Promotion of exercise prescriptions in general practice for older populations

Regular physical activity in older populations reduces the risks of cardiovascular diseases, diabetes, osteoporosis and falls and also improves mental health. Some programs of written exercise prescriptions by general practitioners have been shown to significantly increase physical activity levels over the medium-term (six to 12 months). Increasing the confidence and skills of general practitioners to prescribe and monitor exercise programs is important. However, the more challenging barriers to the widespread uptake of exercise prescription programs are the structural and economic constraints within general practice, as well as the competing promotion of prescribing pharmaceutical products. Implementation research on overcoming these barriers is urgently needed.

Body composition changes, metabolic fuel use and energy expenditure during extended fasting in subantarctic fur seal (Arctocephalus tropicalis) pups at Amsterdam Island

The fasting metabolism of 71- to 235-d-old subantarctic fur seal (Arctocephalus tropicalis) pups from Amsterdam Island, southern Indian Ocean, was investigated during the long foraging trips of their mothers. Body lipid reserves were proportionally greater in female than male pups and higher in postmoult (37%) than premoult (10%) animals. The mass-specific rate of mass loss did not differ between the sexes but was lower than observed in other species. Daily mass loss was estimated to 56% fat, 10% protein, and 34% water. The rate of protein catabolism (15 g d⁻¹) was negatively related to the size of initial lipid stores and accounted for 9% (±1%) of total energy expenditure. However, body composition changes during the fast were not equal between the sexes, with females relying more on protein catabolism than males (11% and 5% of total energy expenditure, respectively). Energy expenditure (270 kJ kg⁻¹ d⁻¹) and metabolic water production (11.5 mL kg⁻¹ d⁻¹) rates are the lowest reported for an otariid species. These results suggest that subantarctic fur seal pups greatly reduce activity levels to lower energy expenditure in addition to adopting protein-sparing metabolic pathways in order to survive the extreme fasts they must endure on Amsterdam Island.

Are parental concerns about children's inactivity warranted, and are they associated with a supportive home environment?

This paper explores parental concern about children's activity levels and whether parents who are concerned about their child's activity provide a supportive environment, a sample of 615 parents of 5-6-year-old children and 947 parents of 10-12-year-old children completed a questionnaire. Just over 50% of parents reported they were concerned their child was not getting enough activity. Children of concerned parents were less active than those whose parents were not concerned. These findings suggest that parents who are concerned about their child's physical activity levels provided a less supportive environment for physical activity than parents who are not concerned. The challenge for public health will be to harness parental concerns and translate them into action.

Motivational readiness for active commuting by university students : incentives and barriers

Issue addressed: Walking for transport can contribute significantly to health enhancing physical activity. We examined the associations of stages of motivational readiness for active transport with perceived barriers and incentives to walking to and from university among students. Methods: Mail-back surveys were completed by 781 students in a regional university in southeast Queensland. They identified one of eight options on motivational readiness for active commuting, which were then classified as: pre-contemplation; contemplation-preparation; or, action-maintenance. Open-ended questions were used to identify relevant barriers and incentives. Logistic regressions were used to examine the barriers and incentives that distinguished between those at different stages of motivational readiness. Results: Barriers most frequently reported were long travel distances, inconvenience and time constraints. Incentives most frequently reported were shorter travel distance, having more time, supportive infrastructure and better security. Those not considering active commuting (pre-contemplation) were significantly more likely to report shorter travel distance as an incentive compared to those in contemplation-preparation. Those in contemplation-preparation were significantly more likely to report lack of motivation, inadequate infrastructure, shorter travel distance and inconvenience as barriers; and, having more time, supportive infrastructure, social support and incentive programs as encouragement. Conclusions: Different barriers and incentives to walking to or from university exist for students in the different stages of motivational readiness for active commuting. Interventions targeted specifically to stage of motivational readiness may be potentially helpful in increasing activity levels, through active transport.

