bluuebunny/crossref_metadata_2025 huggingface dataset:
Plasma metabolomic signature of healthy lifestyle, structural brain reserve and risk of dementia
Authors: Tian Fei , Wang Yuhua , Qian Zhengmin (Min) , Ran Shanshan , Zhang Zilong , Wang Chongjian , McMillin Stephen Edward , Chavan Niraj R , Lin Hualiang
Published: September 2024

Although the association between healthy lifestyle and dementia risk has been documented, the relationship between a metabolic signature indicative of healthy lifestyle and dementia risk and the mediating role of structural brain impairment remain unknown.

We retrieved 136 628 dementia-free participants from UK Biobank. Elastic net regression was used to obtain a metabolic signature that represented lifestyle behaviours. Cox proportional hazard models were fitted to explore the associations of lifestyle-associated metabolic signature with incident dementia. Causal associations between identified metabolites and dementia were investigated using Mendelian randomization. Mediation analysis was also conducted to uncover the potential mechanisms involving 19 imaging-derived phenotypes (brain volume, grey matter volume, white matter volume and regional grey matter volumes).

During a follow-up of 12.55 years, 1783 incident cases of all-cause dementia were identified, including 725 cases of Alzheimer's dementia and 418 cases of vascular dementia. We identified 83 metabolites that could represent healthy lifestyle behaviours using elastic net regression. The metabolic signature was associated with a lower dementia risk, and for each standard deviation increment in metabolic signature, the hazard ratio was 0.89 [95% confidence interval (CI): 0.85, 0.93] for all-cause dementia, 0.95 (95% CI: 0.88, 1.03) for Alzheimer's dementia and 0.84 (95% CI: 0.77, 0.91) for vascular dementia. Mendelian randomization revealed potential causal associations between the identified metabolites and risk of dementia. In addition, the specific structural brain reserve, including the hippocampus, grey matter in the hippocampus, parahippocampal gyrus and middle temporal gyrus, were detected to mediate the effects of metabolic signature on dementia risk (mediated proportion ranging from 6.21% to 11.98%).

The metabolic signature associated with a healthy lifestyle is inversely associated with dementia risk, and greater structural brain reserve plays an important role in mediating this relationship. These findings have significant implications for understanding the intricate connections between lifestyle, metabolism and brain health.
Executive Summary: State-of-the-Art Review: Evaluation and Management of Pelvic Osteomyelitis in Stage IV Pressure Injuries: A Multidisciplinary Collaborative Approach
Authors: El Zein Said , Melin Matthew M , Suh Gina A , Tran N V , Rose Peter S , Berbari Elie F
Published: September 2024

Managing pelvic osteomyelitis (POM) in the setting of stage IV pressure injuries requires multidisciplinary evaluation as well as patient and caregiver engagement and is complicated by the lack of high-evidence data to guide best practices. In this review, we describe our approach to pressure injury and POM evaluation and management through multidisciplinary collaboration and highlight areas of future research that are necessary to enhance patient outcomes, reduce healthcare costs, and improve the quality of life of those affected by POM.
Robotic-assisted versus video-assisted thoracoscopic surgery for thymic epithelial tumours, from the European Society of Thoracic Surgeons Database
Authors: Patel Akshay J , Smith Alexander ,   ESTS Thymus Collaborative Steering Group, Podobed Alexandr , Liberman Moishe , Pascal Thomas , Gabryel Piotr , Aigner Clemens , Aresu Giuseppe , Coonar Aman , Nizami Maria , Jimenez Marcelo , Van Schil Paul , Voltolini Luca , Casiraghi Monica , Spaggiari Lorenzo , Ampollini Luca , Carmargo Spencer , Londero Francesco , Schmitt-Opitz Isabelle , Scarci Marco , Turna Akif , Esch Mathhias , Venuta Federico , Mendogni Paolo , Moreno-Mata Nicolas , Martelo Fernando , Elkhayat Hussein , Fitzmaurice Gerald , Szanto Zalan , Moser Bernhard , Lyberis Paraskevas , Ruffini Enrico , Bille Andrea
Published: September 2024

OBJECTIVES

Minimally invasive thymectomy is an accepted approach for early-stage thymic epithelial neoplasia, reducing pain and length of stay compared with open surgery. In this study, we compare robotic and video-assisted thymectomy to assess pathological resection status, overall and disease-free survival.

METHODS

Data were retrieved from the European Society of Thoracic Surgeons prospectively maintained thymic database. Eighty-two international centres were invited to participate in the ESTS registry. Thirty-seven centres agreed to take part. We included all patients who had undergone complete thymectomy for malignancy through a minimally invasive approach and excluded patients in whom complete data were not available.

