Definition, measurement, and health risks associated with sedentary behavior. A systematic review of school-based interventions targeting physical activity and sedentary behaviour among older adolescents Intervening to Reduce Sedentary Behaviors and Childhood Obesity among School-Age Youth: A Systematic Review of Randomized Trials A cluster-randomized controlled trial to reduce sedentary behavior and promote physical activity and health of 8-9 year olds: The Transform-Us! Study Economic evaluation in short bowel syndrome (SBS): an algorithm to estimate utility scores for a patient-reported SBS-specific quality of life scale (SBS-QoL™) Correlates of preschool children’s objectively measured physical activity and sedentary behavior: a cross-sectional analysis of the SPLASHY study Comparison of Actical and activPAL measures of sedentary behaviour in preschool children. Motivational counselling and SMS-reminders for reduction of daily sitting time in patients with rheumatoid arthritis: a descriptive randomised controlled feasibility study A Pan-Canadian practice guideline: prevention, screening, assessment, and treatment of sleep disturbances in adults with cancer Randomised controlled feasibility study of a school-based multi-level intervention to increase physical activity and decrease sedentary behaviour among vocational school students The John Charnley Award. Practice surveillance: a practical method to assess outcome and to perform clinical research. What are the most effective behaviour change techniques to promote physical activity and/or reduce sedentary behaviour in inactive adults? A systematic review protocol Examination of mid-intervention mediating effects on objectively assessed sedentary time among children in the Transform-Us! cluster-randomized controlled trial Feasibility and preliminary efficacy of an intervention to reduce older adults’ sedentary behavior Surveillance bronchoscopy in lung transplant recipients: risk versus benefit. Sedentary behavior & health-related quality of life among congestive heart failure patients. Identifying quality improvement intervention evaluations: is consensus achievable? A Randomised Controlled Trial to Reduce Sedentary Time in Young Adults at Risk of Type 2 Diabetes Mellitus: Project STAND (Sedentary Time ANd Diabetes) Study protocol for Chronic Obstructive Pulmonary Disease-Sitting and ExacerbAtions Trial (COPD-SEAT): a randomised controlled feasibility trial of a home-based self-monitoring sedentary behaviour intervention Testing the transition preparation training program: A randomized controlled trial. Standing Up for Student Health: An Application of the Health Action Process Approach for Reducing Student Sedentary Behavior-Randomised Control Pilot Trial. The effect of a movement-to-music video program on the objectively measured sedentary time and physical activity of preschool-aged children and their mothers: A randomized controlled trial A behaviour change intervention to reduce sedentary time in people with chronic obstructive pulmonary disease: protocol for a randomised controlled trial.
PURPOSE AND METHODS Although evidence is accumulating that sedentary behavior ( SB ) , independent of moderate-to-vigorous intensity physical activity ( MVPA ) , is associated with cardiometabolic and aging outcomes in adults , several gaps present opportunities for future research . This article reports on the " Research Evidence on Sedentary Behavior " session of the Sedentary Behavior : Identifying Research Priorities workshop , sponsored by the National Heart , Lung , and Blood Institute and the National Institute on Aging , which aim ed to identify priorities in SB research . RESULTS AND CONCLUSIONS A consensus definition of SB has not yet been established , although agreement exists that SB is not simply all behaviors other than MVPA . The two most common definitions are as follows : one based solely on intensity ( < 1.5 metabolic equivalents [ METs ] ) and another which combines low intensity ( ≤1.5 METs ) with a seated or reclining posture . Thus , for the definition of SB , evaluation of whether or not to include a postural component is a research priority . SB assessment method ologies include self-report and objective measurement , each offering distinct information . Therefore , evaluation , st and ardization , and comparison across self-report and objective assessment methods are needed . Specific priorities include the development and validation of novel devices capable of assessing posture and st and ardization of research practice s for SB assessment by accelerometry . The prospect i ve evidence that SB relates to health outcomes is limited in that SB is almost exclusively measured by self-report . The lack of longitudinal studies with objective ly measured SB was recognized as a major research gap , making examination of the association between objective ly measured SB and adverse health outcomes in longitudinal studies a research priority . Specifically , studies with repeated measures of SB , evaluating dose-response relationships , with inclusion of more diverse population s are needed ABSTRACT Lack of  physical activity  (  PA  ) and high levels of sedentary behaviour ( SB ) have been associated with health problems . This systematic review evaluates the effectiveness of school-based interventions to increase PA  and decrease SB  among 15–19-year-old adolescents , and examines whether intervention characteristics ( intervention length , delivery mode and intervention provider ) and intervention content ( i.e. behaviour change techniques , BCTs ) are related to intervention effectiveness . A systematic search of r and omised or cluster r and omised controlled trials with outcome measures of PA and /or SB rendered 10 results . Risk of bias was assessed using the Cochrane risk of bias tool . Intervention content was coded using Behaviour Change Technique Taxonomy v1 . Seven out of 10 studies reported significant increases in PA . Effects were generally small and short-term ( Cohen 's d ranged from 0.132 to 0.659 ) . Two out of four studies that measured SB reported significant reductions in SB . Interventions that increased PA  included a higher number of BCTs , specific BCTs ( e.g. , goal setting , action planning and self-monitoring ) , and were delivered by research staff . Intervention length and mode of delivery were unrelated to effectiveness . More studies are needed that evaluate long-term intervention effectiveness and target SBs among older adolescents Objective . To assess the effectiveness of interventions that focus on reducing  sedentary behavior ( SB ) among school-age youth and to identify elements associated with interventions ' potential for translation into practice setting s. Methods . A comprehensive literature search was conducted using 4 data bases for peer- review ed studies published between 1980 and April 2011 . R and omized trials , which lasted at least 12 weeks , aim ed at decreasing  SB among children aged 6 to 19 years were identified . Results . Twelve studies were included ; 3 focused only on SB , 1 focused on  physical activity ( PA )  , 6 were combined SB and PA interventions , and 2 studies targeted SB , PA , and diet .  