Purpose: Weight loss interventions as the primary strategy for diabetes management is often unsuccessful in the long term. These interventions can lead to poor mental health and quality of life due to weight cycling. There are several weight neutral interventions to improve diabetic outcomes. Our objective was to summarize the results of weight neutral behavioral approaches to diabetes management.
Methods: Six bibliographic databases were searched: CINAHL (EBSCO), Embase.com, Health Source: Nursing/Academic (EBSCO), MEDLINE via PubMed, PsycInfo (EBSCO) and Web of Science Core Collection. Inclusion criteria included: participants ages 13+ years with or at risk for type 2 diabetes; outcomes of glucose metabolism; articles between January 1, 2000 and May 31, 2022. Exclusion criteria included: studies in animals, weight loss interventions or any calorie restriction. Study designs included were randomized trials and prospective observational studies. Cochrane Risk of Bias and Grading of Recommendations, Assessment, Development, and Evaluation were used to assess methodology.
Results: There were 3001 studies screened, 243 full text studies assessed, and 55 studies included in the review. Studies were divided into categories based on intervention type; diabetes self-management education (DSME) (23 studies), diet and exercise (23 studies), and other (9 studies) which included comprehensive interventions (DSME + specific diet and exercise components and support). Out of the total, 21 were rated as low amount of bias and 14 had high methodological quality. There was good evidence for the use of DSME interventions without weight loss, where most studies showed improvement by six months. Diet interventions alone did not improve diabetic outcomes, most studies were three months in duration.
Conclusions: Improvement of diabetic health outcomes without focus on weight loss is possible. Behavior change in this area requires ongoing support and a combination of education and improvements in diet quality and exercise. This review may provide new strategies for healthcare providers of patients with or at risk for type 2 diabetes. Targeted advice on how to change diet, monitor disease and overcome barriers to behavior change that does not involve a scale would improve the mental health and quality of life of these patients.

Polycystic Ovary Syndrome (PCOS) is an endocrine disorder affecting 8 to 13% of reproductive aged women. Lifestyle changes are the first-line therapy to assist with symptom and weight management and to reduce the risk of reproductive, metabolic and psychological comorbidities. However, women with PCOS have a higher weight, experience weight gain, and a higher prevalence of living in a larger body. Health professionals (HPs) play a crucial role in delivering lifestyle advice for people with PCOS. Thus, the aim of this systematic review is to understand the barriers, facilitators, experiences, and perceptions of engagement and compliance with lifestyle modifications in people with PCOS and in HPs providing or referring people with PCOS to lifestyle modifications. A mixed-method systematic review was conducted with quantitative studies narratively synthesised and all studies thematically analysed. There were 68 eligible papers, including n=59 (n=5198) people with PCOS and n=17 (n=2,622) HPs. Several themes were identified as impacting people with PCOS' ability to make lifestyle changes. HP education on PCOS management through lifestyle was viewed by HPs and people with PCOS to be inadequate, further impacting the quality of care and health outcomes. Lifestyle advice delivered by a multidisciplinary team, including dietitians, was identified as a key component for change. Both people with PCOS and HPs agreed that there was a need for individualised and PCOS specific lifestyle advice. However, HPs viewed that there was limited evidence supporting these recommendations and a lack of time to deliver this care. Weight stigma was identified as impacting both those in larger and smaller bodies with PCOS, reducing the quality of care and affecting self-perception and mental health. People with PCOS perceived that lifestyle advice is overly focused on weight loss and fertility, independent of their own personal motivations and goals. Systemic changes, including receiving lifestyle advice that meet the individual's needs, are necessary for leading to long-term sustainable changes and improvements in health outcomes. A multidisciplinary team approach and an overhaul of HPs' perceptions and mentality of weight and weight-centric care for those with PCOS are essential in delivering effective lifestyle advice.

Purpose: To support physical activity through co-production in people with severe mental illness (SPACES) and address a novel research question; What does a co-produced National Health Service (NHS) delivered physical activity (PA) intervention for people with severe mental illness (SMI) look like in the UK? People living with SMI experience a mortality gap of 10–20 years compared with those without SMI. The majority of deaths are attributable to physical health conditions and modifiable lifestyle behaviours including physical (in)activity. Helping people with SMI increase their PA could reduce the mortality gap.

Methods: Data collection involved an iterative process of multi-stakeholder focus groups and literature searches. Co-production of the SPACES intervention utilised focus groups involving NHS health professionals, people with SMI lived experience, carers, and academics to collaboratively work from the outset to design and deliver the SPACES intervention. Data collection sought to uncover barriers and facilitators to PA and unearth pragmatic solutions. A multi-stakeholder intervention design group utilised this data to inform decisions regarding the SPACES intervention. A Patient and Public Involvement and Engagement group supported the co-production process and intervention design. The behaviour change technique (BCT) mechanisms of action tool was utilised to identify key intervention BCTs.

Results/findings: Co-design, uniting literature and primary data from multiple perspectives led to the creation of a 20-week multi-component intervention, including 30 BCTs. Components included (1) a 2-hour weekly group-based session comprising of up to 60-minutes PA, a 30-minute workshop on a relevant subject and up to 30-minutes social time, (2) 3-6 one-to-one consultations (long-form) with a physical activity coordinator (PAC), (3) 2-4 one-to-one check-ins (short-form) with a PAC, (4) participant handbook, (5) activity monitor offer, (6) attendance prompts, and (7) social support (professional and peer).

Conclusions: The co-production process strengthened the design of a PA intervention delivered within the NHS. The combined nature of lived experience and expertise enabled negotiation of complex behavioural and institutional needs, requirements, and hurdles, whilst achieving programme aims. The co-production process highlighted nuanced considerations for intervention design and behaviour change that would have been missed or difficult to overcome in the absence of multi-stakeholder co-production.