RESULTS

Between October 2001 and May 2021, a total of 899 patients with thymic malignancy underwent minimal access surgical resection and were included in the study. A propensity matched analysis was conducted with interrogation of 732 patients. Median age was 55 years, and 408 (56%) patients were female. Propensity matched was performed with 1:1 matching for surgical approach (video assisted = 366, robot assisted = 366). Robot-assisted surgery conferred significantly lower odds of incomplete resection (R1; 0.203 95% CI 0.13–0.317; P < 0.001). However, there was no difference in terms of overall and disease-free survival between the 2 techniques.

CONCLUSIONS

In this analysis, after adjusting for thymoma stage, the odds of incomplete surgical resection were higher in patients undergoing video-assisted surgery than robotic. However, there was no difference in overall or disease-free survival. With data maturation and increased follow-up, this would need repeat analysis and perhaps may provide more credence to the concept of a prospective randomized study to compare outcomes in thymic epithelial neoplasia by surgical approach with a standardized pathological work-up.
Heart rate response and recovery in cycle exercise testing: normal values and association with mortality
Authors: Jou Jordi , Zhou Xingwu , Lindow Thomas , Brudin Lars , Hedman Kristofer , Ekström Magnus , Malinovschi Andrei
Published: September 2024

Aims

Chronotropic incompetence and impaired heart rate (HR) recovery are related to mortality. Guidelines lack specific reference values for HR recovery. We defined normal values and studied blunted HR response and recovery and mortality risk.

Methods and results

We included 9917 subjects (45% females) aged 18–85 years who performed a cycle exercise test. We defined normal values for peak HR, HR reserve, and HR recovery at 1 and 2 min (HRR1 and HRR2) based on individuals apparently healthy (N = 2242). Associations between blunted HR indices (<5th percentile) and mortality over a median follow-up of 8.6 years were analysed using Cox regression and competing risk analysis. All HR indices were age-dependent and independent predictors of all-cause and cardiovascular (CV) mortality. The 5th percentiles of HR reserve, HRR1, and HRR2 correlated weakly with existing reference values. Heart rate recovery variables were the strongest predictors of all-cause mortality in both the overall population [HRR1, hazard ratio 1.70 (95% confidence interval, 1.49–1.94), and HRR2, 1.57 (1.37–1.79)] and in subjects with normal exercise capacity [HRR1, 1.96 (1.61–2.39), and HRR2, 1.76 (1.46–2.12)]. Combining HR indices appeared to increase the risk of all-cause [HRR1 and HRR2, 1.96 (1.68–2.29), and peak HR and HRR1, 1.87 (1.56–2.23)] and CV mortality, although no specific combination was superior for predicting CV mortality.

Conclusion

All HR indices were age-dependent and associated with all-cause and CV mortality. Blunted HR recovery variables were the strongest predictors of all-cause mortality, even in subjects with normal exercise capacity. Combined blunted HR indices appeared to add prognostic value.
143 National strategy of physical activity in Georgia - process and results supporting sustainable development
Authors: Gvinianidze Kakha
Published: September 2024

Purpose

National strategy for promoting physical activity (PA) in Georgia aims to decrease insufficient PA in whole population, including children and adults. It is comprehensive document addressing key issues related with physical inactivity and covering all relevant sectors on central and municipal levels. Currently draft of the document is submitted to the government for official approval.

The document considers specific activities for the groups of population, such as pregnant women, children and youth, adults, people with disabilities and elderlies.

Project description

Process has been initiated in 2021 by creating multisectoral group of PA under the National Center for Disease Control and Public Health with support of WHO and funding of EU. The group consists of state, municipal and nonstate representatives of health, education, sport, urban planning, transport and environment. First step was wide scale desk review and situation analysis. This was followed by brainstormings, drafting of the policy document and large-scale policy dialogue with diverse sectors.

Draft of the National Strategy and Action Plan of PA 2024-2030 includes improving PA programs and other opportunities in kindergartens and schools, workplaces, universities; services and opportunities for pregnant women, elderlies, people with disabilities; strengthening active mobility, tourism; increasing scale and attractiveness of green spaces, access to sport infrastructure and programs; integration of PA in health services; building institutional capacity, systematization of surveillance and national communication campaign.

Conclusion

As a practical result of this work it is expected Georgia to have comprehensive national policy for health promoting physical activity with all associated benefits for health and economy of the country.

Nature of comprehensive PA policy requires relevant sustainable development elements to be widely considered in reforms of diverse sectors and therefore document development process includes large scale dialogue. Accordingly, PA on policy development stage became interconnecting issue and platform for policy dialogues regarding specific sustainable development issue of diverse sectors and it is expected to be continued and strengthened in course of its implementation. It may add to the experience and knowledge both from PA and sustainable development discourses especially for developing societies.
149 Accelerometer-based measurement of physical activity and sleep duration in Denmark: A Large Population-Based Study
Authors: Ahrensberg Hannah , Eghøj Martin , Ekholm Ola , Christensen Anne Illemann , Petersen Christina Bjørk , Rasmussen Mette
Published: September 2024

Purpose

Public health surveillance involves regular assessment of health indicators, including physical activity, sedentary behavior, and sleep. Traditionally, self-reported measures have been used, but recent advancements in accelerometer technology and administration offer a new approach. The aim of this study is to monitor and explore accelerometer-based measurements of physical activity and sleep duration in in the adult Danish population.

