Purpose: A gap remains between availability and dissemination of evidence-based physical activity (PA) policies and interventions, and application in “real world” settings. There is a need to better understand the meaning of research impact and whether the research on PA that is widely cited or popular in media (e.g., high Altmetric scores) is also translated into policy. The present study aims to describe highly cited and high altmetric publications in PA research and explore their impact on PA policy and practice.

 

Methods: A review was conducted to collect both the top 100 highly cited and high altmetric publications with “physical activity” and “physical inactivity” in the title from the last ten years. Descriptive information included: 1.Study design; 2.Study population; 3.Age group; 4.Type of PA study (Measurements/trends; correlates/determinants; health outcomes; interventions; and policy); 5.Implications (use in local/regional/global policy proposals/laws/regulations) and, 6.Number of citations or Altmetric score. From the top 100 highly cited/high altmetrics publications, the top three first authors overall, in interventions, and in policy were asked to interview on research dissemination and implications on PA policy and practice. 

 

Results: For publication type, the most frequent for highly cited work were health consequences (40%, altmetrics=42%); followed by measurement/trends (23%, altmetrics=10%), correlates/determinants (21%, altmetrics=26%), policy (11%, altmetrics=5%), and interventions (5%, altmetrics=17%). When examining study design for highly cited publications, cross sectional studies had the most publications (87%, altmetrics=42%); followed by systematic reviews (38%, altmetrics=18%), longitudinal (8%, altmetrics=40%), and experimental (5%, altmetrics=17%). Interviews highlighted inadequate capacity for dissemination (e.g., funding, training, resources), journal bias, and lack of incentives as barriers. Individual behaviors (e.g., social media use, networking, training) and perspectives were also important in dissemination efforts.

 

Conclusions: Overall, most study designs tend to be observational. However, high altmetric publications had more representation of experimental studies. Both groups had little representation of policy and intervention publications, highlighting a barrier to dissemination as observational studies may be informing policy and practice. Building capacity for research dissemination and putting mechanisms in place (e.g., incentives to disseminate beyond journal publication) that support dissemination may help to produce research that has more direct implications for policy and practice.

Purpose: Diet and exercise have been identified as the cornerstones in reversing frailty/pre-frailty. This study aims to investigate perspectives on diet and exercise in frail/pre-frail older adults, before, during and after hospitalization.



Methods: A qualitative study on perspectives of diet and exercise, before, during and post- hospitalization, using semi-structured interviews was conducted. A total of 22 frail or pre-frail older adults aged 67 – 90 years (mean age, 80.6 years; female 41%; living alone 41%; body mass index, 27.2kg/m2) admitted to the acute medical unit at a tertiary hospital in South Australia, were interviewed. Sessions were audio-recorded, transcribed verbatim and analyzed thematically.



Results: The perspectives of the participants’ own diet prior to hospitalization were grouped into seven themes: preference for home-cooked food over takeaway; energy-balanced meals; a variety of food groups; emphasis on particular food group(s); three regular meals; minimal discretionary foods; and professionally pre-made meals. The following were identified as components of an ideal diet for older adults: energy-balanced meals; sufficient protein; sufficient hydration; plant-based; use of whole foods; dietitian planned, and professionally pre-made meals. Participants described a lack (defining exercise as household chores and stretching) or range of exercises prior to admission: walking, strength-training, self-guided and group. Regular walking and golfing were described as ideal exercise routines. During hospitalization, participants noticed a difference in the taste of food served. There were also feelings of unfamiliarity in the type of food, and reduced variety and quantity compared to what is served at home. Participants also described a wide range of changes in exercise during hospitalization, from complete bed rest to increased exercise from baseline. Post-hospitalization, participants anticipated an improvement diet adequacy and quality. The general consensus for exercise were initiation of home exercise services or physiotherapy, increased exercise intensity, and exercising with mobility aids if necessary.

Conclusion: This research revealed important viewpoints pertaining to diet and exercise that can inform future interventions for frail/pre-frail older adults both in hospital and on discharge home.

Purpose: Osteoarthritis (OA) is a highly prevalent degenerative joint disorder, leading to significant disability in daily life. Previous studies have demonstrated that lifestyle modifications (e.g. increasing physical activity levels and weight reduction) result in reduced pain and improved physical functioning. However, lifestyle interventions (LIs) are currently underutilized in the conservative treatment of OA. Some research has been conducted among healthcare professionals (HCPs) on the implementation of LIs in their daily practice, however, a systematic overview of barriers and facilitators is still lacking. Therefore, this scoping review aimed to provide an overview of factors affecting the implementation of LIs within hip and/or knee OA care as perceived by HCPs.

Methods: A scoping review was conducted. The databases PubMed, Embase, CINAHL, PsycINFO and the Cochrane Library were searched up to January 2021. Primary research articles with a quantitative, qualitative or mixed-methods design were eligible for inclusion if they reported: (1) perceptions of primary and/or secondary HCPs; (2) on implementing LIs with physical activity and/or weight management as key components; (3) on conservative management of hip and/or knee OA. Barriers and facilitators were extracted by two researchers independently and linked to a framework based on the Tailored Implementation for Chronic Diseases checklist.

Results: Thirty-six articles were included. In total, 809 factors were extracted and subdivided into nine domains. Extracted barriers were mostly related to non-optimal interdisciplinary collaboration, patients’ negative attitude toward LIs, patients’ low health literacy, and HCPs’ lack of knowledge and skills around LIs or promoting behavioral change. Extracted facilitators were mostly related to good interdisciplinary collaboration, a positive perception of HCPs’ own role in implementing LIs, the content or structure of LIs, and HCPs’ positive attitude toward LIs.

Conclusions: Multiple individual and environmental factors influence the implementation of LIs by HCPs in patients with hip and/or knee OA. The resulting overview of barriers and facilitators can guide future research on the implementation of LIs within OA care. To investigate whether factor frequency is related to the relevance of each domain, further research should assess the relative importance of the identified factors involving all relevant disciplines of primary and secondary HCPs.

Purpose: Mobility underpins many features of positive ageing for community-dwelling older adults and is often considered differently depending on the approach taken to collecting and interpreting data. We extended our recent scoping review on ‘conceptualising positive ageing’ to explore the role of mobility (defined as meaningful movement within/across an environment) in positive ageing. Furthermore, we separately considered closed/validatory (etic) and open/exploratory (emic) approaches to exploring positive ageing and mobility.

