Iterative development of MobileMums : a physical activity intervention for women with young children.

Background To describe the iterative development process and final version of ‘MobileMums’: a physical activity intervention for women with young children (<5 years) delivered primarily via mobile telephone (mHealth) short messaging service (SMS). Methods MobileMums development followed the five steps outlined in the mHealth development and evaluation framework: 1) conceptualization (critique of literature and theory); 2) formative research (focus groups, n= 48); 3) pre-testing (qualitative pilot of intervention components, n= 12); 4) pilot testing (pilot RCT, n= 88); and, 5) qualitative evaluation of the refined intervention (n= 6). Results Key findings identified throughout the development process that shaped the MobileMums program were the need for: behaviour change techniques to be grounded in Social Cognitive Theory; tailored SMS content; two-way SMS interaction; rapport between SMS sender and recipient; an automated software platform to generate and send SMS; and, flexibility in location of a face-to-face delivered component. Conclusions The final version of MobileMums is flexible and adaptive to individual participant’s physical activity goals, expectations and environment. MobileMums is being evaluated in a community-based randomised controlled efficacy trial (ACTRN12611000481976).

Incentive-based interventions for increasing physical activity and fitness

This is the protocol for a review and there is no abstract. The objectives are as follows: The main aim of the review is to determine the effectiveness of using incentive-based approaches (IBAs) (financial and non-financial) to increase physical activity in community-dwelling children and adults. A secondary objective will be to address the use of incentives to improve cardiovascular and metabolic fitness. A final objective will be to explore: - whether there are any adverse effects associated with the use of IBAs for increasing physical activity; - whether there are any differential effects of IBAs within and between study populations by age, gender, education, inequalities and health status; and - whether the use of disincentive/aversive approaches leads to a reduction in sedentary behaviour.

Community interventions for physical activity : the role of a new Cochrane systematic review

Introduction: Systematic reviews are essential in summarising the results of a range of research studies on a specific topic into a single report. They serve as a key source of evidence-based information to support and develop policy and practice for healthy communities. This presentation will examine a new review of community-wide strategies to increase population levels of physical activity and compare it to an earlier Community Guide Review (CGR) of Community-wide campaigns to increase physical activity which recommended community wide interventions. Methods: We registered a Cochrane Systematic Review (CSR) title, published a protocol and recently completed the review of Community-wide interventions to increase physical activity. We compared the definitions, design and findings of the CSR to the CGR. Results: The two reviews differed remarkably in their conclusions with the CGR recommending “strong evidence exists that community-wide campaigns are effective in increasing levels of physical activity”, and the new CSR stating “The body of evidence in this review does not support the hypothesis that multi-component community wide interventions effectively increase population levels of physical activity”. We observed that both reviews examined multi-component interventions as a “combined package”. Possible explanations for the different conclusions may be due to the definition of community (CSR defined community as “comprising those persons residing in a geographically defined community, such as a village, town, or city”, excluding interventions which were whole of state or country, and CGR as “a group of individuals who share one or more characteristics. The CSR utilised a logic model at various stages of the review process and explicitly defined a combination of strategies encompassed within the intervention. The CSR included 25 and CGR 10 studies, respectively. Six of the 10 studies that were included in CGR were excluded from the CSR due to issues relating to study design, intervention definition or duration. The two reviews also differ in function as the CSR seeks to summarise global evidence and included 7 studies in low-income countries, where as the CGR contained only studies deemed relevant to the USA context. Discussion: Differences in the findings between older and newer reviews can be due to a variety of factors. For example, in updating a review the definition of an intervention can be changed. Further, differences may also be due to improvements in the standards and methodologies for systematic reviews as well as the inclusion of newer studies. These factors need to be understood whenever differences between newer and older reviews are considered.