Methods

Data were obtained from the Danish National Health Survey conducted in 2023. From participants delivering a web-based response, 6,993 individuals (age 16 to 92 years) were invited to participate in an accelerometer-based measurement of physical activity, sedentary behavior, and sleep. A total of 1,595 individuals accepted (22,8%). Each participant received a SENS motion® accelerometer in the post, an instruction letter (with a QR-code to access a mobile-application), a mounting patch, and a pre-paid return envelope. Data were analyzed using the MOTUS algorithm, which is a refined version of the Acti4-algoritmen.

Results

The average time spent on physical activity with moderate to vigorous intensity was 31 min/day (Range: 0.5-178). Overall, 58% were sufficiently physically active according to WHO recommendations. The average total sedentary time was 527 min/day (equivalent to 8 hours and 47 minutes). Men were more sedentary than women. Participants took an average of 10,577 steps/day and cycled for 19 min/day (median: 13 minutes; range: 3-103 min/day). Within the primary sleep period, the average sleep time was 7 hours and 13 minutes/day and 33% of participants slept less than 7 hours/day.

Conclusion

The use of accelerometers has the potential to contribute significantly to monitoring of physical activity, sedentary behavior, and sleep at the population level in Denmark. However, this should be combined with questionnaire-based information as self-report and accelerometer measurements does not seem to capture the same facets of physical activity. Nevertheless, further development is necessary to enhance administration and user experiences.
92 Enhancing Self-Efficacy for and Adherence to Resistance Training in Older Adults: A Multi-Stakeholder Perspective of a Supervised-to-Unsupervised Step-Down Model
Authors: Mulhare Brian , O’Hagan Ciara , Harrison Michael , Fagan Sarah , Kehoe Bróna
Published: September 2024

Background

With the ageing population, it is increasingly important to support older adults in maintaining good health and independence. Resistance exercise has been proven to have physical, physiological, and cognitive benefits. However, only a small percentage of older adults participate in sufficient muscle-strengthening activities. Community or home-based programs may offer the best mode to address this, but lack long-term sustainability. A model combining both approaches could reinforce meaningful behavioural change. Expert consultation is necessary to identify potential challenges in this approach.

Methods

A multi-stakeholder expert panel (n = 11) of academics, facilitators, and older adults was consulted to critically evaluate a step-down exercise model using a multi-stage framework. Initially, the panel was briefed with an executive summary of a behavioural analysis of resistance training in older adults based on formative qualitative research (n = 27). In the first stage, the panel engaged in a structured process to outline the intervention’s key components, identify potential difficulties, and develop solutions through voting. The second stage focused on determining necessary content and resources, employing a silent generation technique for devising solutions, followed by group discussions and round-robin sharing to address implementation challenges. This was audio-recorded, transcribed and thematically analysed to identify the barriers and facilitators to the implementation of a step-down model.

Results

The primary themes were: Messaging, Health Autonomy, Education, Tiers/Levels, Individual Exerciser, and Equity and Scalability. Challenges include poor messaging to older adults about resistance training, leading to a lack of awareness, misconceptions and poor engagement. The approach to healthcare and social welfare fosters dependency, hindering self-responsibility and health literacy. Starting with a supervised group setting supports education and behavioural change, and allows intensive guidance with unfamiliar exercise to build self-efficacy, eventually transitioning to more independent, remotely-supported exercise. The tiered approach was perceived to gradually reduce dependency whilst providing benchmarks for progress. However, there were concerns about the suitability for unsupervised high-intensity exercise and acceptance of independent exercise among older adults.

Conclusion

Multi-stakeholder perspectives in the development of complex interventions are valuable to exploring potential implementation challenges and solutions, thereby enhancing the feasibility, acceptance, and, hence, potential success of the intervention.
80 Improving policy and practice for cyclists with a disability in The Netherlands
Authors: Rauws Robin , Noordzij Mark , van Lindert Caroline
Published: September 2024

Purpose

Cycling is known to have great health benefits and to contribute to the autonomy and independence in mobility of people with a disability. However, Dutch streets and cycling lanes are not designed for adapted bicycles, and other traffic users often do not know how to react to cyclists with an adapted bicycle. Furthermore, there is a lack of cycling policy that accounts for disabled cyclists. This raises the following questions:

- Why, when, and where do people with a disability cycle?

- What challenges do cyclists with a disability experience when cycling?

- How can these challenges be addressed, according to people with a disability themselves and professionals in the field?

This study will help to gain insight into the practice of cycling among Dutch adults with a disability, in order to better understand their challenges and needs. A better understanding of these challenges and needs is necessary to make cycling more accessible. We also aim to raise awareness amongst designers and policy officials of the great diversity within cyclists’ needs and the types of bicycles used. We ultimately hope to contribute to greater cycling participation among people with a disability.