Methods: Our scoping review process was guided by Arksey and O’Malley’s framework. We systematically searched six electronic databases (CINAHL, Embase, Web of Science Core Collection, Medline, Scopus, PsycINFO) and articles included in seven relevant reviews. Articles meeting all general (English language; peer-reviewed primary study; conceptualising positive ageing for community-dwelling adults ≥65 years) and specific (incorporating mobility) inclusion criteria were included. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Extracted mobility characteristics were grouped according to ‘implied mobility’ (i.e., activities where physical movement was likely involved, but not specified) and/or ‘realised mobility’ (activities where physical movement was involved). Data will be analysed descriptively and thematically following the six-step reflexive thematic analysis approach of Braun and Clark (2006).

Results: Of 2,416 retrieved articles (duplicates removed), 39 articles incorporated positive ageing and mobility (24 etic, 14 emic, 1 etic/emic combination). Methodological quality ranged from low to high. Mobility was predominantly presented as an ‘implied’ concept, often involving employment, community/social engagement, and caregiving activities – although the emphasis on specific activities differed across etic and emic perspectives. Our preliminary thematic analysis of ‘realised mobility’ highlighted complexity within/across etic and emic perspectives. ‘Realised mobility’ extended beyond physical movement, had an underlying health focus and imperative to be mobile, and involved active intention to use/adapt resources to support meaningful interaction and engagement.

Conclusions: Implied and realised mobility illustrate the unique role of physical movement in supporting positive ageing. Realised mobility is complex and involves a range of contributing factors and intentions. Etic and emic approaches present unique and complementary perspectives. Ultimately, this knowledge can inform research and policy initiatives to create enriching environments for positive ageing and meaningful mobility.

 

Purpose: The ubiquity of energy-dense, nutrient-poor discretionary foods in large servings and packages may have distorted the portion size norm (defined as the perception regarding how much of a given food people choose to eat in one eating occasion), resulting in unconscious overconsumption. An overview of existing portion size norms for discretionary foods has yet to be established. The aim of this systematic review was to examine the portion size norm of discretionary foods and drinks, and methodologies used to assess the norm.

Methods: Primary peer-reviewed studies investigating the portion size norm of discretionary food and drinks were included. The search was conducted in six selected databases including Medline, CINAHL, Embase, Emarald, PsycInfo, and Scopus following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The risk of bias assessment was performed using the Joanna Briggs Institute (JBI) critical appraisal checklists for the appropriate study design.

Results: After screening 7416 articles, 32 articles (comprising of 31 quantitative studies and seven qualitative studies) were eligible. All included studies were from high-income western countries and most studies were conducted in a single setting. The most examined discretionary food types were packaged potato crisps and confectionery, with normal portion sizes varying from 27-64 g for crisps (n=7), and 15-72 g for confectionery (n=6), based on studies using validated tools. Reviewed studies differed considerably in their design including the setting, selected food type, food presentation, the articulated questions, and the range and number of displayed serving size options  participants could choose. The quality of reviewed studies was mixed (three low risk of bias, 22 fair risk of bias, 13 high risk of bias); portion size assessment tasks were not validated in 11 of 31 quantitative studies.

Conclusions: A wide range of portion sizes could be considered normal but there is lack of consistency and validation in terms of portion size tasks adapted to assess portion size norms. Large variations in food presentation and displayed serving size options was observed across studies. Further high-quality evidence using pre-piloted, validated tools are needed to accurately assess the portion size norm of discretionary foods.

Purpose: Sedentary behaviour is a known independent contributor to preventable chronic conditions in adults. Office-based workers spend most of their awake time sitting during working hours, suggesting a high likelihood of cardiometabolic diseases. Given the paucity of data in the South African setting, this study aimed to understand sedentariness during the occupation time among a sample of office-workers and to determine the correlation between sitting time and cardiometabolic risk factors associated thereof.

Methods: A cross-sectional study was conducted on adult South African office-based workers. Participant biomarkers such as age, gender, anthropometry, blood pressure, glucose, glycated haemoglobin (HbA1c) and lipid profiles were collected. Sedentary behaviour during work hours was measured as the amount of time sitting at work, and breaking sitting time while at work using the sit-q-7d questionnaire.

Results: Descriptive statistics for participants mean; age (36.9 ±8.7), BMI (23.5 ±5.7), random glucose (6.2 ±1.9) and HbA1c (6.1 ±1.5). Interrupting sitting time showed a positive association with waist circumference (r = 0.24; p = 0.046), systolic blood pressure (r = 0.25; p = 0.038), and diastolic blood pressure (r = 0.27; p = 0.021). No other significant correlation was identified.

Conclusions: Sedentary behaviour is a health risk among workers, as such, the workplace remains an ideal setting for interventions to interraupt sitting time.

Purpose: The present work seeks to provide insights for the design of communication strategies to reduce discretionary salt consumption (i.e., salt added during cooking or at the table), a major source of dietary sodium in Uruguay. Its aims were to: (i) explore the automatic mental associations raised by salt and (ii) co-create potential messages for a communication intervention to reduce discretionary salt usage at the population level.  

Methods: An online study was conducted in Uruguay using a non-probabilistic sample of 581 participants, recruited using an advertisement on Facebook and Instagram. Participants were first asked to write down the first words that came to their mind when thinking of salt. Then, they answered a questionnaire on discretionary salt consumption patterns and a series of open-ended questions to provide ideas for the development of a communication campaign to reduce the use of discretionary salt. In addition, two co-creation workshops involving designers, communicators, nutritionists, and general population were held in two different cities in the country. 

Results/findings: Results revealed that the most frequent associations elicited by salt were related to negative health effects (41.5%), being hypertension the most frequently mentioned (76% of the responses within this category). This result suggests that participants were already aware of the negative health consequences of excessive sodium consumption. Only 8% of participants self-reported consuming an excessive amount of salt, suggesting the need to increase perceived susceptibility of potential health problems associated with excessive sodium intake. The Health Belief Model was used as the theoretical framework to code participants’ ideas on messages to reduce discretionary salt usage. Three dimensions were identified: highlighting benefits (e.g., increasing life expectancy and rediscovering the natural taste of food); bringing down barriers and improving self-efficacy towards sodium reduction (e.g., promoting the use of species); and increasing risk perception (with emphasis on the severity). These results were used in the workshops to create sketches of messages (image and text) for communication strategies, focused on promoting alternatives to salt and raising perceived susceptibility.

Conclusions: Valuable insights for the development of well-informed communication strategies to reduce discretionary salt consumption were gathered.

Purpose: Lifestyle behaviour interventions focusing on changing diet or physical activity (PA) are key to promoting long term health and reducing the burden of disease. However, adherence to dietary or PA recommendations during and after these programs is low. To date, no work has consolidated the facilitators and barriers to lifestyle intervention adherence participants experience. Therefore, the purpose of this systematic review was to qualitatively explore participant perceived barriers and facilitators to lifestyle intervention adherence. 

