Introduction: Increasing and maintaining physical activity in special populations

Exercise Physiology in Special Populations covers the prevalent health conditions that are either linked to an inactive lifestyle or whose effects can be ameliorated by increasing physical activity and physical fitness. The book explores physiological aspects of obesity and diabetes before moving on to cardiac disease, lung disease, arthritis and back pain, ageing and older people, bone health, the female participant, neurological and neuromuscular disorders, and spinal chord injury. The author team includes many of the UK?s leading researchers and exercise science and rehabilitation practitioners that specialise in each of the topic areas

Pragmatic evaluation of the Go2Play Active Play intervention on physical activity and fundamental movement skills in children

Active play is a novel approach to addressing low physical activity levels and fundamental movement skills (FMS) in children. This study aimed to determine if a new school-based, ‘Go2Play Active Play’ intervention improved school day physical activity and FMS. This was a pragmatic evaluation conducted in Scotland during 2015–16. Participants (n = 172; mean age = 7 years) were recruited from seven primary schools taking part in the 5-month intervention, plus 24 participants not receiving the intervention were recruited to act as a comparison group.189 participants had physical activity measured using an Actigraph GT3X accelerometer at baseline and again at follow-up 5 months later. A sub-sample of participants from the intervention (n = 102) and comparison (n = 21) groups had their FMS assessed using the Test of Gross Motor Development (TGMD-2) at baseline and follow-up. Changes in school day physical activity and FMS variables were examined using repeated measures ANOVA. The main effect was ‘group’ on ‘time’ from baseline to follow-up. Results indicated there was a significant interaction for mean counts per minute and percent time in sedentary behavior, light intensity physical activity and moderate to vigorous physical activity (MVPA) (all p < 0.01) for school day physical activity. There was a significant interaction for gross motor quotient (GMQ) score (p = 0.02) and percentile (p = 0.04), locomotor skills score and percentile (both p = 0.02), but no significant interaction for object control skills score (p = 0.1) and percentile (p = 0.3). The Go2Play Active Play intervention may be a promising way of improving physical activity and FMS but this needs to be confirmed in an RCT

Parents’ journey through treatment for their child’s obesity: a qualitative study

Background: Treatment for childhood obesity is characterised by patient non-attendance and drop-out, and widespread failure to achieve weight maintenance. Qualitative methods may improve our understanding of patient perceptions and so improve treatment for childhood obesity. Aim: To provide insight into the perceptions of parents of obese children as they &lsquo;journey&rsquo; from pre-treatment to end of treatment. Methods: We used purposive sampling and studied 17 parents of children attending 6-month outpatient treatments for obesity (BMI&gt;98th percentile). Parent&rsquo;s perceptions were explored by in-depth interviews, analysed using Framework methods. Results: Parents were characterised as being unaware of their child&rsquo;s weight, in denial, or actively seeking treatment. Parents were consistently motivated to enter treatment due to perceived benefits to their child&rsquo;s self esteem or quality of life, and weight outcomes appeared typically less important. During treatment parents expressed a lack of support for lifestyle changes outside the clinic, and noted that members of the extended family often undermined or failed to support lifestyle changes. Parents generally felt that treatment should have continued beyond six months, and it had provided benefits to their child&rsquo;s well-being, self esteem, and quality of life, and this is what motivated many to remain engaged with treatment. Discussion: This study may help inform future treatments for childhood obesity by providing insights into the aspects of treatment of greatest importance to parents. Future treatments may need to consider providing greater support to lifestyle changes within the extended family, and may need to focus more on psycho-social outcomes

Associations of screen time, sedentary time and physical activity with sleep in under 5s: a systematic review and meta-analysis

Sleep is crucial to children's health and development. Reduced physical activity and increased screen time adversely impact older children’s sleep, but little is known about these associations in children under 5 years. This systematic review examined the association between screen time/movement behaviors (sedentary behavior, physical activity) and sleep outcomes in infants (0-1 year); toddlers (1-2 years); and preschoolers (3-4 years). Evidence was selected according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and synthesized using vote counting based on the direction of association. Quality assessment and a Grading of Recommendations, Assessment, Development and Evaluation was performed, stratified according to child age, exposure and outcome measure. Thirty-one papers were included. Results indicate that screen time is associated with poorer sleep outcomes in infants, toddlers and preschoolers. Meta-analysis confirmed these unfavorable associations in infants and toddlers but not preschoolers. For movement behaviors results were mixed, though physical activity and outdoor play in particular were favorably associated with most sleep outcomes in toddlers and preschoolers. Overall, quality of evidence was very low, with strongest evidence for daily/evening screen time use in toddlers and preschoolers. Although high-quality experimental evidence is required, our findings should prompt parents, clinicians and educators to encourage sleep-promoting behaviors (e.g. less evening screen time) in the under 5s