Methods

We conducted ten interviews with Dutch adults with different disabilities who shared their experiences of cycling in their neighborhood environment and beyond. The interview transcripts were coded and analyzed based on main themes we identified: characteristics of general cycling behavior, motivation(s) to cycle, challenges in cycling and possibilities to improve the cycling experience. We discussed these results for improvement in a workshop with professionals in spatial and traffic design.

Results

We will present the experiences of cyclists with a disability, the challenges they face and suggestions for improvements.

Conclusions

With this study, we hope to contribute to a better understanding of the needs and experiences of cyclists with a disability. Applying these insights will help policy officers and other professionals in the field in making their policies and designs more effective and improve road designs for cyclists with a disability.

Funding

This research project is funded by the Dutch Ministry of Health, Welfare and Sport (VWS).
43 Involvement in active transport is related to organizational factors and physical environment infrastructure
Authors: Motiejunaite Kristina , Mieziene Brigita , Gasiuniene Laima
Published: September 2024

Purpose

Active transport (AT) is considered the most sustainable and accessible mode for travel purposes. AT (walking and cycling) contributes to health-enhancing physical activity as it is a convenient and accessible way to increase physical activity levels. Convenient infrastructure promotion and support are important factors in shift from motor transport towards active travel. The purpose of this study was to determine how organizational factors and neighbourhood physical environment differ between using and not using AT among the Lithuanian young adult population.

Methods

This cross-sectional study included 250 Lithuanian young adults aged 18-39 years, with a mean age of 20.38 years. Of these, 80% were women. AT was measured using the Stages of Change Model-based Questionnaire. Infrastructure was measured by ALPHA Questionnaire–REVISED (Spittals et al., 2010). Organization-related items were developed by study researchers.

Results

Young Lithuanian people preferred cars and/or public transport (62.4%) instead of active transportation (AT) (27.6%) when choosing mobility. The results support a strong link between AT and organizational aspects. AT is more often chosen by people who belong to an organization where environmentally friendly behaviour is encouraged (waste sorting, using AT (p = 0.018); conditions are created to safely store a bicycle or scooter (p = 0.024); that talks about sustainable development, environmentally friendly behaviour, sustainability, etc. (p = 0.034). Quality of the neighbourhood physical environment, such as maintained bicycle paths (p = 0.011), maintained sidewalks (p = 0.049), maintained parks, and other open spaces (p = 0.050) significantly associated with the choice of AT. However, the choice of active transport was not significantly related to the infrastructure of pedestrian zones or paths, infrastructure of special lanes, routes for bicycles, or separation of bicycle paths from car traffic.

Conclusions

Young people’s involvement in AT is influenced by the attitude of the organization in which they work or study towards environmentally friendly behaviour, AT, and sustainable development. The quality of the neighbourhood physical environment also determines the involvement of young people in AT.
57 Nature based social prescribing for enhancing mental health and well-being
Authors: Lynch Mary , Whiteley Holly , Hartfiel Ned , Edwards Rhiannon Tudor , Cuthbert Andrew
Published: September 2024

Objectives

Nature Based Social Prescribing (NBSP) is a means of connecting people with non-clinical, nature-based community-led interventions delivered by 3rd sector organisations using local community assets. This research used a mixed-method Social Return on Investment (SROI) of a six-month pilot ‘Making Well’ NBSP programme to support individuals with chronic mental health conditions in Wales.

Methods

The ‘Making Well’ programme costs were estimated by means of SROI along projected 20% overheads, were incorporated to reflect sustainable costs as the charity develops and more accurately estimate the future social value expected to be generated. The ‘Making Well’ project delivered two separate programmes between October 2021 and April 2022. Data was collected from participants (n = 12) at baseline and eight-week follow-up along with interviews to collect in-depth data on individuals lived experience of participating in the programme. The ‘Making Well’ programme costs were estimated and financial proxies from the HACT Social Value (SV) bank were applied to identified benefits.

Results

The estimated cost of ‘Making Well’ programme inputs were £1,312 per participant and the net value of well-being benefits were £4,313 to £6,130 per participant, giving a range of SVR’s between £3.30 to £4.70 for every £1 invested in this NBSP intervention. The SROI forecast provides a three-year projection of the annual social value created and the estimated forecast cost of programme inputs was £797 per participant. The net value of well-being benefits was £4,313 to £6,130 per participant, giving a range of social value ratios between £5.40 to £7.70 for every £1 invested.