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, five electronic data bases (i.e., Google Scholar, Cochrane Reviews, Medline, PubMed, and Web of Science) were searched from 2005 to 2020. Only qualitative studies assessing participant perceived barriers and/or facilitators to adherence were considered. For this review, lifestyle interventions included those focused on changing diet and/or PA related behaviours to improve eating, exercise, or weight loss. All studies were conducted in adults (>18 years) living without a mental or physical impairment. Similar themes across studies were grouped together into individual, environmental and intervention level facilitators/barriers.  

Results: Fifty papers were included. At the individual level, possessing health literacy, positive attitudes towards intervention guidelines (e.g., prescribed foods or PA exercises) or perceived ease of incorporation facilitated adherence to the intervention. Barriers included a lack of clarity on how intervention recommendations affected personal health or unwillingness to change behaviours. Environmental barriers included financial, access to unhealthy foods and poor neighbourhood walkability. Social interactions within the home acted both as a facilitator and as a barrier at this level. At the intervention level, personalizing intervention guidelines (e.g., picking type of PA), having clear guidelines and inclusion of social interactions embedded within interventions (e.g., group exercise sessions, or intervention ‘coaches’) facilitated adherence. Conversely, interventions that were time intensive, rigid in delivery or provided no opportunities for personalization were viewed as harder to adhere to. 

Conclusions: Greater adherence to lifestyle interventions may promote maintained adoption of dietary or PA behaviours with health benefits. This includes incorporating theoretical underpinnings that support development of skills necessary for behaviour change (e.g., knowledge), social companionship and personalization of intervention guidelines. 

Purpose: Recent studies have shown that the prevalence of mental illness is on the rise within the college aged population. Mental health is a wide range of conditions that affect mood, behavior and thought with the most common types consisting of depression, anxiety, and increased stress. Mental health problems can impact a variety of lifestyle factors, including eating behaviors. Therefore, the purpose of this study was to determine the association between mental health and eating styles among college students. 

Methods: Data was collected in the Fall of 2021 by inviting currently enrolled students to participate in an online survey via Qualtrics. The survey measured depression using the Patient Health Questionnaire (9-Item), stress using the Generalized Anxiety Disorder-7 Item (GAD-7), stress using Cohen’s Perceived Stress Scale-10 Item (PSS-10), and eating styles using the Three Factor Eating Questionnaire (TFEQ) which contains subscales of cognitive restraint, emotional eating and uncontrolled eating. Descriptive statistics were computed for all variables and One-Way ANOVA was used to determine differences in mean eating styles scores among different levels of depression, anxiety, and stress. 

Results: Respondents (N=1645) had a 13.5 % prevalence of moderately severe depression and 9.7% prevalence of severe depression. The prevalence of moderate anxiety was 21.3% and 18.0% for severe anxiety. High stress impacted 20.3% of respondents. One-Way ANOVA analysis revealed that respondents with severe depression had significantly higher scores in cognitive restraint eating, emotional eating and uncontrolled eating (p<.0001). Individuals with severe anxiety had significantly higher scores in cognitive restraint eating, emotional eating and uncontrolled eating (p<.0001). The data further revealed that individuals with high stress reported significantly higher scores in cognitive restraint eating, emotional eating and uncontrolled eating (p<.0001).  

Conclusions: These results suggest that individuals suffering from mental health disorders such as depression, anxiety, and/or stress may also be engaging in unhealthy eating styles. Determining the association between mental health and eating styles will allow for specific nutrition education and food resources to be available for those with depression, anxiety, and/or stress. 

Human nutrition significantly contributes to greenhouse gas emissions worldwide, while the climate impact differs substantially between foods and nutritional styles. The carbon footprint of products is a way to inform consumers about the ecological impact of their food choices. The current research investigated the provision of that information to customers in corporate catering services.

The carbon footprint of all dishes in a corporate catering service was calculated and displayed at three canteens for a period of two weeks. As a control, the same menu had been offered earlier in a control period without providing the information. Sales numbers were collected and compared between control and intervention period. In addition, the initiative was evaluated among customers using a questionnaire.

Carbon footprints of the offered dishes varied between 305 g and 7087 g carbon dioxide equivalents. A vast majority of the customers evaluated the provision of the information positively. While only 30% of survey participants indicated that the information did not influence their choice of a dish, the differences in sales between control and intervention period are inconclusive. Over the two-week period, the average carbon footprint did not differ significantly, and the number of lower carbon footprint dishes did not increase significantly and neither did the number of high carbon footprint dishes.

As consumers show positive attitudes towards sustainability information such as the carbon footprint of food products, further research is needed to learn under which conditions this information impacts consumer behaviour. The results do not indicate the provision of the carbon footprint to be a promising and effective intervention to substantially shrink the climate impact of a corporate catering service compared to other methods, such as nudges or a shift on the supply side, for instance by changes in offered dishes and recipes or monetary incentives.

Purpose: The aim of this review was to review and synthesize existing literature analyzing demographic, psychological and behavioral determinants of sustained adherence to physical exercise in health clubs. 

Methods: This review included quantitative studies that report these determinants, published between 2010 and 2021, with adult population. Clinical trials and reviews published in peer-reviewed scientific journals and written in Portuguese, English and Spanish, and indexed in PubMed database, were included. 

Results: A total of 461 articles were selected through keyword combination and two were added by manual search. Seven studies were included in this review, including a sample of 1051 participants. Of the selected studies, one was cross-sectional study, one longitudinal, three uncontrolled clinical trials, and two randomized controlled trials. The identified determinants were categorized into demographic determinants, psychological determinants and behavioral determinants. 

Conclusions: Motivation was the psychological determinant most often studied and with the highest score of positive associations, followed by the notion of health and well-being. In the behavioral determinants, habits, past behavior and intention seem to predict sustained adherence to physical exercise in a health club context.

Purpose: Dietary modification is a key therapy for patients with cardiovascular diseases (CVDs); however dietary nonadherence is often a challenge, placing burden on the healthcare system. Evidence suggests that mHealth interventions may be effective for supporting CVD patients in following dietary prescriptions. The aim of this study was to conduct a systematic review to determine if the use of diet-focused mHealth interventions are effective for supporting patients with CVDs in adhering to dietary recommendations.

