People living with osteoporosis can experience worse mental health and quality of life (QoL), including pain and psychological distress than those without. Psychological stress and poor mental health are associated with an increased risk of osteoporosis (OP). We conducted a systematic review and meta-analysis of randomised controlled trials investigating the effect of exercise on mental health, QoL and pain in people living with OP. A systematic review and meta-analysis was conducted following PRISMA guidelines (PROSPERO: CRD42023440020). Inclusion criteria were randomised controlled trials investigating exercise in people diagnosed with OP, including QoL, mental health, and/or pain outcomes. Exclusion criteria were non-human studies or studies not translatable into English. An electronic search of the literature was performed from inception to December 2025 in PubMed, EMBASE, PsycINFO, CINAHL, Scopus, and Web of Science. Bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The Consensus on Exercise Reporting Template was used to assess reporting quality. Three authors independently extracted data into Microsoft Excel. Data were analysed using Cochrane Review Manager Web (version 9.4.1), including mean differences (MD) and standardised mean differences (SMD) using a random-effects inverse variance model. Moderator analyses assessed modality, intensity, duration, frequency, setting, participant age, the presence of fracture (

(Central) Auditory Processing Disorder ([C]APD) is an umbrella term for children who have difficulty with listening, despite normal hearing. Children with (C)APD frequently experience academic, behavioural, emotional, cognitive and social difficulties, and lack accessible, long-lasting wholistic treatments. Hence, a transdisciplinary intervention has been developed - Auditory-Cued Exercise Therapy (ACET). This manuscript details the protocol for a two-group, feasibility and preliminary effectiveness trial. Eighty participants meeting diagnostic criteria for (C)APD, aged seven to 12 years, will be quasi-randomly assigned to the ACET intervention group or a matched physical exercise-only intervention group. The intervention will consist of 8 weeks of twice-weekly 50-min exercise sessions incorporating age-appropriate activities and games to develop physical literacy. The ACET intervention will involve elements of listening practice and auditory training, using auditory cues and engagement with music and rhythm throughout exercise sessions. Improvements in auditory processing ability from baseline testing to post-intervention assessment are considered the primary outcome measure, while changes in electrophysiology, physical literacy and quality of life are secondary outcome measures. Feasibility will be reported in line with the CONSORT extension recommendations for pilot and feasibility trials. To date, no randomised control trial has evaluated ACET for this population. This paper provides important information for transparency and reproducibility of the study protocol.Trial registrationAustralia New Zealand Clinical Trials Registry; ACTRN12622001090707. Registered 8 August 2022, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384407&isReview=true.

BACKGROUND: The menopausal transition is characterised by declines in lean body mass (LBM) and increased fat mass, contributing to elevated cardiovascular disease risk and all-cause mortality. Resistance Training (RT) is a gold standard intervention for increasing LBM, potentially lowering disease risk. Despite the possible benefits to health, few studies have examined the effects of RT during the menopausal transition. AIM: To investigate the effect of RT on body composition, strength, and cardiometabolic measures in females approaching or in the menopausal transition. METHODS: Females aged 38-50 years (mean=45.42) were randomly assigned with a 2:1 allocation ratio, stratified by hormone use, to a 12-week, twice weekly RT program (n=34) or waitlist non-exercise control (n=14). Four participants dropped out during the study (RT=2, control=2). Body composition was assessed using Dual-Energy X-ray Absorptiometry. Secondary outcomes included lower and upper body muscle strength (3-RM), finger pin-prick blood glucose and total cholesterol (CardioChek PA analyser), and blood pressure. A linear mixed-effects model for repeated measures was used to analyse data. RESULTS: Females in RT gained significantly more LBM than controls (+1.05±0.36kg; p=0.005). There were no significant group-time effects for changes in total fat mass (p=0.90), body fat percentage (p=0.24), visceral fat mass (p=0.30) or bone mineral density (p=0.80). Participants in RT gained significantly more leg (+58.18±8.96kg; p<0.001) and chest strength (+8.03±1.20kg; p<0.001). No significant group-time effects were observed for blood glucose (p=0.98), total cholesterol (p=0.13), and systolic (p=0.88) or diastolic blood pressure (p=0.29). CONCLUSION: Participating in RT resulted in significant gains in LBM and strength in females approaching or in the menopausal transition. No changes were observed for body fat measures, bone mineral density, or cardiometabolic measures. Our findings suggest RT is an effective intervention for improving musculoskeletal health during this life stage.

INTRODUCTION & AIM: Despite evidence linking low physical fitness to poorer health outcomes in individuals with severe mental illness, the clinical utility of physical performance assessments in acute inpatient settings remains underexplored. This study evaluated the feasibility and reliability of a standardised physical assessment battery within an adult inpatient mental health service. METHODS: Feasibility was assessed according to four domains of the Bowen et al. (2009) framework: demand, acceptability, implementation, and practicality. To assess reliability, a subset of participants completed the physical assessment battery on two occasions within 14 days. Outcomes measures included isometric grip strength and a submaximal graded cardiorespiratory fitness (CRF) cycling test with a threshold set at 85% of predicted maximum heart rate (HR). Reliability was examined using paired samples t-tests, effect sizes (Cohen’s d), and intraclass correlation coefficients (ICCs) with 95% confidence intervals. RESULTS: Of 93 inpatients offered testing, 64 (69%) consented and completed a testing session. The reliability study included a subset of 25 participants (mean age=39, 19-64 yrs; 80% male sex; 60% schizophrenia spectrum disorders) with 100% completion of grip strength across sessions. CRF was completed-per-protocol by 45% and 38%, with 55% and 62% of participants terminating the test before reaching target HR primarily due to leg fatigue (58%/60%). Grip strength demonstrated excellent reliability (ICC = 0.88–0.92), while CRF outcomes showed good reliability (ICC = 0.80–0.85). No adverse events occurred. CONCLUSION: Physical fitness testing was acceptable to acute mental health inpatients, with high uptake. Grip strength testing was highly feasible and reliable. Submaximal CRF testing showed implementation and completion challenges but demonstrated good reliability. Overall, findings support integrating a standardised physical assessment battery into routine inpatient care. Future research should examine lower-intensity aerobic fitness protocols to reduce participation barriers and the integration of outcomes into medical care.