Conclusions

The SROI results demonstrate that the ‘Making Well’ programme is an effective NBSP intervention for supporting people with enduring mild to moderate mental health conditions. This SROI contributes to emerging evidence on the use of community assets and NBSP in generating a return on investment and positive social value. SROI forecasting for socially prescribed interventions delivered by local community assets, such as The Fathom Trust, can help organisations demonstrate transparent and effective investment of public funds and support optimal future social value creation and long-term public health outcomes.
105 Physical activity in relation to WHO guidelines, among Swedish adults during the COVID-19 pandemic. A repeated cross-sectional study
Authors: Samaratunga Bodhini , Kerstis Birgitta , Lindberg Daniel , Elvén Maria , Hellström Charlotta , Stier Jonas , Lehtinen-Jacks Susanna
Published: September 2024

Purpose

Assess changes in health-promoting physical activity (HPPA), according to the WHO guidelines, among Swedish adults during the COVID-19 pandemic. HPPA has been ignored as an outcome in the physical activity (PA) studies during the pandemic.

Methods

A population-based repeated cross-sectional study was conducted among 18-79-year-old Swedes (n = 1035 in December 2020 [response rate 52%], n = 1095 in January 2022 [55%], n = 1027 in December 2022 [55%]). Data was collected via online questionnaires, including sex, age, civil status, education, employment, and country of birth. PA was measured using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). In 2020, recall questions about PA one year earlier were included. The WHO guidelines for moderate, vigorous, or combined HPPA were applied, and the proportions of respondents completing the guidelines for these three HPPA categories were calculated.

Differences in proportions of moderate, vigorous, and combined HPPA across the survey timepoints were tested by chi-square tests, and by McNemar tests concerning differences between the recall in 2019 and December 2020. Binary logistic regression analyses were performed for women and men to assess whether the survey timepoints or the sociodemographic variables were independently associated with HPPA. Interaction terms between each sociodemographic factor and survey timepoint were added to the models to assess differences in changes in HPPA in different sociodemographic subgroups.

Results

While the proportions of moderate, vigorous, and combined HPPA decreased substantially from 2019 (recall) to 2020 in both sexes, the changes seen between 2020 and 2022 were statistically non-significant. No significant interactions between sociodemographic factors and survey timepoint were observed, and survey timepoint was not associated with HPPA in the logistic regression models. Factors most consistently associated with the different HPPA categories were education in women and employment in men. In women, compulsory and/or high school indicated less HPPA than university education. Among men, white-collar and/or retired had less HPPA than the blue-collar employment category.

Conclusions

No clear changes in HPPA were observed between December 2020 and December 2022. Differences in HPPA according to education and employment indicate need for research on targeted PA promotion measures.

Support

Mälardalen University, Sweden.
228 Physical literacy and inclusion within the context of disability and impairment: A multiple case study approach
Authors: Pushkarenko Kyle , Crane Jeffrey , Cowan Jennifer
Published: September 2024

Background and Purpose

Physical literacy (PL) holds significant importance in various organizational agendas, being prioritized as a core programming priority under the premise of inclusivity irrespective of ability. However, there is a notable gap in understanding PL within the context of disability and impairment, as application of PL often occurs through a lens of normativity and standardization by those who do not experience disability. This study aims to establish an evidence-based, context-specific and foundational understanding of PL and its inclusivity of all individuals regardless of ability level, that can be utilized to inform, guide, and support current and future programs.

Methods

Employing the communities of practice theoretical model, a multiple case study design was utilized to delve into three purposefully selected cases rich in PL and inclusive practices. Data was collected through face-to-face, semi-structured interviews with stakeholders including participants, parents, practitioners, supervisors, and administrators. Supplemental data sources included direct observations, exploration of program documents, site photographs, and reflexive engagement. An inductive thematic analysis was conducted to uncover stakeholder perspectives, providing context-specific insights into PL as an inclusive concept.

Findings

Three overarching themes emerged, elucidating the foundations of PL as an inclusive concept: environmental considerations, operating with intention, and ethical and informed practice. These themes intersect with one another to foster opportunities for PL development across age and ability spectrums.

Conclusions

The findings offer evidence-based insights into PL and inclusion practices, offering a framework to move beyond normative and standardized notions of PL development.

Support/Funding Source

Government of Canada Social Sciences and Humanities Research Council Partnership Engage Grant (File No. 892-2021-1009).
60 Sustainable impact of an outdoor exercise program on health outcomes of older adults: a quasi-randomized controlled trial with a 3-month follow-up
Authors: Zwingmann Katharina , Schlesinger Torsten , Müller Katrin
Published: September 2024

Older people benefit in several health-promoting outcomes from needs-oriented exercise programs in their immediate living environment. For a low-threshold, and thus sustainable and cost-effective design of exercise programs a transfer to self-organisation is favourable. The aim of our study is to examine the health-promoting impacts of an outdoor exercise program developed for older persons, as well as its sustainability after 3 months.

