Living well with diabetes: a randomized controlled trial of a telephone-delivered intervention for maintenance of weight loss, physical activity and glycaemic control in adults with type 2 diabetes

Background By 2025, it is estimated that approximately 1.8 million Australian adults (approximately 8.4% of the adult population) will have diabetes, with the majority having type 2 diabetes. Weight management via improved physical activity and diet is the cornerstone of type 2 diabetes management. However, the majority of weight loss trials in diabetes have evaluated short-term, intensive clinic-based interventions that, while producing short-term outcomes, have failed to address issues of maintenance and broad population reach. Telephone-delivered interventions have the potential to address these gaps. Methods/Design Using a two-arm randomised controlled design, this study will evaluate an 18-month, telephone-delivered, behavioural weight loss intervention focussing on physical activity, diet and behavioural therapy, versus usual care, with follow-up at 24 months. Three-hundred adult participants, aged 20-75 years, with type 2 diabetes, will be recruited from 10 general practices via electronic medical records search. The Social-Cognitive Theory driven intervention involves a six-month intensive phase (4 weekly calls and 11 fortnightly calls) and a 12-month maintenance phase (one call per month). Primary outcomes, assessed at 6, 18 and 24 months, are: weight loss, physical activity, and glycaemic control (HbA1c), with weight loss and physical activity also measured at 12 months. Incremental cost-effectiveness will also be examined. Study recruitment began in February 2009, with final data collection expected by February 2013. Discussion This is the first study to evaluate the telephone as the primary method of delivering a behavioural weight loss intervention in type 2 diabetes. The evaluation of maintenance outcomes (6 months following the end of intervention), the use of accelerometers to objectively measure physical activity, and the inclusion of a cost-effectiveness analysis will advance the science of broad reach approaches to weight control and health behaviour change, and will build the evidence base needed to advocate for the translation of this work into population health practice.

Dangers of the after-dark wonderlands : Part A - A review of the impact of physical environment design on nightclub violence

Nightclubs are businesses. Their business is pleasure; however pleasure has its price. People have become increasingly concerned about the problems of violence in society but why do higher levels of violence occur in nightclubs despite the established patterns of behaviour that dictates how we socialise and act? In response, researchers have focused on identifying social and situational factors that may contribute to violence from a government perspective, focusing on a variety of specific issues ranging from financial standpoints with effective target marketing strategies to legal obligations of supplying alcohol and abiding regulatory conditions. There is little research into specific design properties that can determine design standards to ensure/improve the physical design of nightclub environments to reduce patron violence. To address this gap, this current article aims to understand how people experience and respond to the physical environment of nightclubs and how these spaces influence their behaviour. The first section of this paper examines the background on nightclubs and theories concerning the influence of pleasure. The second section of this paper details the findings of existing studies that have examined the nightlife context and the various factors that influence patron violence. The main finding of this paper is that although alcohol likely plays a contributing role in aggressive patron behaviour, there is evidence that the relationship is moderated by a number of significant factors relating to the characteristics of the drinking environment such as: physical comfort; the degree of overall 'permissiveness‘ in the establishment; crowding; and physical environmental elements most influenced by day to-day management practices such as lighting, ventilation, cleanliness and seating arrangements. The findings from this paper have been used to develop a framework to guide exploratory research on how specific elements of the physical environment of nightclubs have an impact on elevated patron aggression and assault (Koleczko & Garcia Hansen, 2011).

