Objectives: Fibromyalgia is a chronic condition characterised by persistent pain, fatigue, and poor sleep, with major impacts on quality of life, psychological wellbeing, and disability. Physical activity is a cornerstone of management, and the National Institute for Health and Care Excellence recommends supervised programmes tailored to individual needs. Yet, people with fibromyalgia frequently face barriers to physical activity, and few studies have explored experiences of group-based interventions. This study examined the perspectives of adults with fibromyalgia on group-based physical activity to identify challenges and inform future practice. Methods: Two focus groups were conducted with participants (n=8) recruited from Musculoskeletal and Pain Management Services in NHS Ayrshire and Arran. Discussions were audio-recorded, transcribed, and thematically analysed by three independent researchers. Results: An overarching theme was a lack of understanding of the impact of fibromyalgia and a desire for validation. This was evident across all discussions. Two further themes were identified: the challenges of engaging in physical activity, and priorities for intervention design and delivery. Participants emphasised the need for practitioners who recognise the fluctuating nature of fibromyalgia and who demonstrate empathy, openness, and collaboration. Conclusions: Findings highlight the importance of practitioner understanding and patient-centred design in developing acceptable group-based physical activity interventions for people with fibromyalgia.

Abstract BackgroundChronic pain affects approximately 1 in 5 adults worldwide and imposes a major personal and societal burden. Supported self-management, increasingly delivered through digital health systems, is recommended to improve quality of life and function. Dual-facing digital health systems (DDHSs), which engage both patients and professionals, show promise but remain underexplored, with limited use of established frameworks to guide their design and evaluation. ObjectiveThis protocol outlines the planned methods for conducting a scoping review that aims to map existing DDHSs for chronic pain self-management; examine the frameworks used to inform their design, implementation, and evaluation; and identify gaps to guide future research and practice. MethodsThe review will follow the Joanna Briggs Institute methodology and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) reporting guidelines. Peer-reviewed studies (2010-present) on DDHSs for use by health care professionals and adults with chronic pain will be included. Searches will be conducted across MEDLINE, CINAHL, Embase, Scopus, Web of Science, and APA PsycInfo, supplemented by citation tracking. Two reviewers will independently screen and extract data using a structured template. Results will be synthesized narratively, with emphasis on system features, populations, and applied frameworks. The quality of the included studies will be assessed using the Quality Assessment for Diverse Studies tool to support the interpretation of the findings. ResultsSearches identified 1377 records, with 822 (59.7%) screened after deduplication. Following full-text assessment, 19 studies were included. The scoping review is expected to be completed by June 2026. The first search was conducted in September 2025, and screening was completed in November 2025. The results are expected to be published in June to August 2026. The evidence base is anticipated to be heterogeneous, with variation in system features, populations, and outcomes. Early indications suggest inconsistent use of theoretical and implementation frameworks, limited integration of dual-facing components, and a predominance of feasibility and acceptability outcomes. ConclusionsThis review will provide a structured overview of DDHSs for chronic pain self-management and the frameworks informing their design and evaluation, with findings intended to guide the development and implementation of future digital interventions.

Group-based physical activity interventions improve symptoms, quality of life and function, and are a cost-effective treatment approach for the management for Fibromyalgia Syndrome. Multiple forms of physical activity have been examined in the Fibromyalgia population; however, a comprehensive review of these approaches is lacking. This review aimed to map the current research and descriptively report on attrition data. A scoping review was undertaken searching Medline, CINAHL, SCOPUS, SPORTDiscus and Web-of-Science for studies meeting the following criteria: English language; peer-reviewed; published January 1, 2000 - February 23, 2023; adults (≥18 years) diagnosed with Fibromyalgia; group-based exercise or group-based physical activity. Study selection and data extraction were performed independently by two reviewers. Data were recorded into spreadsheets, then descriptively analysed and tabulated. 17 studies were included enrolling a total of 893 participants. Most examined multi-component intervention designs. Twelve included resistance exercise, ten included flexibility, eight included aerobic, six included hydrotherapy, four included balance training, three included "mindful movement" (e.g. Qi-Gong), one included Pilates, and one included exergames. Mean attrition was 21%. Current literature on group-based physical activity for Fibromyalgia examines mostly multi-component programmes delivered by multi-disciplinary teams in community settings, matching best-practice guidelines. Future studies should explore attrition further, examining influential variables.