Methodological challenges in conducting a systematic review of community wide interventions to increase physical activity

Introduction: Evaluating the effectiveness of interventions designed to increase the physical activity in communities is often a difficult and complex task, requiring considerable expertise and investment, and often constrained by methodological limitations. These limitations, in turn, create additional challenges when these studies are used in systematic reviews as they hinder the confidence, precision and interpretation of results. The objective of this paper is to summarise the methodological challenges posed in conducting a systematic review of community-wide physical activity interventions to help inform those conducting future primary research and systematic reviews. Methods: We conducted a Cochrane systematic review of community-wide interventions to increase physical activity. We assessed the methodological quality of the included studies. We will investigate these in greater detail, particularly in relation to the potential impact on measures of effect, confidence in results, generalizability of results and general interpretation. Results: The systematic review was conducted and has been published in the Cochrane Library. A logic model was helpful in defining and interpreting the studies. Many studies of unsuitable study design were excluded; however several important methodological limitations of the primary studies evaluating community-wide physical activity interventions emerged. These included: - the failure to use validated tools to measure physical activity; - issues associated with pre and post test designs; - inadequate sampling of populations; - poor control groups; and - intervention and measurement protocols of inadequate duration. Although it is challenging to undertake rigorous evaluations of complex interventions, these issues result in significant uncertainty over the effectiveness of these interventions, and the possible factors required for a community-wide intervention to be successful. In particular, the combination of several of these limitations (e.g. un-validated tools, inadequate sampling, and short duration) is that studies may lack the sensitivity to detect any meaningful change. Multiple publications of findings for the same study also made interpretation difficult; however, interventions with parallel qualitative publications were helpful. Discussion: Evaluating community wide interventions to increase physical activity in a rigorous way is incredibly challenging. These findings reflect these challenges but have important ramifications for researchers conducting primary studies to determine the efficacy of such interventions, as well as for researchers conducting systematic reviews. This new review shows that the inadequacies of design and evaluation are continuing. It is hoped that the adoption of such suggestions may aid in the development of systematic reviews, but more importantly, in enabling translation of such findings into policy and practice.

The association between motivation in school physical education and self-reported physical activity during Finnish junior high school : a self-determination theory approach

The main purpose of this longitudinal study was to investigate the role of motivational climates, perceived competence and motivational regulations as antecedents of self-reported physical activity during junior high school years. The participants included 237 Finnish students (101 girls, 136 boys) that were 13 years old at the first stage of the study. Students completed the motivational climate and perceived competence questionnaires at Grade 7, motivation towards physical education questionnaire at Grade 8, and self-reported physical activity questionnaire at Grade 9. A path analysis revealed a path from task-involving motivational climate via perceived competence and intrinsic motivation to self-reported physical activity. Perceived competence and intrinsic motivation were statistically significant mediators between task-involving motivational climate and self-reported physical activity. This finding supports the four-stage causal sequence model of motivation.

‘The health-location connection’: using GIS and social media on smartphones to track engagement with the Local urban environment for work, recreation, and physical activity

A technologically innovative study was undertaken across two suburbs in Brisbane, Australia, to assess socioeconomic differences in women's use of the local environment for work, recreation, and physical activity. Mothers from high and low socioeconomic suburbs were instructed to continue with usual daily routines, and to use mobile phone applications (Facebook Places, Twitter, and Foursquare) on their mobile phones to ‘check-in’ at each location and destination they reached during a one-week period. These smartphone applications are able to track travel logistics via built-in geographical information systems (GIS), which record participants’ points of latitude and longitude at each destination they reach. Location data were downloaded to Google Earth and excel for analysis. Women provided additional qualitative data via text regarding the reasons and social contexts of their travel. We analysed 2183 ‘check-ins’ for 54 women in this pilot study to gain quantitative, qualitative, and spatial data on human-environment interactions. Data was gathered on distances travelled, mode of transport, reason for travel, social context of travel, and categorised in terms of physical activity type – walking, running, sports, gym, cycling, or playing in the park. We found that the women in both suburbs had similar daily routines with the exception of physical activity. We identified 15% of ‘check-ins’ in the lower socioeconomic group as qualifying for the physical activity category, compared with 23% in the higher socioeconomic group. This was explained by more daily walking for transport (1.7kms to 0.2kms) and less car travel each week (28.km to 48.4kms) in the higher socioeconomic suburb. We ascertained insights regarding the socio-cultural influences on these differences via additional qualitative data. We discuss the benefits and limitations of using new technologies and Google Earth with implications for informing future physical and social aspects of urban design, and health promotion in socioeconomically diverse cities.