Decline in physical fitness from childhood to adulthood associated with increased obesity and insulin resistance in adults

To examine how fitness in both childhood and adulthood is associated with adult obesity and insulin resistance. A prospective cohort study set in Australia in 2004-2006 followed up a cohort of 647 adults who had participated in the Australian Schools Health and Fitness Survey in 1985 and who had undergone anthropometry and cardiorespiratory fitness assessment during the survey. Outcome measures were insulin resistance and obesity, defined as a homeostasis model assessment index above the 75th sex-specific percentile and BMI ≥30 kg/m^sup 2^, respectively. Lower levels of child cardiorespiratory fitness were associated with increased odds of adult obesity (adjusted odds ratio [OR] per unit decrease 3.0 [95% CI 1.6- 5.6]) and insulin resistance (1.7 [1.1-2.6]). A decline in fitness level between childhood and adulthood was associated with increased obesity (4.5 [2.6-7.7]) and insulin resistance (2.1 [1.5- 2.9]) per unit decline. A decline in fitness from childhood to adulthood, and by inference a decline in physical activity, is associated with obesity and insulin resistance in adulthood. Programs aimed at maintaining high childhood physical activity levels into adulthood may have potential for reducing the burden of obesity and type 2 diabetes in adults.

How active are rural children in Australian physical education

Physical education lessons offer a venue for children to accrue valuable and health-conferring time being physically active. The first Australian direct observational data are presented on activity of year 3 and 4 children during physical education. Analysis accounts for the nested nature of the data through multi level logistic regression using 13,080 records within 231 lessons within 18 randomly selected schools. Activity was analysed in relation to lesson context (focus of lesson), child gender, school year of child, teacher gender, lesson duration and start time. Children spent 36.7% of a lesson in moderate to vigorous and 12.9% in vigorous activity. Most of the lesson was spent in the context of management/instruction (37.4%), followed by games (25.0%), skill (21.4%), and fitness (14.7%). The highest level of moderate to vigorous activity was observed in the fitness lesson context (61.9%), followed by skill (46.4%), games (42.6%) and management/instruction (17.1%). Moderate to vigorous activity was significantly higher for boys than girls. There was no significant difference in moderate to vigorous activity in lessons led by male or female teachers. However vigorous activity was significantly higher for female led lessons. Children participated in less physical activity during physical education lessons timetabled in the afternoon, compared to physical education lessons time-tabled in the morning. Physical activity levels were not related to lesson duration. Physical education lessons can potentially be more active. However improvement rests on school capacity and may require a health promoting schools approach to implement curricular policy.

