Effectiveness of behaviour change techniques in physiotherapy interventions to promote physical activity adherence in lower limb osteoarthritis patients: A systematic review

Background: Lower limb osteoarthritis (OA) causes high levels of individual pain and disability and is an increasing socio-economic burden to global healthcare systems. Physical Activity interventions are commonly provided by physiotherapists to help patients with lower limb OA manage their clinical symptoms. Objective: To identify and evaluate the effectiveness of behavioural change techniques (BCTs) within physiotherapy interventions to increase physical activity (PA) adherence in patients with lower limb OA. Design: A systematic review was conducted, following Cochrane guidelines according to a published and registered protocol (CRD42016039932). Two independent researchers conducted searches, determined eligibility, assessed risk of bias (Cochrane tool), intervention fidelity (NIHBCC checklist), and coded randomised controlled trials (RCTs) for BCTs (V1 taxonomy). BCT effectiveness ratios were calculated and RCT risk of bias and intervention fidelity were summarised narratively. Data sources: A highly sensitive search strategy was conducted on Medline, Embase, PsycINFO, CENTRAL, CINAHL and PEDro and grey literature databases from inception to January 2nd, 2018. Reference lists of included RCTs and relevant articles were reviewed, and a citation search was conducted using Web of Science. Eligibility criteria for selecting studies: RCTs that evaluated the effectiveness of a physiotherapy intervention that incorporated >1 BCT that promoted home or community-based PA adherence in patients with lower limb osteoarthritis. Results: Twenty-four RCTs (n = 2366 participants) of variable risk of bias (RoB) (5 low; 7 moderate; 12 high) and poor intervention reporting from 10 countries were included. Heterogeneity of intervention BCTs and PA adherence outcome measures precluded meta-analysis. Thirty-one distinct BCTs were identified in 31 interventions across RCTs. In general, BCTs demonstrated higher effectiveness ratios for short-term and long-term PA adherence compared with medium-term outcomes. The BCTs ‘behavioural contract’, ‘non-specific reward’, ‘patient-led goal setting’ (behaviour), ‘self-monitoring of behaviour’, and ‘social support (unspecified) demonstrated the highest effectiveness ratios across time points to promote PA adherence. Conclusions BCTs demonstrate higher short and long-term than medium-term effectiveness ratios. Further research involving low RoB RCTs incorporating transparently reported interventions with pre-specified BCTs aimed at optimising lower limb OA patient PA adherence is required.Peer reviewedFinal Published versio

The Contribution of Youth Sport Football to Weekend Physical Activity for Males Aged 9 to 16 Years: Variability Related to Age and Playing Position

The aims of this study were (1) to determine minutes of moderate-to-vigorous physical activity (PA) and vigorous PA accrued in youth sport football (also internationally referred to as soccer), and the contribution toward daily weekend moderate-to-vigorous PA and vigorous PA for males aged 9-16 years, and (2) to investigate variability in these outcomes related to age and playing position. One hundred and nine male grassroots footballers (Mean age = 11.98 ± 1.75 years) wore a GT3x accelerometer for 7 days. Weekend youth sport football participation and playing position were recorded. Youth sport football moderate-to-vigorous PA (M = 51.51 ± 17.99) and vigorous PA (M = 27.78 ± 14.55) contributed 60.27% and 70.68% toward daily weekend moderate-to-vigorous PA and vigorous PA, respectively. Overall, 36.70% of participants accumulated ≥60 min moderate-to-vigorous PA and 69.70% accrued &lt; 20 min of vigorous PA during youth sport. For participants aged 13 to16 years, youth sport football moderate-to-vigorous PA and vigorous PA were significantly higher, and contributed a greater amount toward daily weekend moderate-to-vigorous PA and vigorous PA than for participants aged 9-12 years (p = &gt;.01). Youth sport football is an important source of moderate-to-vigorous PA and vigorous PA at the weekend for male youth, and particularly for adolescents. Participation may offer opportunity for weekend engagement in vigorous PA toward health enhancing levels.</jats:p

Maximising youth sport as a context for physical activity promotion: a self-determination theory approach

Youth sport has been advocated as a vehicle through which more physically active lifestyles can be encouraged among children and adolescents. Employing objective assessments of physical activity (PA), the purpose of this thesis was to investigate the value of youth sport as a context for PA promotion and obesity prevention. Results from Study 1 indicated 37% of youth sport football participants did not meet recommended levels of moderate-to-vigorous PA (MVPA) during their youth sport engagement. Study 2 demonstrated negative associations between daily PA levels of grassroots footballers and obesity linked health outcomes, with the reverse true for sedentary time (ST). Guided by self-determination theory (Deci & Ryan, 1987), findings from Studies 3 and 4 revealed perceptions of coach provided autonomy support were positively associated with sport related autonomous motivation, and in turn, higher MVPA participation (daily MVPA as well as PA accrued during youth sport) and lower ST. This thesis underlines the value of youth sport as a setting through which levels of PA can be increased, and ST reduced among youth. Research described within also points to the important role of the coach-created environment and player motivation in predicting variability in PA engagement and ST among young grassroots footballers

Increasing prevalence of male homosexual partnerships and practices in Britain 1990-2000: evidence from national probability surveys.