The majority of the studies were conducted in a school setting , while others were conducted in such setting s as clinics , community centers , and libraries . Conclusions . Overall , interventions that focused on decreasing SB were associated with reduction in time spent on SB and /or improvements in anthropometric measurements related to childhood obesity . Several of the studies did consider elements related to the intervention 's potential for translation into practice setting Background Physical activity ( PA ) is associated with positive cardio-metabolic health and emerging evidence suggests sedentary behavior ( SB ) may be detrimental to children 's health independent of PA . The primary aim of the Transform-Us ! study is to determine whether an 18-month , behavioral and environmental intervention in the school and family setting s results in higher levels of PA and lower rates of SB among 8 - 9 year old children compared with usual practice ( post-intervention and 12-months follow-up ) . The secondary aims are to determine the independent and combined effects of PA and SB on  children 's cardio-metabolic health risk factors ; identify the factors that mediate the success of the intervention ; and determine whether the intervention is cost-effective . Methods / design A four-arm cluster-r and omized controlled trial ( RCT ) with a 2 × 2 factorial design , with schools as the unit of r and omization . Twenty schools will be allocated to one of four intervention groups , sedentary behavior ( SB-I ) , physical activity ( PA-I ) , combined SB and PA ( SB+PA-I ) or current practice control ( C ) , which will be evaluated among approximately 600 children aged 8 - 9 years in school year 3 living in Melbourne , Australia . All children in year 3 at intervention schools in 2010 ( 8 - 9 years ) will receive the intervention over an 18-month period with a maintenance ' booster ' delivered in 2012 and children at all schools will be invited to participate in the evaluation assessment s. To maximize the sample and to capture new students arriving at intervention and control schools , recruitment will be on-going up to the post-intervention time point . Primary outcomes are time spent sitting and in PA assessed via accelerometers and inclinometers and survey . Discussion To our knowledge , Transform-Us ! is the first RCT to examine the effectiveness of intervention strategies for reducing children 's overall sedentary time , promoting PA and optimizing health outcomes . The integration of consistent strategies and messages to children from teachers and parents in both school and family setting s is a critical component of this study , and if shown to be effective , may have a significant impact on educational policies as well as on pedagogical and parenting practice s . Trial registration ACTRN12609000715279 ; Current Controlled Trials IS RCT Purpose Condition-specific preference-based measures can offer utility data where they would not otherwise be available or where generic measures may lack sensitivity , although they lack comparability across conditions . This study aim ed to develop an algorithm for estimating utilities from the short bowel syndrome health-related quality of life scale ( SBS-QoL ™ ) . Methods SBS-QoL ™ items were selected based on factor and item performance analysis of a European SBS-QoL ™ data set and consultation with 3 SBS clinical experts . Six-dimension health states were developed using 8 SBS-QoL ™ items ( 2 dimensions combined 2 SBS-QoL ™ items ) . SBS health states were valued by a UK general population sample ( N = 250 ) using the lead-time time trade-off method . Preference weights or ‘ utility decrements ’ for each severity level of each dimension were estimated by regression models and used to develop the scoring algorithm . Results Mean utilities for the SBS health states ranged from −0.46 ( worst health state , very much affected on all dimensions ) to 0.92 ( best health state , not at all affected on all dimensions ) . The r and om effects model with maximum likelihood estimation regression had the best predictive ability and lowest root mean squared error and mean absolute error , and was used to develop the scoring algorithm . Conclusions The preference-weighted scoring algorithm for the SBS-QoL ™ developed is able to estimate a wide range of utility values from patient-level SBS-QoL ™ data . This allows estimation of SBS HRQL impact for the purpose of economic evaluation of SBS treatment benefits Background Identifying ways to promote physical activity and decrease sedentary time during childhood is a key public health issue . Research on the putative influences on preschool children ’s  physical activity ( PA ) and  sedentary behavior  ( SB ) is limited and has yielded inconsistent results . Our aim was to identify correlates of PA and SB in preschool children . Methods Cross-sectional data were drawn from the Swiss Preschoolers ’ Health Study ( SPLASHY ) , a Swiss population -based cohort study . Of 476 two to six year old children , 394 ( 54 % boys ) had valid PA data assessed by accelerometry .  