Methods: Literature searches were conducted in the Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane, CENTRAL, CINAHL, Ovid PsycINFO, Scopus, Web of Science, and ProQuest Dissertations & Theses Global databases, from June to September 2021. Randomized controlled trials (RCTs) and non-randomized experimental studies were included if participants were ≥18 years old, had a CVD diagnosis, tested an mHealth intervention, and measured dietary adherence. Studies were excluded if the intervention involved open two-way communication, or were qualitative studies or systematic reviews. Two independent reviewers conducted screening and risk of bias assessments.

Results/Findings: After removal of duplicates, 2011 studies were identified and underwent title and abstract screening. Fifty articles underwent full text screening; 13 studies were included in the systematic review: 10 RCTs and 3 non-randomized studies, ranging from 1 to 12 months in duration. The mHealth interventions assessed included text messages (n=5), apps (n=4), a combination of texts and apps (n=1), e-mails (n=1), and websites (n=2). Studies tested the effects of these mHeath interventions on intake of specific foods/nutrients (e.g., vegetable, fruit, and sodium) (n=10), the DASH diet (n=2) and Mediterranean diet adherence (n=1). Five studies assessed blood pressure (n=5). Most studies (n=8) showed that patients who used mHealth interventions had significantly improved adherence to diet recommendations; others showed mixed results (n=3) or no support for the intervention (n=2). Overall, 5 studies had low risk of bias, 3 had some concerns, and 5 had high risk of bias.

Conclusions: mHealth interventions have a primarily positive effect on dietary adherence among patients with CVD. However, due to the risk of bias identified within the included studies, caution is advised when applying these findings to clinical settings for patients with CVD.

Introduction: Physical activity is important for children’s healthy growth and development; however, few children meet recommended levels of physical activity. A potential area for intervention is via encouraging more walking and playing with the family dog. Despite many families owning a dog only a small proportion of children gain the benefits of dog ownership through dog walking and play. The PLAYCE PAWS study pilot tested a mobile health (mHealth) dog-facilitated physical activity intervention to encourage more family dog walking and play.

Methods: 150 children (5 – 10 years old) recruited from Perth, Western Australia were randomly assigned to either one of two intervention groups (‘SMS’ and ‘SMS and pedometer’) or an ‘usual care’ control group. A mHealth strategy consisting of text messages to parents was administered; the ‘SMS and pedometer’ group also received a dog pedometer and personalised dog steps diary. Other supports include information about dog friendly parks and beaches; games for children to play with their dog; and tips on how safe interaction between child and dog. Child outcome measures (dog walking and dog play) as well as socio-demographic factors were collected using parent-report online surveys at baseline, 1 month and 3-month post intervention. Dog-facilitated physical activity was calculated by summing dog walking and dog play scores. Both intervention groups were combined to form one intervention group (‘combined intervention’). Ordinal logistic modelling was used to examine the impact of the intervention on children’s dog walking and dog play behaviours

Results: Compared with controls, the ‘SMS’ and combined intervention groups were significantly more likely to engage in dog-facilitated physical activity at 3-month follow-up (‘SMS’ OR 2.61 95% CI 1.17, 5.83; combined intervention OR 1.97 95% CI 1.01, 3.86). However, after adjustment for socio-demographic factors the associations did not achieve significance. Nevertheless, families reported the intervention was acceptable and feasible.

Conclusion: The PAWS mHealth intervention appears effective and feasible in encouraging children to be more active with their dog. Larger trials are needed to confirm these findings as well as the impact of mHealth dog-facilitated interventions on children’s overall physical activity levels and other health and developmental outcomes

Purpose: To assess community utilisation, stakeholder perceptions, and identify enablers and barriers to implementation of a pilot Play Street initiative in the Inner West area of Sydney, Australia. Play Streets are a priority in the Inner West Council’s strategy for increasing access to outdoor space for play and recreation in high-density areas.

Methods: The pilot Play Street was held in March 2020. We used a post-only mixed methods design comprising: (i) brief intercept surveys with Play Street visitors exploring their motivations and expectations for attending and, (ii) semi-structured stakeholder interviews examining stakeholders’ experiences related to planning and implementation of Play Streets (current and future). Survey data were analysed to provide descriptive statistics about visitors and utilisation and perceptions of the event. Interviews were recorded, transcribed, and analysed for themes.

Results: Of n=32 survey respondents, the majority were female, aged 35-54, lived in the Play Street’s postcode, came in groups of adults and children. Respondents mainly came to socialise and meet friends (78%) and to let children play (53%). Overall, the Play Street was rated positively by respondents who indicated it was “enjoyable or very enjoyable” (100%), “safe or very safe” (97%) and “well or very well organised” (81%). Only two stakeholders were interviewed due to COVID-19 lockdown in Sydney, both with roles in local government. Issues highlighted were importance of community consultation; balancing the needs and concerns of street residents to achieve compromise; concerns about safety and insurance costs; the role of Council as facilitator to help residents take ownership of Play Street. Contextual factors that impacted planning, implementation, and evaluation of this pilot included postponements due to community concerns and poor air quality arising from bush fires, heavy rain on event day, and COVID-19 restrictions.

Conclusion: This pilot demonstrates that it is feasible and acceptable to use streets as recreation spaces in Sydney’s Inner West. Recommendations for future planning and delivery include prioritisation of locations with less access to open outdoor space, encourage community to lead initiative, highlight Council’s role as facilitator, ensure adequate community consultation, develop strategic plan with clear procedures and accessible resources.

Purpose: Lunches packed by parents for their children to consume at childcare services often contain inadequate quantities of healthy foods. The use of mHealth to support parents to pack healthier lunchboxes represents a novel way to potentially improve lunchbox contents. The purpose of this study is to report on the preliminary impact of an mHealth intervention, embedded within an existing childcare-parent communication app, on packing of discretionary foods and core food groups in children’s lunchboxes.

Method: A single- blind randomised controlled trial was undertaken with 17 childcare services in the Hunter New England region of NSW Australia. Eligible services were those that required food to be brought from home in a lunchbox, and who were currently using or were willing to use the intervention app. Parents in the intervention group received an eleven-week program via an existing childcare-parent communication app. The intervention consisted of weekly push notification messages which aimed to address known barriers to packing of healthy lunchboxes. Lunchbox contents were recorded at baseline and follow up, using photography and weighed food records. Fidelity and parent engagement with intervention implementation was monitored using service manager self- completed records and app analytics. Outcomes included number of discretionary food serves and number of core food groups packed. The analysis controlled for baseline outcomes and were adjusted for clustering.