Purpose
Women are less likely than men to meet physical activity guidelines, and women who are mothers are particularly likely to be inactive. Furthermore, adult women are more likely to participate in individual or group exercise than team sports; an important distinction given that while any form of physical activity is associated with physiological benefits, participation in team sports may have higher psychosocial benefits than individual exercise. The aim of this study was to identify factors contributing to the success of a community-based non-competitive team sport programme in engaging women in physical activity.

Methods
Gaelic football is a popular field sport in Ireland which has some similarities to soccer and Australian Rules football. “Gaelic for Mothers & Others” (G4MO) is an extremely successful novel community-based non-competitive programme administered via the pre-existing network of Gaelic football clubs. G4MO is played using the standard rules of Gaelic Football but there are no competitions and all matches are “friendlies” with no scores recorded. Sixteen current and previous G4MO participants (age 29 to 49 years) recruited via purposive sampling from clubs in urban, suburban and rural locations participated in individual semi-structured interviews focusing on their reasons for initiating and continuing participation in the programme. Interview data were analysed using an inductive thematic analysis method.

Results
Initial analysis (8 interviews) has identified three themes in participants’ reasons for playing G4MO. (1) Sense of belonging: women felt that they both gained and contributed to a social and emotional support network which developed through training together. (2) Sport without pressure: women greatly valued the opportunity to play organised sport without an expectation to be highly skilled or to engage in training schedules which did not suit their interests, goals or other life commitments. (3) Non-formal competition: despite the stated non-competitive ethos of the programme, women enjoyed the chance to express their competitive nature, without the pressure to win matches or tournaments.

Conclusions
Development of non-competitive pathways for participation in mainstream sports may be a way to engage women in physical activity by harnessing the value of social support while removing the perceived pressures associated with competitive sport.

Purpose: Exercise improves quality of life (QOL) in adults with heart failure (HF); however, few initiate and adhere to long-term exercise. Improving self-efficacy, attitudes, and relapse management increase exercise adherence in adults with HF. Few studies have examined the relationship between anticipated consequences of engaging in exercise and long-term exercise adherence. Aligned with Social Cognitive Theory, the purpose of this study is to test the hypothesis that anticipated consequences (outcome expectations) of engaging in exercise are associated with long-term exercise adherence in adults with HF.

Methods: This secondary analysis used a convergent mixed methods approach to integrate qualitative and quantitative data. The parent study randomized 204 adults with HF to test interventional effects on long-term exercise adherence. Prior to randomization, open-ended questions explored participants’ expectations of exercise. Qualitative responses were organized into themes using content analysis. Minutes of moderate intensity exercise were extracted from heart rate monitors at 6- and 12-months. Adherence was defined as ≥120 minutes of exercise per week. Data were integrated using Chi-square tests to evaluate associations between each theme and 6- and 12-month exercise adherence.

Results: Participants with complete expectation and adherence data (n=134) were 47% female, 42% non-White, and 60.2 years old. We identified five, non-mutually exclusive themes for exercise outcome expectations: Improved physical and mental health (n=110), HF symptom control (n=68), Global health improvements (n=67), Better QOL with HF (n=67), and Establishing exercise routines (n=62). Within each theme, participants were balanced between intervention and usual care; group assignment did not bias the impact of outcome expectation themes on exercise adherence. At 6 months, exercise adherence was significantly less likely (p=0.02) in participants expecting improved physical and mental health and significantly more likely (p=0.01) in those expecting better QOL with HF. No significant associations were identified at 12 months.

Conclusion: These important findings suggest outcome expectations may initially promote exercise adherence in adults with HF, an association needing further study. Future studies are needed to further elucidate the role of outcome expectations in exercise behavior and examine the application of social cognitive constructs in clinical practice to promote long-term exercise adherence in adults with HF.

Purpose:
Sitting at work can be associated with musculoskeletal pain, but the effect of reductions in sitting is not well understood. We examined relationships with musculoskeletal pain of changes in sitting, standing, stepping, and short and long bouts of these behaviors.
Methods:
Analyses pooled data from 224 desk workers (68.4% women; mean ± SD age = 45.5 ± 9.4 yr; body mass index = 28.1 ± 6.1 kg⋅m−2) in intervention trial. Device-assessed (activPAL3) sitting, standing, and stepping time and multisite musculoskeletal pain (Nordic Questionnaire; 12 body areas) were assessed at baseline, 3 months, and 12 months. Compositional data analyses in linear mixed-effects regressions examined relationships within 16 waking hours of the behaviors and their short and long bouts, with changes from baseline in acute and chronic multisite musculoskeletal pain at 3 and 12 months. Analyses were adjusted for initial group randomization and relevant covariates.
Results:
At 3 months, increased standing relative to changes in other compositions was significantly associated with increased multisite musculoskeletal pain (acute: β = 1.54, 95% confidence interval [CI] = 0.10 to 2.98; chronic: β = 1.49, 95% CI = 0.12 to 2.83). By contrast, increased stepping relative to changes in other compositions was significantly associated with reduced multisite musculoskeletal pain (acute: β = −1.49, 95% CI = −2.97 to −0.02; chronic: β = −1.87, 95% CI = −3.75 to −0.01). Neither sitting reduction relative to changes in other compositions nor changes in short bouts relative to long bouts of the behaviors were significantly associated with multisite musculoskeletal pain changes. At 12 months, there were no significant associations for any of the compositional changes.
Conclusions:
In the short term, while increasing standing with reduced sitting time can be unfavorable, concurrently increasing stepping could potentially reduce musculoskeletal pain. In the longer term, musculoskeletal pain may not be increased by moderate reductions in sitting time through spending more time standing or stepping.