Sitting-time, physical activity and depressive symptoms in mid-aged women

Background: Associations between sitting-time and physical activity (PA) with depression are unclear. Purpose: To examine concurrent and prospective associations between both sitting-time and PA with prevalent depressive symptoms in mid-aged Australian women. Methods: Data were from 8,950 women, aged 50-55 years in 2001, who completed mail surveys in 2001, 2004, 2007 and 2010. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression questionnaire. Associations between sitting-time (≤4, >4-7, >7 hrs/day) and PA (none, some, meeting guidelines) with depressive symptoms (symptoms/no symptoms) were examined in 2011 in concurrent and lagged mixed effect logistic modeling. Both main effects and interaction models were developed. Results: In main effects modeling, women who sat >7 hrs/day (OR 1.47, 95%CI 1.29-1.67) and women who did no PA (OR 1.99, 95%CI 1.75-2.27) were more likely to have depressive symptoms than women who sat ≤4 hrs/day and who met PA guidelines, respectively. In interaction modeling, the likelihood of depressive symptoms in women who sat >7 hrs/day and did no PA was triple that of women who sat ≤4 hrs/day and met PA guidelines (OR 2.96, 95%CI 2.37-3.69). In prospective main effects and interaction modeling, sitting-time was not associated with depressive symptoms, but women who did no PA were more likely than those who met PA guidelines to have future depressive symptoms (OR 1.26, 95%CI 1.08-1.47). Conclusions: Increasing PA to a level commensurate with PA guidelines can alleviate current depression symptoms and prevent future symptoms in mid-aged women. Reducing sitting-time may ameliorate current symptoms.

Australian adolescents’ perceived school-based barriers and facilitators to engagement in physical activity

OBJECTIVE: School-aged youth spend a significant amount of time either in transit to and from school, or within school settings performing a range of varying learning-based activities. Adolescent physical activity has also been shown to increase the likelihood of maintaining physical activity throughout adulthood. The purpose of this study is to investigate adolescents’ perceived school-based barriers and facilitators to engagement in physical activity. METHODS: One-hundred and twenty four participants (38 males and 86 females) were recruited from two non-denominational same-sex private schools, in Brisbane, Australia. The mean age and standard deviation (SD) was 13.83 (0.56) and 14.40 (2.33) for males and females respectively. Participants responded to a series questions regarding perceived barriers and facilitators to engagement in physical activity. Quantitative data was analysed using descriptive statistics and frequency distributions, and qualitative data with thematic analysis. RESULTS: A total of 121 (97.6%) participants had complete data sets and were included in the analysis. School timetable (44.6%), homework (81.8%), and assessment (81.0%) were identified as the most prominent perceived factors, increasing the difficulty of physical activity engagement. Physical Education classes (71.9%) and school sport programs (80.2%) were identified as the most prominent perceived factors that facilitate engagement in physical activity. There was no significant gender effect. CONCLUSIONS: Each of the identified factors perceived by adolescent's as either barriers or facilitators to engagement in physical activity may be addressed by administrators at a school and government policy level. These may include strategies such as; increasing the assigned hours to physical education classes, providing additional extra-curricular sporting opportunities, and reviewing the time allocated to homework and assessment items. This may provide a simpler, low-cost solution to increasing youth physical activity, as opposed to contemporary higher-cost strategies utilising increased staff commitment, mass media, provision of equipment and counsellors and other health professionals.