Information on exposure data was directly measured or extracted from parental question naires . Multilevel linear regression modeling was used to separately assess associations between 35 potential correlates and  total PA ( TPA ) , moderate-to-vigorous PA ( MVPA ) and SB . Results In total , 12 correlates from different domains were identified . TPA and MVPA were greater in boys than girls , increased with age and were positively associated with gross motor skills . Children from single parent families had a higher level of TPA and spent less time sedentary than those living with two parents . Time spent outdoors was positively associated with TPA and negatively with SB . The child ’s activity temperament was related all three outcomes , whereas parental sports club membership , living area per person and neighborhood safety were associated with SB only . Fixed and r and om factors in the final models accounted for 28 % , 32 % and 22 % of the total variance in TPA , MVPA and SB , respectively . Variance decomposition revealed that age , sex and activity temperament were the most influential correlates of both , TPA and MVPA , whereas the child ’s activity temperament , time outdoors and neighborhood safety were identified as the most important correlates of SB . Conclusions A multidimensional set of correlates of young children ’s  activity behavior has been identified . Personal factors had the greatest influence on PA , whereas environmental-level factors had the greatest influence on SB . Moreover , we identified a number of previously unreported , potentially modifiable correlates of young children ’s PA and SB . These factors could serve to define target groups or become valuable targets for change in future interventions .Trial registration Current Controlled Trials IS RCT N41045021 ( date of registration : 21.03.14 ) OBJECTIVES The purpose of this study was to examine the convergent validity of the Actical and activPAL to measure  sedentary behaviour ( SB ) and non-SB in preschoolers in a free-living environment . DESIGN A convenience sample of 49 preschoolers ( 22 boys ; 4.0 ± 0.5 years ) from six early childhood centres in Auckl and , New Zeal and were included in data analysis . METHODS Participants wore a hip-mounted Actical and a thigh-mounted activPAL accelerometer simultaneously during centre attendance for one day and data were collected in 15s epochs . Bl and -Altman tests were used to assess differences in group mean minutes and percentage of time in (non-)SB between both monitors . Agreement between binary coded ( SB vs. non-SB ) 15s-by-15s Actical and activPAL data was evaluated by calculating percentage agreement and κ statistic . RESULTS The monitors were worn on average for 294.8 ± 46.3 min result ing in a total of 57,780 15s epochs . Bl and -Altman tests suggested a small group mean difference in (non-)SB ( 1.3 min ; 0.1 % ) and a wide prediction interval ( 121.3 min ; 39.2 % ) . No obvious systematic bias was observed in the Bl and -Altman plot . Percentage agreement between the 15s-by-15s Actical and activPAL data of all participants was 73.0 % ( inter-child range : 36.8 - 93.8 % ) . The κ statistic showed moderate agreement with a value of 0.46 ( 95 % CI : 0.45 - 0.47 ) . CONCLUSIONS Although the group mean estimate of (non-)SB was similar between the Actical and activPAL , the output of both monitors can not be considered convergent as meaningful r and om disagreement was found between both monitors Background Patients with rheumatoid arthritis ( RA ) spend a high proportion of their waking time in sedentary behaviour ( SB ) and have an increased risk of cardiovascular disease . Reduction of SB and increase in light intensity physical activity has been suggested as a means of improvement of health in patients with mobility problems . Short-term intervention studies have demonstrated that SB can be reduced by behavioural interventions in sedentary population s. To evaluate descriptively the feasibility of recruitment , r and omisation , outcome assessment s , retention and the acceptability of an individually tailored , theory-based behavioural intervention targeting reduction in daily sitting time in patients with RA . Methods A r and omised , controlled trial with two parallel groups . RA patients > 18 years of age and Health Assessment Question naire ( HAQ ) score < 2.5 were consecutively invited and screened for daily leisure time sitting > 4 h. The 16-week intervention included 1 ) three individual motivational counselling sessions and 2 ) individual text message reminders aim ed at reducing daily sitting time . The control group was encouraged to maintain their usual lifestyles . Outcomes were assessed at baseline and after the 16 week intervention . Daily sitting time was measured using  an ActivPAL3TM activity monitor .  The study was not powered to show superiority ; rather the objective was to focus on acceptability among patients and clinical health professionals . Results In total , 107 patients were invited and screened before 20 met eligibility criteria and consented ; reasons for declining study participation were mostly flares , lack of time and co-morbidities . One patient from the control group dropped out before end of intervention ( due to a RA flare ) . Intervention participants completed all counselling sessions . All procedures regarding implementation of the trial protocol were feasible . The daily sitting time was reduced on average by 0.30 h in the intervention group unlike the control group that tended to increase it by 0.15 h after 16 weeks . Conclusions This study shows that an individually tailored behavioural intervention targeting reduction of SB was feasible and acceptable to patients with RA.Trial registration The Danish Data Protection Agency ( ref.nb . 711 - 1 - 08 - 20 March 2011 ) , the Ethics Committee of the Capital Region of Denmark ( ref.nb . H-2 - 2012 - 112- 17 October 2012 ) , clinical trials.gov ( NCT01969604 - October 17 2013 , retrospectively registered ) Purpose This study aims to provide recommendations on the optimal strategies and interventions for the prevention , screening , assessment , and management of  cancer-related sleep disturbance ( insomnia and insomnia syndrome ) in adult cancer population s. Methods A systematic search of the published health literature was conducted to identify r and omized controlled trials , clinical practice guidelines , systematic review s , and other guidance documents . The Sleep Disturbance Expert Panel [ comprised of nurses , psychologists , primary care physicians , oncologists , physicians specialized in sleep disturbances , research ers , and guideline method ologists ] review ed , discussed , and approved the final version of the guideline . Health care professionals across Canada were asked to provide feedback through an external review process . Results Three clinical