Background: The impact of bronchiectasis on sedentary behaviour and physical activity is unknown.... more Background: The impact of bronchiectasis on sedentary behaviour and physical activity is unknown. It is important to explore this to identify the need for physical activity interventions and how to tailor interventions to this patient population. We aimed to explore the patterns and correlates of sedentary behaviour and physical activity in bronchiectasis. Methods: Physical activity was assessed in 63 patients with bronchiectasis using an ActiGraph GT3X+ accelerometer over seven days. Patients completed: questionnaires on health-related quality-of-life and attitudes to physical activity (questions based on an adaption of the transtheoretical model (TTM) of behaviour change); spirometry; and the modified shuttle test (MST). Multiple linear regression analysis using forward selection based on likelihood ratio statistics explored the correlates of sedentary behaviour and physical activity dimensions. Between-group analysis using independent sample t-tests were used to explore differences for selected variables. Results: Fifty-five patients had complete datasets. Average daily time, mean(standard deviation) spent in sedentary behaviour was 634(77)mins, light-lifestyle physical activity was 207(63)mins and moderate-vigorous physical activity (MVPA) was 25(20)mins. Only 11% of patients met recommended guidelines. Forced expiratory volume in one-second percentage predicted (FEV 1 % predicted) and disease severity were not correlates of sedentary behaviour or physical activity. For sedentary behaviour, decisional balance 'pros' score was the only correlate. Performance on the MST was the strongest correlate of physical activity. In addition to the MST, there were other important correlate variables for MVPA accumulated in ≥10-minute bouts (QOL-B Social Functioning) and for activity energy expenditure (Body Mass Index and QOL-B Respiratory Symptoms). Conclusions: Patients with bronchiectasis demonstrated a largely inactive lifestyle and few met the recommended physical activity guidelines. Exercise capacity was the strongest correlate of physical activity, and dimensions of the QOL-B were also important. FEV 1 % predicted and disease severity were not correlates of sedentary behaviour or physical activity. The inclusion of a range of physical activity dimensions could facilitate in-depth exploration of patterns of physical activity. This study demonstrates the need for interventions targeted at reducing sedentary behaviour and increasing physical activity, and provides information to tailor interventions to the bronchiectasis population.
Background: There are challenges for researchers and clinicians to select the most appropriate ph... more Background: There are challenges for researchers and clinicians to select the most appropriate physical activity tool, and a balance between precision and feasibility is needed. Currently it is unclear which physical activity tool should be used to assess physical activity in Bronchiectasis. The aim of this research is to compare assessment methods (pedometer and IPAQ) to our criterion method (ActiGraph) for the measurement of physical activity dimensions in Bronchiectasis (BE), and to assess their feasibility and acceptability. Methods: Patients in this analysis were enrolled in a cross-sectional study. The ActiGraph and pedometer were worn for seven consecutive days and the IPAQ was completed for the same period. Statistical analyses were performed using SPSS 20 (IBM). Descriptive statistics were used; the percentage agreement between ActiGraph and the other measures were calculated using limits of agreement. Feedback about the feasibility of the activity monitors and the IPAQ was obtained. Results: There were 55 (22 male) data sets available. For step count there was no significant difference between the ActiGraph and Pedometer, however, total physical activity time (mins) as recorded by the ActiGraph was significantly higher than the pedometer (mean ± SD, 232 (75) vs. 63 (32)). Levels of agreement between the two devices was very good for step count (97% agreement); and variation in the levels of agreement were within accepted limits of ±2 standard deviations from the mean value. IPAQ reported more bouted-moderate-vigorous physical activity (MVPA) [mean, SD; 167(170) vs 6(9) mins/day], and significantly less sedentary time than ActiGraph [mean, SD; 362(115) vs 634(76) vmins/day]. There were low levels of agreement between the two tools (57% sedentary behaviour; 0% MVPA 10+), with IPAQ under-reporting sedentary behaviour and over-reporting MVPA 10+ compared to ActiGraph. The monitors were found to be feasible and acceptable by participants and researchers; while the IPAQ was accepta ble to use, most patients required assistance to complete it. Conclusions: Accurate measurement of physical activity is feasible in BE and will be valuable for future trials of therapeutic interventions. ActiGraph or pedometer could be used to measure simple daily step counts, but ActiGraph was superior as it measured intensity of physical activity and was a more precise measure of time spent walking. The IPAQ does not appear to represent an accurate measure of physical activity in this population.
Background: The global incidence of type 1 diabetes is rising, and youths with type 1 diabetes co... more Background: The global incidence of type 1 diabetes is rising, and youths with type 1 diabetes continue to suffer poorer health than peers without diabetes. Evidence suggests youths with type 1 diabetes have physical activity (PA) levels well below the recommendations for health and have high levels of sedentary behaviour. An active lifestyle is therefore recommended to improve health. There is limited research showing effective lifestyle behaviour change in this population; therefore, an evidence gap exists between the need to promote physical activity in type 1 diabetes care and lack of understanding on how to do this. This protocol paper describes a feasibility and pilot study of the ActivPals programme-an intervention to support active lifestyles in youths with type 1 diabetes. Methods/design: Key intervention components have been identified from preliminary work (individual and family focus, peer mentoring, technology integration and improved communication and understanding) and are being developed into a pragmatic randomised controlled trial (RCT) supported by recruitment pathways. A steering group of health care professionals and managers will refine the intervention to patient needs. A pilot trial is providing data on intervention implementation, acceptability and feasibility. Twenty youths with type 1 diabetes are being recruited and randomised into an intervention or control group. Physical activity is being measured objectively using the Actigraph GT3X+ monitor at baseline and 1-month follow-up. Contextual factors associated with intervention delivery are being explored. Discussion: This study will contribute to the development of evidence-based, user-informed and pragmatic interventions leading to healthier lifestyles in youths with type 1 diabetes.