Ecology and conservation of insectivorous bats in rural landscapes

Throughout the world, the increasing use of land for agriculture has been associated with extensive loss and fragmentation of natural habitats and, frequently, the degradation of remaining habitats. The effects of such habitat changes have been well studied for some faunal groups, but little is known of their consequences for bats. The aim of this study was to investigate the ecology and conservation of an assemblage of insectivorous bats in a rural landscape, with particular focus on their foraging and roosting requirements. This increased knowledge will, hopefully, assist the formulation of policy and management decisions to ensure the long-term survival of bats in these altered environments. The distribution and abundance of insectivorous bats in the Northern Plains of Victoria was investigated to determine the impacts of land-use change and to identify factors influencing the distribution of bats in rural landscapes. Thirteen species of insectivorous bats were recorded across the region by sampling at 184 sites. Two species were rare, but the remaining 11 species were widespread and occurred in all types of remnant wooded vegetation, ranging from large blocks (≥200 ha) to small isolated remnants (≤5 ha) and scattered trees in cleared farm paddocks. There was no significant difference between remnant types in the relative abundance of bat species, in species richness, or in the composition of bat assemblages at study sites. In a subsequent study, no difference in the activity levels of bats was found between remnants with different tree densities, ranging from densely-vegetated blocks to single paddock trees. However, sites in open paddocks devoid of trees differed significantly from all types of wooded remnants and had significantly lower levels of bat activity and a different species composition. In highly cleared and modified landscapes, all native vegetation has value to bats, even the smallest remnant, roadside and single paddock tree. Roost sites are a key habitat requirement for bats and may be a limiting resource in highly modified environments. Two species, the lesser long-eared bat Nyctophilus geoffroyi and Gould's wattled bat Chalinolobus gouldii, were investigated as a basis for understanding the capacity of bats to survive in agricultural landscapes. These species have different wing morphologies, which may be influential in how they use the landscape, and anecdotal evidence suggested differences in their roosting ecology. Roosting ecology was examined using radio-tracking to locate 376 roosts in two study areas with contrasting tree cover in northern Victoria. Both species were highly selective in the location of their roosts in the landscape, in roost-site selection and in roosting behaviour, and responded differently to differing levels of availability of roosts. The Barmah-Picola study area incorporated remnant vegetation in farmland and an adjacent extensive floodplain forest (Barmah forest). Male N. geojfroyi roosted predominantly within 3 km of their foraging areas in remnants in farmland. However, most female N. geoffroyi, and both sexes of C. gouldii, roosted in Barmah forest up to 12 km from their foraging areas in farmland remnants. These distances were greater than previously recorded for these species and further than predicted by wing morphology. In contrast, in the second study area (Naring) where only small remnants of wooded vegetation remain in farmland, individuals of both species moved significantly shorter distances between roost sites and foraging areas. There were marked inter- and intra-specific differences in the roosts selected. C. gouldii used similar types of roosts in both areas - predominantly dead spouts in large, live trees. N. geoffroyi used a broader range of roost types, especially in the farmland environment. Roosts were typically under bark and in fissures, with males in particular also using anthropogenic structures. A strong preference was shown by both sexes for roosts in dead trees, and entrance dimensions of roosts were consistently narrow (2.5 cm). In Barmah forest, maternity roosts used by N. geoffroyi were predominantly in narrow fissures in large-diameter, dead trees, while at Naring maternity roosts were also found under bark, in buildings, and in small-diameter, live and dead trees. The number of roost trees that are required for an individual or colony is influenced by the frequency with which bats move between roosts, the proportion of roosts that are re-used, the distance between consecutive roosts, and the size of roosting colonies. Both species roosted in small colonies and regularly shifted roost sites within a discrete roost area. These behavioural traits suggest that a high density of roost sites is required. There were marked differences in these aspects of behaviour between individuals roosting in Barmah forest and in the fragmented rural landscape. At Naring, N. geqffroyi remained in roosts for longer periods and moved greater distances between consecutive roosts than in Barmah forest. In contrast, C. gouldii used a smaller pool of roosts in the farmland environment by re-using roosts more frequently. Within Barmah forest, there is an extensive area of forest but the density of hollow-bearing trees is reduced due to timber harvesting and silvicultural practices. Individuals were selective in the location of their roosting areas, with both species selecting parts of the forest that contained higher densities of their preferred roost trees than was generally available in the forest. In contrast, in farmland at Naring, where there were small pockets of remnant vegetation with high densities of potential roost sites surrounded by cleared paddocks with few roosting opportunities, little selection was shown. This suggests that in Barmah forest the density of trees with potential roosts is lower than optimal, while in farmland roosting resources may be adequate in woodland remnants, but limiting at the landscape scale since more than 95% of the landscape now provides no roosting opportunities. Insectivorous bats appear to be less severely affected than some other faunal groups by habitat fragmentation and land-use change. A highly developed capacity for flight, the spatial scale at which they move and their ability to cross open areas means that they can regularly move among multiple landscape elements, rather than depend on single remnants for all their resources. In addition, bats forage and roost mainly at elevated levels in trees and so are less sensitive to degradation of wooded habitats at ground level. Although seemingly resilient to habitat fragmentation, insectivorous bats are fundamentally dependent on trees for roosting and foraging, and so are vulnerable to habitat loss and ongoing rural tree decline. Protection of the remaining large old trees and measures to ensure regeneration to provide ongoing replacement of hollow-bearing trees through time are critical to ensure the long-term conservation of bats in rural landscapes.