practice guidelines and 12 r and omized controlled trials were identified as the evidence base . Overall , despite the paucity of evidence , the evidence and expert consensus suggest that it is important to screen and assess adult cancer patients for sleep disturbances using st and ardized screening tools on a routine basis . While prevention of sleep disturbance is the desired objective , cognitive behavioral therapies are effective in improving sleep outcomes . As part of the external review with 16 health care providers , 81 % indicated that they agreed with the recommendations as written . Conclusions Sleep difficulty is a prevalent problem in cancer population s that needs greater recognition by health professionals . Prevention , screening , assessment , and treatment strategies supported by the best available evidence are critical . Recommendations and care path algorithms for practice are offered Background No school-based physical activity ( PA ) interventions among older adolescents have demonstrated long-term effectiveness , and few of them so far have addressed sedentary behaviour ( SB ) . Based on behavioural theories and evidence , we design ed a multi-level intervention to increase  PA  and decrease SB  among vocational school students . This study investigates feasibility and acceptability of two main intervention components and research procedures . We also examine uptake of behaviour change techniques ( BCTs ) by the participants . Methods Design was an outcome assessor blinded , cluster-r and omised controlled trial . Four classes of students ( matched pairs ) were r and omised into one intervention and one control arm . The intervention consisted of ( 1 ) a 6-h group-based intervention for students , ( 2 ) two 2-h training workshops to reduce their students ’ sitting in class for teachers , and ( 3 ) provision of light PA equipment in classrooms . At baseline ( T1 ) , mid-intervention ( T2 ) at 3 weeks , post-intervention ( T3 ) and 6 months after baseline ( T4 ) we measured hypothesised psychosocial mediators and self-reported PA and sitting . Objective assessment of PA and SB ( 7-day accelerometry ) was conducted at T1 , T3 and T4 . Body composition ( bioimpedance ) was measured at T1 and T4 . Students and teachers in the intervention arm filled in acceptability question naires at T3 . Results  Recruitment rate was 64 % ( students ) and 88.9 % ( teachers ) , and at T3 , all post-intervention measurements were completed by 33 students ( retention 76.7 % ) and 15 teachers ( retention 93.8 % ) .  Acceptability ratings of sessions were high ( students M = 6.29 , scale 1–7 ) , and data collection procedures were feasible . Intervention arm students reported increased use of BCTs , but uptake of some key BCTs was suboptimal . BCT use correlated highly with objective measures of PA . Based on both self-report and student evaluation , teachers in the intervention arm increased the use of sitting reduction strategies  at post-intervention and T4 follow-up ( p < .05 ) . Conclusions We detected willingness of the target groups to participate , good response rates to question naires , adequate retention , as well as acceptability of the trial protocol . Investigation of BCT use among students helped further enhance intervention procedures to promote BCT use . After making necessary modifications identified , intervention effectiveness can next be tested in a definitive trial . Trial registration IS RCT N34534846 . Registered 23 May 2014 . Retrospectively registered The senior author systematic ally began collecting preoperative and postoperative data on all the total hip arthroplasties he performed starting in July 1970 . The data collected represent a 26-year experience using practice surveillance ( preoperative and regular interval postoperative collection and analysis of outcomes ) as a method to document the outcome of the total hip arthroplasty procedure and as a method to evaluate the need for changes in the procedure . As the senior author made few selected changes in the operative procedure during the followup period , the primary author has been able to evaluate the change in outcome based on these changes . The six studies reported in the current study show the durability of the long-term results of cemented total hip arthroplasty , the improvement in radiographic reproducibility obtained on the femoral side of the construct with improved cementing techniques , the deleterious effects of using cable to reattach the greater trochanter , the deleterious effects of changing femoral component design that included a change in surface finish , the improvement in acetabular fixation using cementless fixation , and the optimization of bearing surface wear using smaller diameter femoral heads . All of these findings have been incorporated into the primary surgeon 's practice based on this practice surveillance . As shown , practice surveillance also has provided a tool for performing clinical research . Although practice surveillance of controlled cohorts never will supplant prospect i ve r and omized clinical trials in evidence based medicine , it should help each surgeon with his or her own practice and can be used as an important research tool to study the optimization of outcomes of a surgical procedure Introduction Large proportions of the population are not meeting recommended levels of physical activity and have increasingly sedentary lifestyles . Low levels of physical activity are predictive of poor health outcomes and time spent sedentary is related to a host of risk factors independently of physical activity levels . Building an evidence base of the best approaches to intervene in the lifestyles of inactive individuals is crucial in preventing long-term disease , disability and higher mortality rates . Methods and analysis Systematic search es will be conducted on all relevant data bases ( eg , PubMed , Scopus , CINAHL , PsycINFO ) . Studies will be included if they assess interventions aim ed at changing physical activity or sedentary behaviour levels in adults ( over 18 ) who are inactive and do not suffer from chronic conditions . Studies must also be r and omised controlled trials ( RCTs ) , have a primary outcome of physical activity or sedentary behaviour , and measure outcomes at least 6 months after intervention completion . Studies will be coded using the Behaviour Change Technique ( BCT ) taxonomy v1 and Template for Intervention Description and Replication ( TIDieR ) guidelines . 