through professional networks and social media. The survey asked CPs to record their perceptions ... more through professional networks and social media. The survey asked CPs to record their perceptions on how often patients sought advice on several common sleep problems, as either 'very often' (most days), 'often' (1-3 times/week), 'occasionally' (1-3 times/month) or 'rarely' < once/month). Other areas included self-rated confidence dealing with requests on sleep problems (1-5 Likert scale: 1 being 'not confident' and 5 'confident'), estimated proportion of GPreferred requests for advice and the perceived need for community-based sleep-related services. Data analyses were descriptive. Results Completed responses were obtained from 120 CPs. Results summarised in figures 1 and 2. Combining 'often' and 'very often', the most common sleep-related problems encountered were insomnia (60%) and sleepiness/tiredness/fatigue (54%). Half the CPs self-rated their confidence as 3 on the 'confident-not confident' scale. Fifty-seven percent reported that they received no undergraduate training on sleep problems. Proposed pharmacist involvement in sleep screening/signposting services or a pharmacy-based intervention/referral programme was supported by 78% and 70% respectively. Fifty-eight percent of CPs were 'very often' or 'often' asked about symptoms of OSAS, with the majority (93%) asked 'occasionally'. Discussion CPs frequently encounter patients with symptoms of sleep disorders, but their confidence and training in dealing with these is lacking. This study highlights the need for specialist sleep training for pharmacists and the development of pharmacy-based services to support and improve patient outcomes.
Heart Rate Variability (HRV), and 6-minute walk test (6MWT). Nonparametric and parametric statist... more Heart Rate Variability (HRV), and 6-minute walk test (6MWT). Nonparametric and parametric statistics were used with p≤0.05. Data are mean (SD) or md (Q1,Q3) for self-report measures. RESULTS: In both MSD and C groups prior to BD, QOL correlated with FIS (rs =-0.63) and BDI (rs =-0.70). FIS correlated with BDI (rs = 0.72). HRV correlated with QOL (rs= 0.47) and BDI (rs =-0.56) but not with FIS. (rs =-0.32). No variables correlated with 6MWT. For the MSD group, HRV (pre = 31 (19) post = 38 (19) ms, p = 0.03) and 6MWT (pre = 432 (114) post = 462 (126) m, p = 0.03) increased. Of the self-report outcomes, BDI improved (pre= 9 (5,15) post = 4 (0,10), p = 0.04). There were no changes in any measured outcome for the C group. CONCLUSION: BD can lead to significant improvements in HRV and depression. Further, HRV but not 6MWT might mediate improvements in QOL through depression in pwMS. This study was supported by the Greater Milwaukee Foundation.
Little is known about the response of post‐partum women from deprived backgrounds to weight manag... more Little is known about the response of post‐partum women from deprived backgrounds to weight management interventions, however behavioural intervention trials in disadvantaged communities are often characterised by recruitment difficulties. Recruitment and retention is key to the robust conduct of an effective trial, and exploratory work is essential prior to a definitive randomised controlled trial. This paper describes strategies used to recruit to the WeighWell feasibility study, which aimed to recruit 60 overweight or obese post‐partum women living in areas of deprivation to a trial of a weight‐loss intervention. Recruitment strategies included the following: (1) distribution of posters and ‘business cards’; (2) newspaper advertisements; (3) visits to community groups; and (4) personalised letters of invitation sent via the National Health Service (NHS). Potential participants were screened for eligibility following response to a Freephone number. Body mass index was calculated u...
International Journal of Environmental Research and Public Health, Nov 4, 2021
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Background: Informal caregivers, or carers (unpaid family members and friends), are instrumental ... more Background: Informal caregivers, or carers (unpaid family members and friends), are instrumental to millions worldwide for the ongoing delivery of health and well-being needs. The risk of crisis points (eg, hospitalizations) for caregivers increases with the absence of physical activity. The COVID-19 pandemic is highly likely to have increased the risk of crisis points for caregivers by increasing the amount of time spent indoors due to shielding and lockdown restrictions. Thus, accessible evidence-based tools to facilitate physical activity for caregivers indoors are urgently needed. Objective: The aim of this study was to co-design and develop a novel mobile app to educate and support carers in the undertaking of regular physical activity at home during and beyond COVID-19 restrictions via integration of the transtheoretical model of behavior change and UK physical activity guidelines. Methods: We co-designed a mobile app, "CareFit," by directly involving caregivers, health care professionals, and social care professionals in the requirements, capturing, and evaluation phases of three Agile Scrum design and development sprints. Seven participants representing multistakeholder views took part in three co-design sessions, each of which was followed by a development sprint. Requirements for CareFit were grounded in a combination of behavioral change science and UK government guidelines for physical activity. Results: Participants identified different barriers and enablers to physical activity, such as a lack of time, recognition of existing activities, and concerns regarding safely undertaking physical activity. Requirements analysis highlighted the importance of simplicity in design and a need to anchor development around the everyday needs of caregivers (eg, easy-to-use video instructions). Our final prototype app integrated guidance for undertaking physical activity at home through educational, physical activity, and communication components. Conclusions: Integrating government guidelines with models of behavioral change into a mobile app to support the physical activity of carers is novel. We found that integrating core physical activity guidelines into a co-designed smartphone app with functionality such as a weekly planner and educational material for users is feasible. This work holds promise to fill the gap of effective physical activity solutions for caregivers both during and beyond the COVID-19 pandemic. Further work is now needed to explore the feasibility, acceptability, and usability of the approach in real-world settings.
