Attitudes and practices of physicians and nurses regarding physical activity promotion in the Catalan primary health-care system

Background: In Catalonia a high percentage of the population remains inactive. General practices are an ideal setting to advise on physical activity (PA). However, there is a lack of evidence regarding practices, barriers and predictors of such promotion in the Catalan primary health-care system. This study set out to establish descriptive baseline data for PA promotion in Catalan general practices, and to explore the experiences of doctors/nurses in promoting PA in their day-to-day professional lives. Methods: A mixedmethod approach was adopted. A survey was conducted with 245 physicians/nurses (58% response rate). Subsequently, focus groups (n ¼ 5) and semi-structured interviews (n ¼ 7) were conducted with 18 physicians and 15 nurses. After coding for important themes, the final interpretation was confirmed by contributors. Results: Eighty-eight percent of physicians/nurses promoted PA at least infrequently. However, work conditions were perceived as unfavourable, with the main barriers being lack of (i) time, (ii) training and (iii) protocols. Qualitative data showed that PA promotion was opportunistic, focused on selected patients, used generalized messages and was highly dependent on personal interests. Regular promotion was encouraged by direct experiences of the benefits of regular exercising, knowing patients well, being supported by medical colleagues and creating links with other community institutions. PA promotion was especially hindered by seeing PA promotion as a secondary task, and patients ignoring recommendations. Conclusions: PA promotion in Catalonia remains to be integrated into practice consultations. Therefore, strategies should be developed within public health. Using a mixed-method approach provided a broader range of evidence than most studies, which rely on quantitative methods

Perceived Barriers to Physical Activity and Related Factors in Spanish University Students

Objective: The purpose of this study was to identify the influence of readiness of change for physical activity (PA), sociodemographic factors, lifestyle and physical activity status (PAS) on perceived barriers among Spanish university students. Participants: Seven hundred and seventy two (n = 772) men and women ages 17 - 39 at a north-west regional university in Spain participated in the study. Methods: The International Physical Activity Questionnaire, the States of Change for Physical Activity Behaviour Questionnaire and the Self-perceived Barriers for Physical Activity Questionnaire were used. Description, correlation and multiple regression analyses were completed. Results: Participants self-perceived low average-score barriers (2.6 ± 1.4 over 10.0). The 3-higher scores barriers corresponded to “too much work”; “lack of time for exercise” and “laziness”. Gender, PAS and self-perceived health were shown to be associated with perceived barriers. Conclusions: University institutions should consider those factors that predict barriers to PA to develop effective intervention programs

Learnt effects of environmental cues on transport-related walking; disrupting habits with health promotion?

BackgroundIn Ecological models, physical environments can be important determinants of transport-related walking. With repeated exposure to the same environment, learning of a linkage between the cues in the environment and walking should occur. Subsequent encounters with the cues can prompt the behaviour relatively automatically. No studies have experimentally tested the potential learning of this linkage between cues and behaviour. Choices between stairs and escalators in public access settings were employed to test this premise for transport-related walking.MethodsThree studies investigated the effects of visual cues on stair/escalator choices (combined n = 115,062). In quasi-experimental, interrupted time-series designs, observers audited choices in public access settings. Design alone phases with art or coloured backgrounds were compared with design plus message phases in which verbal health promotion messages were superimposed on the visual cues. Analyses used bootstrapped logistic regression.ResultsIn initial studies, the design alone phases had no effect whereas subsequent design plus message phases reduced escalator choice. In two further studies, a 5-6 week design plus message phase that reduced escalator choice preceded a design alone phase. The visual background behind the successful health promotion message was reintroduced four weeks after the intervention was removed. The visual cue of design alone reduced escalator choice after it had been paired with the verbal health promotion message. There were no differences between art and coloured backgrounds.ConclusionThese studies demonstrate for the first time a learnt linkage between transport-related walking and environmental cues. Discussion focuses on the mechanisms that may underlie this learning and cues in the environment that are relevant to transport-related walking

Increasing stair climbing in a train station: effects of contextual variables and visibility

Accumulation of physical activity during daily living is a current public health target that is influenced by the layout of the built environment. This study reports how the layout of the environment may influence responsiveness to an intervention. Pedestrian choices (n = 41 717) between stairs and the adjacent escalators were monitored for seven weeks in a train station (Birmingham, UK). After a 3.5 week baseline period, a stair riser banner intervention to increase stair climbing was installed on two staircases adjacent to escalators and monitoring continued for a further 3.5 weeks. Logistic regression analyses revealed that the visibility of the intervention, defined as the area of visibility in the horizontal plane opposite to the direction of travel (termed the isovist) had a major effect on success of the intervention. Only the largest isovist produced an increase in stair climbing (isovist=77.6 m2, OR = 1.10, CIs 1.02-1.19; isovist=40.7 m2, OR = 0.98, CIs 0.91-1.06; isovist=53.2 m2, OR = 1.00, CIs 0.95-1.06). Additionally, stair climbing was more common during the morning rush hour (OR = 1.56, CIs 1.80-2.59) and at higher levels of pedestrian traffic volume (OR = 1.92, CIs 1.68-2.21). The layout of the intervention site can influence responsiveness to point-of-choice interventions. Changes to the design of train stations may maximize the choice of the stairs at the expense of the escalator by pedestrians leaving the station

Validation study of the Spanish version of the Last-7-d Sedentary Time Questionnaire (SIT-Q-7d-Sp) in young adults.