Dangers of the after-dark wonderlands : Part B - A review of the impact of the physical environment design on nightclub violence

Violence in nightclubs is a serious problem that has the Australian government launching multimillion dollar drinking campaigns. Research on nightclub violence has focused on identifying contributing social and environmental factors, with many concentrating on a variety of specific issues ranging from financial standpoints with effective target marketing strategies to legal obligations of supplying alcohol and abiding regulatory conditions. Moreover, existing research suggests that there is no single factor that directly affects the rate violence in licensed venues. As detailed in the review paper of Koleczko and Garcia Hansen (2011), there is little research about the physical environment of nightclubs and which specific design properties can be used to determine design standards to ensure/improve the physical design of nightclub environments to reduce patron violence. This current study seeks to address this omission by reporting on a series of interviews with participants from management and design domains. Featured case studies are both located in Fortitude Valley, a Mecca for party-goers and the busiest nightclub district in Queensland. The results and analysis support the conclusions that a number of elements of the physical environment influence elevated patron aggression and assault.

The embodied hybrid space : designing for digital encounters in physical environments

The emergence of mobile and ubiquitous computing has created what is referred to as a hybrid space – a virtual layer of digital information and interaction opportunities that sits on top and augments the physical environment. The increasing connectedness through such media, from anywhere to anybody at anytime, makes us less dependent on being physically present somewhere in particular. But, what is the role of ubiquitous computing in making physical presence at a particular place more attractive? Acknowledging historic context and identity as important attributes of place, this work embarks on a ‘global sense of place’ in which the cultural diversity, multiple identities, backgrounds, skills and experiences of people traversing a place are regarded as social assets of that place. The aim is to explore ways how physical architecture and infrastructure of a place can be mediated towards making invisible social assets visible, thus augmenting people’s situated social experience. Thereby, the focus is on embodied media, i.e. media that materialise digital information as observable and sometimes interactive parts of the physical environment hence amplify people’s real world experience, rather than substituting or moving it to virtual spaces.

The constraints-based approach to motor learning : Implications for a non-linear pedagogy in sport and physical education

Recently, a constraints- led approach has been promoted as a framework for understanding how children and adults acquire movement skills for sport and exercise (see Davids, Button & Bennett, 2008; Araújo et al., 2004). The aim of a constraints- led approach is to identify the nature of interacting constraints that influence skill acquisition in learners. In this chapter the main theoretical ideas behind a constraints- led approach are outlined to assist practical applications by sports practitioners and physical educators in a non- linear pedagogy (see Chow et al., 2006, 2007). To achieve this goal, this chapter examines implications for some of the typical challenges facing sport pedagogists and physical educators in the design of learning programmes.

Fitness and fatness in childhood obesity : implications of physical activity

Overweight and obesity are a significant cause of poor health worldwide, particularly in conjunction with low levels of physical activity (PA). PA is health-protective and essential for the physical growth and development of children, promoting physical and psychological health while simultaneously increasing the probability of remaining active as an adult. However, many obese children and adolescents have a unique set of physiological, biomechanical, and neuromuscular barriers to PA that they must overcome. It is essential to understand the influence of these barriers on an obese child's motivation in order to exercise and tailor exercise programs to the special needs of this population. Chapter Outline • Introduction • Defining Physical Activity, Exercise, and Physical Fitness • Physical Activity, Physical Fitness, And Motor Competence In Obese Children • Physical Activity and Obesity in Children • Physical Fitness in Obese Children • Balance and Gait in Obese Children • Motor Competence in Obese Children • Physical Activity Guidelines for Obese Children • Clinical Assessment of the Obese Child • Physical Activity Characteristics: Mode • Physical Activity Characteristics: Intensity • Physical Activity Characteristics: Frequency • Physical Activity Characteristics: Duration • Conclusion

Ezine and iRadio as knowledge creation metaphors for scaffolding learning in physical and virtual learning spaces

eZine and iRadio represent metaphors for multimedia communication on the Internet. Participating students experience a simulated Internet publishing environment in both their classroom and virtual learning environment. This chapter presents an autoethnographic account highlighting the voices of the learning designer and the teacher and provides evidence of the planning and implementation of two tertiary music elective courses over three iterations of each course. A blended learning environment was incorporated within each elective music course and a collaborative approach to development between lecturers, tutors, learning and technological designers using an iterative research design. The research suggests that learning design which provides real world examples and resources integrating authentic task design into their unit can provide meaningful and engaging experiences for students. The dialogue between learning designers and teachers and iterative review of the learning process and student outcomes, we believe, has engaged students meaningfully to achieve transferable learning outcomes.