Results: No significant differences in packing of discretionary foods (0.13, p=0.53), fruit (-0.1, p=.47), vegetables (0.00, p=.97), breads and cereals (-0.10, p=0.61), dairy (0.02, p=0.75) or meat and alternatives (0.01, p=0.60) were found at follow up between the intervention and control services. Likewise, no significant between group changes were identified for mean total mean energy provided by core foods (-71.72, p=0.35). App analytics indicated that 100% of messages were delivered during the intervention, however estimated mean percentage of parents downloading the app and engaging with the messages was 62% and 25% respectively.

Conclusion: Preliminary results suggest that the intervention had a null effect on parent packing of core food groups in childcare lunchboxes. Further research into the barriers for parent uptake and engagement with app-based interventions in the childcare setting are warranted.

Background: Early Childhood Education and Care (ECEC) services are an important place for supporting children to be physically active, healthy, and developmentally on track. Play Active is an evidence-informed physical activity policy template coupled with resources and training to enable ECEC services to successfully implement their policy. This presentation describes the baseline physical activity context of ECEC services as measured through educator practices and attitudes.

Methods: In 2021, baseline data were collected from 565 educators across 79 ECEC services participating in the Play Active Program pragmatic randomised controlled in Perth, Western Australia. Educator physical activity practices were collected using established items in an online survey. To identify patterns of physical activity practices and attitudes baseline data were analysed using exploratory factor analysis (EFA) and latent class analysis (LCA).

Results: EFA revealed three physical activity practice subscales (Encouraging, Planning, and Using Rewards), two attitudinal subscales (Values and Space perceptions), one confidence subscale, one motivation subscale, and one support subscale. Scores derived from these subscales were dichotomised into ‘high’ or ‘low’ and entered into either the physical activity practices LCA or the attitudes LCA. LCA identified three physical activity practice latent classes: ‘Low encouraging, low planning’ (62% of educators); ‘High encouraging, high planning’ (22%); and ‘Low encouraging, high planning’ (17%); and three attitude latent classes: ‘High confidence, motivation, support’ (46%); ‘High intrapersonal’ (32%); ‘Low intrapersonal’ (22%). Only 12% of educators were in both the ‘High encouraging, high planning’ and ‘High intrapersonal’ latent classes and 19% were in both the ‘Low encouraging, low planning’ and ‘Low intrapersonal’ latent classes.

Discussion: Only 12% of educators participating in the Play Active trial had positive physical activity practices, attitudes, confidence, motivation, and support at baseline. This is concerning given these factors are critical for supporting children’s physical activity while in care. Improving educator’s attitudes and practices is a key objective of the Play Active Program. Further evaluation on the effectiveness of Play Active will be undertaken in 2022.

Purpose: Children show health inequalities already at a young age. Among children from families with diverse ethnic backgrounds and/or low socioeconomic positions, excess weight gain and unhealthy behaviors are still common. The need for early interventions to promote healthy behaviors in disadvantaged children is widely recognized. An Early Childhood Education and Care (ECEC) teacher-parent partnership regarding healthy behaviors may support parents and stimulate their children’s development. A preschool-based intervention was developed to strengthen such a collaboration. The intervention consists of a toolkit with parent-child activities and (information) materials. ECEC teachers supervise the activities at the standard walk-in play time. This study describes the systematic development of the toolkit. 

Methods: The Intervention Mapping approach was used to develop the parent-child activities. The needs assessment included interviews with experts and focus groups with ECEC teachers. Furthermore, parents were asked to identify healthy lifestyle topics for their child which they think are easy or difficult to pursue. Parent could put a green (for easy) or a yellow (for difficult) sticker at a predefined list of topics. 

Results: ECEC teachers (n=10) indicated that the activities should be fun, accessible, practical [in their execution] and should fit in their regular program. The interviews with experts (n=9) and conversations with parents (n=28) resulted in 10 important behaviors in which difficulties are experienced: providing a healthy breakfast,  involving their child in meal planning and preparation, providing healthy foods, controlling portion sizes, providing water, exercising together, giving opportunities to be physically active, letting a child play outside, and ensuring their child has enough sleep. The developed parent-child activities relate directly to these lifestyle behaviors. A reader and training for ECEC teachers was designed to improve implementation by the teachers.

Conclusions: The toolkit and associated training will provide a practical guide for ECEC teachers to communicate with parents about lifestyle-related topics. In future research, we will explore parents' and ECEC teachers’ views and experiences of receiving and implementing the toolkit and study the effect of the toolkit on the teacher-parent partnership.

Purpose: For young children, play is physical activity by stealth. Children tend to be more physically active outdoors compared to indoors and nature-based play has been shown to benefit children’s motor skill development. To inform the promotion of outdoor nature-based play in Early Care and Education (ECE) centres, we applied a systems science perspective to identify the crucial factors that can better support the implementation of outdoor nature-based play.

Methods: Using Group Model Building (GMB), data were collected during two workshops with 10 educators in managerial roles and 10 in practitioner roles working in ECE settings across Scotland. The relationship between elicited factors influencing the implementation of outdoor nature-based play were appraised using Causal Loop Diagrams (CLD). The finalized CLD was used to understand the complex relationships that lay behind the implementation of the policy. To further explore and validate the findings, descriptive network analysis was employed.Network analysis identified the leverage points important for this policy implementation.

Findings: Forty-two factors were identified which were grouped into the categories: Educator attributes, ECE practice, Resources, Parental factors, Child-related factors, other (e.g., Culture of being outdoors) and external factors not directly influencing the system (e.g., Access to nature space). Fifty-seven connections and eleven causal loops emerged relating to Affordability of nature-based childcare, Practice of nature-based childcare, Risks-Benefits, Collaborating to agreed vision, Formal and informal capacity building, Educator-child relationship, Children’s playing experiences outdoors, Weather, Parental choice, and Parental ‘outdoorsiness’. Factors were not equally essential for implementation of the policy. Three factors were found to be the most important in connecting the CLD (Use of outdoor space, ECE culture of outdoor play, Educator confidence). Three factors were found to be part of a higher number of causal loops (Use of outdoor space, Educator agency, Perceived child safety and enjoyment).

Conclusions: The CLD enabled identification of five important leverage points that could enhance outdoor nature-based play in ECE settings which could have further impacts on children’s health and wellbeing. This study allows researchers and policy makers to appraise the state of art of the outdoor nature-based ECE.

Purpose: Tummy time is a recommended type of physical activity for infants not yet mobile. This study examined: change in tummy time patterns and preferences, dose-response relationships between tummy time duration and development, and differences in tummy time patterns between higher and lower tummy time preference groups in the first six months of life.