Pharmacist assessment of adherence, risk and treatment in cardiovascular disease (PAART CVD)

Cardiovascular disease (CVD) accounts for 18% of disease burden in Australia, and 35% of deaths. Evidence- based management of CVD risk requires systematic consideration of individual risk factors and overall CVD risk, and a balanced approach to lifestyle modification, the optimal use of medicines, and medicines adherence.

This project examines a pHot model for primary prevention of CVD in community pharmacy aimed at improving quality of care. Pharmacists from ten pharmacies received training in CVD risk factor management and facilitating patient lifestyle modification.

They recruited 70 participants aged 50-74 years, taking medicines for blood pressure (BP) or cholesterol, and without diabetes or CVD, At baseline, research assistants conducted a clinical assessment of anthropometric and biomedical risk factors, and conducted interviews to examine health behaviours, medicines use and related issues. Data was analysed by a consultant pharmacist and summary reports produced, with recommendations and targets for risk reduction. These were addressed by patients and their community pharmacists over five monthly sessions. At follow up, the relative risk reduction for CVD onset over the next five years was 24%, contributed to by reductions in mean systolic BP (-7mmHg), diastolic PP (-5 mmHg), total:HDL cholesterol ratio (—0.2), waist circumference (—2cm in males, —0.7cm in females) and other risk factors.

Several key health behaviours improved, including diet quality and physical activity levels. Prevalence of non-adherence to cardiovascular medicines dropped by 1 6% to 22%.

The potential health benefits from this intervention need to be confirmed via larger, controlled clinical trials. Overall, this appears to be a feasible and potentially effective public health measure.

Docosapentaenoic acid (22:5n-3) : a review of its biological effects

This article summarizes the current knowledge available on metabolism and the biological effects of n-3 docosapentaenoic acid (DPA). n-3 DPA has not been extensively studied because of the limited availability of the pure compound. n-3 DPA is an elongated metabolite of EPA and is an intermediary product between EPA and DHA. The literature on n-3 DPA is limited, however the available data suggests it has beneficial health effects. In vitro n-3 DPA is retro-converted back to EPA, however it does not appear to be readily metabolised to DHA. In vivo studies have shown limited conversion of n-3 DPA to DHA, mainly in liver, but in addition retro-conversion to EPA is evident in a number of tissues. n-3 DPA can be metabolised by lipoxygenase, in platelets, to form ll-hydroxy-7,9,13,16,19- and 14-hydroxy-7,10,12,16,19-DPA. It has also been reported that n-3 DPA is effective (more so than EPA and DHA) in inhibition of aggregation in platelets obtained from rabbit blood. In addition, there is evidence that n-3 DPA possesses 10-fold greater endothelial cell migration ability than EPA, which is important in wound-healing processes. An in vivo study has reported that n-3 DPA reduces the fatty acid synthase and malic enzyme activity levels in n-3 DPA-supplemented mice and these effects were stronger than the EPA-supplemented mice. Another recent in vivo study has reported that n-3 DPA may have a role in attenuating age-related decrease in spatial learning and long-term potentiation. However, more research remains to be done to further investigate the biological effects of this n-3 VLCPUFA.

Healthy eating and obesity prevention for preschoolers : a randomised controlled trial

Background
Developing effective prevention and intervention programs for the formative preschool years is seen as an essential step in combating the obesity epidemic across the lifespan. The overall goal of the current project is to measure the effectiveness of a healthy eating and childhood obesity prevention intervention, the MEND (Mind Exercise Nutrition Do It!) program that is delivered to parents of children aged 2-4 years.

