People who are more physically active tend to have more favorable automatic evaluations of exercise (i.e., nonconscious evaluations based on mental associations between "exercise" and "pleasant" or "unpleasant" that manifest into approach tendencies). Although some interventions have been shown to modify automatic evaluations in lab-based settings, the training regimes may not translate into scalable real-world interventions. The aim of these studies were to (a) test how often people tend to engage with the app in a "real-world" setting, and (b) test whether an app with gamification features and evaluative conditioning strategies change automatic evaluations of exercise versus sedentary behavior. Participants (N = 289, 238 female, M age = 33) were randomly allocated to have access to either Flex Exercise-a game-based app which contained 70% exercise-related content or Flex Control-the same game-based app with no exercise content. Participants completed an Implicit Association Test (IAT) as assessments of automatic evaluations immediately after exposure to Flex and 24 hr later. No significant between-group difference was observed immediately after exposure to Flex for automatic evaluations; however, 1 day following exposure, those in the Flex Exercise condition had significantly more favorable automatic evaluations of exercise than those in the Flex Control condition (d = 0.24). This effect was driven by a change in automatic evaluations, as assessed through the IAT, in the control condition more favorable toward sedentary behavior relative to physical activity and was magnified by user engagement. This mHealth intervention may have inadvertently enhanced sedentary automatic evaluations.

BACKGROUND Dual process theories propose that the brain uses 2 types of thinking to influence behavior: automatic processing and reflective processing. Automatic processing is fast, immediate, nonconscious, and unintentional, whereas reflective processing focuses on logical reasoning, and it is slow, step by step, and intentional. Most digital psychological health interventions tend to solely target the reflective system, although the automatic processing pathway can have strong influences on behavior. Laboratory-based research has highlighted that automatic processing tasks can create behavior change; however, there are substantial gaps in the field on the design, implementation, and delivery of automatic processing tasks in real-world settings. It is important to identify and summarize the existing literature in this area to inform the translation of laboratory-based research to real-world settings. OBJECTIVE This scoping review aims to explore the effectiveness of automatic training tasks, types of training tasks commonly used, mode of delivery, and impacts of gamification on automatic processing tasks designed for digital psychological health interventions in real-world settings among adults. METHODS The scoping review methodology proposed by Arskey and O’Malley and Colquhoun was applied. A scoping review was chosen because of the novelty of the digital automatic processing field and to encompass a broad review of the existing evidence base. Electronic databases and gray literature databases were searched with the search terms “automatic processing,” “computerised technologies,” “health intervention,” “real-world,” and “adults” and synonyms of these words. The search was up to date until September 2018. A manual search was also completed on the reference lists of the included studies. RESULTS A total of 14 studies met all inclusion criteria. There was a wide variety of health conditions targeted, with the most prevalent being alcohol abuse followed by social anxiety. Attention bias modification tasks were the most prevalent type of automatic processing task, and the majority of tasks were most commonly delivered over the web via a personal computer. Of the 14 studies included in the review, 8 demonstrated significant changes to automatic processes and 4 demonstrated significant behavioral changes as a result of changed automatic processes. CONCLUSIONS This is the first review to synthesize the evidence on automatic processing tasks in real-world settings targeting adults. This review has highlighted promising, albeit limited, research demonstrating that automatic processing tasks may be used effectively in a real-world setting to influence behavior change.

Objective: To test the feasibility and usability of ‘Exercise Guide’, a patient‐centred online guidance tool that aims to increase levels of exercise knowledge, confidence and skills whilst undergoing treatment for or living with metastatic prostate cancer. Methods: In total 15 men with diagnosed metastatic prostate cancer will be recruited to test the online tool in a lab‐based setting. This will involve navigating around the website, and generating and viewing tailored exercise prescription. Participants will engage in a ‘think aloud’ protocol and sessions will be recorded, transcribed, and coded to identify interactions. The prescribed exercises will be performed and filmed under observation. Expert exercise physiologists will determine safety and effectiveness of exercises by using a movement screening pro‐forma to grade filmed exercises. Following the testing period, participants will be asked to complete a questionnaire assessing their perceptions of the advice received in terms of relevance, usefulness, credibility, and ease of understanding. Results: Given we are using a person‐centred approach, we expect the men will find the tool acceptable and understandable as considerations have been made based on preferences and needs. However, due to the iterative nature of the project, we will use feedback to further tailor the guidance tool. The study will be completed in August 2018. Conclusions: The results from this study will help refine the ‘Exercise Guide’ tool, which will then be implemented within a pilot randomised control trial. This potentially valuable tool may enhance physical activity levels and quality of life for men with metastatic prostate cancer.