A systematic review of physical activity and sedentary behavior intervention studies in youth wit... more A systematic review of physical activity and sedentary behavior intervention studies in youth with type 1 diabetes: study characteristics, intervention design, and efficacy. Pediatric Diabetes 2013. Objective: To systematically review physical activity and/or sedentary behavior intervention studies for youth with type 1 diabetes. Methods: Several databases were searched for articles reporting on randomized-controlled trials (RCTs) in youth (<18 yr) with type 1 diabetes. Data was extracted and bias assessed to evaluate study characteristics, intervention design, and efficacy of interventions on physical activity and health. Where sufficient data were available meta-analyses of health outcomes [for hemoglobin A1c (HbA1c)] were performed. Weighted mean differences (WMD) were calculated using fixed and random effect models. Results: The literature search identified 12/2397 full-text articles reporting on 11 studies. Two interventions were wholly unsupervised and only one was based on behavior change theory with no studies exploring changes in behavior processes. Nine interventions aimed to improve fitness or physical activity, two aimed to improve health, and none aimed at changing sedentary behavior. Eight interventions improved physical activity and/or fitness. At least one beneficial effect on health was found in each intervention group apart from two studies where no changes were found. Meta-analysis of 10 studies showed the interventions have a significant beneficial reduction of HbA1c (%), indicating an improvement in glycemic control [WMD, −0.85% (95% CI, −1.45 to −0.25%)]. There were insufficient data to pool other health outcome data. Conclusions: Few RCTs explored the efficacy of unsupervised theory-based physical activity and/or sedentary behavior interventions in youth with type 1 diabetes. Limited reporting made comparison of findings challenging. There was an overall significant beneficial effect of physical activity on HbA1c.
OBJECTIVE-To evaluate effect of exercise consultation on physical activity and resultant physiolo... more OBJECTIVE-To evaluate effect of exercise consultation on physical activity and resultant physiological and biochemical variables at 6 months in people with type 2 diabetes. RESEARCH DESIGN AND METHODS-A total of 70 inactive people with type 2 diabetes were given standard exercise information and were randomized to receive an exercise consultation (n ϭ 35) or not (n ϭ 35). Exercise consultation, based on the transtheoretical model, combines motivational theory and cognitive behavioral strategies into an individualized intervention to promote physical activity. Changes from baseline to 6 months were assessed in 1) physical activity (7-day recall, accelerometer, cardiorespiratory fitness, stage, and processes of change), 2) physiological variables (blood pressure and BMI), and 3) biochemical variables (HbA 1c , lipid profile, and fibrinogen). RESULTS-Between-group differences were recorded for the change in minutes of moderate activity (P Ͻ 0.001) and activity counts (P Ͻ 0.001) per week. Experimental participants recorded an increase in activity counts per week and minutes of moderate activity per week (P Ͻ 0.001). The control group recorded no significant changes. More experimental participants increased stage of change (2 ϭ 22.6, P Ͻ 0.001). Between-group differences were recorded for the change in total exercise duration and peak gradient (P Ͻ 0.005), HbA 1c (P ϭ 0.02), systolic BP (P ϭ 0.02), and fibrinogen (P ϭ 0.03). CONCLUSIONS-Exercise consultation increased physical activity and improved glycemic control and cardiovascular risk factors in people with type 2 diabetes.
Sedentary behaviours have been linked to poor health, independent of physical activity levels. Th... more Sedentary behaviours have been linked to poor health, independent of physical activity levels. The objective of this study was to explore an individualised intervention strategy aimed at reducing sedentary behaviours in older Scottish adults. This feasibility and pilot study was a pre-experimental (one group pretest-posttest) study design. Participants were enrolled into the study in January-March 2012 and data analysis was completed April-October 2012. The study was based in Glasgow, Scotland. Participants received an individualised consultation targeting sedentary behaviour incorporating feedback from an activPAL activity monitor. Outcome measures were objectively (activPAL) and subjectively measured (Sedentary Behaviour Questionnaire) sedentary time. Twenty four participants received the intervention. Objectively measured total time spent sitting/lying was reduced by 24 min/day (p=0.042), a reduction of 2.2%. Total time spent in stepping activities, such as walking increased by 13 min/day (p=0.044). Self-report data suggested participants achieved behaviour change by reducing time spent watching television and/or using motorised transport. Interventions to reduce sedentary behaviours in older people are urgently needed. The results of this feasibility and pilot study suggest a consultation approach may help individuals reduce time spent in sedentary behaviours. A larger, controlled trial is warranted with a diverse sample to increase generalisability.