Ninety-five persons aged 60+ were randomized according to their residence (IG: n = 40, mean age = 72.35 years, 24 female; KG: n = 55, mean age = 75.05 years, 34 female). An age-adjusted exercise program was carried out over 12 weeks (2x/week á 45-60min; adherence: 90.9%) by professional exercise instructors in urban parks. During this instructor-led exercise phase, seven participants were trained as mentors, and thus, enabled to continue the exercise program for further 12 weeks (1-2x/week á 45-60min; adherence: 2-3x/month = 11.5%, 1-2x/week = 88.5%). Before (T1) and after the instructor-led exercise phase (T2) as well as after the mentor-led exercise phase (T3), health outcomes (e.g., walking distance/6MWT, neurocognitive performance/DSST) of IG and CG (no intervention) were assessed and analysed using paired t-Tests.

75.1% of IG participants completed both phases of the exercise program. Neurocognitive performance improved significantly for IG between T1 and T2 (+2.32 correct number-symbol matches; p = .003; d = -.509) and remained stable between T2 and T3 (+0.15 correct matches; p = .863; d = -.028) while for CG the opposite development was observed (T1-T2: -0.6 correct matches; p = .451; d = .102; T2-T3: +2.18 correct matches; p = .004; d = -.423). IG improved their walking distance for T1-T2 by 21.39m (p = .172; d = -.223), which could be maintained for T2-T3 (+5,1m; p = .648; d = -.074). Improvements in CG for walking distance were smaller (T1-T2: +2.8m; p = .690; d = -.055; T2-T3: +14.26m, p = .315; d = -.147).

The mentoring of the exercise groups proved to be very successful, as evidenced by the maintained effects in the mentor-led phase, ensuring sustainability of health-promoting interventions.

(Funded by the Free State of Saxony, “Demographics” #100535625)
91 The use of process evaluations in physical activity interventions for older adults: a systematic review
Authors: Adams Michael , Hardeman Wendy , Murphy Marie , Simpson Liz , Tully Mark
Published: September 2024

Background and purpose

Development of effective physical activity interventions for older adults is important in eliciting positive health and well-being outcomes. Process evaluations of interventions are important in understanding implementation, mechanisms of impact and contextual factors that may influence these outcomes. However, it is unclear whether process evaluation frameworks are rigourously applied to physical activity interventions with older adults, particularly in relation to Medical Research Council (MRC) process evaluation guidance. This study aimed to systematically review the application and reporting of process evaluations of physical activity interventions for older adults against MRC process evaluation guidance.

Methods

MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, SPORTDiscus, OpenGrey, ProQuest Dissertations & Theses Database (PQDT) databases were searched. Process evaluation studies of physical activity interventions for older adults which measured at least two key MRC domains of implementation, mechanisms of impact and context were included. Two authors completed independent screening of title, abstract and full-text articles. A bespoke coding frame was developed to map and extract methods and findings on to key MRC process evaluation domains. Given the qualitative nature of the data, a narrative synthesis approach was undertaken.

Results

17,002 studies were identified in the search, of which 27 were included. After mapping the methods of included studies against key domains of the coding framework; 21 assessed implementation, 27 assessed mechanisms of impact and 12 assessed context. 16 interventions reported the use of a process evaluation framework, 15 cited the use of a theoretical behavioural model and 7 reported the application of a logic model in intervention design. There were substantial differences in both the extent and quality of process evaluation methods. Such disparities were shaped in part by variations in the application of theoretical models and frameworks.

Conclusions

When mapping the included studies against MRC process evaluation guidelines, this review presented inconsistencies in how process evaluations have been reported and findings suggest a lack of methodological rigour. Findings highlight the need to extend the scope and quality of process evaluations of physical activity interventions for older adults.
46 Understanding the wants and needs of adults with cerebral palsy who use wheelchairs to participate in community-based physical activity – a qualitative study
Authors: Czencz James , Wallen Margaret , Shields Nora , Imms Christine , Wilson Peter H
Published: September 2024

Purpose

This study explored the perspectives of adults with CP who use wheelchairs and their support providers regarding physical activity, specifically what they wanted to do and what they needed to participate.

Method

A qualitative study using interpretive description was conducted from a convenience sample of seven adults with CP (5 female, mean age 17.7 years) and five support persons (5 female) who participated in semi-structured interviews. Interviews were conducted using videoconferencing software and were recorded and transcribed. Data were analysed using qualitative data analysis software. Transcripts were checked by the research team. The research team conducted an inductive thematic analysis to identify themes. Consumer partners provided feedback on the project, including interpretation of the themes to ensure relevance to the intended population.

Results

Analysis identified that adults who use wheelchairs strongly desire to engage in physical activity in their community but need inclusive options tailored to their specific needs. Six themes were identified: 1) appreciating diversity among wheelchair users - by recognising individuality, advocating for inclusive activities, and recognising the individual beyond their disability; 2) self-determination and control - emphasising that adults with CP using wheelchairs seek autonomy in their choices and decision-making; 3) flexibility and creativity in adapting activities - participants seek customised, flexible physical activities; 4) accessibility, both physical and social - emphasising the important role of accessible environments, including physical structures and social attitudes, staff training, and knowledge. 5) the crucial role of support providers who hold positions of trust and recognise their recommendations or concerns play an important role in determining the types of activities that adults engage in; and 6) appropriately challenging activities that maximise involvement – ensuring activity and ability are matched carefully, leading to feelings of satisfaction and pride.

