Evidence generated from a realist synthesis of trials on educational weight loss interventions in type 2 diabetes mellitus

Background: Obesity and diabetes are major public health problems. Current approaches to weight loss show varying success. Complex community‐based interventions work through several interconnected stages. An individual’s actions in response to an intervention depend on many known and unknown factors, which vary among individuals.Aim: To conduct a realist synthesis to identify in which context, for whom, in what circumstances, and how weight loss interventions work in obese or overweight individuals with type 2 diabetes.Methods: A total of 49 trials identified during a systematic review were subsequently analysed using realist methodology. This iterative process involved hypothesis generation about how participants within a particular context respond to an intervention’s resources producing the outcomes. We used established behaviour change theory to look for repeating themes. Theory and ‘mechanisms’ were tested against the literature on what is shown to be effective. Where established theory was lacking, we discussed issues during discussion groups with individuals living with the condition to generate our own programme theories.Results: Mechanisms that were repeatedly identified included high‐frequency contact with those delivering the intervention, social support, education increasing awareness of diabetes‐related modifiable risk factors, motivational interviewing and counselling, goal‐setting, self‐monitoring and feedback and meal replacements. The central theme underlying successful mechanisms was personalizing each intervention component to the participants’ gender, culture and family setting.Conclusion: This is the first comprehensive realist synthesis in this field. Our findings suggest that, for weight loss interventions to be successful in those with diabetes, they must be personalized to the individual and their specific context

Use it or lose it: a qualitative study of the maintenance of physical activity in older adults

BACKGROUND: Lack of physical activity (PA) is a recognised global public health problem, which is increasing in prevalence with a detrimental impact on the pattern of disease worldwide. In the UK, older adults comprise the most sedentary group, with only 57% of males and 52% of females aged 65-74 years and 43% of males and 21% of females aged 75-84 years meeting PA recommendations. PA confers multiple health benefits including increased stamina, muscle, bone and joint strength, increased independence and reduced risk of falls in old age. Despite benefits experienced during time-limited PA programmes, increased PA is not always continued. This study aimed to provide a better understanding of PA maintenance behaviours in older people

‘We got more than we expected.’ Older people’s experiences of falls-prevention exercise interventions and implications for practice; a qualitative study

AIM: To explore the experiences of older adults participating in strength and balance exercise programmes and understand participants' rationale for programme uptake and completion. BACKGROUND: Regular physical activity, specifically strength and balance exercises, has been shown to improve health and well-being and reduce the risk of falling in older adults. With the number of people living into older age increasing, understanding older people's experiences of strength and balance programmes and what encourages their take-up and completion is extremely important. This paper reports on the qualitative experiences of older adults that previously participated in ProAct65+, a randomised controlled trial of Falls Management Exercise (FaME) programme and Otago Exercise Programme (OEP) versus usual care. METHODS: Ten general practices in Nottinghamshire and Derbyshire, England, who participated in the ProAct65+ trial were approached to take part. Using maximum variation sampling (age, gender, falls history, fear of falling and trial arm) we recruited, via the practices, 30 people that had participated in the FaME (n = 15) or OEP (n = 15) trial arms. Participants were interviewed in their own homes. Interviews were audio-recorded, transcribed verbatim and thematically analysed. FINDINGS: We identified five themes: choice of exercise programme; commitment, discipline and motivation; benchmarking, feedback and monitoring; benefits of the exercise programmes and reactions to the end of the programmes. There were four sub-themes within the benefits theme: pleasure and boredom, social interaction and isolation, physical benefits, and knowledge and understanding.This study has outlined the experiences and identified specific barriers and facilitators to uptake and completion of falls-prevention exercises by older adults. The perspective and experiences of these participants is important if programmes are to be designed to meet the needs of the target population. Insights from this study will enable commissioners to develop and provide appropriate falls-prevention exercise programmes that encourage high uptake and programme completion

Keeping active:maintenance of physical activity after exercise programmes for older adults

Objectives: To explore factors associated with maintenance of moderate-to-vigorous physical activity (MVPA) in community-dwelling adults aged ≥65 years after completing a 24-week exercise programme.Study design: Cohort study nested within a randomised controlled trial evaluating group and home-based exercise programmes for older people in England.Methods: MVPA levels and factors potentially associated with physical activity (PA) were self-reported at recruitment, 6, 12, 18 and 24 months post exercise programme. Multilevel logistic regression estimated odds ratios for achieving target MVPA level (150 minutes/week) 6-24 months after exercise programmes ended.Results: Older people (OR per year increase: 0.89, 95%CI 0.86, 0.93) and women (OR 0.47, 95%CI 0.33, 0.67) were less likely to achieve target MVPA. Those physically active at recruitment (OR 11.28, 95%CI 7.95, 16.01), with wider social networks (OR per unit increase in Lubben Social Network Scale: 1.06, 95%CI 1.03, 1.10) and performing more sit-to-stands in 30 seconds (OR for quartile 3 compared to quartile 1: 1.87, 95%CI 1.12, 3.10) were more likely to achieve target MVPA. Negative exercise expectations increased the odds of achieving target MVPA, but only amongst the less active at recruitment (OR per unit increase in Outcome and Expectation for Exercise Negative Subscale: 1.90, 95%CI 1.39, 2.60). Associations did not differ significantly across the follow-up period.Conclusion: A range of factors are associated with maintenance of PA 6-24 months after exercise programmes. Factors are not more strongly associated with shorter versus longer term PA maintenance. Commissioners and providers should consider targeting maintenance interventions to those least likely to maintain PA

Risk and protective factors for falls from furniture in young children: multicenter case-control study

Importance: Falls from furniture are common in young children but there is little evidence on protective factors for these falls. Objective: To estimate associations for risk and protective factors for falls from furniture in children aged 0 to 4 years. Design, Setting, and Participants: Multicenter case-control study at hospitals, minor injury units, and general practices in and around 4 UK study centers. Recruitment commenced June 14, 2010, and ended April 27, 2012. Participants included 672 children with falls from furniture and 2648 control participants matched on age, sex, calendar time, and study center. Thirty-five percent of cases and 33% of control individuals agreed to participate. The mean age was 1.74 years for cases and 1.91 years for control participants. Fifty-four percent of cases and 56% of control participants were male. Exposures included safety practices, safety equipment use, and home hazards. Main Outcomes and Measures: Falls from furniture occurring at the child’s home resulting in attendance at an emergency department, minor injury unit, or hospital admission. Results: Compared with parents of control participants, parents of cases were significantly more likely not to use safety gates in the home (adjusted odds ratio [AOR], 1.65; 95% CI, 1.29-2.12) and not to have taught their children rules about climbing on kitchen objects (AOR, 1.58; 95% CI, 1.16-2.15). Cases aged 0 to 12 months were significantly more likely to have been left on raised surfaces (AOR, 5.62; 95% CI, 3.62-8.72), had their diapers changed on raised surfaces (AOR, 1.89; 95% CI, 1.24-2.88), and been put in car/bouncing seats on raised surfaces (AOR, 2.05; 95% CI, 1.29-3.27). Cases 3 years and older were significantly more likely to have played or climbed on furniture (AOR, 9.25; 95% CI, 1.22-70.07). Cases were significantly less likely to have played or climbed on garden furniture (AOR, 0.74; 95% CI, 0.56-0.97). Conclusions and Relevance: If estimated associations are causal, some falls from furniture may be prevented by incorporating advice into child health contacts, personal child health records, and home safety assessments about use of safety gates; not leaving children, changing diapers, or putting children in car/bouncing seats on raised surfaces; allowing children to play or climb on furniture; and teaching children safety rules about climbing on objects