Effects of a home-based physical training and activity promotion program in community-dwelling older persons with cognitive impairment after discharge from rehabilitation: A randomized controlled trial

Background Older people with cognitive impairment (CI) are at high risk for mobility limitations and adverse outcomes after discharge from geriatric rehabilitation settings. Study aim was to estimate the effects of a specifically designed home-based physical training and activity promotion program on physical capacity, different aspects of physical activity (PA), and psychosocial status. Methods Patients with mild-to-moderate CI (Mini-Mental State Examination [MMSE]: 17-26 points) discharged home after rehabilitation were included in this randomized, double-blind, placebo-controlled trial with a 12-week intervention and 12-week follow-up period. The intervention group performed a CI-specific, autonomous, home-based strength, balance and walking training supported by tailored motivational strategies to foster training adherence and promote PA. The control group participated in an unspecific motor placebo activity. Primary outcomes were physical capacity (Short Physical Performance Battery [SPPB]) and PA (sensor-based activity time). Results Among 118 randomized participants (82.3±6.0 years) with CI (MMSE: 23.3±2.4) and high levels of multi-morbidity, those participants undergoing home-based training demonstrated superior outcomes to the control group in SPPB (mean difference between groups 1.9 points; 95%-CI: 1.0-2.8; p<.001), with persistent benefits over the follow-up (1.3 points; 95%-CI: 0.4-2.2; p<.001). There were no differences in PA across any time points. Among secondary outcomes, fear of falling and activity avoidance behavior were reduced in the intervention group at all time points, life-space mobility improved short-term. Conclusions Study results demonstrate clinically important benefits of an individually tailored autonomous physical training and activity promotion program on physical capacity and secondary outcomes in different domains in a vulnerable, multi-morbid population.

Exercise medicine and physical activity promotion: core curricula for US medical schools, residencies and sports medicine fellowships: developed by the American Medical Society for Sports Medicine and endorsed by the Canadian Academy of Sport and Exercise Medicine

Regular physical activity provides a variety of health benefits and is proven to treat and prevent several non-communicable diseases. Specifically, physical activity enhances muscular and osseous strength, improves cardiorespiratory fitness, and reduces the risk of hypertension, coronary heart disease, stroke, type 2 diabetes, mental health disorders, cognitive decline and several cancers. Despite these well-known benefits, physical activity promotion in clinical practice is underused due to insufficient training during medical education. Medical trainees in the USA receive relatively few hours of instruction in sports and exercise medicine (SEM). One reason for this shortage of instruction is a lack of curricular resources at each level of medical education. To address this need, the American Medical Society for Sports Medicine (AMSSM) assembled a group of SEM experts to develop curricular guidance for exercise medicine and physical activity promotion at the medical school, residency and sports medicine fellowship levels of training. After an evidence review of existing curricular examples, we performed a modified Delphi process to create curricula for medical students, residents and sports medicine fellows. Three training level-specific curricula emerged, each containing Domains, General Learning Areas, and Specific Learning Areas; options for additional training and suggestions for assessment and evaluation were also provided. Review and comment on the initial curricula were conducted by three groups: a second set of experts in exercise medicine and physical activity promotion, sports medicine fellowship directors representing a variety of fellowship settings and the AMSSM Board of Directors. The final curricula for each training level were prepared based on input from the review groups. We believe enhanced medical education will enable clinicians to better integrate exercise medicine and physical activity promotion in their clinical practice and result in healthier, more physically active patients.

Modelling decay in effectiveness for evaluation of behaviour change interventions: a tutorial for public health economists