In this article, we consider children's perceptions of their social and physical outdoor environm... more In this article, we consider children's perceptions of their social and physical outdoor environment in relation to their physical activity (PA) behaviour in Scotland, United Kingdom. Drawing from a pilot study, participants included three groups of children aged between ten and twelve of mixed gender (n=15). Visual and verbal representations of their perceived environment were analysed to assess environmental determinants of PA. Results found an absence of suitable play affordances, safety, parental restriction, and environmental aesthetics was a key factor to children spending time outdoors. Strengths and limitations of the study are discussed, as are implications for policy and practice.
This poster discusses exploring children’s perceptions of their social and physical environment i... more This poster discusses exploring children’s perceptions of their social and physical environment in relation to physical activity behaviour.
Background: Around two thirds of 5-18 year olds fail to meet physical activity (PA) recommendatio... more Background: Around two thirds of 5-18 year olds fail to meet physical activity (PA) recommendations. Children with Type 1 Diabetes (T1D) tend to be less active and more sedentary than non-diabetic peers. Research into motivations for PA in this population is lacking. Objective: To investigate motivating factors for PA in youth with T1D participating in a 4 week PA intervention (ActivPals study), to inform the practice of health care professionals promoting PA. Methods: Semi-structured interviews with participants and their parent (n=16) were carried out between May and July 2016. Following completion of the ActivPals intervention, participants who agreed to interview were recruited to this study. Interviews were recorded, transcribed verbatim and analysed thematically. Results: Factors contributing to motivation to participate in PA are presented as 6 key themes and 9 sub-themes. The 6 themes were: 'motivators related to health', 'enjoyment', 'selfefficacy', 'family and friends participating', 'contribution of 3 rd parties' and 'good weather'. Conclusion: Enjoyment was key to participation in PA and could be increased by goal setting and the involvement of friends and family. Education and support to manage diabetes for PA is crucial in developing self-efficacy to enable sustained behaviour change and HCPs play a key role in providing this support, as well as having the potential to be a motivating role model. Subjective improvement in blood glucose readings and psychological benefits were also acknowledged to provide motivation for further PA. These motivating factors should be applied in supporting children with T1D to engage in PA.
Physical activity is an important, but often underused, therapeutic strategy within diabetes care... more Physical activity is an important, but often underused, therapeutic strategy within diabetes care. To date, little is known about the best way to promote physical activity in diabetes care. Physical activity consultation is an intervention designed to promote physical activity behaviour change. This article provides guidelines on how to conduct a physical activity consultation with people who have Type 2 diabetes, and reviews the evidence surrounding the effectiveness of this intervention in this population. The trans-theoretical model is the underlying theory of behaviour change for the physical activity consultation intervention. The review identifies research which supports the use of this model for understanding physical activity behaviour in people with Type 2 diabetes. The review outlines a number of modifiable variables associated with physical activity behaviour change in this population. How each of these variables is addressed within the guidelines for conducting a physical activity consultation is identified. Finally, limited but consistent research highlights the effectiveness of physical activity consultation for promoting physical activity in people with Type 2 diabetes.
Aims/hypothesis. The aim of this study was to investigate the effectiveness of physical activity ... more Aims/hypothesis. The aim of this study was to investigate the effectiveness of physical activity counselling in promoting physical activity in people with Type 2 diabetes and to evaluate resultant physiological and biochemical effects. Methods. A total of 70 inactive people with Type 2 diabetes were given standard exercise information and randomised to receive physical activity counselling (n=35, experimental) or not (n=35, control). Physical activity consultations were delivered at baseline and after 6 months, with follow-up phone calls after 1, 3, 6 and 9 months. Changes from baseline after 6 and 12 months were assessed for physical activity (7-day recall and accelerometer), for physiological characteristics (body mass index and blood pressure) and for biochemical variables (HbA 1 c, lipid profile, fibrinogen, tissue plasminogen activator and microalbuminuria). Results. Significant differences between groups were recorded for physical activity after 6 and 12 months (p<0.01). The experimental group had increased levels of physical activity from baseline to 6 months (p<0.01), with no decrease from 6 to 12 months (p>0.05). In the control group, accelerometer counts per week decreased from baseline to 12 months (p=0.03). Between-group differences (p<0.05) were recorded for the change in HbA 1 c (experimental: 0.26% decrease; control: 0.15% increase), for systolic blood pressure (experimental: 7.7 mm Hg decrease; control: 5.6 mm Hg increase) and for fibrinogen (experimental: 0.28 mmol/l decrease; control: 1.43 mmol/l increase) from baseline to 6 months, and for total cholesterol (experimental: 0.33 mmol/l decrease; control: 0.04 mmol/l increase) from baseline to 12 months (p<0.05). No significant differences were recorded in other measured variables. Conclusions/interpretations. Physical activity counselling was effective in promoting physical activity in people with Type 2 diabetes. The counselling improved glycaemic control as well as the status of cardiovascular risk factors in these patients.