Methods: Participants were parents of infants from the Early Movers project in Edmonton, Canada (baseline: n=411). At 2, 4, and 6 months of age, tummy time duration and preference (i.e., 1=really dislikes to 5=really likes) and development (i.e., Ages & Stages Questionnaire [ASQ-3] communication, fine motor, gross motor, problem-solving, personal-social) were measured using a parental questionnaire. In a subsample (n=127), tummy time patterns (i.e., bout frequency, mean and median bout length) were measured using a 3-day time-use diary. Linear mixed models, linear regression models, and Mann-Whitney tests were conducted.

Results: Tummy time bout frequency, bout length, and preference significantly increased over time. Dose-response relationships between tummy time duration and developmental outcomes were observed at 4 (gross motor) and 6 months (all developmental outcomes). Moreover, at 2 months, 30-44 min/d of tummy time was associated with a higher total development score (vs. <15 min/d; B=11.14; 95%CI: 1.60,20.68). At 6 months, 61-120 min/d (vs. <30min/d; B=27.12; 95%CI: 11.93,42.32) and >120 min/d (vs. <30 min/d; B=33.80; 95%CI: 18.90,48.70) of tummy time were associated with higher total development scores. Differences in threshold doses between some developmental outcomes were observed. For gross motor development, threshold doses were 30-44 min/d at 2 months and 45-60 min/d at 4 and 6 months. Infants with higher tummy time preference (score >3) at 4 and 6 months, compared to those with a lower preference had more frequent and longer tummy time bouts.

Conclusion: Infant preference and ability to participate in more frequent and longer bouts of tummy time increased in the first 6 months of life. This finding may explain why the optimal amount of tummy time needed for advanced development appeared to increase with age. Parents of infants with lower tummy time preference may need additional support to facilitate optimal amounts of tummy time.

Purpose: Determine impact of the Happy Healthy Homes intervention to enhance nutrition environment and optimal practices in Family Child Care Homes (FCCH) in Oklahoma.

Methods: FCCH providers (n=45) in Oklahoma City who participated in the Child and Adult Care Food Program (CACFP) were recruited. The randomized, attention-matched intervention was tailored for FCCH and focused on goal setting. Arms were either nutrition (NUT) or environmental health (ECO). Nutrition and Physical Activity Self-Assessment in Child Care (NAPSACC) for FCCH was completed at baseline, immediately following intervention (~3-months) and at ~12-months post-baseline. For each NAPSACC section (i.e., foods provided, beverages provided, feeding environment, feeding practices, menu variety, and education and professional development) the changes in score and frequency of optimal practices (OP) from baseline-to-3-months and baseline-to-12-months were compared using mixed regression models.

Results/Findings: FCCH providers supervised 9.2±3.9 children and spent 1.9±0.9 hours/day preparing meals. No baseline differences between arms emerged. NUT baseline NAPSACC total score was 129.25±14.59, average score was 3.18±0.25, OP was 15.75±4.8. NUT foods provided remained unchanged at 3 months. However, the score (baseline=3.29 [max of 4] +0.18, p=0.0094) and OP (baseline=7.07 [max of 13] +1.27, p=0.007) were improved at 12 months. The beverages provided score increased at 3 months (baseline=3.4 [max of 4] +0.17, p=0.02) and 12 months (+0.28, p=0.0003). Beverages provided OP remained unchanged at 3 months but improved at 12 months (baseline=3.8 [max of 5] +0.79, p=0.0004). Feeding environment score (baseline=2.87 [max of 4] +0.22, p=0.0003) and OP (baseline=2.55 [max of 7] +0.68, p=0.02) improved at 3 months but did not remain statistically significant at 12 months. No other NUT intervention effects were observed. ECO scores and OP remained unchanged after intervention.

Conclusion: This FCCH-tailored goal-setting intervention improved food and beverage quality in FCCH receiving the nutrition intervention 12-months post-baseline. Integration of food and beverage changes took longer than the intervention period but were evident at 12-months. In contrast, initially observed improvements in food environment, including family style meal service, presence of TV, and role modeling, diminished by 12 months suggesting that these behaviors may need additional support to be sustained.

Purpose: Childcare centers play a key role in providing outdoor play opportunities. Guided by the socio-ecological model, this study investigated center demographic, educator, parental, social, environmental, and policy factors associated with scheduling outdoor play in Alberta, Canada childcare settings during the pandemic.

Methods: Childcare center directors (n=159) in Alberta, Canada participated in this cross-sectional study from June to August 2021. Centre demographic (number of cohorts, educator certification, center location), educator (barrier self-efficacy, positive outcome expectation), parental (interest, support), social (support from the government, health authority, licensing), environmental (play areas, alternatives to licensed spaces, amount of equipment, variety of equipment), and policy factors (centers’ written outdoor play policy, perceived attributes of government COVID-19 guidelines) were measured via a questionnaire adapted from previous tools. Changes in the frequency and amount of outdoor playtime scheduled during COVID-19 compared to before COVID-19 were measured separately for winter (December-March) and non-winter months (April-November) on a 5-point Likert scale. Hierarchical regression analyses were conducted.

Results: In winter months, parental interest (β=0.277), social support (β=0.289), play areas (β=0.213), and compatibility of government COVID-19 guidelines (β=0.216) were positively associated with changes in the frequency of outdoor playtime. Similarly, parental interest (β=0.184), social support (β=0.199), play areas (β=0.224) were positively associated with changes in the amount of outdoor playtime. The final models accounted for 26.7% (frequency) and 29.5% (amount) of the variance. In non-winter months, parental interest (β=0.292), social support (β=0.194), and alternatives to licensed spaces (β=0.155) were positively associated with changes in the frequency of outdoor playtime, while the number of cohorts (β=-0.150) was negatively associated. Similarly, parental interest (β=0.276), social support (β=0.203), and alternatives to licensed spaces (β=0.211) were positively associated with changes in the amount of outdoor playtime, while the number of cohorts (β=-0.180) was negatively associated. The final models accounted for 28.5% (frequency) and 34.3% (amount) of the variance.

Conclusions: Factors from multiple socio-ecological levels were associated with scheduling more outdoor play in childcare centers during the COVID-19 pandemic compared to before. Findings can help inform interventions and initiatives targeting the scheduling of outdoor play in childcare settings during and after the on-going pandemic.

Purpose: The prevalence of chronic disease is rising and therefore presents an imperative need for prevention, likely through nutrition counseling implemented by practitioners. The Appalachian region have high rates of chronic disease, a result of lifestyle factors and poor diet. Although there is research on the positive effects of diet on disease prevention, there is less known about the implementation of nutrition counseling among providers in West Virginia and their level of knowledge, self-efficacy, and attitudes towards the use of nutrition. Therefore, the objective of this study is to investigate the knowledge, self-efficacy, and attitudes regarding the use of nutrition counseling within clinical settings of practitioners in an Appalachian region.