2 review ers will independently screen full-text articles and extract data on study characteristics , participants , BCTs , intervention features and outcome measures . Study quality will also be assessed independently by 2 review ers using the Cochrane risk of bias tool . A meta- analysis will be considered if there is sufficient homogeneity across outcomes . GRADE criteria will be used to assess quality of evidence . Dissemination This will be the first review to systematic ally appraise interventions aim ed at changing the physical activity or sedentary behaviour of inactive individuals using RCT design s with a 6-month follow-up post-intervention . This review will better inform intervention design ers targeting inactive population s and inform the design of a future complex intervention . Review registration number This protocol was registered with the International Prospect i ve Register of Systematic Review s ( PROSPERO ) on 17 October 2014 ( registration number : CRD42014014321 ) Background The optimal targets and strategies for effectively reducing sedentary behavior among young people are unknown . Intervention research that explores changes in mediated effects as well as in outcome behaviors is needed to help inform more effective interventions . Therefore , the purpose of this study was to examine the mid-intervention mediating effects on children ’s objective ly assessed classroom and total weekday sedentary time in the Transform-Us ! intervention . Methods The results are based on 293 children , aged 7- to 9-years-old at baseline , from 20 schools in Melbourne , Australia . Each school was r and omly allocated to one of four groups , which targeted reducing sedentary time in the school and family setting s ( SB ; n = 74 ) , increasing or maintaining moderate- to vigorous-intensity physical activity in the school and family setting s ( PA ; n = 75 ) , combined SB and PA ( SB + PA ; n = 80 ) , or the current practice control ( C ; n = 64 ) . Baseline and mid-intervention data ( 5–9 months ) were collected in 2010 and analyzed in 2012 . Classroom and total weekday sedentary time was objective ly assessed using ActiGraph accelerometers . The hypothesized mediators including , child enjoyment , parent and teacher outcome expectancies , and child perceived access to st and ing opportunities in the classroom environment , were assessed by question naire . Results The SB + PA group spent 13.3 min/day less in weekday sedentary time at mid-intervention compared to the control group . At mid-intervention , children in the SB group had higher enjoyment of st and ing in class ( 0.9 units ; 5-unit scale ) and all intervention groups had more positive perceptions of access to st and ing opportunities in the classroom environment ( 0.3 - 0.4 units ; 3-unit scale ) , compared to the control group . However , none of the hypothesized mediator variables had an effect on sedentary time ; thus , no mediating effects were observed . Conclusions While beneficial intervention effects were observed on some hypothesized mediating variables and total weekday sedentary time at mid-intervention , no significant mediating effects were found . Given the dearth of existing information , future intervention research is needed that explores mediated effects . More work is also needed on the development of reliable mediator measures that are sensitive to change overtime . Trial registration ACTRN12609000715279IS RCT Older adults represent the segment of the population that sits the most . This study evaluated the feasibility , acceptability , safety , and preliminary efficacy of an intervention to reduce sedentary behavior ( SB ) in older adults that can be disseminated broadly for limited cost and delivered by paraprofessionals with limited training . Senior centers in Central Pennsylvania were r and omized to receive one of two healthy aging programs ( i.e. , intervention or comparison ) . Participants in both groups attended three 90-min meetings over 2 weeks . Behavior change content was delivered at the second session ( i.e. , day 7 ) . Forty-two participants ( nintervention = 25 , ncomparison = 17 ) were recruited from five senior centers . Content for the intervention group focused on  reducing SB while comparison group content focused on reducing social isolation  . Self-reported SB was assessed on days 7 and 14 . Repeated- measures ANOVA revealed a significant group × time interaction for total and weekday , but not weekend , SB . In the week following the delivery of group content , participants in the intervention group reported an average decrease in total SB of 837.8 min/week ; however , the comparison group reported a nonsignificant average decrease of 263.0 min/week of total SB . Participants in the intervention group also reported an average decrease in weekday SB of 132.6 min/weekday ( d = −0.83 ) in the week following the delivery of group content ; however , the comparison group reported a nonsignificant decrease of 24.0 min/weekday ( d = −0.16 ) . There were no significant changes in weekend SB in either group in the week following the delivery of group content . Participants ’ attendance , measurement completion , and program ratings were high . Safety issues were minimal . This intervention was feasible to implement and evaluate , acceptable to older adults , and showed promise for reducing older adults ’ SB BACKGROUND Long-term survival of lung transplant ( LT ) recipients is limited by the development of the bronchiolitis obliterans syndrome ( BOS ) . A number of risk factors for BOS have been identified , which can be detected using bronchoscopy with transbronchial biopsy ( TBB ) . Many LT units perform routine surveillance bronchoscopy ( SB ) to detect problems such as : acute rejection ( AR ) ; infection , particularly with cytomegalovirus ( CMV ) ; and lymphocytic bronchiolitis . This study aim ed to assess the safety and efficacy of surveillance bronchoscopy in lung transplant recipients ( LTRs ) , including TBB and bronchoalveolar lavage ( BAL ) . METHODS All bronchoscopy procedures , including SB and clinical ly indicated ( CB ) procedures performed on LTRs in one calendar year , were audited prospect ively . Complications and clinical utility were recorded to determine the clinical utility both early ( 3 