Strength and balance exercise for older adults can be effective in reducing both rate and risk of falls but uptake and adherence to community programmes is low due to a combination of individual, social, and systemic barriers. Exergaming technology (interactive exercise-based video-games) is a promising tool to increase exercise uptake and adherence among older people due to their motivational features. To understand whether using Exergames influences exercise participation from the perspectives of older adults and therapists using Exergames in the community. This study was part of a cluster randomised controlled trial which investigated the use of purpose-built strength and balance Exergames by older adults in 18 community assisted-living facilities in the UK. The qualitative component of the study was conducted on completion of the 12-weeks Exergames intervention. Data collection involved focus groups with residents of assisted living facilities who completed the programme, and semi-structured interviews with physiotherapists/physiotherapist assistants delivering the Exergames to share observations recorded during the trial. Thematic analysis was used to analyse the data. Overall, 67 older adults took part in 13 focus groups, and 3 therapists were interviewed. Three overarching themes were identified: i) Perceived physical and psychological outcomes ii) Practicalities of using the Exergames system and iii) Motivational effects of the Exergames. Findings suggest older adults enjoyed using the strength and balance Exergames, and reported physical, psychological and functional gains. Social components, feedback, music and colourful animation appeared to increase appeal of the Exergames. Support from a healthcare professional during initial familiarisation and to address technical problems was valued. Providing ample choice of ability matched games may sustain adherence. The older users’ and therapists’ perceptions of exergames in community assisted living facilities and provides valuable insight into barriers, facilitators, and perceived benefits and drawbacks following 12 weeks use.

BackgroundResearch regarding the effectiveness of digital health interventions (DHIs) for people living with chronic pain is widely documented, although it is often measured against changes in clinical outcomes. To gain a comprehensive understanding of the full impact of DHIs, it is vital to understand the experience of individuals who are using them. An exploration of qualitative data regarding the experience of people living with chronic pain engaging with DHIs could provide a more in-depth account of how individuals interact and engage with such tools, uncovering the overall impact DHIs can have on the lives of people living with chronic pain. ObjectiveThis qualitative systematic review and thematic synthesis aimed to appraise and synthesize relevant qualitative evidence on patients’ experiences of engaging with DHIs for the self-management of chronic pain symptoms. MethodsA systematic literature search of qualitative and mixed methods studies published between 2013 and 2023 was conducted across 6 databases: MEDLINE, PubMed, Embase, CINAHL, PsycINFO, and Scopus. Eligible studies included adult patients aged ≥18 years with a chronic pain diagnosis (ie, >12 weeks) reporting on the experience of engaging in a DHI for the self-management of chronic pain. The Critical Appraisal Skills Program checklist for qualitative research was used to appraise each study. Following a 3-step inductive thematic synthesis approach, the researcher performed line-by-line coding of each eligible article to identify descriptive themes. Through iterative evaluation of the descriptive themes, analytical themes that facilitated a deeper understanding of the data were derived. ResultsIn total, 37 qualitative and mixed methods studies were included in the review. Thematic synthesis revealed three overarching themes encompassing five subthemes: (1) personal growth, with 2 subthemes (gaining new insights and renewed mindset); (2) active involvement, with 3 subthemes (motivation, improved access, and health care decision-making); and (3) connectedness and support. ConclusionsA positive experience with DHIs among people living with chronic pain is achieved through an improved understanding of their condition, greater self-awareness of how symptoms impact their lives, and an increase in motivation to play an active role in their health care. DHIs promote the confidence and independence of people living with chronic pain, as well as facilitate a sense of ongoing support between routine appointments. However, DHIs may disempower people living with chronic pain by placing too much focus on their pain and should be used as an adjunct to existing care as opposed to replacing in-person appointments. To appropriately meet the needs of people living with chronic pain, the content and features of DHIs should be personalized. Development of future DHIs should use a co-design approach involving key stakeholders to ensure the needs of people living with chronic pain are met. Trial RegistrationPROSPERO CRD42023445100; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023445100 International Registered Report Identifier (IRRID)RR2-10.2196/52469

