Short Orals: Physical activity in healthcare

Background:

Over one quarter of the global population is physically inactive. Despite healthcare professional promotion physical activity (PA) guidance, questions remain. These include how behaviour change (BC) is incorporated into their use and what the most effective components of PA interventions are?

Purpose:

To conduct a scoping review to map how theory frames delivery of BC interventions and techniques; exploring how theory, models or frameworks govern PA BC intervention design and implementation.

Methods:

JBI scoping review methodology was applied and protocol registered with the Open Science Framework (June 2022). Searches were conducted in July 2022. Eligible literature focused on healthcare professional PA BC interventions for inactive adults. The Behaviour Change Technique Taxonomy (v1) (BCTT) was used for defining intervention techniques and the Behaviour Change Wheel for a narrative analysis framework.

Results:

Twenty five studies were included. Interventions included in-person (n=17), in-person plus telephone (n=2), either (n=1) or telephone only (n=1). Web-based advice was used (n=2) or combined with human support (n=2). Single brief interventions were offered (n=12) or with follow ups (n=13). Isolated educational approaches (n=1) or prescriptive advice (n=1) were rare. Counselling (n=6), acceptance and commitment therapy (n=1), facilitation or supervision (n=3) motivational interviewing approaches (n=7) and coaching (n=1) were used, with five providing no details. Eleven theories were extracted: the most frequently cited being the Transtheoretical Model (n=8), Social Cognitive Theory (n=6) and Theories of Planned Behaviour ( n=5). Twenty-five, BC technique definitions were identified using the BCTT, spanning 12 categories. Goal and Planning was the most frequently utilised.

Conclusions:

Mapping of evidence concluded broad variability in language, reporting and theoretical approaches. Categorising BC techniques was difficult due to lack of clarity in reporting. Transparency in theoretical underpinning is required to facilitate future research on PA BC technique effectiveness.

Funding:

Staff-funded PhD at Cardiff University.

Background: Weight bias is highly prevalent in the fitness industry, posing significant challenges for people in larger bodies seeking to engage in health-promoting behaviours, such as physical activity. Despite small ideological shifts in the fitness industry calling for more weight-inclusive practices, little is known about fitness professionals’ engagement with such approaches. Purpose: To explore weight bias attitudes among weight-normative and weight-inclusive fitness professionals and factors influencing adoption of inclusive approaches. Methods: Mixed-methods survey among 120 fitness professionals (Mage=34yrs) to gather quantitative data on weight bias and experiences of working with people in larger bodies, and qualitative data on facilitators and barriers to adopting weight-inclusive approaches. Results: Weight bias was positively associated with negative attitudes towards working with people in larger bodies. “Weight-inclusive” fitness professionals reported higher empathy (p<.001; d=-.86) and size acceptance (p<.001; d=-.79), and less negative attitudes towards working with people in larger bodies (p<.001; d=.81) than “weight-normative” fitness professionals. Thematic analysis of qualitative data resulted in four higher-order themes: (1) Inclusivity and accessibility; (2) Weight as a motivator; (3) Does weight equal health?; and (4) What’s body image got to do with it?. Conclusions: Fitness professionals who adopt weight-inclusive practices display lower levels of weight bias and less negative attitudes towards working with people in larger bodies. Qualitative findings highlighted multiple barriers that need to be addressed in order to encourage more fitness professionals to adopt weight-inclusive approaches. Practical implications: Insights gained from this research will serve as a basis for developing future weight bias interventions for fitness professionals that are relevant, acceptable, and effective, to ensure all people feel comfortable accessing fitness spaces. Funding: This research was funded by a Vice Chancellor’s Early Career Researcher (VC ECR) Development Award 2023–25, University of the West of England (ref. USOS1010).