Conclusion

Findings highlight the importance of implementing individualised and inclusive approaches to promote physical activity participation among adults with CP who use wheelchairs. To improve participation in physical activity, it is important to not only enhance physical accessibility but also make accommodations that support active involvement by focusing on attitudes, staff training, and listening to the voices of adults with CP.
157 ’Finding Our Tribe’: Parental Experiences Navigating Sport and Physical Activity Opportunities for Neurodivergent Children and Young People
Authors: Byrd Erin , Carlin Angela , Fitzpatrick Ben , Hemmings Laura
Published: September 2024

Purpose

Neurodivergent children and young people (CYP) experience higher risk of poor physical and mental health. Many community programmes have been designed to provide young people with a physical activity (PA) outlet to improve health and wellness, however, neurodivergent CYP and their families continue to face stigmatising attitudes and exclusion when trying to access these opportunities. This study aimed to explore the experience of parents and caregivers of neurodivergent CYP, in the United Kingdom (UK), in finding, accessing, and engaging with inclusive community sport and physical activity opportunities and resources for their children.

Methods

An online qualitative survey explored the experience of parents and caregivers of neurodivergent CYP in the UK in finding and accessing community sport and PA opportunities. One-hundred and twelve parents and caregivers completed the survey from across all 4 devolved nations in the UK. Recruitment of participants occurred through collaboration with parent and advocacy groups for neurodivergent populations, charities providing services to these populations across the UK, as well as through social media platforms. Data collected was interpreted using inductive-thematic analysis, allowing for emergent themes to be identified using a constructivist framework.

Results

Qualitative data revealed an overarching theme: the ‘Constant Struggle’ parents of neurodivergent CYP face in trying to find, access, and support their children to participate in sport and physical activities. Four main themes emerged under this overarching theme including: 1) An awareness of inequity in the sport and physical opportunities available, 2) A need for flexibility and adaptability, 3) The importance of the coach, and 4) Empowering the parent through inclusion and support.

Conclusion

Parents and caregivers of neurodivergent CYP express the desire for more equitable provision and delivery of community sport and PA opportunities. It is recognised that there are currently challenges in identifying and accessing appropriate opportunities, however, solutions are offered that will support parents to feel more empowered to engage with sport and PA opportunities.

Support/Funding Source

Supported by Ulster University and the University of Birmingham.
89 Associations of active commuting and leisure-time physical activity with mental health symptoms among Finnish adults: a population-based study
Authors: Appelqvist-Schmidlechner Kaija , Ervasti Jenni , Halonen Jaana I , Jussila Juuso J , Lahti Jouni , Lanki Timo , Mikkonen Santtu , Pulakka Anna , Salo Paula
Published: September 2024

Purpose

Active commuting, that is, walking or cycling to work, can improve physical health. Yet, few studies have explored whether it could also enhance mental health. We examined cross-sectional associations of active commuting and, for comparison, leisure-time physical activity with depressive symptoms and psychological distress among Finnish adults.

Methods

We included 3439 adults (mean age 45.0 years; 51% women) from the FinHealth 2017 Study. Based on their commuting and leisure-time physical activity behaviour, participants were categorised as active or passive commuters and as sedentary, recreationally active, or exercisers and athletes. Logistic regression was used to estimate odds ratios (OR), with 95% confidence intervals (CI), adjusting for major sociodemographic, health behaviour, and physical activity variables.

Results

Active commuting, as a binary variable, was not associated with mental health outcomes compared to passive commuting. However, in dose-response analyses, high volumes of active commuting (≥ 30 minutes a day) were associated with higher odds of depressive symptoms (OR 1.58, 95% CI 1.18-2.13). Regarding leisure-time physical activity, recreationally active adults had lower odds of depressive symptoms (OR 0.57, 95% CI 0.44-0.73) and psychological distress (OR 0.46, 95% CI 0.32-0.68) compared to sedentary individuals. Similarly, exercisers and athletes had lower odds of depressive symptoms (OR 0.44, 95% CI 0.32-0.61) and lower odds of psychological distress (OR 0.34, 95% CI 0.21-0.55).

Conclusions

We found leisure-time physical activity, but not active commuting, to be associated with lower odds of mental health symptoms. More research on commuting behaviour is needed to understand the complex relationship between active commuting and mental health.
154 Avoidance of Physical Activity Among Patients with Chronic Obstructive Pulmonary Disease (COPD): An Observational Study
Authors: Andelius Dea Kejlberg , Løkke Anders , Jacobsen Julie Sandell , Nielsen Rasmus Østergaard
Published: September 2024

Purpose

While physical activity is recognized as an essential component in COPD treatment, patients with COPD often exhibit lower levels of physical activity compared with their lung-healthy peers. The primary objective of our study was to describe the proportion of patients with COPD who report avoidance behavior related to physical activity.