Methods: Data was collected in the Spring of 2021 by using a Qualtrics survey sent to Physicians, Dietitians, Registered Nurses, Physical Therapists, and other providers across an Appalachian state. Means of nutrition knowledge, attitudes, and self-efficacy were calculated and One-Way ANOVA was used to determine differences in mean scores by job title. All data was analyzed using JMP Pro Version 15.0.

Results: When surveyed, 54.55% (n=28) reported that they routinely ask their patients diet related questions, while the other 54.45% reported only asking their patients diet related questions sometimes. The data revealed that there was a significant association between nutrition knowledge and job title (0.013) and self-efficacy and job title (p=0.01) but no significant association between attitude and job title (p=0.24). Additionally, dietitians reported the highest levels of nutritional knowledge with a mean score of 21.5 + 5.65 (95% CI 18.24, 24.76)and self-efficacy with a mean score of 103.17 + 11.39 (95% CI 95.93, 110.4) when compared to other practitioners. 

Conclusions: All practitioners displayed positive attitudes towards the use of nutrition within clinical settings yet possessed low self-efficacy and knowledge regarding the implementation of nutrition, except for dietitians. Although dietitians are regarded as the nutrition experts, all practitioners play a role in providing nutrition advice and should therefore have improved nutrition knowledge and self-efficacy. Increasing the importance of nutrition knowledge among providers will serve as a method to reduce the prevalence of chronic disease.

Background: Studies have shown positive associations between residential greenness, parks and open space access, and walkability and women’s physical activity (PA) during pregnancy and postpartum. However, research that examines the day-level relationship of Global position systems (GPS)-based dynamic exposures to these built-environment (BE) characteristics and PA outcomes remained limited. This study investigated the associations between dynamic daily BE exposures and the day-level PA outcomes in Hispanic, predominantly low-income pregnant women during the pregnancy and postpartum periods.

Methods: Smartphone location and accelerometer-assessed PA data of women (N = 552 person-days) were collected across three measurement bursts (i.e., 1^st and 3^rd trimesters, and 4-6 months postpartum) between 2016 and 2018. Each measurement burst lasted four days (2 weekdays and 2 weekend days). Time-weighted activity surfaces (TWAS) were derived from location data using Kernel Density Estimation methods and integrated with BE layers (e.g., walkability index score) to derive dynamic daily BE exposures. Mixed-effects models examined the associations of dynamic daily BE exposures with women’s day-level moderate to vigorous PA (MVPA) minutes and whether the associations differed by daily averaged temperature, pregnancy and postpartum periods, weekdays vs. weekend days, pre-pregnancy body mass index, maternal parity, employment status, and neighborhood cohesion and safety.

Results: On days when women were exposed to any parks and open space as estimated through TWAS, they engaged in more MVPA. Additionally, walkability from TWAS was positively associated with women’s MVPA minutes per day, but only on weekend days or for those whose index child was their first, were obese prior to pregnancy, or lived in neighborhoods with low perceived safety and cohesion. Percent of green space along walkable roads and park proximity from TWAS; however, were not associated with women’s day-level MVPA.

Conclusions: Daily exposures to any parks and open space at locations visited and during travel were critical in women’s day-to-day PA outcomes during pregnancy and early postpartum. Future PA research should further explore park use behaviors of women of low SES or specific racial/ethnic minority groups and the quality of parks they frequently visited such as its maintenance, safety, and amenities to formulate more targeted and efficacious interventions.

 

Purpose: Diabetes effects 451 million adults worldwide and cardiovascular disease (CVD) causes 17.9 million deaths/year. High sedentary behaviour (SB) has been linked to increased risk of type 2 diabetes (T2D) and CVD, however, an umbrella review comparing and contrasting all reviews would allow for summation of higher-level evidence. Thus, the primary purpose of this umbrella review is to summarize the link between SB and T2D and CVD.

Methods: Databases (PubMED, EMBASE, Scopus, Web of Science, PsycINFO, SPORTDiscus, CINAHL and Cochrane Library) were searched with the assistance of a librarian. The titles/abstract review followed by full text review was done by two independent researchers. At both screening stages, discrepancies were settled by a third researcher. Reviews were included if they: (1) comprised of any population; (2) incorporated a SB intervention or exposure measured by any means except lack of physical activity; (3) contained any/or no comparison group; (4) measured T2D and/or CVD as an outcome; (5) embodied a systematic review design with or without a meta-analysis; and (6) were published in English. Data from each of the included reviews were extracted independently by one researcher and checked by a second researcher for accuracy. Two researchers assessed the quality of each review independently using the AMSTAR 2 tool and discrepancies were resolved by a third researcher. Results were described using a narrative approach.

Results: A total of 12 reviews were included. For T2D, 11 reviews were included, 7 included a meta-analysis, and all 7 found an association between increased SB and incidence of T2D. For CVD, 9 reviews were included, 5 included a meta-analysis, and all 5 found an association between increased SB and incidence of CVD. The association between SB and T2D was stronger than the association between SB and CVD.

Conclusions: This umbrella review highlights clear and consistent associations between increased SB and incidence of T2D and CVD among middle-aged adults. Intervention research using objective measures of SB are needed to provide more robust evidence for these associations. Future work should also focus on older adults and clinical populations (i.e., those “at risk” for or diagnosed with T2D or CVD).

 

Introduction: Community parks are an important environmental factor that increases the physical activity levels of older adults. Previous studies have demonstrated that the application of technology may enhance the benefits of health promotion and smart aging; however, research on community parks and the application of technology is very limited in Taiwan. Thus, this study explored the feasibility of using smart aging programs in community parks through  focus groups and content analysis.

Methods: This study carried out preliminary integration and induction of outdoor fitness equipment projects provided by the parks. Furthermore, we conducted focus group interviews with seven experts regarding the environmental smart aging platform system of community parks.

Result: The major results of this study are as follows: i) more demographic factors, such as income, location, behavioral intent, and personal ability; ii) research designs should consider the characteristics of the older adults and add incentives to attract them to participate and reduce the threshold of participation; iii) intelligent equipment should consider the feasibility and accessibility of community parks; and iv) further investigations should be conducted on older adults, the amount of physical activity performed in community parks, and the status and needs of other adults.

Discussion: These results can be used as a relevant unit and the future policy for building a smart aging exercise promotion platform in the context of community parks.