Background: In Singapore, over 400,000 Singaporeans live with diabetes with a higher than global average of both prevalence of prediabetes and diabetes. This is of great concern, given that 1 in 4 Singapore residents will have prediabetes, and if preventive measures are not taken, 35% of them will eventually develop diabetes. Progression from prediabetes to diabetes is preventable through appropriate lifestyle management, highlighting a need for effective lifestyle interventions and support. Although many physical activity interventions have shown to be effective in clinical trials, their practical efficacy and sustainability over time is largely dependent on the individual’s motivation amongst other factors. A key challenge of engaging individuals at risk is that they are likely to feel well and therefore, not see the need to change their behaviours. In Singapore, Active Health is a national social movement to empower individuals to take ownership of their health and wellness with the support from Active Health Coaches. Purpose: This study aims to examine if a physical activity intervention coupled with health coaching promotes greater adherence to physical activity in individuals at risk of diabetes. Methods: To achieve this, a six-week Active Health Targeted Programme combining sport-inspired exercises, building a health and wellness vision and health coaching support was introduced to 100 individuals aged 18-39 years at the start of a 12-Week period. Participants were randomly allocated into two groups, with the intervention group receiving health coaching support. Participants exercised independently from week seven and returned on Week 12 for assessment. Results & Conclusion: Significant differences in anthropometric and health biomarkers were observed in all participants at week 12. This was accompanied by a significant increase in moderate-intensity physical activity days for the intervention group. Practical implications: Provision of health coaching in exercise programmes can increase adherence for sustainable habits in individuals. Funding: NIL

Background: The BewegtVersorgt project is the first study to implement a physical activity referral scheme (PARS) in the German healthcare system. The PARS aims to increase physical activity (PA) levels among persons with non-communicable diseases and includes a brief PA advice by physicians, followed by an individualized PA promotion by physical therapists or sports therapists. Purpose: Based on the RE-AIM framework, this qualitative study evaluates specific dimensions of implementation success of the PARS, all from health professionals’ perspective. Methods: We conducted semi-structured interviews (n=13) with eight (out of 17) medical practices and with five (out of 14) therapy practices. Following the principles of intensity case sampling, the practices were purposefully selected based on the number of participants treated and dropped-out. The interview transcripts were analyzed using thematic analysis, combining deductive and inductive category building. Results: Most health professionals report that they would already address PA promotion in some way and see this as part of their job, but in different roles. Eleven out of thirteen interviewees believe that the PARS has added value for the participants. While most physicians did not use intended techniques of motivational interviewing (MI) for PA advice, therapists largely adhered to intervention guidelines and integrated MI. Both, therapists and physicians faced barriers with integrating the process into everyday practice and during intervention delivery. Most interviewees advocate a sustainable implementation of the program, considering adjustments to the intervention concept as well as structural and system-related changes. Conclusions: Given the intervention adjustments and barriers faced with the implementation in routine care, implementation success was only partially achieved. Practical implications: These results, in combination with the evaluation of all dimensions of implementation success, will help to adapt the PARS to be more suitable for integration into the German healthcare system. Funding: Funded by the German Federal Ministry of Health.

Background Promotion of physical activity by health professionals can increase physical activity participation among patients. However, promotion of PA is not part of routine clinical care and systematic implementation within hospital settings is lacking. Purpose The Promotion of Physical Activity by Health Professionals (PROMOTE-PA) study is a hybrid type I effectiveness-implementation cluster randomised controlled trial that aims to evaluate the effectiveness of support for physical activity promotion by hospital-based health professionals on physical activity participation of patients. Methods Health professionals delivering outpatient healthcare services within five local health districts in Sydney, Australia will be included. The target patient population is children (5-17 years) and adults who are willing to receive additional support to be more physically active. The evidence-based intervention is brief physical activity promotion informed by the ‘5As’ physical activity counselling model and behavioural theory, embedded into routine clinical practice. A multi-faceted strategy to support implementation of physical activity promotion has been developed based on preliminary research and consultation with stakeholders, The tailored implementation strategy includes education, pathways/linkages to community-based PA, access to clinical mentors, and clinical champions. Thirty outpatient clinical teams will be randomised to receive the implementation strategy immediately or after a 3-month delay (waitlist control). Each team will recruit ~ 20 patients (n= approx. 720) to collect self-reported moderate-vigorous physical activity (minutes per week, primary outcome), frequency of balance and strength exercise, mobility, and quality of life at baseline, 3-months, and 6-months post-randomisation. Data on the impact of the implementation strategy will also be collected. Conclusion The PROMOTE-PA study aims to address the increasing burden of physical inactivity in a high-risk population using the existing health workforce to deliver physical activity promotion. Practical Implications The PROMOTE-PA study will inform future interventions focused on promoting PA in hospital settings. Funding: NHMRC Partnership Projects APP2011157