Background and purpose Recent methodological reviews of evaluations of behaviour change interventions in public health have highlighted that the decay in effectiveness over time has been mostly overlooked, potentially leading to suboptimal decision-making. While, in principle, discrete-time Markov chains—the most commonly used modelling approach—can be adapted to account for decay in effectiveness, this framework inherently lends itself to strong model simplifications. The application of formal and more appropriate modelling approaches has been supported, but limited progress has been made to date. The purpose of this paper is to encourage this shift by offering a practical guide on how to model decay in effectiveness using a continuous-time Markov chain (CTMC)-based approach. Methods A CTMC approach is demonstrated, with a contextualized tutorial being presented to facilitate learning and uptake. A worked example based on the stylized case study in physical activity promotion is illustrated with accompanying R code. Discussion The proposed framework presents a relatively small incremental change from the current modelling practice. CTMC represents a technical solution which, in absence of relevant data, allows for formally testing the sensitivity of results to assumptions regarding the long-term sustainability of intervention effects and improving model transparency. Conclusions The use of CTMC should be considered in evaluations where decay in effectiveness is likely to be a key factor to consider. This would enable more robust model-based evaluations of population-level programmes to promote behaviour change and reduce the uncertainty surrounding the decision to invest in these public health interventions.

Economic Models of Community-Based Falls Prevention: A Systematic Review With Subsequent Commissioning And Methodological Recommendations

Background: Falls impose significant health and economic burdens among older populations, making their prevention a priority. Health economic decision models can inform whether the falls prevention intervention represents a cost-effective use of resources and/or meet additional decisional objectives such as reducing social inequities of health. This study aims to conduct a systematic review (SR) of community-based falls prevention models to: (i) systematically identify such models; (ii) synthesise and critically appraise the modelling methods/results; and (iii) formulate methodological and commissioning recommendations.Methods: The SR followed the PRISMA guideline, covering the period 2003-2020, 12 academic databases and grey literature. A study was included if it: targeted community-dwelling persons aged 60 and over and/or aged 50-59 at high falls risk; evaluated intervention(s) designed to reduce falls or fall-related injuries; against any comparator(s); reported outcomes of economic evaluation; used decision modelling; and had English full text. Extracted data fields were grouped under higher categories: (A) model and evaluation overview; (B) falls epidemiology features; (C) falls prevention intervention features; and (D) evaluation methods and outcomes. A checklist for falls prevention economic evaluations assessed reporting/methodological quality. Extracted fields were narratively synthesised and critically appraised to inform methodological and commissioning recommendations. The SR protocol is registered in the Prospective Register of Systematic Reviews (CRD42021232147).Results: 46 models were identified. The most prevalent issue according to the checklist was non-incorporation of all-cause care costs. Based on general population, lifetime models conducting cost-utility analyses, seven interventions produced favourable ICERs relative to no intervention under the cost-effectiveness threshold of £30,000 per QALY gained; of these, results for (1) combined multifactorial and environmental intervention, (2) physical activity promotion for women, and (3) targeted vitamin D supplementation were from validated models. Decision-makers should explore the transferability and feasible reaches of these interventions in their local settings. There was some evidence that exercise and home modification exacerbate existing social inequities of health. Sixteen methodological recommendations were formulated from critical appraisal.Conclusion: There is significant methodological heterogeneity across falls prevention models. This SR’s appraisals of modelling methods should facilitate the conceptualisation of future falls prevention models. Its synthesis of evaluation outcomes could inform commissioning.

Physical Activity Promotion Programmes in Childhood Cancer Patients and Their Impact on Fatigue and Pain: A Systematic Review

Cancer is one of the main causes of death in children, however, the techniques and interventions applied allow the cure of 80% of diagnosed cases. The aim of this review was to determine the benefits of a health and physical activity promotion programme to reduce pain and fatigue symptoms in children and adolescents with cancer. The databases PubMed, Embase, Scopus, Cochrane, Web of Science and PEDro were searched between December 2020 and January 2021 to elaborate this review, using the keywords child, cancer, exercise, fatigue and pain. The review was preregistered in PROSPERO (ID CRD42021262183). Six studies, out of 937 identified at baseline, were finally included in the review: four randomised controlled trials and two quasi-experimental studies. The total sample size of all the included studies was of 474 participants with very different types of cancer and evolution, and outcome variables were pain, fatigue, physical activity level, self-efficacy and quality of life. A health and physical activity promotion programme seems to improve fatigue in paediatric cancer patients and survivors, but no significant results were found related to pain.