Background: The impact of bronchiectasis on sedentary behaviour and physical activity is unknown.... more Background: The impact of bronchiectasis on sedentary behaviour and physical activity is unknown. It is important to explore this to identify the need for physical activity interventions and how to tailor interventions to this patient population. We aimed to explore the patterns and correlates of sedentary behaviour and physical activity in bronchiectasis. Methods: Physical activity was assessed in 63 patients with bronchiectasis using an ActiGraph GT3X+ accelerometer over seven days. Patients completed: questionnaires on health-related quality-of-life and attitudes to physical activity (questions based on an adaption of the transtheoretical model (TTM) of behaviour change); spirometry; and the modified shuttle test (MST). Multiple linear regression analysis using forward selection based on likelihood ratio statistics explored the correlates of sedentary behaviour and physical activity dimensions. Between-group analysis using independent sample t-tests were used to explore differences for selected variables. Results: Fifty-five patients had complete datasets. Average daily time, mean(standard deviation) spent in sedentary behaviour was 634(77)mins, light-lifestyle physical activity was 207(63)mins and moderate-vigorous physical activity (MVPA) was 25(20)mins. Only 11% of patients met recommended guidelines. Forced expiratory volume in one-second percentage predicted (FEV 1 % predicted) and disease severity were not correlates of sedentary behaviour or physical activity. For sedentary behaviour, decisional balance 'pros' score was the only correlate. Performance on the MST was the strongest correlate of physical activity. In addition to the MST, there were other important correlate variables for MVPA accumulated in ≥10-minute bouts (QOL-B Social Functioning) and for activity energy expenditure (Body Mass Index and QOL-B Respiratory Symptoms). Conclusions: Patients with bronchiectasis demonstrated a largely inactive lifestyle and few met the recommended physical activity guidelines. Exercise capacity was the strongest correlate of physical activity, and dimensions of the QOL-B were also important. FEV 1 % predicted and disease severity were not correlates of sedentary behaviour or physical activity. The inclusion of a range of physical activity dimensions could facilitate in-depth exploration of patterns of physical activity. This study demonstrates the need for interventions targeted at reducing sedentary behaviour and increasing physical activity, and provides information to tailor interventions to the bronchiectasis population.
Background: There are challenges for researchers and clinicians to select the most appropriate ph... more Background: There are challenges for researchers and clinicians to select the most appropriate physical activity tool, and a balance between precision and feasibility is needed. Currently it is unclear which physical activity tool should be used to assess physical activity in Bronchiectasis. The aim of this research is to compare assessment methods (pedometer and IPAQ) to our criterion method (ActiGraph) for the measurement of physical activity dimensions in Bronchiectasis (BE), and to assess their feasibility and acceptability. Methods: Patients in this analysis were enrolled in a cross-sectional study. The ActiGraph and pedometer were worn for seven consecutive days and the IPAQ was completed for the same period. Statistical analyses were performed using SPSS 20 (IBM). Descriptive statistics were used; the percentage agreement between ActiGraph and the other measures were calculated using limits of agreement. Feedback about the feasibility of the activity monitors and the IPAQ was obtained. Results: There were 55 (22 male) data sets available. For step count there was no significant difference between the ActiGraph and Pedometer, however, total physical activity time (mins) as recorded by the ActiGraph was significantly higher than the pedometer (mean ± SD, 232 (75) vs. 63 (32)). Levels of agreement between the two devices was very good for step count (97% agreement); and variation in the levels of agreement were within accepted limits of ±2 standard deviations from the mean value. IPAQ reported more bouted-moderate-vigorous physical activity (MVPA) [mean, SD; 167(170) vs 6(9) mins/day], and significantly less sedentary time than ActiGraph [mean, SD; 362(115) vs 634(76) vmins/day]. There were low levels of agreement between the two tools (57% sedentary behaviour; 0% MVPA 10+), with IPAQ under-reporting sedentary behaviour and over-reporting MVPA 10+ compared to ActiGraph. The monitors were found to be feasible and acceptable by participants and researchers; while the IPAQ was accepta ble to use, most patients required assistance to complete it. Conclusions: Accurate measurement of physical activity is feasible in BE and will be valuable for future trials of therapeutic interventions. ActiGraph or pedometer could be used to measure simple daily step counts, but ActiGraph was superior as it measured intensity of physical activity and was a more precise measure of time spent walking. The IPAQ does not appear to represent an accurate measure of physical activity in this population.
Background: The global incidence of type 1 diabetes is rising, and youths with type 1 diabetes co... more Background: The global incidence of type 1 diabetes is rising, and youths with type 1 diabetes continue to suffer poorer health than peers without diabetes. Evidence suggests youths with type 1 diabetes have physical activity (PA) levels well below the recommendations for health and have high levels of sedentary behaviour. An active lifestyle is therefore recommended to improve health. There is limited research showing effective lifestyle behaviour change in this population; therefore, an evidence gap exists between the need to promote physical activity in type 1 diabetes care and lack of understanding on how to do this. This protocol paper describes a feasibility and pilot study of the ActivPals programme-an intervention to support active lifestyles in youths with type 1 diabetes. Methods/design: Key intervention components have been identified from preliminary work (individual and family focus, peer mentoring, technology integration and improved communication and understanding) and are being developed into a pragmatic randomised controlled trial (RCT) supported by recruitment pathways. A steering group of health care professionals and managers will refine the intervention to patient needs. A pilot trial is providing data on intervention implementation, acceptability and feasibility. Twenty youths with type 1 diabetes are being recruited and randomised into an intervention or control group. Physical activity is being measured objectively using the Actigraph GT3X+ monitor at baseline and 1-month follow-up. Contextual factors associated with intervention delivery are being explored. Discussion: This study will contribute to the development of evidence-based, user-informed and pragmatic interventions leading to healthier lifestyles in youths with type 1 diabetes.