months and 3 to 12 months ) and late ( > 12 months ) post-LT . RESULTS In one calendar year , 353 procedures ( 232 SBs and 121 CBs ) were performed on 124 LTRs , with 246 performed < 1 year post-LT . The complication rates were similar to those reported previously , except for an increased rate of sedation-related complications , particularly up to 3 months post-LT . SBs showed high rates of acute rejection , particularly in the first year post-LT ( p = 0.01 ) . The rate of asymptomatic infection diagnosed on BAL remained high regardless of time post-transplant . CONCLUSIONS This study confirms that SB can frequently detect clinical ly significant infection and rejection with very low complication rates . The data support SB with TBB up to 12 months post-LT , and ongoing use of SB with BAL ( only ) to detect clinical ly silent infection beyond 1 year post-LT BACKGROUND Previous research demonstrates that participation in light-intensity physical activity ( LIPA ) and moderate-to-vigorous physical activity ( MVPA ) are favorably associated with health-related quality of life ( HRQOL ) . Emerging work demonstrates that  sedentary behavior  ( SB ) is detrimentally associated with various cardiometabolic biomarkers , with few studies exploring the association of SB on HRQOL , and no studies examining this among congestive heart failure patients . Therefore , the purpose of this study was to examine the potential independent associations of SB on HRQOL among congestive heart failure patients . METHODS Data from the 2003 - 2006 National Health and Nutrition Examination Survey were used .  Physical activity was assessed over 7days during all waking hours using the ActiGraph 7164 accelerometer .  HRQOL was assessed using the Centers for Disease Control HRQOL index survey . RESULTS 190 participants self-reported a physician-diagnosis of congestive heart failure . After adjustments , SB behavior ( 1-min/day increase ) was associated with worse HRQOL ( β=0.004 ; 95 % CI : 0.0004 - 0.007 ; P=0.03 ) . When MVPA was added as a covariate to this model , SB remained significantly associated with worse HRQOL ( β=0.003 ; 95 % CI : 0.0001 - 0.007 ; P=0.04 ) . However , when adding LIPA to this model that also included MVPA as a covariate , SB was no longer associated with HRQOL ( β=0.0001 ; 95 % CI : -0.003 - 0.004 ; P=0.92 ) . CONCLUSIONS If confirmed by prospect ive/experimental work , this suggests that SB may not have detrimental HRQOL effects among congestive heart failure patients Background The diversity of quality improvement interventions ( QIIs ) has impeded the use of evidence review to advance quality improvement activities . An agreed-upon framework for identifying QII articles would facilitate evidence review and consensus around best practice s. Aim To adapt and test evidence review methods for identifying empirical QII evaluations that would be suitable for assessing QII effectiveness , impact or success . Design Literature search with measurement of multilevel inter-rater agreement and review of disagreement . Methods Ten journals ( 2005 - 2007 ) were search ed electronically and the output was screened based on title and abstract . Three pairs of review ers then independently rated 22 articles , r and omly selected from the screened list .  Kappa statistics and percentage agreement were assessed . 12 stakeholders in quality improvement , including QII experts and journal editors , rated and discussed publications about which review ers disagreed . Results The level of agreement among review ers for identifying empirical evaluations of QII development , implementation or results was 73 % ( with a paradoxically low kappa of 0.041 ) . Discussion by raters and stakeholders regarding how to improve agreement focused on three controversial article selection issues : no data on patient health , provider behaviour or process of care outcomes ; no evidence for adaptation of an intervention to a local context ; and a design using only observational methods , as correlational analyses , with no comparison group . Conclusion The level of review er agreement was only moderate . Reliable identification of relevant articles is an initial step in assessing published evidence . Advancement in quality improvement will depend on the theory- and consensus-based development and testing of a generalizable framework for identifying QII evaluations Aims Type 2 diabetes mellitus ( T2DM ) , a serious and prevalent chronic disease , is traditionally associated with older age . However , due to the rising rates of obesity and sedentary lifestyles , it is increasingly being diagnosed in the younger population . Sedentary ( sitting ) behaviour has been shown to be associated with greater risk of cardio-metabolic health outcomes , including T2DM . Little is known about effective interventions to reduce sedentary behaviour in younger adults at risk of T2DM . We aim ed to investigate , through a r and omised controlled trial ( RCT ) design , whether a group-based structured education workshop focused on sitting reduction , with self-monitoring , reduced sitting time . Methods Adults aged 18–40 years who were either overweight ( with an additional risk factor for T2DM ) or obese were recruited for the Sedentary Time ANd Diabetes ( ST AND ) RCT . The intervention programme comprised of a 3-hour group-based structured education workshop , use of a self-monitoring tool , and follow-up motivational phone call . Data were collected at three time points : baseline , 3 and 12 months after baseline . The primary outcome measure was accelerometer-assessed sedentary behaviour after 12 months . Secondary outcomes included other objective ( activPAL ) and self-reported measures of sedentary behaviour and physical activity , and biochemical , anthropometric , and psycho-social variables . Results 187 individuals ( 69 % female ; mean age 33 years ; mean BMI 35 kg/m2 ) were r and omised to intervention and control groups . 