BackgroundChronic pain is a highly prevalent condition that requires multidisciplinary treatment. However, in the United Kingdom, access to specialist pain clinics where patients can receive medical multidisciplinary treatment is limited, and provision varies between health boards. As such, self-management of chronic pain using digital tools has been gaining traction recently, but evidence of its effectiveness from clinical-based trials focuses mainly on quantitative outcomes. ObjectiveThis systematic review aims to identify, appraise, and synthesize qualitative evidence on patients’ experiences with digital health interventions (DHIs) for the management of chronic pain. MethodsThis systematic review will consider qualitative and mixed methods studies that explore the experience of patients (aged 18 years and older) with chronic pain engaging in DHIs to manage their pain. MEDLINE Ovid, PubMed, Embase, CINAHL, PsycINFO, and Scopus databases will be searched for published studies. The systematic review will be conducted in accordance with the ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) guidelines. Following the 3-step thematic synthesis methodology of Thomas and Harden, titles and abstracts will be screened by 2 independent reviewers (AM and HM), and a third reviewer (MI or FM) will resolve any conflict that arises before the full-text screening. The Critical Appraisal Skills Programme checklist tool will be used to critically appraise the included studies. The extracted data will be imported to NVivo (QSR International), where thematic synthesis will be used to derive analytical themes from the included studies. ResultsThemes that encapsulate the patient experience will be identified from qualitative evidence, and these themes will shed light on the perceived benefits and disadvantages, usability, acceptability, and the overall impact digital tools can have on the lives of those with chronic pain. ConclusionsThis systematic review will identify, appraise, and synthesize the overall experience of patients engaging in DHI to manage a diverse range of chronic pain conditions. By elaborating the patient experience through qualitative analysis, the findings from this review will enhance our current understanding of the experiences of patients with chronic pain using digital tools for the self-management of their pain and highlight what person-centered elements are essential for future DHI development. Trial RegistrationPROSPERO CRD42023445100; http://tinyurl.com/4z77khfs International Registered Report Identifier (IRRID)DERR1-10.2196/52469

Introduction: Understanding daily movement patterns (i.e., the relative proportion of time spent on Sedentary behaviour (SB), light physical activity (LPA), moderate-vigorous physical activity (MVPA) and sleep) to establish links with chronic diseases is a contemporary topic. Little research has looked at the effects of 24-hour movement behaviour on bone health (particularly bone mineral density (BMD)) despite investigation on other health parameters. The aim of this rapid narrative review was to build on previous work published on the association between SB and BMD in older adults by investigating the association of the more holistic 24- hour movement behaviours in relation to BMD. Methods: A database search of Web of Science and NIH PubMed was conducted using broad MeSH terms (older adults, sedentary, and bone). Searches were limited from the year 2019 onward. Results/Discussion: Five published articles were reviewed, and there are discrepancies amongst the findings which could be attributed to the different measurement methods (Peripheral Quantitative Computed Tomography (pQCT) versus Dual-energy X-Ray Absorptiometry (DEXA)) and the sites of measured BMD. There are also notable differences between genders, with BMD in men appearing to be most reliant on time spent in MVPA, compared to women who appear to see benefit to BMD with replacement of SB with LPA and not require more time spent in MVPA. This highlights the complexity of movement behaviours and requires further research.

Vitamin D insufficiency may be common among elite athletes, but prevalence is unclear, and some potentially important risk factors are uncertain. The present study aimed to (a) estimate the prevalence of vitamin D insufficiency in elite athletes, and (b) examine differences in prevalence between the sexes, and between adults and adolescents, from recent studies which used a contemporary definition of insufficiency. Four databases (Web of Science, SPORTDiscus, PubMed, and Sports Medicine and Education Index) were searched for studies in elite athletes. Literature selection, data extraction, and risk of bias assessment were conducted independently by two researchers. Vitamin D insufficiency was defined as 25(OH)D < 50 nmol/L. Meta-analysis was conducted, using R software x64 4.0.2, to provide estimates of prevalence of insufficiency for adults and adolescents, and to examine between-sex differences in risk of insufficiency. From the initial 943 literature search hits, 51 studies were eligible with 5456 participants, 33 studies in adults (12/33 in winter and spring), 15 studies in adolescents (6/15 in winter and spring) and 3 studies with age of study participants not given. Prevalence of vitamin D insufficiency from meta-analysis was 30