through professional networks and social media. The survey asked CPs to record their perceptions ... more through professional networks and social media. The survey asked CPs to record their perceptions on how often patients sought advice on several common sleep problems, as either 'very often' (most days), 'often' (1-3 times/week), 'occasionally' (1-3 times/month) or 'rarely' < once/month). Other areas included self-rated confidence dealing with requests on sleep problems (1-5 Likert scale: 1 being 'not confident' and 5 'confident'), estimated proportion of GPreferred requests for advice and the perceived need for community-based sleep-related services. Data analyses were descriptive. Results Completed responses were obtained from 120 CPs. Results summarised in figures 1 and 2. Combining 'often' and 'very often', the most common sleep-related problems encountered were insomnia (60%) and sleepiness/tiredness/fatigue (54%). Half the CPs self-rated their confidence as 3 on the 'confident-not confident' scale. Fifty-seven percent reported that they received no undergraduate training on sleep problems. Proposed pharmacist involvement in sleep screening/signposting services or a pharmacy-based intervention/referral programme was supported by 78% and 70% respectively. Fifty-eight percent of CPs were 'very often' or 'often' asked about symptoms of OSAS, with the majority (93%) asked 'occasionally'. Discussion CPs frequently encounter patients with symptoms of sleep disorders, but their confidence and training in dealing with these is lacking. This study highlights the need for specialist sleep training for pharmacists and the development of pharmacy-based services to support and improve patient outcomes.
Heart Rate Variability (HRV), and 6-minute walk test (6MWT). Nonparametric and parametric statist... more Heart Rate Variability (HRV), and 6-minute walk test (6MWT). Nonparametric and parametric statistics were used with p≤0.05. Data are mean (SD) or md (Q1,Q3) for self-report measures. RESULTS: In both MSD and C groups prior to BD, QOL correlated with FIS (rs =-0.63) and BDI (rs =-0.70). FIS correlated with BDI (rs = 0.72). HRV correlated with QOL (rs= 0.47) and BDI (rs =-0.56) but not with FIS. (rs =-0.32). No variables correlated with 6MWT. For the MSD group, HRV (pre = 31 (19) post = 38 (19) ms, p = 0.03) and 6MWT (pre = 432 (114) post = 462 (126) m, p = 0.03) increased. Of the self-report outcomes, BDI improved (pre= 9 (5,15) post = 4 (0,10), p = 0.04). There were no changes in any measured outcome for the C group. CONCLUSION: BD can lead to significant improvements in HRV and depression. Further, HRV but not 6MWT might mediate improvements in QOL through depression in pwMS. This study was supported by the Greater Milwaukee Foundation.
Little is known about the response of post‐partum women from deprived backgrounds to weight manag... more Little is known about the response of post‐partum women from deprived backgrounds to weight management interventions, however behavioural intervention trials in disadvantaged communities are often characterised by recruitment difficulties. Recruitment and retention is key to the robust conduct of an effective trial, and exploratory work is essential prior to a definitive randomised controlled trial. This paper describes strategies used to recruit to the WeighWell feasibility study, which aimed to recruit 60 overweight or obese post‐partum women living in areas of deprivation to a trial of a weight‐loss intervention. Recruitment strategies included the following: (1) distribution of posters and ‘business cards’; (2) newspaper advertisements; (3) visits to community groups; and (4) personalised letters of invitation sent via the National Health Service (NHS). Potential participants were screened for eligibility following response to a Freephone number. Body mass index was calculated u...
International Journal of Environmental Research and Public Health, Nov 4, 2021
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Background: Informal caregivers, or carers (unpaid family members and friends), are instrumental ... more Background: Informal caregivers, or carers (unpaid family members and friends), are instrumental to millions worldwide for the ongoing delivery of health and well-being needs. The risk of crisis points (eg, hospitalizations) for caregivers increases with the absence of physical activity. The COVID-19 pandemic is highly likely to have increased the risk of crisis points for caregivers by increasing the amount of time spent indoors due to shielding and lockdown restrictions. Thus, accessible evidence-based tools to facilitate physical activity for caregivers indoors are urgently needed. Objective: The aim of this study was to co-design and develop a novel mobile app to educate and support carers in the undertaking of regular physical activity at home during and beyond COVID-19 restrictions via integration of the transtheoretical model of behavior change and UK physical activity guidelines. Methods: We co-designed a mobile app, "CareFit," by directly involving caregivers, health care professionals, and social care professionals in the requirements, capturing, and evaluation phases of three Agile Scrum design and development sprints. Seven participants representing multistakeholder views took part in three co-design sessions, each of which was followed by a development sprint. Requirements for CareFit were grounded in a combination of behavioral change science and UK government guidelines for physical activity. Results: Participants identified different barriers and enablers to physical activity, such as a lack of time, recognition of existing activities, and concerns regarding safely undertaking physical activity. Requirements analysis highlighted the importance of simplicity in design and a need to anchor development around the everyday needs of caregivers (eg, easy-to-use video instructions). Our final prototype app integrated guidance for undertaking physical activity at home through educational, physical activity, and communication components. Conclusions: Integrating government guidelines with models of behavioral change into a mobile app to support the physical activity of carers is novel. We found that integrating core physical activity guidelines into a co-designed smartphone app with functionality such as a weekly planner and educational material for users is feasible. This work holds promise to fill the gap of effective physical activity solutions for caregivers both during and beyond the COVID-19 pandemic. Further work is now needed to explore the feasibility, acceptability, and usability of the approach in real-world settings.
