Multi-stakeholder perspectives of factors that influence contact centre call agent’s workplace physical activity and sedentary behaviour

Contact centre call agents are highly sedentary at work, which can negatively affect cardio-metabolic health. This qualitative cross-sectional study explored factors influencing call agents’ workplace physical activity (PA) and sedentary behaviour (SB), and perspectives on strategies to help agents move more and sit less at work. Semi-structured interviews and focus groups with call agents (n = 20), team leaders (n = 11) and senior staff (n = 12) across four contact centres were guided by the socio-ecological model and analysed thematically. Agents offered insights into the impact of high occupational sitting and low PA on their physical and mental health, and factors influencing their motivation to move more and sit less at work. Team leaders, although pivotal in influencing behaviours, identified their own workload, and agents’ requirement to meet targets, as factors influencing their ability to promote agents to move more and sit less at work. Further, senior team leaders offered a broad organisational perspective on influential factors, including business needs and the importance of return on investment from PA and SB interventions. Unique factors, including continuous monitoring of productivity metrics and personal time, a physical connection to their workstation, and low autonomy over their working practices, seemed to limit call agents’ opportunity to move more and sit less at work. Proposed strategies included acknowledgement of PA and SB within policy and job roles, height-adjustable workstations, education and training sessions and greater interpersonal support. Additionally, measuring the impact of interventions was perceived to be key for developing a business case and enhancing organisational buy-in. Multi-level interventions embedded into current working practices appear important for the multiple stakeholders, while addressing concerns regarding productivity

A protocol to encourage accelerometer wear in children and young people

Background: Improving compliance to physical activity monitoring is critical for obtaining valid, comparable data free from inconsistencies that occur during data reduction. The first aim of this study was to investigate children (8-11 years) and young people’s (12-15 years) views on strategies to promote habitual wear of hip (ActiGraph) and wrist-worn (GENEActiv) accelerometers. The second aim was to subsequently develop a protocol to reduce participant and researcher burden and maximise accelerometer wear time data. Methods: An interpretivist methodology was used with semi-structured, mixed-gender focus groups in 7 elementary (n=10; 47 children) and 5 high schools (n =10; 49 young people). Focus groups were transcribed verbatim and outcomes from deductive and inductive analysis were represented via pen profiles. Results: Deductive content analysis revealed four general dimensions: 1) participant driven compliance strategies; 2) reasons for non-compliance to wear time; 3) strategies to improve accelerometer care; 4) reasons for non-compliance to study conditions. Children perceived popular wear time compliance strategies to be: 1) sticky note reminders; 2) mobile phone reminders; 3) social conformity, whereas young people’s perceptions were: 1) social conformity; 2) mobile phone reminders; 3) monetary compensation. Conclusions: Where possible, compliance strategies should accommodate the varying preferences of children and young people. It is recommended that future accelerometry based research adopts a formative phase. In the absence of a formative research phase, future research should consider the use of this informed protocol to improve compliance to physical activity monitoring in children and young people

Educator perspectives on factors influencing children’s school-based physical activity

Formative research is an important first step in the design and development of children’s school-based physical activity (PA) interventions. Exploration of educator (headteacher and PE-coordinator) perceptions toward the promotion of school-based PA, including physical education (PE) delivery has however been limited. This study took a socio-ecological approach to explore the barriers and facilitators of children’s school-based PA from the perspective of school educators. Interviews were conducted with headteachers (n=4), PE-coordinators (n=4) and a deputy headteacher (n=1) and data thematically analysed using Nvivo software (version 10). Findings suggested that, at an organisational level headteachers were the predominant driving force in the promotion of PA opportunities, yet institutional barriers including low priority for PA and PE were perceived to negate delivery. At an interpersonal level, strategies to increase the delivery of school-based PA were developed, however poor teacher-coach relationships and significant others reduced PA promotion opportunities. Child PA was further negated through intrapersonal factors, including lack of PE-specific teacher training and varying teacher interest in PA and sport. To increase primary school children’s school-based PA, barriers and facilitators at the organisational, interpersonal and intrapersonal level must be considered and targeted, and researchers and schools should work in partnership to develop future interventions

Systematic review of the methods used in economic evaluations of targeted physical activity and sedentary behaviour interventions

The burden of noncommunicable diseases (NCD) on health systems worldwide is substantial. Physical inactivity and sedentary behaviour are major risk factors for NCD. Previous attempts to understand the value for money of preventative interventions targeting physically inactive individuals have proved to be challenging due to key methodological challenges associated with the conduct of economic evaluations in public health. A systematic review was carried out across six databases (Medline, SPORTSDiscus, EconLit, PsychINFO, NHS EED, HTA) along with supplementary searches. The review examines how economic evaluations published between 2009-March 2017 have addressed methodological challenges with the aim of bringing to light examples of good practice for future studies. Fifteen economic evaluations from four high-income countries were retrieved; there is a dearth of studies targeting sedentary behaviour as an independent risk factor from physical activity. Comparability of studies from the healthcare and societal perspectives were limited due to analysts’ choice in cost categories, valuation technique and time horizon differing substantially. The scarcity of and inconsistencies across economic evaluations for these two behaviours have exposed a mismatch between calls for more preventative action to tackle NCD and the lack of information available on how resources may be optimally allocated in practice. Consequently, this paper offers a table of recommendations on how future studies can be improved