There are few valid instruments to assess domain-specific sedentary behaviours (SB) among Spanish-speaking populations. This study validated the original English version of the last 7 days SB questionnaire (SIT-Q-7d) into Spanish (Castilian). A total of 151 undergraduates (52% male, 21.19±2.57 yrs.) wore an activPAL3M (AP3M) for 7 days and subsequently completed the Spanish version of the SIT-Q-7d (SIT-Q-7d-Sp). A subsample of 30 participants (70% male, 22.89±1.54 yrs.) simultaneously wore the AP3M and used a domain-log to register the context where the SB occurred. The SIT-Q-7d-Sp differed significantly from the AP3M, overestimating sitting time by an average of 60.69 mins.d-1 (all p0.016). However, screen-based and other leisure-based sitting activities were significantly overestimated (ranging from 94.68 mins.d-1 to 234.08 mins.d-1, p<0.001). The SIT-Q-7d-Sp appears to provide acceptable estimates of sitting time during transportation, occupational and meal-based domains. The SIT-Q-7d-Sp is not an appropriate measure of SB when examining total sitting time and leisure-based SB in young adults. For total sitting time and leisure-based SB, the use of objective measures is recommended.KW was supported by the UK Medical Research Council (unit programme number MC_UU_12015/3). The authors like to thank Kate Westgate for their cooperation and for sharing their materials. In addition, the authors would like to thank the undergraduate students from the UVic-UCC to voluntary participated in the study

Workplace physical activity practices in real life: a scoping review of grey literature for small- and medium-sized enterprises

Background: There is a need to scale-up effective physical activity (PA) programmes for small- and medium-sized enterprises (SMEs), where the uptake of PA interventions is low. Identifying real-life workplace practices in PA could contribute to a better understanding of what PA programmes might be most grounded in the ‘real world’. However, there is a scarcity of evidence showing what gets done. This study aimed to identify, describe and comprehensively summarize the real-life implementations of workplace PA initiatives, particularly in Europe, as a prior step to dissem inating future feasible PA practices for SMEs. Methods: A scoping review of grey literature included a systematic search in the Google advanced search platform that permuted a combination of key concepts (PA, workplace, interventions/programmes), internet domains, and search operators in six different languages (Catalan, Finnish, French, Dutch, English and Spanish) between 2015 and November 2020. The analysis process was iterative, and multiple methods were used to sort, group and categorize the initiatives. Results: There were a total of 713 real life workplace PA initiatives from different-sized organizations identified. These were categorized into five themes: active work and living, exercise and fitness programs, management and leadership, communication and dissemination, and facilities. Finally, feature trees showing a menu for real-life workplace PA practices were implemented. Conclusions: Identifying real-life practice providing a state-of-the-art snapshot of current PA practices in workplaces, which is a starting point to better understand feasible practices in the context of small- and medium-sized workplaces

Do walking strategies to increase physical activity reduce reported sitting in workplaces: a randomized control trial

Background Interventions designed to increase workplace physical activity may not automatically reduce high volumes of sitting, a behaviour independently linked to chronic diseases such as obesity and type II diabetes. This study compared the impact two different walking strategies had on step counts and reported sitting times. Methods Participants were white-collar university employees (n = 179; age 41.3 ± 10.1 years; 141 women), who volunteered and undertook a standardised ten-week intervention at three sites. Pre-intervention step counts (Yamax SW-200) and self-reported sitting times were measured over five consecutive workdays. Using pre-intervention step counts, employees at each site were randomly allocated to a control group (n = 60; maintain normal behaviour), a route-based walking group (n = 60; at least 10 minutes sustained walking each workday) or an incidental walking group (n = 59; walking in workday tasks). Workday step counts and reported sitting times were re-assessed at the beginning, mid- and endpoint of intervention and group mean± SD steps/day and reported sitting times for pre-intervention and intervention measurement points compared using a mixed factorial ANOVA; paired sample-t-tests were used for follow-up, simple effect analyses. Results A significant interactive effect (F = 3.5; p < 0.003) was found between group and step counts. Daily steps for controls decreased over the intervention period (-391 steps/day) and increased for route (968 steps/day; t = 3.9, p < 0.000) and incidental (699 steps/day; t = 2.5, p < 0.014) groups. There were no significant changes for reported sitting times, but average values did decrease relative to the control (routes group = 7 minutes/day; incidental group = 15 minutes/day). Reductions were most evident for the incidental group in the first week of intervention, where reported sitting decreased by an average of 21 minutes/day (t = 1.9; p < 0.057). Conclusion Compared to controls, both route and incidental walking increased physical activity in white-collar employees. Our data suggests that workplace walking, particularly through incidental movement, also has the potential to decrease employee sitting times, but there is a need for on-going research using concurrent and objective measures of sitting, standing and walking