Effect of an exercise consultation on maintenance of physical activity after completion of phase III exercise-based cardiac rehabilitation

Background Many patients do not maintain physical activity levels after completion of phase III exercise-based cardiac rehabilitation. Design This study determined the effect of the exercise consultation on maintenance of physical activity and cardiorespiratory fitness 12 months after completion of a phase III exercise programme. Seventy cardiac patients were randomized to the experimental (exercise consultation and exercise information) or control groups (exercise information only). Methods Outcomes recorded at baseline, six and 12 months were physical activity (stage of change, 7-day recall, accelerometer), cardiorespiratory fitness, lipids, quality of life, anxiety and depression. Results Both groups were regularly active at baseline. The between group difference for the change in total activity (minutes/week) assessed by the 7-day recall was significant from baseline to 12 months (98%CI –295, -20). Total activity was maintained in the experimental group (98%CI -63, 154) and significantly decreased in the control group (115 minutes/week; 98%CI -228, -28) from baseline to 12 months. The between group difference for the change in accelerometer counts/week was not significant from baseline to six (98%CI -1143720, 607430) or 12 months (98%CI -1131128, 366473). A comparable, significant decrease in peak oxygen uptake occurred from baseline to 12 months in experimental (1.8 ml/kg/min; 98%CI -3.2, -0.3) and control participants (2.3 ml/kg/min; -3.8, -0.8). Lipids, quality of life, anxiety and depression were normal at baseline and did not significantly change in either group over time. Conclusion Exercise consultation was effective in maintaining self-reported physical activity, but not peak oxygen uptake, for 12 months after completion of phase III

More Active Mums in Stirling (MAMMiS): a physical activity intervention for postnatal women. Study protocol for a randomized controlled trial

Background: Many postnatal women are insufficiently physically active in the year after childbirth and could benefit from interventions to increase activity levels. However, there is limited information about the efficacy, feasibility and acceptability of motivational and behavioral interventions promoting postnatal physical activity in the UK. Methods: The MAMMiS study is a randomized, controlled trial, conducted within a large National Health Service (NHS) region in Scotland. Up to 76 postnatal women will be recruited to test the impact of two physical activity consultations and a 10-week group pram-walking program on physical activity behavior change. The intervention uses evidence-based motivational and behavioral techniques and will be systematically evaluated using objective measures (accelerometers) at three months, with a maintenance measure taken at a six-month follow-up. Secondary health and well-being measures and psychological mediators of physical activity change are included. Discussion: The (MAMMiS study will provide a test of a theoretical and evidence-based physical activity behavior change intervention for postnatal women and provide information to inform future intervention development and testing within this population

Impact of Physical Activity on Adiposity and Risk Markers for Cardiovascular and Metabolic Disease

The main aim of the present study was to investigate the impact of physical activity (PA) on adiposity and for cardiovascular and metabolic disease risk markers (CMDRMs). In total, 55 adults (33 lean [L] and 22 overweight/obesity [O/O]) visited the laboratory on two occasions. During the first session, body composition and anthropometric measurements were taken as well as resting blood pressure (BP). Free-living PA intensity was monitored using an ActiGraph accelerometer, which the participants wore for a period of 6 days. During the second visit, blood samples for the analysis of disease risk markers were obtained from the participants in the morning after overnight fasting (≥10 hr). There was no significant difference between groups in the percentage of time spent in PA levels (54.5% ± 1.2% and 54.9% ± 2.1% for L and O/O, respectively). Although, the O/O group was within recommended PA level, they had higher leptin, insulin, homeostatic model assessment of insulin resistance (HOMA-IR), and high-sensitivity C-reactive protein (hsCRP) levels than the L group (all p < .01). The O/O group had higher levels of triglycerides, low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) and lower levels of high-density lipoprotein (HDL; all p < .01). Interestingly, vigorous activity was positively correlated with HDL (r = .30, p < .05) and negatively with LDL (r = −.26, p = .05) levels and the arachidonic acid to eicosapentaenoic acid (ARA/EPA) ratio (r = −.30, p < .05). Only the O/O group had elevated CMDRMs. However, vigorous activity may improve health-related blood lipids such as HDL, LDL, and ARA/EPA ratio. Regardless of body composition status, low active participants were more likely to have higher level of leptin and hsCRP. Further exploration of the beneficial effects of vigorous exercise on adiposity and CMDRMs is warranted