Non-Inferiority of a Group LiFE Version Compared to the Original, Individual LiFE to Prevent Falls

The ‘Lifestyle-integrated Functional Exercise’ (LiFE) program has been shown to reduce risk of falling via improvements in balance and strength while increasing physical activity in older adults. Its one-to-one delivery comes with considerable costs hampering large scale implementability. To potentially reduce costs, a group format (gLiFE) was developed and analyzed for its non-inferiority to LiFE in reducing activity-adjusted fall incidence after 6 months. Further, intervention costs and physical activity were analyzed. Older adults (70+ years) at risk of falling were included in this multi-centre, single-blinded, randomized non-inferiority trial. LiFE was delivered in nine intervention sessions to increase balance, strength, and physical activity, either in a group (gLiFE) or at the participant’s home (LiFE). 309 persons were randomized into gLiFE (n=153) and LiFE (n=156). Non-inferiority for activity-adjusted falls was inconclusive; the incidence risk ratio (IRR) of gLiFE was 1.350 (95% CI: 0.856; 2.128) at 6 months. Falls were largely reduced in both groups. Physical activity was superior in the gLiFE group (gLiFE +880 steps; CI 252, 1,509) which also had a cost advantage under study conditions as well as real world estimations. GLiFE was associated with lower intervention costs, making it a cost-efficient alternative to the individually delivered LiFE. The added value of gLiFE is the greater effect on physical activity, making it particularly attractive for large scale PA promotion in public health concepts. Depending on individual needs and preferences, both formats could be offered to individuals, with a greater focus on either fall prevention (LiFE) or physical activity promotion (gLiFE).

The Effect of a Virtual Reality Delivered Physical Activity Intervention on the Physical Function of Older Adults

COVID-19 public health recommendations have prohibited many older adults from attending in-person physical activity (PA) programs that improve physical function and promote functional independence. Most PA programs have shifted towards a video conference (VC) format, but this modality has been noted to “flatten” the social experience which is fundamental for lasting behavior change. Virtual reality (VR) is now designed for immersion and place-presence and may be better suited for instilling a feeling of social connection, which will likely improve physical function. The purpose of this study was to evaluate differences in physical function after a 4-week in-home VR or VC based PA intervention. Low-active adults (66.8±4.8 years) were randomized to VR (n=5) or VC (n=4) based PA counselling and instructed to find activities that were intrinsically motivating. VR participants were asked to select pre-approved available active games in addition to enjoyable real-world activities. ANCOVA models were used to explore group differences in six-minute walk distances across time. Results are reported using η^2 effect sizes based on the small sample size. After controlling for baseline values, the ANCOVA models revealed a moderate-to-large magnitude effect for distance traveled during the six-minute walk test (η^2=.10). Additionally, the VR group participants walked 42.63 meters further, which approaches a clinically meaningful difference. These promising early findings suggest there is value to exploring the impact of VR-delivered, group-mediated activity promotion on physical functioning in older adults. Future research should investigate aspects of VR that promote increased social connection and physical function in the older adult population.

Cross-cultural comparison of fundamental movement skills in 9- to 10-year-old children from England and China

The present study aimed to examine cross-cultural differences in fundamental movement skills (FMS) proficiency levels in children aged 9–10 years old in England and China, using a process-oriented FMS measurement. Four FMS (run, jump, throw, catch) were measured using the Test of Gross Motor Development-2 (TGMD-2). The sample consisted of 272 (58.3% boys, 41.7% girls) Chinese children and 273 (48.7% boys, 51.3% girls) English children. ANCOVA analysis for the raw FMS scores showed significant sex by country interaction ( P = .022, partial η2 = .01). Chinese children scored higher than English children on total FMS, locomotor, and object control skill subsets. Additional Chi-squared analyses revealed significant differences regarding mastery levels of skills, with a higher proportion of Chinese children being classified as having advanced skill proficiency across three of four selected FMS (i.e. run, throw, and catch). The substantial cross-cultural differences found may be related to aspects such as Physical Education (PE) provision and process, educational policy, and other physical activity opportunities (e.g. extracurricular organised sports). Our findings require further examination of the contextual influences, in order to understand the optimal strategies that promote children's FMS development through PE, youth sports, or physical activity promotion.