OBJECTIVES: To estimate the prevalence and timing of homosexual experience among British men; to explore the patterns of sexual practices and partnerships in 2000, and behavioural and attitudinal changes between 1990 and 2000 among men who have sex with men (MSM). DESIGN: Two large, stratified probability sample surveys of the general population. METHODS: Trained interviewers administered a combination of face-to-face and self-completion questionnaires to men aged 16 to 44 years resident in Britain (n = 6000 in 1990 and n = 4762 in 2000). RESULTS: In 2000, 2.8% of British men reported sex with men in the past 5 years. 46.0% of MSM reported five or more partners in the past 5 years, and 59.8% reported unprotected anal intercourse in the past year. A total of 33.0% of MSM reported one or more female partner(s) in the past year. In comparison with 1990, there was a significant increase in the proportion of MSM in the population in 2000, and among these men, in the proportion reporting receptive anal intercourse in the past year [age-adjusted odds ratio (OR), 2.08; 95% confidence interval (CI), 1.08-4.00], but no significant change in self-perceived HIV-risk (age-adjusted OR, 1.11; 95% CI, 0.49-2.51) or HIV testing in past 5 years (age-adjusted OR, 1.14; 95% CI, 0.57-2.25). CONCLUSIONS: Evidence of increasing prevalence of homosexual intercourse among the British male population coupled with increases in some HIV-risk behaviours among MSM suggests overall increasing numbers at risk in the population. Although these changes may partly reflect an increased willingness to report these behaviours, our results are consistent with increasing incidence of sexually transmitted infections and behavioural surveillance data

Empowering youth sport environments: Implications for daily moderate-to-vigorous physical activity and adiposity

AbstractBackgroundEvidence suggests involvement in youth sport does not guarantee daily guidelines for moderate-to-vigorous physical activity (MVPA) are met, and participation may not mitigate the risks associated with physical inactivity. The need to promote higher habitual MVPA engagement amongst children active in the youth sport context has therefore been underlined. Framed by self-determination theory, the aim of the present study was to examine the implications of the motivational climate created in youth sport, for children's daily engagement in MVPA and associated adiposity. Specifically, we sought to test a motivational sequence in which children's perceptions of an empowering coach-created motivational climate were related to autonomous and controlled motivation, which in turn predicted sport-related enjoyment. Finally, enjoyment is assumed to predict accelerometer assessed daily MVPA and, following this, adiposity.MethodsMale and female youth sport participants aged 9–16 years (n = 112) completed multi-section questionnaires assessing their perceptions of the motivational climate created in youth sport (i.e., autonomy supportive, task involving, socially supportive), autonomous and controlled motivation, and sport-related enjoyment. Daily MVPA engagement was determined via 7 days of accelerometry. Percent body fat (BF%) was estimated using bio-electrical impedance analysis.ResultsPath analysis revealed perceptions of an empowering motivational climate positively predicted players' autonomous motivation, and in turn, sport-related enjoyment. Enjoyment was also significantly negatively related to players' BF%, via a positive association with daily MVPA.ConclusionFostering more empowering youth sport environments may hold implications for the prevention of excess adiposity, through encouraging higher habitual MVPA engagement. Findings may inform the optimal design of youth sport settings for MVPA promotion, and contribute towards associated healthy weight maintenance amongst youth active in this context. Longitudinal and intervention studies are required to confirm these results

Ethnic variations in sexual behaviour in Great Britain and risk of sexually transmitted infections: a probability survey.

BACKGROUND: Ethnic variations in the rate of diagnosed sexually transmitted infections (STIs) have been reported in many developed countries. We used data from the second British National Survey of Sexual Attitudes and Lifestyles (Natsal 2000) to investigate the frequency of high-risk sexual behaviours and adverse sexual health outcomes in five ethnic groups in Great Britain. METHODS: We did a stratified probability sample survey of 11161 men and women aged 16-44 years, resident in Great Britain, using computer-assisted interviews. Additional sampling enabled us to do more detailed analyses for 949 black Caribbean, black African, Indian, and Pakistani respondents. We used logistic regression to assess reporting of STI diagnoses in the past 5 years, after controlling for demographic and behavioural variables. FINDINGS: We noted striking variations in number of sexual partnerships by ethnic group and between men and women. Reported numbers of sexual partnerships in a lifetime were highest in black Caribbean (median 9 [IQR 4-20]) and black African (9 [3-20]) men, and in white (5 [2-9]) and black Caribbean (4 [2-7]) women. Indian and Pakistani men and women reported fewer sexual partnerships, later first intercourse, and substantially lower prevalence of diagnosed STIs than did other groups. We recorded a significant association between ethnic origin and reported STIs in the past 5 years with increased risk in sexually active black Caribbean (OR 2.74 [95% CI 1.22-6.15]) and black African (2.95 [1.45-5.99]) men compared with white men, and black Caribbean (2.41 [1.35-4.28]) women compared with white women. Odds ratios changed little after controlling for age, number of sexual partnerships, homosexual and overseas partnerships, and condom use at last sexual intercourse. INTERPRETATION: Individual sexual behaviour is a key determinant of STI transmission risk, but alone does not explain the varying risk across ethnic groups. Our findings suggest a need for targeted and culturally competent prevention interventions