Introduction: Pregnant women in socioeconomically disadvantaged circumstances, such as Indigenous women, have a high prevalence of smoking. Tobacco smoking is the most significant reversible risk factor for the health of Indigenous pregnant women and their babies.Methods: As researchers working in this specialized area, we conducted a narrative review of the literature on smoking among Indigenous pregnant women in the United States, Canada, New Zealand, and Australia. We summarize prevalence and factors influencing tobacco use, interventions, and evidence gaps for tobacco control and smoking cessation. Recommendations are made for future interventions, policy changes, and much-needed research.Results: Common themes emerging across the four countries reveal opportunities for cross-cultural collaborative studies and trials. These include the social-normative use of tobacco as barriers to quitting in pregnancy and the need for evaluations of interventions at the family and community level. Socioeconomic disparities underscore the importance of enhancing the implementation and reach of strategies to prevent and reduce prenatal tobacco smoking among Indigenous women. Elders and community health care providers as role models for nontobacco use could be explored. Qualitative work is needed to understand the barriers and opportunities, such as cultural strengths supporting quitting tobacco to develop more effective approaches.Conclusions: Although a high-priority group, there remains a dearth of research on Indigenous women's smoking in pregnancy. Studies have assessed knowledge and attitudes to smoking in pregnancy, and small feasibility studies and a few empirical trials have been conducted. Recommendations for promising culturally appropriate cessation interventions have been made. Larger trials are warranted.Implications: Strategies to support quitting among pregnant Indigenous women need to be multifactorial and take account of the social determinants of smoking including historical antecedents, community norms, cultural strengths, and recognition of individual and community needs. Cross-country research collaborations have the potential to leverage funding, share expertise, and strengthen approaches to tackle an important and poorly attended health disparity that has a profound impact on the entire life course for Indigenous peoples.

Regelmäßige Bewegung wirkt sich in vielfältiger Weise gesundheitsfördernd aus, insbesondere ist ein positiver Beitrag zum Management chronischer Krankheiten wie beispielsweise Asthma umfassend dokumentiert. In manchen Fällen kann körperliche Belastung aber auch die Verschlimmerung einer Asthmaerkrankung und entsprechende akute Anfälle von Atemnot, Husten, Engegefühl in der Brust und pfeifenden Atem (Giemen) auslösen. Dieser physiologische Prozess wird als belastungsinduzierte Bronchokonstriktion (exercise-induced bronchoconstriction, EIB) bezeichnet und ist als Abnahme der Einsekundenkapazität nach körperlicher Belastung um 10-15% gegenüber dem Ausgangswert definiert. Während EIB unter Asthmatikern sehr weit verbreitet ist und sich mit einer ähnlichen respiratorischen Symptomatik manifestiert, sind Asthma und EIB nicht zwingend miteinander vergesellschaftet. Das Ziel der vorliegenden Übersichtsarbeit ist es, einen umfassenden Überblick über beide Krankheitsbilder zu geben, um die Kenntnisse über ihre Gemeinsamkeiten und Unterschiede auszubauen und ihre Unterscheidung als zwei separate Entitäten zu schärfen. Die Pathophysiologie und die Mechanismen, die der Asthmaerkrankung zugrunde liegen, sind umfassend beschrieben; derzeit konzentriert sich die Forschung darauf, Phänotypen für zielgerichtete Managementstrategien zu definieren. Die zugrunde liegenden Mechanismen der EIB hingegen sind noch weitgehend ungeklärt. Für beide gibt es ähnliche etablierte Diagnosepfade sowie ähnliche pharmakologische und nichtpharmakologische Behandlungs- und Managementansätze, die bei früherer Erkennung bessere Erfolgsaussichten zeigen. Angesichts der Gefahr von Asthmaanfällen meiden viele Asthma-Patienten körperliche Anstrengung. Dies ist jedoch kontraproduktiv, da aktuelle Daten belegen, dass Bewegung gut verträglich ist und die Lebensqualität verbessert. Die Literatur, die sich für einen Nutzen von körperlicher Aktivität bei EIB ausspricht, ist gegenwärtig sehr positiv eingestellt, jedoch von äußerst begrenztem Umfang. Daher sollten zukünftige Forschungsbemühungen sich sowohl mit diesem Aspekt als auch mit der weiteren Erforschung der Pathophysiologie und der Mechanismen, die EIB und Asthma zugrunde liegen, befassen.