The use of SMS messaging for physical activity promotion : preferences of Australian adolescents and their parents

OBJECTIVE: Recent increases in youth mobile phone ownership and usage may provide a unique and innovative opportunity for engagement by health promoters, via a familiar and immediately accessible medium. This study investigated adolescents’ and their parents’ preferences for promoting physical activity via means of SMS messaging. METHODS: Adolescents (36 males and 76 females) and their parents (37 males 75 females) were recruited from two non-denominational same-sex private schools, in Brisbane, Australia. The mean age and standard deviation (SD) for adolescents and parents was 14.03 (0.58) and 47.18 (4.65) respectively. Participants responded to a series of questions regarding mobile phone ownership, and preferences for physical activity, school-based physical activity programs, and programs invovling SMS messaging. Data analysis included descriptive statistics and frequency distributions. T-tests were employed to measure gender effect. RESULTS: Overall, 47 (42%) parents desired their child to be more physically active, and were interested for their child to participate in a school-based physical activity program. Of those parents, 16 (34%) parents were interested in their child participating in an SMS-based physical activity program, with 21 (45%) not interested, and 10 (21%) neutral. One hundred and four (95%) adolescents owned a mobile phone, with 84 (82%) of those adolescents wanting to be more physically active. Of those adolescents, 14 (17%) were interested in participating in an SMS-based physical activity program, with 40 (48%) not interested, and 30 (36%) neutral. There was no significant gender effect. CONCLUSIONS: Although SMS messaging may provide an innovative method for youth physical activity promotion, low levels of interest are concerning. These results differ from other studies utilising SMS messaging for the purpose of health promotion, where more positive feedback from participants were reported. A screening process to gauge interest prior to the implementation of any SMS-based health promotion program may prove invaluable toward the success of the program.

Perception and reality : meeting Australia’s physical activity guidelines for 12-18 year olds

Governments regularly publish empirically derived minimum physical activity (PA) guidelines for youth, in response to the ongoing trend of youth physical inactivity. The purpose of this investigation was to explore parents’ awareness of the national PA guidelines for youth, and adolescents’ and their parents’ perceptions of adolescent PA, and compare these to self-reported adolescent PA. A total of 115 adolescents (aged 12-14) and their parents completed questionnaire assessments. Parents responded to questions concerning their awareness of the national PA guidelines, and whether they believed their child to be sufficiently active. Adolescents completed the International Physical Activity Questionnaire for Adolescents, and questions concerning their perceived level of PA. Adolescents were deemed sufficiently active if they participated in an average of at least 60 minutes of moderate-to-vigorous PA each day. Overall, 104 (90.4%) adolescents and their parents had complete data sets and were included in the analysis. Of the 45 (43.3%) sufficiently and 59 (56.7%) insufficiently active adolescents, 42 (93%) and 41 (69.5%) respectively believed that they were active enough for good general health. Additionally, 41 (91.1%) parents of active and 44 (74.6%) parents of inactive adolescents either agreed or strongly agreed that their child participates in sufficient PA for good general health. Twenty-four (53.3%) parents of active adolescents were unaware of the national PA guidelines, with 10 (22.2%) neither aware or unaware, and 11 (24.4%) aware. Similar results were found for the parents of inactive adolescents with 31 (52.5%) unaware, 17 (28.8%) neither aware or unaware, and 11 (18.6%) aware. These results suggest that the youth PA guidelines are being inadequately received by both adolescents, and their parents. Opportunities to effectively communicate these guidelines such as embedment in curriculum for adolescents, or the dissemination of materials for parents, should be maximised by appropriate authorities.

Pre-service Physical Education teachers and concerns regarding their ability to successfully facilitate school-based physical activity promotion strategies