Results from Scotland's 2018 report card on physical activity for children and youth

Previous Active Healthy Kids Scotland Report Cards from 2013 and 2016 (www.activehealthykidsscotland.co.uk) demonstrated that only a small minority of Scottish school-aged children and adolescents meet the recommended amount of daily moderate-tovigorous intensity physical activity (MVPA; ≥60 minutes). These low levels of MVPA occur despite a favorable physical and policy environment in Scotland. Previous report cards also identified major limitations in surveillance of physical activity and related behaviors in Scotland. The aim of this short paper is to (a) summarize the Scottish grades included in the Global Matrix 3.0 (www.activehealthykids.org) and (b) highlight the continuing limitations in surveillance of physical activity among children and adolescents in Scotland

Healthy Habits Happy Homes Scotland (4HS) feasibility study : translation of a home-based early childhood obesity prevention intervention evaluated using RE-AIM framework

Objective Healthy Habits, Happy Homes (4H) is a home-based, pre-school childhood obesity prevention intervention which demonstrated efficacy in North America which we translated to Scotland (4HS) by considering contextual factors and adapting study design. RE-AIM Framework was used to assess 1) extent to which development of 4HS intervention (including recruitment) was participatory and inclusive; 2) feasibility of translating a complex public health intervention from one setting to another; 3) extent to which translation was pragmatic and 4) fidelity of intervention to the principles of Motivational Interviewing (MI). Study design Feasibility testing, process evaluation and measurements of intervention fidelity were undertaken to evaluate the translation of 4H to an economically deprived area of Scotland (4HS). Methods 4HS study processes; participatory approach, recruitment methods, level of pragmatism were evaluated using the RE-AIM framework. Qualitative and quantitative measures identified key implementation features and functioning of 4HS intervention. Fidelity MI principles was determined through coding of audiotapes using Motivation Interviewing Treatment Integrity (MITI) code. Results Key facilitators for positive impact with families, included: inclusive recruitment methods, appropriate channels of communication and correspondence (Reach) with n ​= ​126 enquiries and n ​= ​26 (21%) families recruited. Positive links with local parents and community workers integral to the research process at n ​= ​9 meetings (Effectiveness). 61.5% of families lived in the most deprived data zone in Scotland, 23% were one parent families, thus awareness and consideration of local contextual factors (Adoption) and locally relevant materials were important. 4HS was feasible to deliver, pragmatic in nature and intervention demonstrated good fidelity to MI (Implementation). Conclusion Translation of 4H from North America to Scotland was successful. Future studies should consider implementation of 4HS approach within routine practice within the UK (practice based evidence) or through thoughtful evaluation in a future trial (evidence based practice)

GRADE-ADOLOPMENT process to develop 24-hour movement behavior recommendations and physical activity guidelines for the under 5s in the United Kingdom, 2019

Background: This article summarizes the approach taken to develop UK Chief Medical Officers' physical activity guidelines for the Under 5s, 2019. Methods: The Grading of Recommendations Assessment, Development and Evaluation (GRADE)- Adaptation, Adoption, De Novo Development (ADOLOPMENT) approach was used, based on the guidelines from Canada and Australia, with evidence updated to February 2018. Recommendations were based on the associations between (1) time spent in sleep, sedentary time, physical activity, and 10 health outcomes and (2) time spent in physical activity and sedentary behavior on sleep outcomes (duration and latency). Results: For many outcomes, more time spent in physical activity and sleep (up to a point) was beneficial, as was less time spent in sedentary behavior. The authors present, for the first time, evidence in GRADE format on behavior type-outcome associations for infants, toddlers, and preschoolers. Stakeholders supported all recommendations, but recommendations on sleep and screen time were not accepted by the Chief Medical Officers; UK guidelines will refer only to physical activity. Conclusions: This is the first European use of GRADE-ADOLOPMENT to develop physical activity guidelines. The process is robust, rapid, and inexpensive, but the UK experience illustrates a number of challenges that should help development of physical activity guidelines in future