440 Joint Annual Meeting of the Schweizerische Gesellschaft für Pneumologie / Société Suisse de Pneumologie Schweizerische Gesellschaft für Pädiatrische Pneumologie / Société Suisse de Pneumologie Pédiatrique Schweizerische Gesellschaft für Thoraxchirurgie / Société Suisse de Chirurgie Thoracique Schweizerische Gesellschaft für Pulmonale Hypertonie / Société Suisse sur l’Hypertension Pulmonaire 16–17 April 2015, Lugano

Exercising regularly has a wide range of beneficial health effects; in particular, it has been well documented to help in the management of chronic illnesses including asthma. However, in some individuals, exertion can also trigger an exacerbation of asthmatic episodes and subsequent acute attacks of breathlessness, coughing, tightness of the chest and wheezing. This physiological process is called exercise-induced bronchoconstriction (EIB) whereby post-exercise forced expiratory volume in 1 s is reduced by 10-15% from baseline. While EIB is highly prevalent in asthmatics and presents with similar respiratory symptoms, asthma and EIB are not mutually exclusive. The aim of this review is to present a broad overview of both conditions in order to enhance the understanding of the similarities and differences distinguishing them as two separate entities. The pathophysiology and mechanisms underlying asthma are well described with research now focussing on defining phenotypes for targeted management strategies. Conversely, the mechanistic understanding of EIB remains largely under-described. Diagnostic pathways for both are established and similar, as are pharmacologic and non-pharmacologic treatments and management approaches, which have enhanced success with early detection. Given the potential for exacerbation of asthma, exercise avoidance is common but counterproductive as current evidence indicates that it is well tolerated and improves quality of life. Literature supporting the benefit of exercise for EIB sufferers is at present favourable, yet extremely limited; therefore, future research should be directed in this area as well as towards further developing the understanding of the pathophysiology and mechanisms underpinning both EIB and asthma.

This article systematically reviews 91 smoking cessation and tobacco prevention studies tailored for Indigenous populations around the world, with a particular focus on Aboriginal and Torres Strait Islander populations in Australia. We identified several components of effective interventions, including the use of multifaceted programs that simultaneously address the behavioural, psychological and biochemical aspects of addiction, using resources culturally tailored for the needs of individual Indigenous populations. Pharmacotherapy for smoking cessation was effective when combined with culturally tailored behavioural interventions and health professional support, though it is generally underused in clinical practice. From a policy perspective, interventions of greater intensity, with more components, were more likely to be effective than those of lower intensity and shorter duration. For any new policy it is important to consider community capacity building, development of knowledge, and sustainability of the policy beyond guided implementation. Future research should address how the intervention can be supported into standard practice, policy, or translation into the front-line of clinical care. Investigations are also required to determine the efficacy of emerging therapies (such as e-cigarettes and the use of social media to tackle youth smoking), and under-researched interventions that hold promise based on non-Indigenous studies, such as the use of Champix. We conclude that more methodologically rigorous investigations are required to determine components of the less-successful interventions to aid future policy, practice and research initiatives. Evidence Base, issue 3, 2014