Methods/Design
This randomised controlled trial will be conducted with 200 parents and their 2-4 year old children who attend the MEND 2-4 program in metropolitan and regional Victoria. Parent-child dyads will attend ten 90-minute group workshops. These workshops focus on general nutrition, as well as physical activity and behaviours. They are typically held at community or maternal and child health centres and run by a MEND 2-4 trained program leader. Child eating habits, physical activity levels and parental behaviours and cognitions pertaining to nutrition and physical activity will be assessed at baseline, the end of the intervention, and at 6 and 12 months post the intervention. Informed consent will be obtained from all parents, who will then be randomly allocated to the intervention or wait-list control group.

Discussion
Our study is the first RCT of a healthy eating and childhood obesity prevention intervention targeted specifically to Australian parents and their preschool children aged 2-4 years. It responds to the call by experts in the area of childhood obesity and child health that prevention of overweight in the formative preschool years should focus on parents, given that parental beliefs, attitudes, perceptions and behaviours appear to impact significantly on the development of early overweight. This is 'solution-oriented' rather than 'problem-oriented' research, with its focus being on prevention rather than intervention. If this is a positive trial, the MEND2-4 program can be implemented as a national program.

Trial Registration
Australian New Zealand Clinical Trials Registry ACTRN12610000200088

Individual, social and physical environmental correlates of children's active free-play : a cross-sectional study

Background
Children's unstructured outdoor free-play (or active free-play) has the potential to make an important contribution to children's overall physical activity levels. Limited research has, however, examined physical activity in this domain. This study examined associations between individual, social and physical environmental factors and the frequency with which children play in particular outdoor locations outside school hours. This study also investigated whether the frequency of playing in outdoor locations was associated with children's overall physical activity levels.

Methods
Participants including 8-9 year old children and their parents (n = 187) were recruited from a selection of primary schools of varying socioeconomic status across metropolitan Melbourne, Australia. Parents completed a survey and children's overall physical activity levels were measured by accelerometry. Regression models examined the odds of children playing in various outdoor settings according to particular correlates.

Results
Inverse associations were found between preference for activities not involving physical activity, and the likelihood of children playing in the yard at home on the weekend (OR = 0.65; CI = 0.45,0.95). Positive correlates of children playing in their own street included: parental perceptions that it was safe for their child to play in their street (weekdays [OR = 6.46; CI = 2.84,14.71], weekend days [OR = 6.01; CI = 2.68,13.47]); children having many friends in their neighbourhood (OR = 2.63; CI = 1.21,5.76); and living in a cul-de-sac (weekdays [OR = 3.99; CI = 1.65,9.66], weekend days [OR = 3.49; CI = 1.49,8.16]). Positive correlates of more frequent play in the park/playground on weekdays included family going to the park together on a weekly basis on weekdays (OR = 6.8; CI = 3.4,13.6); and on weekend days (OR = 7.36; CI = 3.6,15.0). No differences in mean mins/day of moderate-vigorous physical activity were found between children in the highest and lowest tertiles for frequency of playing in particular outdoor locations.

Conclusion
The presence of friends, safety issues and aspects of the built environment were reported by parents to be associated with children's active free-play in outdoor locations. Future research needs to further examine associations with time spent in active free-play and objectively-measured overall physical activity levels. It is also important to investigate strategies for developing a supportive social and physical environment that provides opportunities for children to engage in active free-play.

Socio-demographic correlates of prolonged television viewing time in Australian men and women : the AusDiab study

Background: Sedentary behaviors, particularly television viewing (TV) time, are associated with adverse health outcomes in adults, independent of physical activity levels. These associations are stronger and more consistent for women than for men. Methods: Multivariate regression models examined the sociodemographic correlates of 2 categories of TV time (≥2 hours/day and ≥4 hours/day); in a large, population-based sample of Australian adults (4950 men, 6001 women; mean age 48.1 years, range 25-91) who participated in the 1999/2000 Australian Diabetes, Obesity, and Lifestyle (AusDiab) study. Results: Some 46% of men and 40% of women watched ≥ 2 hours TV/day; 9% and 6% respectively watched ≥ 4 hours/day. For both men and women, ≥2 hours TV/day was associated with less than tertiary education, living outside of state capital cities, and having no paid employment. For women, mid and older age (45-64 and 65+) were also significant correlates of ≥2 hours TV/day. Similar patterns of association were observed in those viewing ≥4 hours/day. Conclusions: Prolonged TV time is associated with indices of social disadvantage and older age. These findings can inform the understanding of potential contextual influences and guide preventive initiatives.