Methods

A questionnaire-based, observational study was conducted among patients with COPD, scheduled to attend a pulmonary rehabilitation program. Participants completed the COPD Anxiety Questionnaire (CAF-R) and functional tests were conducted prior to participation of the rehabilitation program.

Results

We included 48 participants (24 males, mean: age 70±7.8 years, body mass index 25±5.0, MRC dyspnoea scale 2.5±0.9, One-Minute-Sit-To-Stand-Test 19 ±6.0 repetitions). Findings revealed that 60% (95% CI [46%-0,74%]) reported avoidance of physical exertion, 44% (95% CI [24%-52%]) avoid activities causing breathlessness, and 35% (95% CI [22%-48%]) try avoid any form of physical activity.

Conclusions

Our findings show that a large proportion of patients with COPD exhibit avoidance behavior concerning physical activity. While the underlying reasons are likely multifaceted, apprehension towards breathlessness emerges as a potential contributing factor. The results underscore the importance of investigating avoidance behavior in people with COPD to better understand how to promote physical activity within this population. Future interventions designed to increase physical activity in patients with COPD should include identification of the extent of avoidance behavior and implementation of strategies to manage the behavior, such as exposing individuals to physical activity within a secure environment.

Support/funding

This study received financial support from the Karen Elise Jensen Foundation and the Eva Merethe Falck Crones Foundation.
38 Combining healthcare and fitness through physical co-location: is that alone enough to get people physically active?
Authors: Grinvalds Natalie , Copeland Robert J , Shearn Katie , Humphreys Helen
Published: September 2024

The primary purpose of this research was to explain how co-location of healthcare (community or secondary healthcare clinics) with fitness centres (gyms, leisure centres) works (or does not work) to promote and facilitate access to physical activity opportunities and physical activity behaviour. As part of 2012 London Olympic Legacy and National Centre for Sport & Exercise Medicine, National Health Service (NHS) clinics were co-located with leisure centres. 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 work as an appropriate environment.

This work is innovative topically as it is the first study (at time of publication) to research co-location of healthcare and fitness in UK and methodologically novel for the use of realist review and evaluation to develop a set of theories to explain co-location.

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 works (or not). Theories developed in Phase 1 were ‘tested’ through interviews with ten healthcare professionals and ten patients in four clinical services (including diabetes, pain management, musculoskeletal physiotherapy, podiatry) in 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 of health and fitness works for healthcare professionals (HCPs) who are active, knowledgeable, make time to discuss PA with patients. Co-location creates a salutogenic environment which enables patients and HCPs 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, with optimal implementation, can result in promotion of PA through healthcare, enabling people become physically active and reduce the burden of LTCs on society.

Ukactive and a SHU Vice Chancellor’s scholarship
34 Evaluation Experiences from The Healthy & Active Fund​ in Wales
Authors: Kolovou Vasiliki , Kolosowska Anna , Embling Rochelle , Mchugh Niamh , Bradley John , Pilkington Paul
Published: September 2024

Purpose

To explore diverse perspectives of stakeholders involved in the evaluation of community-based projects. Third-sector organisations and public sector bodies based across different regions in Wales, delivered a variety of physical activity and mental well-being interventions, as part of the Healthy and Active Fund programme. Projects designed and completed evaluations of their process and outcomes, and their experiences offer lessons to inform future community-based delivery to under-served populations.

Methods

Semi-structured interviews (N = 14) were completed with project members (N = 15, 12 projects) that had roles in leading, managing or completing aspects of the project-level evaluations. Interviews were analysed according to reflexive thematic analysis and themes were collaboratively developed.

Results

Three major themes were identified across interviews that were relevant to the lessons learnt from the evaluation of community-level projects and delivering to under-served populations: structural level of support, capturing impact, and adapting and learning. All projects were required to use questionnaire-based, self-reported physical activity and mental well-being outcome measures (IPAQ and WEMWBS), while some projects collected additional data through interviews, focus groups and questionnaires. Projects acknowledged the importance of robust evaluation of their activities, but for many organisations and members it was the first time they had planned evaluations of that scope and level of detail. The support provided from the Healthy and Active Fund programme was valuable. Some projects needed closer guidance and problem-solving, despite most projects having sought external evaluation expertise to plan or conduct evaluations of their projects.

Conclusions

This study revealed several barriers and facilitators for engaging under-served populations in monitoring and evaluation, especially in using standard questionnaires. The lessons from these projects can inform future community-based approaches to evaluation and encourage a culture of evaluation and monitoring as standard practice. Such evaluation and monitoring can assist third-sector organisations and public bodies with showcasing their impact and securing ongoing funding.

Support/Funding Source

None. Conducted by Public Health Wales.