12 month data , when analysed using intention-to-treat analysis ( ITT ) and per- protocol analyses , showed no significant difference in the primary outcome variable , nor in the majority of the secondary outcome measures . Conclusions A structured education intervention design ed to reduce sitting in young adults at risk of T2DM was not successful in changing behaviour at 12 months . Lack of change may be due to the brief nature of such an intervention and lack of focus on environmental change . Moreover , some participants reported a focus on physical activity rather than reductions in sitting per se . The habitual nature of sedentary behaviour means that behaviour change is challenging . Trial Registration Controlled-Trials.com IS RCT Introduction An acute exacerbation of chronic obstructive pulmonary disease ( COPD ) marks a critical life event , which can lower patient quality of life and ability to perform daily activities . Patients with COPD tend to lead inactive and highly sedentary lifestyles , which may contribute to reductions in functional capacity . Targeting sedentary behaviour ( SB ) may be more attainable than exercise ( at a moderate-to-vigorous intensity ) for behaviour change in patients following an exacerbation . This study aims to evaluate the feasibility and acceptability of a 2-week at-home intervention providing education and self-monitoring to reduce prolonged periods of SB in patients with COPD discharged following an acute exacerbation . Methods and analysis Patients will be r and omised into 1 of 3 conditions : usual care ( control ) , education or education+feedback . The education group will receive information and suggestions about reducing long periods of sitting . The education+feedback group will receive real-time feedback on their  sitting time , st and -ups and step count at home through an inclinometer linked to a smart device app . The inclinometer will also provide vibration prompts to encourage movement when the wearer has been sedentary for too long . Data will be collected during hospital admission and 2 weeks after discharge . Qualitative interviews will be conducted with patients in the intervention groups to explore patient experiences . Interviews with healthcare staff will also be conducted . All data will be collected January to August 2016 . The primary outcomes are feasibility and acceptability , which will be assessed by qualitative interviews , uptake and drop-out rates , reasons for refusing the intervention , compliance , app usage and response to vibration prompts . Ethics and dissemination The research ethics committee East Midl and s Leicester- Central has provided ethical approval for the conduct of this study . The results of the study will be disseminated through appropriate conference proceedings and peer- review ed journals . Trial registration number IS RCT N13790881 ; Pre- results The effectiveness of a cognitive-behavioral program , Transition Preparation Training ( TPT ) , in combination with spina bifida ( SB ) management was compared to adolescents with SB who received only SB management .  Design , setting and participants : Prospect i ve controlled trial with an ethnically diverse sample ( 94 % ) of 65 adolescents with SB ( 31 in treatment group [ mean age : 16.19 ] ; 34 in control group [ mean age : 15.71 ] ) conducted at Childrens Hospital Los Angeles between September 2006 and September 2008 . INTERVENTIONS : TPT was a three-module , eight sessions program offered in a 2 day workshop format to facilitate development of health care transition plan . MAIN OUTCOME MEASURES : Subjective well being as measured by the Personal Adjustment and Role Skills Scale ( PARS III ) , Role mastery measured using Community Life Skills Scale ( CLSS ) , and Self Care Practice with the Denyes Self-Care Practice Instrument ( DSCPI-90 © ) . RESULTS : No significant differences were found between groups of any treatment effect or treatment follow-up interaction . No substantial changes in the scores either between treatments of post treatments were found BACKGROUND Sedentary behavior ( SB ) has been associated with chronic diseases . University students are a high-risk population for excessive SB . The purpose of this pilot study was to determine if a Health Action Process Approach ( HAPA ) based intervention , specifically action and coping planning , would increase student break frequency and decrease duration . METHODS Fifty-two university students ( 14 men , mean age 23.5 ) were r and omised into an 8-week HAPA-treatment ( sedentary behavior ) or HAPA-control ( nutrition ) group . Participants completed an SB question naire that assessed break frequency and duration of student SB ( Baseline , Weeks 1 - 6 Treatment , and Weeks 7 - 8 Follow-up ) , and received behavioral counselling on either dietary information or SB ( Baseline and Week 3 ) . RESULTS An intent-to-treat analysis revealed a significant group by time interaction effect for student break frequency ( p = .05 , ηρ2 = 0.27 ) , and a non-significant effect for student break duration ( p = .10 , ηρ2 = 0.23 ) . For occupational ( student ) break frequency and duration , the large accompanying effect sizes favored the treatment group . CONCLUSIONS The current pilot study provides preliminary evidence for the potential of a HAPA-based intervention for increasing student break frequency in full-time university students Regular physical activity ( PA ) and the avoidance of prolonged sitting are essential for children ’s healthy growth , and for the physical and mental wellbeing of both children and adults . In the context of exercise , music may promote behavioral change through increased exercise adherence and participation . The purpose of this study was to determine whether a movement-to-music video program could reduce sedentary behavior ( SB ) and increase PA in mother-child pairs in the home environment . A r and omized controlled trial was conducted in the Pirkanmaa region , Finl and , in 2014–2016 . The participants consisted of 228 mother-child pairs ( child age 5–7 years ) . The primary outcomes of interest were tri-axial accelerometer-derived SB and PA , which were measured in weeks one ( baseline ) , two , and eight in both the intervention and control groups . Further , the mothers and children in the intervention group used a movement-to-music video program from the beginning of week two to the end of week eight . Secondary outcomes included self-reported screen time . The statistical methods employed comprised an intention-to-treat and linear mixed effects model design . No statistically significant differences between groups were found in primary or secondary outcomes . Among the children in the control group  , light PA  decreased significantly over time and screen time increased from 89 ( st and ard deviation , SD 37 ) to 99 ( SD 