright © 2012 Anokye et al.Background: Little is known about the correlates of meeting recommended levels of participation in physical activity (PA) and how this understanding informs public health policies on behaviour change. Objective: To analyse who meets the recommended level of participation in PA in males and females separately by applying ‘process’ modelling frameworks (single vs. sequential 2-step process). Methods: Using the Health Survey for England 2006, (n = 14 142; ≥16 years), gender-specific regression models were estimated using bivariate probit with selectivity correction and single probit models. A ‘sequential, 2-step process’ modelled participation and meeting the recommended level separately, whereas the ‘single process’ considered both participation and level together. Results: In females, meeting the recommended level was associated with degree holders [Marginal effect (ME) = 0.013] and age (ME = −0.001), whereas in males, age was a significant correlate (ME = −0.003 to −0.004). The order of importance of correlates was similar across genders, with ethnicity being the most important correlate in both males (ME = −0.060) and females (ME = −0.133). In females, the ‘sequential, 2-step process’ performed better (ρ = −0.364, P < 0.001) than that in males (ρ = 0.154). Conclusion: The degree to which people undertake the recommended level of PA through vigorous activity varies between males and females, and the process that best predicts such decisions, i.e. whether it is a sequential, 2-step process or a single-step choice, is also different for males and females. Understanding this should help to identify subgroups that are less likely to meet the recommended level of PA (and hence more likely to benefit from any PA promotion intervention).This study was funded by the Department of Health’s Policy Research Programme

Determinants of COVID-19 outcomes: A systematic review

PROSPERO registration number CRD42021237063.This article is a preprint and has not been peer-reviewed [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.Background: The current pandemic, COVID-19, caused by a novel coronavirus SARS-CoV-2, has claimed over a million lives worldwide in a year, warranting the need for more research into the wider determinants of COVID-19 outcomes to support evidence-based policies. Objective: This study aimed to investigate what factors determined the mortality and length of hospitalisation in individuals with COVID-19. Data Source: This is a systematic review with data from four electronic databases: Scopus, Google Scholar, CINAHL and Web of Science. Eligibility Criteria: Studies were included in this review if they explored determinants of COVID-19 mortality or length of hospitalisation, were written in the English Language, and had available full-text. Study appraisal and data synthesis: The authors assessed the quality of the included studies with the Newcastle□Ottawa Scale and the Agency for Healthcare Research and Quality checklist, depending on their study design. Risk of bias in the included studies was assessed with risk of bias assessment tool for non-randomised studies. A narrative synthesis of the evidence was carried out. The review methods were informed by the Joana Briggs Institute guideline for systematic reviews. Results: The review included 22 studies from nine countries, with participants totalling 239,830. The included studies’ quality was moderate to high. The identified determinants were categorised into demographic, biological, socioeconomic and lifestyle risk factors, based on the Dahlgren and Whitehead determinant of health model. Increasing age (ORs 1.04-20.6, 95%CIs 1.01-22.68) was the common demographic determinant of COVID-19 mortality while living with diabetes (ORs 0.50-3.2, 95%CIs −0.2-0.74) was one of the most common biological determinants of COVID-19 length of hospitalisation. Review limitation: Meta-analysis was not conducted because of included studies’ heterogeneity. Conclusion: COVID-19 outcomes are predicted by multiple determinants, with increasing age and living with diabetes being the most common risk factors. Population-level policies that prioritise interventions for the elderly population and the people living with diabetes may help mitigate the outbreak’s impact.The authors did not receive any funding for this study from any funding agency in the public, commercial, or not-for-profit sectors

Determinants of COVID-19-Related Length of Hospital Stays and Long COVID in Ghana: A Cross-Sectional Analysis

Copyright: © 2022 by the authors. Objectives: There is paucity of data on determinants of length of COVID-19 admissions and long COVID, an emerging long-term sequel of COVID-19, in Ghana. Therefore, this study identified these determinants and discussed their policy implications. Method: Data of 2334 patients seen at the main COVID-19 treatment centre in Ghana were analysed in this study. Their characteristics, such as age, education level and comorbidities, were examined as explanatory variables. The dependent variables were length of COVID-19 hospitalisations and long COVID. Negative binomial and binary logistic regressions were fitted to investigate the determinants. Result: The regression analyses showed that, on average, COVID-19 patients with hypertension and diabetes mellitus spent almost 2 days longer in hospital (p = 0.00, 95% CI = 1.42–2.33) and had 4 times the odds of long COVID (95% CI = 1.61–10.85, p = 0.003) compared to those with no comorbidities. In addition, the odds of long COVID decreased with increasing patient’s education level (primary OR = 0.73, p = 0.02; secondary/vocational OR = 0.26, p = 0.02; tertiary education OR = 0.23, p = 0.12). Conclusion: The presence of hypertension and diabetes mellitus determined both length of hospitalisation and long COVID among patients with COVID-19 in Ghana. COVID-19 prevention and management policies should therefore consider these factors

Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: Systematic review and meta-analysis