Purpose: Balance-challenging exercise can reduce falls in older people. Successful AGEing (SAGE) is a novel randomised controlled trial testing the effectiveness of a 40-week yoga-based exercise program on reducing falls in people aged 60+. The face-to-face yoga classes were moved online following COVID-19 restrictions so initial participants took part in a hybrid program, while current participants are attending classes entirely online. Our evaluation aims to explain continuing high participation rates and positive post-intervention survey feedback indicating adherence to and enjoyment of hybrid and online programs, with reports of improved balance, physical function, sleep and mental wellbeing.

Methods: We conducted a realist process evaluation of the hybrid program. This involved developing and testing program theories that describe which mechanisms the program may be activating and how context mediates this relationship to generate proximal outcomes. Data included purposively sampled interviews and focus groups with participants (n=21) and yoga instructors (n=3), observations of classes, and review of feedback forms (n=46) and routine trial data. We are currently evaluating the online program.

Results: Findings from evaluation of the hybrid program indicate that SAGE is working well for most participants—regardless of the delivery mode—due to the quality of yoga instruction, program structure and inherent yoga characteristics. Gains in transitioning online included greater convenience. Losses included perceived reduction in the effectiveness of yoga instruction. Home environments create barriers for some, and people struggling with pain face greater challenges. We identified six program theories configured around 16 mechanisms: 1. It’s worth the effort and 2. In expert hands (mechanisms were: value expectancy, therapeutic alliance, achievement/mastery), 3. A communal experience (shared experience, social connection, social comparison, position checking), 4. Finding yoga within reach (accessibility, convenience, gratitude), 5. Building yoga habits (purposeful structure, momentum, accountability, continuity), and 6. Yoga’s special properties (embodiment, mindfulness). These program theories are now being explored with participants who completed SAGE entirely online.

Conclusions: For most participants, online delivery of SAGE retains much of the value of the well-received face-to-face program, and increases value in some areas. This indicates that teleyoga can provide engaging, accessible and scalable yoga-based fall prevention programs for people aged 60+.

Purpose: The benefits of physical activity for older adults are well known. Understanding the extent and type of behaviour change techniques (BCTs)  used in programs and services tested in trials can help interpretation of trial results. The purpose of this study was to identify and summarise the number and type of behaviour change techniques used in physical activity programs and services for older adults evaluated in large high-quality trials.

Methods: Our WHO-commissioned systematic review identified 87 large (>100 people per group) high-quality (Physiotherapy Evidence Database (PEDro) score >6) individual randomised controlled trials (RCTs) evaluating physical activity programs/services for older people. We described the trial's impact on physical activity, falls, intrinsic capacity (physical domain), functional ability (physical, social, and cognitive/emotional domains), and quality of life. Forty trials out of 87 included additional strategies to enhance program effectiveness. In the present study, the interventions in these trials were coded for the type and number of BCTs present, using a published taxonomy of 93 behaviour change techniques (the BCTT).

Results: A total of 374 behaviour change techniques were identified in the 40 trials that included additional strategies to enhance program effectiveness. The average number of BCTs used per intervention was eight, with a range of 4 to 17 BCTs used. A total of 39 of the possible 93 behaviour change techniques from the BCTT were identified, and nine of the BCTs accounted for 55% (206/374) of the total BCTs used. The most common BCT was “action planning” (n=38), and the most common BCT groupings were “goals and planning” and “substitution and repetition”.

Conclusion: Understanding which BCTs are used in interventions and their association with trial outcomes will help guide evidence-based practice and improve the effectiveness of future interventions.

 

Background: A growing body of literature indicates that physical and social environments influence myriad health outcomes including physical activity, obesity and chronic conditions. Additionally, individual perceptions of the physical and social environments affects behaviors such as physical activity. This study examines objective measures and individuals’ perceptions of the physical and social environments and the association with leisure time physical activity.   

Methods: The study was conducted in three urban poor communities in Accra. Objective measures of the physical activity environment was assessed using Global Positioning System technology. Residents’ perception of the physical activity and social environments and their involvement in leisure time physical activity were collected through a survey.  Prevalence of leisure time physical activity by perceptions of the physical and social environment were examined using descriptive statistics. Logistic regression analysis was used to predict the likelihood of respondents engaging in leisure time physical activity.    

Results: About two-thirds of the study participants did not engage in any leisure time physical activity. There were more “informal” than formal physical activity space(s) in the study area. About 4 in 5 of the respondents indicated that there were physical activity spaces in their community and about a quarter reported high crime level. Respondents’ perception of the absence of physical activity spaces and high crime level were associated with a lower likelihood on engaging in leisure time physical activity. 

Conclusions: Interventions aimed at encouraging leisure time physical activity in urban poor areas should address the broader physical activity and social environments.

Background: Well-designed exercise programs can reduce falls in older people. Many physical activity and fall prevention intervention trials are now seeking to advance this evidence base, yet these trials frequently report low and unrepresentative recruitment. Better understanding of reasons for participation can help improve recruitment. We explored why participants enrolled in and persevered with the Coaching for Healthy Ageing (CHAnGE) trial, including how recruitment strategies affected their expectations and decision-making. CHAnGE was a cluster randomised controlled trial testing a program targeting inactivity and falls in community-dwelling people aged 60+. Recruitment took place at community centre meetings where health coaches presented trial information in an accessible format and answered questions.

 Methods: We conducted a secondary thematic analysis of data from our qualitative evaluation in which 32 purposively sampled trial participants took part in semi-structured interviews. Data relating to recruitment and participation were analysed inductively, then a coding framework comprising the core constructs of self-determination theory—autonomy, competence and relatedness—was used to explore if and how this theory helped to explain participation.

 Results: Participation was motivated by the desire for improved health and decelerated ageing, altruism and curiosity. At the point of enrolment, participants hoped that the intervention would fulfill these desires via structured support, accountability and achievability—reasons that align with the self-determination concept of competence. However, positive descriptions of what it was like to actually participate in the intervention focused on other attributes such as program flexibility, empowerment and the caring encouragement provided by health coaches—reasons that address the self-determination concepts of autonomy and relatedness as well as competence. Recruitment promoted CHAnGE well in terms of improved health, decelerated ageing and fall prevention, but it was less effective in conveying the intervention’s demonstrated potential to support all aspects of self-determination via person-centred coaching.

 Conclusions: Findings suggest that recruitment could have greater reach using: 1. Empowerment-focused messaging, 2. Participant stories that highlight positive experiences of participation, and 3. Peer support and information sharing to leverage altruism and curiosity. Theory-informed improvements may increase participation in future fall prevention trials and programs, especially of people in harder-to-recruit groups.