41 ) min/d . Among mothers and children in the intervention group , no statistical differences were found . In supplementary analysis , the children who stayed at home instead of attending daycare/preschool had on average 25 ( 95 % confidence interval , CI 19–30 ) min/d more sedentary time and 11 ( 95 % CI 8–14 ) min/d less moderate-to-vigorous PA than those who were at daycare/preschool . The higher body mass index of mothers was related with 5 ( 95 % CI 2–7 ) min/d more sedentary time and 1 ( 95 % CI 0–2 ) min/d less moderate-to-vigorous PA . The movement-to-music video program did not change the objective ly measured SB or PA of the mother-child pairs . However , mothers and children seemed to be more sedentary at home , and therefore interventions for decreasing SB and increasing PA should be targeted in the home environment INTRODUCTION Replacing sedentary behaviour with light intensity physical activity ( ie , activities classified as less than three metabolic equivalents , such as slow-paced walking ) may be a more realistic strategy for reducing cardiometabolic risk in people with chronic obstructive pulmonary disease than only aim ing to increase levels of moderate-vigorous intensity physical activity . Behaviour change interventions to reduce sedentary behaviour in people with chronic obstructive pulmonary disease have not yet been developed or tested . RESEARCH QUESTIONS Is a 6-week behaviour change intervention effective and feasible in reducing sedentary time in people with chronic obstructive pulmonary disease ? DESIGN This study will be a multi-centre , r and omised , controlled trial with concealed allocation , assessor blinding , and intention-to-treat analysis , comparing a 6-week behaviour change intervention aim ed at reducing sedentary time with a sham intervention in people with chronic obstructive pulmonary disease . PARTICIPANTS AND SETTING Seventy participants will be recruited from the waiting lists for pulmonary rehabilitation programs at Royal Prince Alfred Hospital and Prince of Wales Hospital , Sydney , Australia . INTERVENTION The behaviour change intervention aims to reduce sedentary time through a process of guided goal setting with participants to achieve two target behaviours : ( 1 ) replace sitting and lying down with light-intensity physical activity where possible , and ( 2 ) st and up and move for 2minutes after 30minutes of continuous sedentary time . Three face-to-face sessions and three phone sessions will be held with a physiotherapist over the 6-week intervention period . The ' capability ' , ' opportunity ' , ' motivation ' and ' behaviour ' ( COM-B ) model will be applied to each participant to determine which components of behaviour ( capability , opportunity or motivation ) need to change in order to reduce sedentary time . Based on this ' behavioural diagnosis ' , the Behaviour Change Wheel will be used to systematic ally select appropriate behaviour change techniques to assist participants in achieving their weekly goals . Behaviour change techniques will include providing information about the health consequences of sedentary behaviour , self-monitoring and review of weekly goals , problem-solving of barriers to achieving weekly goals , and providing feedback on sedentary time using the Jawbone UP3 activity monitor . CONTROL The sham intervention will consist of weekly phone calls for 6 weeks , to enquire whether the participants ' health status has changed over the intervention period ( eg , hospitalised for an acute exacerbation ) . No instructions regarding physical activity or exercise will be given . MEASUREMENTS Outcomes will be assessed at baseline , at the end of the 6-week intervention period , and at the 3-month follow-up . Primary outcome measures will be : ( 1 ) total sedentary time , including the pattern of accumulation of sedentary time , assessed by the activPAL3 activity monitor , and ( 2 ) feasibility of the intervention assessed by uptake and retention of participants , participant compliance , self-reported achievement of weekly goals , and adverse events . Secondary outcome measures will include functional exercise capacity , health-related quality of life , domain-specific and behaviour-specific sedentary time , patient activation , and anxiety and depression .  Semi-structured interviews will be conducted with participants who receive the behaviour change intervention to explore acceptability and satisfaction with the different components of the intervention . ANALYSIS Analysis of covariance ( ANCOVA ) will be used to calculate between-group comparisons of total sedentary time and the number of bouts of sedentary time>30minutes after adjusting baseline values . Uncertainty about the size of the mean between-group differences will be quantified with 95 % CI . Within-group comparisons will be examined using paired t-tests and described as mean differences with 95 % CIs . Secondary outcome measures will be analysed similarly . The feasibility measures will be analysed descriptively . Semi-structured interviews will be conducted until data saturation is achieved and there are no new emerging themes . De-identified interview transcripts will be coded independently by two research ers and analysed alongside data collection using the COM-B model as a thematic framework . DISCUSSION / SIGNIFICANCE If behaviour change interventions are found to be an effective and feasible method for reducing sedentary time , such interventions may be used to reduce cardiometabolic risk in people with chronic obstructive pulmonary disease . An approach that emphasises participation in light-intensity physical activity may increase the confidence and willingness of people with chronic obstructive pulmonary disease to engage in more intense physical activity , and may serve as an intermediate goal to increase uptake of pulmonary rehabilitation
Assessing SB as a sum of behaviours and using a previous day recall were the most promising features of existing tools .
Accuracy was poor for all existing tools , with underestimation and overestimation of SB .
There was a lack of evidence about sensitivity to change .
OBJECTIVE Sedentary behaviour ( SB ) has distinct deleterious health outcomes , yet there is no consensus on best practice for measurement .
This study aim ed to identify the optimal self-report tool for population surveillance of SB , using a systematic framework .