Assessing the Feasibility and Acceptability of a Primary Care Socio-Ecological Approach to Improve Physical Activity Adherence among People with Type 2 Diabetes : The SENWI Project

Ajuts: This research was funded by Col·legi de Fisioterapeutes de Catalunya (CFC), grant number R05/21.Maintaining an active lifestyle is a key health behavior in people with type 2 diabetes (T2D). This study assessed the feasibility and acceptability of a socio-ecological Nordic walking intervention (SENWI) to enhance healthy behaviors in primary healthcare settings. Participants included individuals with T2D (n = 33; age 70 (95% CI 69-74)) and healthcare professionals (HCPs, n = 3). T2D participants were randomly assigned to a SENWI, active comparator, or control group for twelve weeks. Feasibility and acceptability were evaluated based on a mixed methodology. Quantitative data reported adherence information, differences between follow-up and dropout participants and pre- and post-intervention on physical activity, sedentary behavior, and health outcomes. Qualitative data acquisition was performed using focus groups and semi-structured interviews and analyzed using thematic analysis. Thirty-three T2D invited participants were recruited, and twenty-two (66.7%) provided post-intervention data. The SENWI was deemed acceptable and feasible, but participants highlighted the need to improve options, group schedules, gender inequities, and the intervention's expiration date. Healthcare professionals expressed a lack of institutional support and resources. Nevertheless, no significant difference between the SENWI follow-up and dropout participants or pre- and post- intervention was found (only between the active comparator and control group in the physical quality of life domain). Implementing the SENWI in primary healthcare settings is feasible and acceptable in real-world conditions. However, a larger sample is needed to assess the program's effectiveness in improving healthy behaviors and its impact on health-related outcomes in the long term

Patterns of impact resulting from a 'sit less, move more' web-based program in sedentary office employees.

PURPOSE: Encouraging office workers to 'sit less and move more' encompasses two public health priorities. However, there is little evidence on the effectiveness of workplace interventions for reducing sitting, even less about the longer term effects of such interventions and still less on dual-focused interventions. This study assessed the short and mid-term impacts of a workplace web-based intervention (Walk@WorkSpain, W@WS; 2010-11) on self-reported sitting time, step counts and physical risk factors (waist circumference, BMI, blood pressure) for chronic disease. METHODS: Employees at six Spanish university campuses (n=264; 42±10 years; 171 female) were randomly assigned by worksite and campus to an Intervention (used W@WS; n=129; 87 female) or a Comparison group (maintained normal behavior; n=135; 84 female). This phased, 19-week program aimed to decrease occupational sitting time through increased incidental movement and short walks. A linear mixed model assessed changes in outcome measures between the baseline, ramping (8 weeks), maintenance (11 weeks) and follow-up (two months) phases for Intervention versus Comparison groups. RESULTS: A significant 2 (group) × 2 (program phases) interaction was found for self-reported occupational sitting (F[3]=7.97, p=0.046), daily step counts (F[3]=15.68, p=0.0013) and waist circumference (F[3]=11.67, p=0.0086). The Intervention group decreased minutes of daily occupational sitting while also increasing step counts from baseline (446±126; 8,862±2,475) through ramping (+425±120; 9,345±2,435), maintenance (+422±123; 9,638±3,131) and follow-up (+414±129; 9,786±3,205). In the Comparison group, compared to baseline (404±106), sitting time remained unchanged through ramping and maintenance, but decreased at follow-up (-388±120), while step counts diminished across all phases. The Intervention group significantly reduced waist circumference by 2.1cms from baseline to follow-up while the Comparison group reduced waist circumference by 1.3cms over the same period. CONCLUSIONS: W@WS is a feasible and effective evidence-based intervention that can be successfully deployed with sedentary employees to elicit sustained changes on "sitting less and moving more"

Health representations, perceived valence, and concept associations for symbols as food cues: A mixed-methods approach

Researchers have experimented with a range of point-of-purchase (PoP) interventions in supermarkets, restaurants, and cafeterias. In general, these interventions have employed written materials. This research tested symbols to visually summarize information about the (un)healthiness of food. Study one explored health representations and valence associated with the image of a heart, a bathroom scale, and a running shoe using qualitative field interviews (N = 1200). Study two explored accessibility of a priori concept associations for two of those images, stratified by valence, in a computerized response latency task (N = 40). Study one indicted that the heart was best linked to its intended theme "heart health." Concerning valence, the heart was seen as both positive and negative whereas the scale was less likely to be viewed as positive relative to the running shoe. In study two, the heart was linked to five of the six a priori concepts and there was evidence that three of these were more accessible. Overall, the heart was better linked to positive poles than negative ones. A heart symbol may be useful to prompt heart healthy choices at the PoP. There was evidence that a scale may bias choice away from undesirable foods