Objectives: To investigate how the relationship between vitamin D and COVID-19 has been presented in traditional media sources (UK newspapers) and assess the level of misinformation associated with this issue by comparing newspaper article content to the evidence-based guidelines. Design: Qualitative study Setting: Data were collected over the first year of the pandemic (February 2019-20), from the five most widely read UK based newspapers by searching the Nexis database using keywords vitamin D and COVID. An inductive thematic analysis was carried out on the data to identify themes and subthemes. Quality control of the coding was conducted on a sample of the dataset (20%). Data were also compared to the ground truth identified as the NICE report titled COVID-19 rapid guideline: vitamin D to explore the accuracy of media outputs. Results: The four main themes identified were association of vitamin D with COVID-19, politically informed views, vitamin D deficiency and vitamin D sources. When compared to the ground truth, most of the information from newspaper articles relating to the key findings was correct for each of the findings, except for COVID-19 infection. Conclusions: Although most of the information included in newspaper articles concerning the relationship of vitamin D with COVID-19 was correct, this study highlighted that there was still a notable amount of incorrect information published. In the context of COVID-19, it is imperative that media outputs are accurate and inform the public and front-line health professionals as correct information is a key factor in disease prevention. Future research should focus on the accuracy of media outputs to further investigate health misinformation as an issue in traditional media and how that may affect public health. Attempts should be made to improve journalistic integrity through more rigorous and standardised regulations enforced across all media outlets so that public knowledge on current events is based on evidence rather than conjecture.

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AbstractThe aim of this study was to explore how the relationship between vitamin D and COVID-19 has been represented on the social media site Twitter. NCapture was used to collect textual Tweets on a weekly basis for three months during the pandemic. In total, 21,140 Tweets containing the keywords “vitamin D” and “COVID” were collected and imported to NVivo12. An inductive thematic analysis was carried out on the Tweets collected on the first (12/2/2021) and last week (21/5/2021) of the recording period to identify themes and subthemes. Quality control of the coding was conducted on a sample of the dataset (20%). Data were also compared to the “ground truth” to explore the accuracy of media outputs. The four main themes identified were “association of vitamin D with COVID-19”, “politically informed views”, “vitamin D deficiency” and “vitamin D sources”. When compared to the ground truth, the majority of information relating to the key findings was ‘incorrect’ for all of the findings. This study contributes to the area of research by highlighting the extent of the issue social media sites face with health-related misinformation. In the context of COVID-19, it is important that sites such as Twitter improve their existing misinformation policies, as misinformation can be detrimental in disease prevention.

Older adults spend more than 8 h/day in sedentary behaviours. Detrimental effects of sedentary behaviour (SB) on health are established, yet little is known about SB and bone health (bone mineral density; BMD) in older adults. The purpose of this review is to examine associations of SB with BMD in older adults. Five electronic databases were searched: Web of Science (Core Collection); PubMed; EMBASE; Sports Medicine and Education and PsycInfo. Inclusion criteria were healthy older adults mean age ≥ 65 years; measured SB and measured BMD using dual-energy X-ray absorptiometry. Quality was assessed using National Institute of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. After excluding duplicates 17813 papers were assessed; 17757 were excluded on title/abstract, 49 at full text, resulting in two prospective and five cross-sectional observational studies reviewed. Four were rated ‘good’ and three were rated ‘fair’ using the quality assessment criteria. Findings varied across the studies and differed by gender. In women, four studies reported significant positive associations of SB with BMD at different sites, and two found significant negative associations. Five studies which examined both men and women, men reported negative or no associations of SB with femoral neck, pelvic, whole body, spine or leg BMD. Whilst these findings suggest differences between men and women in the associations of SB with BMD, they may be due to the varying anatomical sections examined for BMD, the different methods used to measure SB, the varied quality of the studies included and the limited number of published findings.