Regular physical activity (PA) in youth has numerous immediate and long-term health benefits. With several studies indicating low levels of youth PA globally, schools settings have become increasingly critical settings for youth health promotion strategies. The role of physical education (PE) teachers has long been considered central to the facilitation of such strategies. However, PE teachers have a selfreported lack of knowledge, skills, understanding, and competence to successfully implement these strategies. Tertiary education programs are fundamental to adequately preparing, and shaping the attitudes and philosophies of future PE teachers towards their involvement within these programs. The aim of this investigation was to explore the beliefs and perceptions of future secondary school PE teachers, regarding their potential roles in future school-based programs designed to promote student PA. Fifty-seven (21 males and 36 females) pre-service PE teachers completed a series of open-ended survey questions concerning their perceptions towards participating in school-based PA promotion programs both as preservice during practicum, and prospectively as practising teachers. Responses were analysed thematically. Participants responded both positively and enthusiastically to both questions. Concerns regarding time, and the intention or expectation to participate in such programs were also key themes for pre-service and practicing teacher participation respectively. Critically in this study, participants did not identify any limitations which may impact upon their ability to successfully promote youth PA in school settings. This may indicate that participants have misconceptions regarding their ability to fulfil this role, or conversely, the deficiency of current PE teachers regarding school-based PA promotion has been recognised by the tertiary institution, and addressed to adequately prepare its students. School-based PA promotion is an integral element of pre-service PE teacher education, and ongoing professional development of practicing PE teachers. This trend is expected to continue in the future, in order to address ongoing public health concerns.

Do adolescents ‘like’ the use of social networking and associated technologies for physical activity promotion?

Physical activity has been identified as a key behaviour in determining an individual’s health and functioning. Adolescent physical inactivity has been shown to track strongly through to adulthood. Interventions in youth to promote and increase physical activity have had mixed results. The significant rise over the past decade in time spent by adolescents performing social networking may provide a unique opportunity for health promoters to interact with adolescents through a familiar medium. The purpose of was study is to investigate the potential utility of social networking and associated technologies for the promotion of physical activity amongst adolescents. Participants were recruited from two nondenominational same-sex private schools, from high socioeconomic backgrounds in Brisbane, Australia. A total of 112 (90.3%) participants had complete data sets and were included in the analysis. Account ownership and rates of access to some social networking sites were high. However, a combination of a lack of interest and additional risks associated with social networking utilities, means that caution should be undertaken prior to the commencement of any intervention seeking to increase engagement in physical activities through these mediums. Student smart phone access and interest in smart phone applications for physical activity promotion purposes were moderate, and may provide opportunities for samples of adolescents from high socioeconomic backgrounds who are more likely to have access to appropriate technologies. As technology advances, the rate of smart phone ownership as opposed to overall phone ownership is likely to steadily increase over time. Access and use of information technology by children likely to continue to become more convenient. This makes smart phone applications as a means for physical activity promotion progressively more practical, and a promising future option.

Development and validation of a new self-report instrument for measuring sedentary behaviors and light-intensity physical activity in adults

Background Low levels of physical activity and high levels of sedentary behavior (SB) are major public health concerns. This study was designed to develop and validate the 7-day Sedentary (S) and Light Intensity Physical Activity (LIPA) Log (7-day SLIPA Log), a self-report measure of specific daily behaviors. Method To develop the log, 62 specific SB and LIPA behaviors were chosen from the Compendium of Physical Activities. Face-to-face interviews were conducted with 32 sedentary volunteers to identify domains and behaviors of SB and LIPA. To validate the log, a further 22 sedentary adults were recruited to wear the GT3X for 7 consecutive days and nights. Results Pearson correlations (r) between the 7-day SLIPA Log and GT3X were significant for sedentary (r =.86, p < 0.001), for LIPA (r =.80, p < 0.001). Lying and sitting postures were positively correlated with GT3X output (r =.60 and r =.64, p < 0.001, respectively). No significant correlation was found for standing posture (r =.14, p = 0.53).The kappa values between the 7-day SLIPA Log and GT3X variables ranged from 0.09–0.61, indicating poor to good agreement. Conclusion The 7-day SLIPA Log is a valid self-report measure of SB and LIPA in specific behavioral domains.

Anthropometry and body composition of Indonesian adults : an evaluation of body image, eating behaviours, and physical activity

This thesis examines the characteristics of anthropometry and body composition in Indonesian adults and some of the risk factors including body image, eating behaviours, and physical activity. Examination on body image, eating behaviours, and physical activity demonstrates significant correlations with anthropometry and body composition in Indonesian adults. The study also identified body image distortion in some of the participants and provides suggestions for intervention development addressed to the groups of participants which have been identified as having a distorted body image.