Relationship between physical activity and stiff or painful joints in mid-aged women and older women: a 3-year prospective study

This prospective study examined the association between physical activity and the incidence of self-reported stiff or painful joints (SPJ) among mid-age women and older women over a 3-year period. Data were collected from cohorts of mid-age (48–55 years at Time 1; n = 4,780) and older women (72–79 years at Time 1; n = 3,970) who completed mailed surveys 3 years apart for the Australian Longitudinal Study on Women's Health. Physical activity was measured with the Active Australia questions and categorized based on metabolic equivalent value minutes per week: none (<40 MET.min/week); very low (40 to <300 MET.min/week); low (300 to <600 MET.min/week); moderate (600 to <1,200 MET.min/week); and high (1,200+ MET.min/week). Cohort-specific logistic regression models were used to examine the association between physical activity at Time 1 and SPJ 'sometimes or often' and separately 'often' at Time 2. Respondents reporting SPJ 'sometimes or often' at Time 1 were excluded from analysis. In univariate models, the odds of reporting SPJ 'sometimes or often' were lower for mid-age respondents reporting low (odds ratio (OR) = 0.77, 95% confidence interval (CI) = 0.63–0.94), moderate (OR = 0.82, 95% CI = 0.68–0.99), and high (OR = 0.75, 95% CI = 0.62–0.90) physical activity levels and for older respondents who were moderately (OR = 0.80, 95% CI = 0.65–0.98) or highly active (OR = 0.83, 95% CI = 0.69–0.99) than for those who were sedentary. After adjustment for confounders, these associations were no longer statistically significant. The odds of reporting SPJ 'often' were lower for mid-age respondents who were moderately active (OR = 0.71, 95% CI = 0.52–0.97) than for sedentary respondents in univariate but not adjusted models. Older women in the low (OR = 0.72, 95% CI = 0.55–0.96), moderate (OR = 0.54, 95% CI = 0.39–0.76), and high (OR = 0.61, 95% CI = 0.46–0.82) physical activity categories had lower odds of reporting SPJ 'often' at Time 2 than their sedentary counterparts, even after adjustment for confounders. These results are the first to show a dose–response relationship between physical activity and arthritis symptoms in older women. They suggest that advice for older women not currently experiencing SPJ should routinely include counseling on the importance of physical activity for preventing the onset of these symptoms.

Prospective association between physical activity and falls in community-dwelling older women

Abstract Objective: To explore associations between physical activity and risk of falls and broken or fractured bones in community-dwelling older women. Design, setting and participants: This was a prospective observational survey with 3- and 6-year follow-ups. The sample included 8562 healthy, community-dwelling women, aged 70-75 years in 1996, who completed surveys as participants in the Australian Longitudinal Study on Women’s Health. Outcomes were reports of a fall to the ground, injury from a fall, and broken or fractured bones in 1999 and 2002. The main predictor variable was physical activity level in 1996, categorized based on weekly frequency as none/very low, low, moderate, high, and very high. Covariates were demographic and health-related variables. Logistic regression models were computed separately for each outcome in 1999 and 2002. Main results: In multivariable models, very high physical activity was associated with decreased risk of a fall in 1999 (odds ratio 0.67, 95% CI 0.48 to 0.93) and in 2002 (odds ratio 0.62, 95% CI 0.42 to 0.92). High/very high physical activity was associated with decreased risk of broken or fractured bones in 2002 (odds ratio 0.64, 95% CI 0.42 to 0.96). No significant association was found between physical activity and injury from a fall. Conclusions: The results suggest that at least daily moderate to vigorous physical activity is required for the primary prevention of falls to the ground and broken or fractured bones in women aged 70-75 years.