A systematic review of physical activity and sedentary behavior intervention studies in youth wit... more A systematic review of physical activity and sedentary behavior intervention studies in youth with type 1 diabetes: study characteristics, intervention design, and efficacy. Pediatric Diabetes 2013. Objective: To systematically review physical activity and/or sedentary behavior intervention studies for youth with type 1 diabetes. Methods: Several databases were searched for articles reporting on randomized-controlled trials (RCTs) in youth (<18 yr) with type 1 diabetes. Data was extracted and bias assessed to evaluate study characteristics, intervention design, and efficacy of interventions on physical activity and health. Where sufficient data were available meta-analyses of health outcomes [for hemoglobin A1c (HbA1c)] were performed. Weighted mean differences (WMD) were calculated using fixed and random effect models. Results: The literature search identified 12/2397 full-text articles reporting on 11 studies. Two interventions were wholly unsupervised and only one was based on behavior change theory with no studies exploring changes in behavior processes. Nine interventions aimed to improve fitness or physical activity, two aimed to improve health, and none aimed at changing sedentary behavior. Eight interventions improved physical activity and/or fitness. At least one beneficial effect on health was found in each intervention group apart from two studies where no changes were found. Meta-analysis of 10 studies showed the interventions have a significant beneficial reduction of HbA1c (%), indicating an improvement in glycemic control [WMD, −0.85% (95% CI, −1.45 to −0.25%)]. There were insufficient data to pool other health outcome data. Conclusions: Few RCTs explored the efficacy of unsupervised theory-based physical activity and/or sedentary behavior interventions in youth with type 1 diabetes. Limited reporting made comparison of findings challenging. There was an overall significant beneficial effect of physical activity on HbA1c.
OBJECTIVE-To evaluate effect of exercise consultation on physical activity and resultant physiolo... more OBJECTIVE-To evaluate effect of exercise consultation on physical activity and resultant physiological and biochemical variables at 6 months in people with type 2 diabetes. RESEARCH DESIGN AND METHODS-A total of 70 inactive people with type 2 diabetes were given standard exercise information and were randomized to receive an exercise consultation (n ϭ 35) or not (n ϭ 35). Exercise consultation, based on the transtheoretical model, combines motivational theory and cognitive behavioral strategies into an individualized intervention to promote physical activity. Changes from baseline to 6 months were assessed in 1) physical activity (7-day recall, accelerometer, cardiorespiratory fitness, stage, and processes of change), 2) physiological variables (blood pressure and BMI), and 3) biochemical variables (HbA 1c , lipid profile, and fibrinogen). RESULTS-Between-group differences were recorded for the change in minutes of moderate activity (P Ͻ 0.001) and activity counts (P Ͻ 0.001) per week. Experimental participants recorded an increase in activity counts per week and minutes of moderate activity per week (P Ͻ 0.001). The control group recorded no significant changes. More experimental participants increased stage of change (2 ϭ 22.6, P Ͻ 0.001). Between-group differences were recorded for the change in total exercise duration and peak gradient (P Ͻ 0.005), HbA 1c (P ϭ 0.02), systolic BP (P ϭ 0.02), and fibrinogen (P ϭ 0.03). CONCLUSIONS-Exercise consultation increased physical activity and improved glycemic control and cardiovascular risk factors in people with type 2 diabetes.
Sedentary behaviours have been linked to poor health, independent of physical activity levels. Th... more Sedentary behaviours have been linked to poor health, independent of physical activity levels. The objective of this study was to explore an individualised intervention strategy aimed at reducing sedentary behaviours in older Scottish adults. This feasibility and pilot study was a pre-experimental (one group pretest-posttest) study design. Participants were enrolled into the study in January-March 2012 and data analysis was completed April-October 2012. The study was based in Glasgow, Scotland. Participants received an individualised consultation targeting sedentary behaviour incorporating feedback from an activPAL activity monitor. Outcome measures were objectively (activPAL) and subjectively measured (Sedentary Behaviour Questionnaire) sedentary time. Twenty four participants received the intervention. Objectively measured total time spent sitting/lying was reduced by 24 min/day (p=0.042), a reduction of 2.2%. Total time spent in stepping activities, such as walking increased by 13 min/day (p=0.044). Self-report data suggested participants achieved behaviour change by reducing time spent watching television and/or using motorised transport. Interventions to reduce sedentary behaviours in older people are urgently needed. The results of this feasibility and pilot study suggest a consultation approach may help individuals reduce time spent in sedentary behaviours. A larger, controlled trial is warranted with a diverse sample to increase generalisability.
