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.

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).

Teachers' Perspectives on the Acceptability and Feasibility of Wearable Technology to Inform School-Based Physical Activity Practices

Background: Many children are not engaging in sufficient physical activity and there are substantial between-children physical activity inequalities. In addition to their primary role as educators, teachers are often regarded as being well-placed to make vital contributions to inclusive visions of physical activity promotion. With the dramatic increase in popularity of wearable technologies for physical activity promotion in recent years, there is a need to better understand teachers' perspectives about using such devices, and the data they produce, to support physical activity promotion in schools.Method: Semi-structured interviews were conducted with 26 UK-based primary school teachers, exploring their responses to children's physical activity data and their views about using wearable technologies during the school day. Interview discussions were facilitated by an elicitation technique whereby participants were presented with graphs illustrating children's in-school physical activity obtained from secondary wearable technology data. Interview transcripts were thematically analyzed.Results: Most teachers spoke positively about the use of wearable technologies specifically designed for school use, highlighting potential benefits and considerations. Many teachers were able to understand and critically interpret data showing unequal physical activity patterns both within-and between-schools. Being presented with the data prompted teachers to provide explanations about observable patterns, emotional reactions—particularly about inequalities—and express motivations to change the current situations in schools.Conclusion: These findings suggest that primary school teachers in the UK are open to integrating wearable technology for measuring children's physical activity into their practices and can interpret the data produced by such devices. Visual representations of physical activity elicited strong responses and thus could be used when working with teachers as an effective trigger to inform school practices and policies seeking to address in-school physical inactivity and inequalities.

Physical activity promotion in an urban district: Analyzing the mechanisms of interorganizational cooperation

Past research has identified the importance of cooperation among community-based organizations from different sectors to address public health problems such as insufficient physical activity. However, little is known about how and why interorganizational cooperation occurs. The present study sought to analyze the structure and emergent patterns of interorganizational cooperation within a network promoting physical activity based in an urban district neighborhood of a city in Southwestern Germany. Survey data on cooperative relations among 61 network organizations and organizational attributes (e.g., possession of sport facilities) were collected. Social network analysis was applied to examine network properties and exponential random graph models were estimated to test hypotheses concerning mechanisms and conditions of cooperative tie formation. The results show that the network of cooperation is sparse but characterized by a tendency for cooperation to occur in triangular structures. Other significant mechanisms of cooperative tie formation are preferential attachment, with the community department for education and sports being the most central network actor, and heterophily regarding the cooperation of organizations from different sectors. This study provides valid and reliable findings on conditions of network formation and significant mechanisms of interorganizational cooperation in the field of physical activity promotion. Knowledge about these mechanisms can help to manage networks effectively and efficiently and reveal potentials for improvement and intensification of interorganizational cooperation in both the present and other research areas of health promotion.

Validity of the Perceived Physical Ability Scale for Children: An Actigraphic Study

This study aimed to provide evidence of the validity of the Perceived Physical Ability Scale for Children against an external-objective criterion of the 24 h motor activity pattern assessed through actigraphy. A total of 107 children (60 females; mean age 10.25 ± 0.48) were originally enrolled. Children wore the actigraph model Actiwatch AW64 (Cambridge Neurotechnology Ltd., Fenstanton, UK) for seven days, 24 h per day, around the non-dominant wrist. At the beginning of the actigraphic recording, participants filled in the Perceived Physical Ability Scale for Children. Functional Linear Modeling was used to examine variation in the 24 h motor activity pattern according to the total score in the Perceived Physical Ability Scale for Children. Higher physical self-efficacy was significantly related to greater levels of motor activity in the afternoon. Overall, this pattern of results supports the validity of the Perceived Physical Ability Scale for Children against the external-objective criterion of the 24 h motor pattern. The Perceived Physical Ability Scale for Children could represent a promising endpoint for studies assessing the effectiveness of physical activity promotion interventions.

Older Public Housing Tenants’ Capabilities for Physical Activity Described Using Walk-Along Interviews in Montreal, Canada

Older public housing tenants experience various factors associated with physical inactivity and are locally dependent on their environment to support their physical activity. A better understanding of the person-environment fit for physical activity could highlight avenues to improve access to physical activity for this subgroup of the population. The aim of this study was to evaluate older public housing tenants’ capabilities for physical activity in their residential environment using a socioecological approach. We conducted individual semi-structured walk-along interviews with 26 tenants (female = 18, male = 8, mean age = 71.96 years old). living in housing developments exclusively for adults aged 60 years or over in three neighborhoods in the city of Montreal, Canada. A hybrid thematic analysis produced five capabilities for physical activity: Political, financial, social, physical, and psychological. Themes spanned across ecological levels including individual, public housing, community, and government. Tenant committees appear important to physical activity promotion. Participants called for psychosocial interventions to boost their capability for physical activity as well as greater implication from the housing authority and from government. Results further support a call for intersectoral action to improve access to physical activity for less affluent subgroups of the population such as older public housing tenants.