This is an open access article - Copyright @ 2011 BMJObjective: To assess the impact of exercise referral schemes on physical activity and health outcomes. Design: Systematic review and meta-analysis. Data sources Medline, Embase, PsycINFO, Cochrane Library, ISI Web of Science, SPORTDiscus, and ongoing trial registries up to October 2009. We also checked study references. Study selection Design: randomised controlled trials or non-randomised controlled (cluster or individual) studies published in peer review journals. Population: sedentary individuals with or without medical diagnosis. Exercise referral schemes defined as: clear referrals by primary care professionals to third party service providers to increase physical activity or exercise, physical activity or exercise programmes tailored to individuals, and initial assessment and monitoring throughout programmes. Comparators: usual care, no intervention, or alternative exercise referral schemes. Results Eight randomised controlled trials met the inclusion criteria, comparing exercise referral schemes with usual care (six trials), alternative physical activity intervention (two), and an exercise referral scheme plus a self determination theory intervention (one). Compared with usual care, follow-up data for exercise referral schemes showed an increased number of participants who achieved 90-150 minutes of physical activity of at least moderate intensity per week (pooled relative risk 1.16, 95% confidence intervals 1.03 to 1.30) and a reduced level of depression (pooled standardised mean difference −0.82, −1.28 to −0.35). Evidence of a between group difference in physical activity of moderate or vigorous intensity or in other health outcomes was inconsistent at follow-up. We did not find any difference in outcomes between exercise referral schemes and the other two comparator groups. None of the included trials separately reported outcomes in individuals with specific medical diagnoses. Substantial heterogeneity in the quality and nature of the exercise referral schemes across studies might have contributed to the inconsistency in outcome findings. Conclusions Considerable uncertainty remains as to the effectiveness of exercise referral schemes for increasing physical activity, fitness, or health indicators, or whether they are an efficient use of resources for sedentary people with or without a medical diagnosis.This project was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme (project number 08/72/01) (www.hta.ac.uk/)

The demand for sports and exercise: Results from an illustrative survey

Funding from the Department of Health policy research programme was used in this study.There is a paucity of empirical evidence on the extent to which price and perceived benefits affect the level of participation in sports and exercise. Using an illustrative sample of 60 adults at Brunel University, West London, we investigate the determinants of demand for sports and exercise. The data were collected through face-to-face interviews that covered indicators of sports and exercise behaviour; money/time price and perceived benefits of participation; and socio- economic/demographic details. Count, linear and probit regression models were fitted as appropriate. Seventy eight per cent of the sample participated in sports and exercise and spent an average of £27 per month and an average of 20 min travelling per occasion of sports and exercise. The demand for sport and exercise was negatively associated with time (travel or access time) and ‘variable’ price and positively correlated with ‘fixed’ price. Demand was price inelastic, except in the case of meeting the UK government’s recommended level of participation, which is time price elastic (elasticity = −2.2). The implications of data from a larger nationally representative sample as well as the role of economic incentives in influencing uptake of sports and exercise are discussed.This article is available through the Brunel Open Access Publishing Fund

Randomised controlled trial of an augmented exercise referral scheme using web-based behavioural support for inactive adults with chronic health conditions: the e-coachER trial.

OBJECTIVE: To determine whether adding web-based support (e-coachER) to an exercise referral scheme (ERS) increases objectively assessed physical activity (PA). DESIGN: Multicentre trial with participants randomised to usual ERS alone (control) or usual ERS plus e-coachER (intervention). SETTING: Primary care and ERS in three UK sites from 2015 to 2018. PARTICIPANTS: 450 inactive ERS referees with chronic health conditions. INTERVENTIONS: Participants received a pedometer, PA recording sheets and a user guide for the web-based support. e-coachER interactively encouraged the use of the ERS and other PA options. MAIN OUTCOME MEASURES: Primary and key secondary outcomes were: objective moderate-to-vigorous PA (MVPA) minutes (in ≥10 min bouts and without bouts), respectively, after 12 months. Secondary outcomes were: other accelerometer-derived and self-reported PA measures, ERS attendance, EQ-5D-5L, Hospital Anxiety and Depression Scale and beliefs about PA. All outcomes were collected at baseline, 4 and 12 months. Primary analysis was an intention to treat comparison between intervention and control arms at 12-month follow-up. RESULTS: There was no significant effect of the intervention on weekly MVPA at 12 months between the groups recorded in ≥10 min bouts (mean difference 11.8 min of MVPA, 95% CI: -2.1 to 26.0; p=0.10) or without bouts (mean difference 13.7 min of MVPA, 95% CI: -26.8 to 54.2; p=0.51) for 232 participants with usable data. There was no difference in the primary or secondary PA outcomes at 4 or 12 months. CONCLUSION: Augmenting ERS referrals with web-based behavioural support had only a weak, non-significant effect on MVPA. TRIAL REGISTRATION NUMBER: ISRCTN15644451

Impact of sports participation on incidence of bone traumatic fractures and health care costs among adolescents: ABCD – Growth Study

This is the author accepted manuscript. The final version is available from Taylor & Francis.Objective: To analyze the risk of bone traumatic fractures according to the engagement in sports, as well as to identify the potential impact of sports participation and traumatic fractures on health care costs among adolescents. Methods: This is a longitudinal 12-months follow-up study of 285 adolescents of both sexes in Brazil. We assessed the occurrence of traumatic fractures and health care services (hospitalizations, medicine use, medical consultations and exams) by phone contact every single month for 12 months. Adolescents were divided into four groups according to sport characteristics: non-sport (n= 104), non-impact sport (swimming [n= 34]), martial arts (n= 49 [judo, karate, kung-Fu]) and impact sports (n= 98 [track-and-field, basketball, gymnastics, tennis, and baseball]). Results: The incidence of new fractures was 2.1%. The overall costs accounted during the 12-month follow-up were U$3,259.66. Swimmers (US$ 13.86) had higher health care costs than non-sport (US$1.82), martial arts (US$ 2.23) and impact sports (US$ 2.32). Conclusion: swimming seems to be related to higher health care costs among adolescents