Objectives: 1) To develop an understanding of the thoughts and opinions of older women diagnosed with osteoporosis regarding sedentary behaviour and 2) Investigate strategies used to reduce sedentary behaviour for future intervention development. Methods: Eleven older women with osteoporosis (mean age=68.2y±6.6(SD)) participated in semi-structured interviews (March-May 2020). They were recruited from the Royal Osteoporosis Society (Scottish) support group networks and the Strathclyde Age-Friendly-Academy. Telephone interviews were recorded, transcribed verbatim and thematically analysed using Braun & Clarke (2006). Results: Three main themes emerged: ‘Older Women’s Knowledge’, ‘Motivators to reduce Sedentary Behaviour’ and ‘Older Adult’s and Technology’. Participants reported an increase/maintenance of physical activity levels after osteoporosis diagnosis, had a good understanding and awareness of sedentary behaviour and how it affects health holistically. Participants identified motivators to interrupt sedentary behaviour (e.g. family/friends) and facilitators of sedentary behaviour (e.g. Television). Technology appeared to be used widely among participants to track movement patterns (e.g. Fitbit) but access and usability were identified as potential barriers when using technology to reduce sedentary behaviour among older adults. Conclusion: Knowledge does not appear to be a factor that needs addressing in relation to sedentary behavior in older women diagnosed with osteoporosis. Identified motivators and barriers could increase awareness of sedentary behaviour among older adults.

Reducing Sedentary Behaviour after hospitalization starts with reducing sedentary behaviour whilst in hospital. Although we have eradicated immobilisation as a therapeutic tool due to its potent detrimental effects, it is still in systemic use within health care systems and hospitals. Evidence shows that when in hospital, patients spend most of their time sedentary. In this editorial, we explore the determinants of, and a system-based approach to, reducing sedentary behaviour in health care.

Prolonged sitting (or sedentary behaviour—SB) has profound detrimental effects on health and is associated with increased risk of chronic disease, hospitalisation and premature death. However, while in hospital, a person will spend the vast majority of the day sitting or lying down. A number of strategies have started to be implemented to counteract this phenomenon and get patients up and moving. This is the first explorative study that used device-based measurements of the postural physical activity of older hospitalised adults taking part in such initiatives. A total of 43 patients, mean age 83.8y (SD 8.3), wore a waterproofed activity monitor (activPAL3) for 4 days (including overnight); physical activity was analysed for waking hours. Interventions designed to get patients up and moving were introduced sequentially. Participants were grouped based on the highest level of intervention they received. There were 4 groups: “control” (n = 12), “education” (advice on SB reduction via infographics on the ward noticeboards, n = 12), “#endpjparalysis” (up and dressed by the nurses before 11: 30 am, n = 9), “personalised activity passports” (agreed by Occupational Therapists and other members of the multidisciplinary team with patients, on SB reduction, n = 10). ANOVA revealed the absence of any differences between the 4 groups for total sitting time (p = 0.989), time spent upright (standing and walking) (p = 0.700), number of sitting events (i.e. sit to stand transitions) (p = 0.418) and longest upright period (p = 0.915). This small explorative study of sequential initiatives within a ward setting to reduce SB found they were not successful. The cross-sectional service-improvement nature of the study limited the ability to assess change in individuals as interventions were introduced. Further work is warranted to untangle the determinants of SB in hospital settings and implement interventions of sustainable SB change in this setting.

Abstract Strength and balance exercise programmes are effective in reducing the rate and risk of falls but uptake and adherence to community based programmes are low. Exergaming technology may be a promising tool to increase exercise uptake and adherence among seniors due to their motivational features. As yet, there is little published on the views of older people and therapists of their experiences of using Exergames to reduce falls in assisted living facilities that may inform implementation. This study is the qualitative component of a cluster randomized controlled trial that investigated the use of purpose-built strength and balance Exergames in community-dwelling older people in 18 assisted-living facilities in the UK. Data collection included 36 hours’ observation, semi-structured interviews with 5 physiotherapists, assistants and researchers, and 13 focus groups with residents of assisted living facilities who had participated in a 12 week Exergame programme. Transcribed data were analysed using thematic content analysis to identify themes arising from older users’ and therapists’ experiences of using the Exergames. Findings suggest that the senior users enjoyed using the strength and balance Exergames and reported physical, psychological and social benefits. Although some games were generally favoured, there was no overall consensus on game preferences although social components, feedback, music and colourful animation appeared to increase the appeal of the Exergames. This is the first study exploring older users and therapists’ perceptions of exergames in assisted living facilities and provides valuable insight into the barriers, facilitators, contextual factors and perceived benefits or drawbacks following 12 weeks use.