In this article, we consider children's perceptions of their social and physical outdoor environm... more In this article, we consider children's perceptions of their social and physical outdoor environment in relation to their physical activity (PA) behaviour in Scotland, United Kingdom. Drawing from a pilot study, participants included three groups of children aged between ten and twelve of mixed gender (n=15). Visual and verbal representations of their perceived environment were analysed to assess environmental determinants of PA. Results found an absence of suitable play affordances, safety, parental restriction, and environmental aesthetics was a key factor to children spending time outdoors. Strengths and limitations of the study are discussed, as are implications for policy and practice.
This poster discusses exploring children’s perceptions of their social and physical environment i... more This poster discusses exploring children’s perceptions of their social and physical environment in relation to physical activity behaviour.
Background: Around two thirds of 5-18 year olds fail to meet physical activity (PA) recommendatio... more Background: Around two thirds of 5-18 year olds fail to meet physical activity (PA) recommendations. Children with Type 1 Diabetes (T1D) tend to be less active and more sedentary than non-diabetic peers. Research into motivations for PA in this population is lacking. Objective: To investigate motivating factors for PA in youth with T1D participating in a 4 week PA intervention (ActivPals study), to inform the practice of health care professionals promoting PA. Methods: Semi-structured interviews with participants and their parent (n=16) were carried out between May and July 2016. Following completion of the ActivPals intervention, participants who agreed to interview were recruited to this study. Interviews were recorded, transcribed verbatim and analysed thematically. Results: Factors contributing to motivation to participate in PA are presented as 6 key themes and 9 sub-themes. The 6 themes were: 'motivators related to health', 'enjoyment', 'selfefficacy', 'family and friends participating', 'contribution of 3 rd parties' and 'good weather'. Conclusion: Enjoyment was key to participation in PA and could be increased by goal setting and the involvement of friends and family. Education and support to manage diabetes for PA is crucial in developing self-efficacy to enable sustained behaviour change and HCPs play a key role in providing this support, as well as having the potential to be a motivating role model. Subjective improvement in blood glucose readings and psychological benefits were also acknowledged to provide motivation for further PA. These motivating factors should be applied in supporting children with T1D to engage in PA.
Physical activity is an important, but often underused, therapeutic strategy within diabetes care... more Physical activity is an important, but often underused, therapeutic strategy within diabetes care. To date, little is known about the best way to promote physical activity in diabetes care. Physical activity consultation is an intervention designed to promote physical activity behaviour change. This article provides guidelines on how to conduct a physical activity consultation with people who have Type 2 diabetes, and reviews the evidence surrounding the effectiveness of this intervention in this population. The trans-theoretical model is the underlying theory of behaviour change for the physical activity consultation intervention. The review identifies research which supports the use of this model for understanding physical activity behaviour in people with Type 2 diabetes. The review outlines a number of modifiable variables associated with physical activity behaviour change in this population. How each of these variables is addressed within the guidelines for conducting a physical activity consultation is identified. Finally, limited but consistent research highlights the effectiveness of physical activity consultation for promoting physical activity in people with Type 2 diabetes.
Aims/hypothesis. The aim of this study was to investigate the effectiveness of physical activity ... more Aims/hypothesis. The aim of this study was to investigate the effectiveness of physical activity counselling in promoting physical activity in people with Type 2 diabetes and to evaluate resultant physiological and biochemical effects. Methods. A total of 70 inactive people with Type 2 diabetes were given standard exercise information and randomised to receive physical activity counselling (n=35, experimental) or not (n=35, control). Physical activity consultations were delivered at baseline and after 6 months, with follow-up phone calls after 1, 3, 6 and 9 months. Changes from baseline after 6 and 12 months were assessed for physical activity (7-day recall and accelerometer), for physiological characteristics (body mass index and blood pressure) and for biochemical variables (HbA 1 c, lipid profile, fibrinogen, tissue plasminogen activator and microalbuminuria). Results. Significant differences between groups were recorded for physical activity after 6 and 12 months (p<0.01). The experimental group had increased levels of physical activity from baseline to 6 months (p<0.01), with no decrease from 6 to 12 months (p>0.05). In the control group, accelerometer counts per week decreased from baseline to 12 months (p=0.03). Between-group differences (p<0.05) were recorded for the change in HbA 1 c (experimental: 0.26% decrease; control: 0.15% increase), for systolic blood pressure (experimental: 7.7 mm Hg decrease; control: 5.6 mm Hg increase) and for fibrinogen (experimental: 0.28 mmol/l decrease; control: 1.43 mmol/l increase) from baseline to 6 months, and for total cholesterol (experimental: 0.33 mmol/l decrease; control: 0.04 mmol/l increase) from baseline to 12 months (p<0.05). No significant differences were recorded in other measured variables. Conclusions/interpretations. Physical activity counselling was effective in promoting physical activity in people with Type 2 diabetes. The counselling improved glycaemic control as well as the status of cardiovascular risk factors in these patients.
Uploads
Papers by Alison Kirk