Increased energy intake entirely accounts for increase in body weight in women but not in men in the UK between 1986 and 2000

There is debate over the casual factors for the rise in body weight in the UK. The present study investigates whether increases between 1986 and 2000 for men and women were a result of increases in mean total energy intake, decreases in mean physical activity levels or both. Estimates of mean total energy intake in 1986 and 2000 were derived from food availability data adjusted for wastage. Estimates of mean body weight for adults aged 19–64 years were derived from nationally representative dietary surveys conducted in 1986–7 and 2000–1. Predicted body weight in 1986 and 2000 was calculated using an equation relating body weight to total energy intake and sex. Differences in predicted mean body weight and actual mean body weight between the two time points were compared. Monte Carlo simulation methods were used to assess the stability of the estimates. The predicted increase in mean body weight due to changes in total energy intake between 1986 and 2000 was 4·7 (95 % credible interval 4·2, 5·3) kg for men and 6·4 (95 % credible interval 5·9, 7·1) kg for women. Actual mean body weight increased by 7·7 kg for men and 5·4 kg for women between the two time points. We conclude that increases in mean total energy intake are sufficient to explain the increase in mean body weight for women between 1986 and 2000, but for men, the increase in mean body weight is likely to be due to a combination of increased total energy intake and reduced physical activity levels.

Parental status and childhood obesity in Australia

The overall aim of this study was to examine obesogenic factors in children from single and dual parent families. Data from the Longitudinal Study of Australian Children (LSAC) (8,717 children) were analyzed to examine the differences in children ’ s activity levels, dietary intake and BMI according to parental status and determine the likelihood of childhood overweight and obesity in a single-parent household. There were higher rates of overweight and obesity in girls aged four to nine whose parents were single (OR 1:60). Children in single-parent households watched more television, ate more food high in fat and sugar and less fresh fruit and vegetables than children from dual-parent households. The findings suggested that an additive effect of dietary and activity variables may contribute to the higher rates of overweight and obesity in Australian children, and that girls from single-parent households may be particularly at risk.

Living with prostate cancer: randomised controlled trial of a multimodal supportive care intervention for men with prostate cancer

Background: Prostate cancer is the most common male cancer in developed countries and diagnosis and treatment carries with it substantial morbidity and related unmet supportive care needs. These difficulties may be amplified by physical inactivity and obesity. We propose to apply a multimodal intervention approach that targets both unmet supportive care needs and physical activity.

Methods/design: A two arm randomised controlled trial will compare usual care to a multimodal supportive care intervention “Living with Prostate Cancer” that will combine self-management with tele-based group peer support. A series of previously validated and reliable self-report measures will be administered to men at four time points: baseline/recruitment (when men are approximately 3-6 months post-diagnosis) and at 3, 6, and 12 months after recruitment and intervention commencement. Social constraints, social support, self-efficacy, group cohesion and therapeutic alliance will be included as potential moderators/mediators of intervention effect. Primary outcomes are unmet supportive care needs and physical activity levels. Secondary outcomes are domain-specific and healthrelated quality of life (QoL); psychological distress; benefit finding; body mass index and waist circumference. Disease variables (e.g. cancer grade, stage) will be assessed through medical and cancer registry records. An economic evaluation will be conducted alongside the randomised trial.

Discussion: This study will address a critical but as yet unanswered research question: to identify a populationbased way to reduce unmet supportive care needs; promote regular physical activity; and improve disease-specific and health-related QoL for prostate cancer survivors. The study will also determine the cost-effectiveness of the intervention.