Introduction: Falls are the leading cause of fatal and non-fatal unintentional injuries in older people. Despite overwhelming evidence for strength/balance training, adherence to both group and home-exercise programmes is often poor1. A novel approach is the use of home-based, strength and balance video-games (EXERGAMES) but data from randomized controlled trials are limited2. The aim of this study was to test whether a 12 week EXERGAMES home-based intervention, co-developed with older adults and therapists, can improve the risk of falling [by Berg Balance Scale (BBS)] in older adults living in sheltered housing. Methods: We conducted a two-site (Manchester/Glasgow) cluster RCT. Twelve sheltered housing facilities were randomised (1:1) to either a 12wk standard care plus 3 times/ week EXERGAMES physiotherapist one-to-one intervention (n=56) or standard care (control group n=50). Standard care involved the provision of a home exercise booklet (standard approach for those unable/unwilling to attend group exercise programmes in the community). Results: A total of 106 older adults (83F, 23M) with a mean age of 77.8y (SD 10.2; range 55-101y), were recruited for the study. A total of 91 (86%) participants completed all study visits. Over 12 weeks the EXERGAMES intervention had a significant positive impact on BBS [p=0.003; mean (SD), 44.6 (10.7) (EXERGAMES) vs. 37.6 (14.9) (Control)]. The mean change of BBS from baseline was 2.9 (8.5) for the EXERGAMES and -2.8 (6.5) for the control group. The estimated increase in BBS score due to EXERGAMES was 6.2 (95% CI 2.4 to 9.9) which is greater than the minimal detectable change for the scale of 4.93. Conclusions: Balance, and thus risk of falling, can be improved through a 12wk physiotherapy led EXERGAMES programme. This type of home based intervention could be considered as an effective alternative to traditional falls prevention exercise regimes to support outcomes for patients.

Organisation describes three groups, the 'physically fithealthy, the 'physically unfit, healthy' and the 'physically unfit-unhealthy'.The National Service Framework for older people describes 'entering old age', 'those in the transition phase' and 'frailer older people' 2 .The addition of MBSBA to the UKs physical activity guidelines are appropriate to all older people, whichever phase of ageing or specific ageing group they are in.MBSBA are recommended for people with diagnosed osteoporosis 3,4 , for those who are frail and sarcopenic 5-8 and for those with AbstractPhysical activity guidelines advocate the inclusion of strength and balance activities, twice a week, for adults and older adults, but with caveat that in some individuals there will be certain movements and activities that could lead to adverse events.This scoping review summarizes the evidence about how safe and efficacious these activities are in older adults with specific challenges that might make them more prone to injury (e.g.having recently fractured or at risk of fracture (osteoporosis) or those who are frail or who have cognitive impairment).The review identified that for prevention of falls in people with a falls history and/or frailer older adults, structured exercise programmes that incorporate progressive resistance training (PRT) with increasing balance challenges over time are safe and effective if performed regularly, with supervision and support, over at least 6 months.Some minor adverse effects mainly transient musculoskeletal pain) have been reported.For those with a higher risk of falls and fractures (very poor balance, vertebral fractures), supervised structured exercise programmes are most appropriate.People with diagnosed osteoporosis should be as active as possible and only avoid activities with a high risk of falls if they are naïve to those activities.For those in transition to frailty who have poor strength and balance, exercises that are known to help maintain strength and balance (such as Tai Chi) are effective in preventing a decline in falls risk.For the very frail older adult, supervised structured exercise that has PRT, balance training and some endurance work, supervised and progressed by a trained person are advocated.