Children’s perceptions of factors that influence PE enjoyment: A qualitative investigation

Background. Physical education (PE) is a key setting for children to engage in health-enhancing physical activity (PA). Factors influencing PE enjoyment in secondary schools are well researched. Less is known, however, about the factors children in elementary schools perceive to be important in promoting enjoyment, and how the current PE delivery framework in UK primary schools (combining specialist external coaches and generalist teachers) impacts on children’s motivational experiences. According to self-determination theory (SDT), enjoyment of activities is an intrinsic motivator for sustained engagement. Understanding children’s perceptions of PE is therefore critical if PE instructors are to increase enjoyment and the promotion of PA within and beyond PE. Purpose. To investigate children’s perceptions of factors that influence PE enjoyment, and interpret findings in the context of SDT and the promotion of autonomous motivation. Participants. Primary school pupils recruited from a cluster of four schools within a socio-economically deprived area of a large city in the North-West of England. Data collection and analysis. Eight focus groups were conducted with 47 children (23 boys) aged 7-11. Mixed gender focus groups included 4-6 children clustered by school years 3-4 (ages 7-9 years) and 5-6 (ages 9-11 years). Children were asked about their PE experiences and factors that influenced their perceived PE enjoyment. Transcripts were transcribed verbatim and analysed thematically using NVivo10 analysis software. Findings. Factors reported to influence children’s perceived PE enjoyment included 1) individual preferences, 2) peer behaviour, 3) instructor behaviour. Findings were interpreted in relation to SDT, and recommendations are given to help instructors and schools create a PE environment that enhances children’s enjoyment of PE. Conclusions. PE instructors and peers are important in creating an environment that supports children’s psychological needs for autonomy, competence and relatedness, which influence PE enjoyment. To consistently provide children with enjoyable PE lessons, primary schools are advised to support the ongoing development of generalist teachers and facilitate better working relationships between generalist teachers and specialist coaches. SDT can be used by instructors to guide practice that enhances children’s enjoyment of PE

Using an e-Health Intervention to Reduce Prolonged Sitting in UK Office Workers: A Randomised Acceptability and Feasibility Study

Low-cost workplace interventions are required to reduce prolonged sitting in office workers as this may improve employees’ health and well-being. This study aimed to assess the acceptability and feasibility of an e-health intervention to reduce prolonged sitting among sedentary UK-based office workers. Secondary aims were to describe preliminary changes in employee health, mood and work productivity after using an e-health intervention. Healthy, university office workers (n = 14) completed this study. An 8 week randomised crossover design was used, consisting of two trials: Intervention (computer-based prompts) and Control. Eligibility and retention rates were recorded to assess the feasibility of the trial and interviews were conducted following the intervention to explore its acceptability. Sitting, standing and stepping were objectively assessed prior to and during week 8 of each trial. Before and after each trial, measurements of vascular function, cerebrovascular function, mood and work productivity were obtained. This study had eligibility and retention rates of 54.5% and 77.8%, respectively. Participants expressed a lack of autonomy and disruption to their workflow when using the e-health intervention, raising concerns over its acceptability and long-term implementation. Preliminary data indicate that the intervention may improve the patterning of activity accrued during work hours, with increases in the number of standing and stepping bouts completed, in addition to improving vascular function. This e-health intervention is feasible to deliver in a cohort of university office workers. However, adaptations to its implementation, such as personalised settings, are needed to increase acceptability before larger trials can be conducted

Clinical exercise provision in the UK: comparison of staff job titles, roles and qualifications across five specialised exercise services

Objectives: In the UK, the NHS long-term plan advocates exercise as a key component of clinical services, but there is no clearly defined workforce to deliver the plan. We aimed to provide an overview of current UK clinical exercise services, focusing on exercise staff job titles, roles, and qualifications across cardiovascular, respiratory, stroke, falls, and cancer services. Methods: Clinical exercise services were identified electronically between May 2020 and September 2020 using publicly available information from clinical commissioning groups (CCG), national health boards and published audit data. Data relating to staff job titles, roles, qualifications and exercise delivery were collected via electronic records and telephone/e-mail contact with service providers. Results: Data were obtained for 731 of 890 eligible clinical services (216 cardiac, 162 respiratory, 129 stroke, 117 falls, 107 cancer). Cardiac rehabilitation services provided both clinical (phase III) and community (phase IV) exercise interventions delivered by physiotherapists, exercise physiologists (exercise specific BSc/MSc) and exercise instructors (vocationally qualified with or without BSc/MSc). Respiratory, stroke and falls services provided a clinical exercise intervention only, mostly delivered by physiotherapists and occupational therapists. Cancer services provided a community exercise service only, delivered by vocationally qualified exercise instructors. Job titles of “exercise physiologists” (n=115) bore little alignment to their qualifications, with a large heterogeneity across services. Conclusion: In the UK, clinical exercise services job titles, roles and qualifications were inconsistent. Regulation of exercise job titles and roles is required to remove the current disparities in this area