Background: Parents are highly influential of their child’s movement behaviours. However, they have noted lacking necessary knowledge to foster healthy movement habits. The purpose of this study was to explore the educational background and information needs of parents of young children for promoting healthy movement behaviours. Methods: Parents living in Canada with a child under the age of 5 years were recruited. Via online survey, participants reported on family demographics, information they received about movement behaviours in early childhood during their prenatal/postnatal care or child’s pediatrician appointments, where they sought information on these topics, topical information they would like more knowledge of, and preferred format for delivery. Descriptive statistics were calculated for all outcome variables and logistic regression was conducted to examine if sociodemographic variables were associated with receiving movement behaviour education across care types. Results: Parents (n = 576) reported no mention of any movement behaviour in their prenatal (49.4%), postnatal (29.6%), and pediatric care (37.2%). Physical activity was the most cited movement behaviour, with 42.4%, 57.9%, and 54.8% of participants indicating this was discussed in their prenatal, postnatal, and pediatric care, respectively. Only 41.7% of parents reported asking their child’s pediatrician about movement behaviours, while most relied on social media (70.9%), internet websites/news articles (68.7%), and family/friends (67.6%). The most requested movement behaviour topics were incorporating movement into traditionally sedentary activities (68.8%) and activity ideas to break up sitting time (65.0%). Participants preferred to receive movement behaviour information via social media (63.2%), an online resource package (47.8%), or email (46.6%). Conclusions: Participants had varied movement behaviour education in maternal and pediatric care, as such, an opportunity exists for greater integration across care types. Ensuring all parents receive evidence-based and consistent guidance on their child’s movement behaviours will ensure children have the best start to a healthy active life.

Numerous attempts have been made to address the burden of long-term conditions (LTCs) and multimorbidity through physical activity (PA) initiatives. As part of the 2012 London Olympic Legacy and National Centre for Sport & Exercise Medicine, National Health Service (NHS) clinics were co-located within leisure centres (or fitness centres). The main aims of this initiative were to promote PA as prevention and treatment through routine healthcare, increase awareness, normalise PA, and bring healthcare out of hospitals and into the community. Despite numerous calls for co-location of healthcare in alternative settings, little empirical evidence exists to show how fitness centres might work as an appropriate environment. As part of a two-phase realist evaluation, phase 2 of this research resulted in theories and evidence to show how, why, for whom and under what circumstances co-location of healthcare with leisure works (or not). Theories develop in Phase 1 were ‘tested’ through interviews with ten healthcare professionals and ten patients across four clinical services (including diabetes, pain management, musculoskeletal physiotherapy and podiatry) based in the co-located sites. Five refined programme theories were developed suggesting that co-location works for people living with LTCs who are motivated to be active but need support. Co-location works for healthcare professionals (HCPs) that are active, knowledgeable and make time to discuss PA with patients. Co-location creates a salutogenic environment which enables patients and HCPs alike to become active. Enabling contexts include aligned business models, shared clinical and PA scheduling and teamwork between HCPs and exercise professionals. Logistical challenges and individual motivations are barriers to co-location working to promote PA. Co-location of healthcare and fitness centres, if implemented optimally, can result in promotion of PA through healthcare, helping people with LTCs to become physically active and help to reduce the burden of LTCs on society. Ukactive SHU Vice Chancellors scholarship

Together an Active Future (TaAF) is a place-based collective of change leaders from across organisations (local government, health, education, voluntary, faith and leisure). A Sport England place-based delivery partner, its uniqueness lies in its nonhierarchic, cross-organisational and shared role model structure across 6 districts in the northwest of England. TaAF aims to establish locally driven cross-policy consideration of tackling physical activity inequalities in a place. Whole-systems, place-based activity has to date involved distributed leadership, collaboration across and within organisations, creative engagement and accessibly communicating science. Central to this approach is to work with local people to co-create meaningful solutions, and challenge societal structures (including cross-sector politics, policy, and practice), and cultural norms for long-lasting change. A differentiated approach of 6 local, people-led programs; 5 universal programs (schools, madrassah, social prescribing, leadership and football therapy); and 5 targeted programs (public health, disability, family hubs, strategic leadership and campaigns) are currently active. A combined approach of embedded process evaluation (Learning Pods, Participatory workshops, Ripple Effect Mapping, and stories of significant change) and multiple researcher-led methods (qualitative and quantitative) with multiple academic partners (University of Liverpool, Edge Hill University, University of Lancaster, University of Glasgow) are deployed to better understand how, and if our approaches to systems change in our places are working A focus on changing the people to change the system, through different approaches to local or system leadership at any level can be achieved through a series of enablers: relationship building, investing in strengths, connection, brave leadership and social learning. Sport England grant of £7M for the Accelerator phase of the initiative (2021-2024). Many hyper-local programs receive some additional local investment or in-kind funding from host organisations. TaAF is currently funded until Dec 2025 but is expected to receive further funding to continue through 2027.