A multi-method exploration of a cardiac rehabilitation service delivered by registered Clinical Exercise Physiologists in the UK: key learnings for current and new services

Background: Cardiac rehabilitation has been identified as having the most homogenous clinical exercise service structure in the United Kingdom (UK), but inconsistencies are evident in staff roles and qualifications within and across services. The recognition of Clinical Exercise Physiologists (CEPs) as a registered health professional in 2021 in the UK, provides a potential solution to standardise the cardiac rehabilitation workforce. This case study examined, in a purposefully selected cardiac exercise service that employed registered CEPs, (i) how staff knowledge, skills and competencies contribute to the provision of the service, (ii) how these components assist in creating effective service teams, and (iii) the existing challenges from staff and patient perspectives. Methods: A multi-method qualitative approach (inc., semi-structured interviews, observations, field notes and researcher reflections) was employed with the researcher immersed for 12-weeks within the service. The Consolidated Framework for Implementation Research was used as an overarching guide for data collection. Data derived from registered CEPs (n=5), clinical nurse specialists (n=2), dietitians (n=1), service managers/leads (n=2) and patients (n=7) were thematically analysed. Results: Registered CEPs delivered innovative exercise prescription based on their training, continued professional development (CPD), academic qualifications and involvement in research studies as part of the service. Exposure to a wide multidisciplinary team (MDT) allowed skill and competency transfer in areas such as clinical assessments. Developing an effective behaviour change strategy was challenging with delivery of lifestyle information more effective during less formal conversations compared to timetabled education sessions. Conclusions: Registered CEPs have the specialist knowledge and skills to undertake and implement the latest evidence-based exercise prescription in a cardiac rehabilitation setting. An MDT service structure enables a more effective team upskilling through shared peer experiences, observations and collaborative working between healthcare professionals

Insights and recommendations into service model structure staff roles and qualifications in a UK cancer specific clinical exercise service a multi-method case study

Purpose: Clinical exercise delivery in the United Kingdom is disparate in terms of service structure, staff roles and qualifications, therefore it is difficult to evaluate and compare across services. Our aim was to explore, in a purposely selected cancer exercise service that was recognised as effective; (i) how staff knowledge, skills and competencies contribute to the provision of the service, (ii) how these components assist in creating effective services, and (iii) to identify existing challenges from staff and service user perspectives. Methods: The Consolidated Framework for Implementation Research was used as an overarching guide to review the Prehab4Cancer service. Exercise specialists and service user perspectives were explored using a multi-method approach (online semi-structured interviews, online focus group and in-person observation) and data triangulation. Results: Exercise specialists were educated to a minimum of undergraduate degree level with extensive cancer-specific knowledge and skills, equivalent to that of a Registration Council for Exercise Physiologist (RCCP) Clinical Exercise Physiologist. Workplace experience was essential for exercise specialist development in behaviour change and communications skills. Conclusions: Staff should be educated to a level comparable with the standards for registered RCCP Clinical Exercise Physiologists, which includes workplace experience to develop knowledge, skills and competencies in real-world settings

Preliminary effects and acceptability of a co-produced physical activity referral intervention

Objectives: To explore the preliminary effects and acceptability of a co-produced physical activity referral intervention. Study Design: Longitudinal design with data collected at baseline and post a 12-week physical activity referral intervention. Setting. Community leisure centre. Methods: 32 adults with controlled lifestyle-related health conditions took part in a physical activity referral intervention (co-produced by a multidisciplinary stakeholder group) comprising 12 weeks’ subsidised fitness centre access plus four behaviour change consultations. A complete case analysis (t-tests and magnitude-based inferences) was conducted to assess baseline-to-12-week change in physical activity, cardiometabolic, and psychological measures. Semi-structured interviews were conducted (n=12) to explore experiences of the intervention. Results: Mean improvements were observed in cardiorespiratory fitness-2 (3.6 ml.kg.-1min-1 (95% confidence interval 1.9 to 5.4) P<0.001) and moderate-to-vigorous physical activity (12.6 min.day (95% CI 4.3 to 29.6) P=0.013). Participants were positive about the support from exercise referral practitioners, but experienced some challenges in a busy and under staffed gym environment. Conclusions: A co-produced physical activity referral intervention elicited short-term improvements in physical activity and cardiometabolic health. Further refinements may be required, via ongoing feedback between stakeholders, researchers and service users, to achieve the intended holistic physical activity focus of the intervention, prior to a definitive trial