Trans young people face systemic barriers to physical activity participation and experience disproportionately higher rates of physical and mental health challenges compared with their cisgender peers, yet evidence-based exercise interventions tailored to this population remain limited. This study evaluated a 12-week structured, group-based, gender-affirming exercise programme for trans youth aged 12 to 24 years in Western Australia, recruited through a specialist paediatric gender diversity service and community-based health and well-being services. Using a nonrandomised effectiveness-implementation hybrid design, the study assessed both the real-world implementation outcomes and health-related effectiveness of the programme, which was collaboratively designed with trans young people, families, and health professionals and grounded in international physical activity guidelines. Twenty participants enrolled, with 18 completing postprogramme assessments. Quantitative analysis revealed modest improvements in muscular strength, endurance, power, aerobic recovery, and well-being from baseline to 12 weeks, alongside high acceptability, appropriateness, feasibility, fidelity, and retention rates. Qualitative analysis identified themes relating to pathways to participation, connection through shared experience, supportive facilitation, and perceived physical and psychological benefits. This study adds to the limited evidence base by demonstrating that gender-affirming exercise programmes are both feasible and acceptable across clinical and community settings. Findings support the broader integration of exercise into gender-affirming health care, with implications for the design of inclusive health services and physical activity policies that address the specific needs of trans youth.

SETTING AND POPULATION: Thriving in Motion’s Kids and Teens program is a exercise service supporting neurodiverse young people who experience barriers to physical activity. Thriving specialises in supporting autistic individuals with complex presentations, including anxiety-driven avoidance and Pathological Demand Avoidance profiles. Within this population, conventional compliance-based exercise coaching often resulted in distress or disengagement, and a different approach was required. SERVICE DELIVERED: Thriving implemented a demand-reduction, relationship-led model of exercise therapy informed by the PANDA approach that guided staff to reduce explicit, implicit, and cumulative demands, whilst maintaining therapeutic intent. Clinicians prioritised psychological safety, trust, and shared control over task compliance. Sessions were flexible and choice-driven, using game-based activities to target strength, balance, and gross motor skills. Familiar activities supported predictability, with novel challenges introduced indirectly and responsively through play-based disguise, visual supports, and real-time adaptation to minimise nervous system activation. Assessments were conducted flexibly, with advance communication and repeated measurement opportunities enabling tracking of assessment outcomes despite variability in regulation and mood. OUTCOMES: This shift in service approach resulted in improved engagement, attendance, and enjoyment of physical activity among participants with complex presentations. Participants showed improvements in multiple physical literacy domains when engaged in the program. One parent reported: “Thriving has become one of the few safe spaces where my child can engage in a community-based activity and leave sessions feeling proud of their achievements.” LEARNINGS / INNOVATION: This work represents an innovative shift in exercise practice, toward an autonomy-centred efficacious service model for autistic children with complex presentations which is feasible, acceptable, and scalable. TRANSLATION AND SUSTAINABILITY: The model has been embedded in services through staff training, with clinicians reporting and demonstrating increased confidence in managing non-linear engagement and arousal/behaviour regulation. By implementing shared practice principles, peer support structures, and encouraging staff creativity/adaptability, sustainable program has been developed.

Fine debt for minor offences disproportionately affects individuals experiencing social and economic disadvantage. To address this, several Australian states have implemented schemes such as the Work and Development Order (WDO) program that allow eligible individuals to pay off fines through nonmonetary means such as counselling, mentoring or voluntary work. Given the therapeutic benefits of physical activity on mental and physical health, integrating exercise referral schemes into the WDO program may offer significant benefits. This study aimed to explore the perspectives of current service administrators, WDO providers and consumers who have used the scheme, focussing on experiences with the existing scheme and views on introducing exercise referral schemes as an eligible WDO activity. One-to-one semistructured interviews were conducted, and the audio-recorded interviews were inductively thematically analysed using an interpretivist approach. In total, 22 interviews were conducted, including 13 WDO providers or administrators and nine consumers. Overall, participants highly valued the scheme, describing perceived benefits for consumer rehabilitation, behaviour change and debt relief, while also raising concerns regarding knowledge of and awareness of the scheme. Participants suggested that introducing exercise referral schemes could improve physical activity levels and reduce health inequities, while also increasing the availability and diversity of WDO programs. Key considerations included the need for safe, inclusive and individualised programs and leveraging community partnerships for referrals.

Trauma and social disadvantage are strongly associated with higher rates of chronic disease, partly driven by modifiable risk factors such as physical inactivity and poor diet. Despite strong evidence supporting exercise and dietary interventions for both physical and mental health, access to allied health professionals-particularly exercise physiologists, physiotherapists and dietitians-remains profoundly inequitable. Current prevention efforts predominantly reach individuals with stable living conditions and sufficient resources, ultimately privileging the privileged and entrenching health disparities. To close these gaps, these workforces must be reoriented: embedded within trusted community settings and delivered earlier in the care pathway, in ways that are trauma-informed and responsive to social context.

INTRODUCTION & AIM: Chest binding is a common practice in trans and gender diverse populations and is associated with many psychological benefits. Despite this, clinical and community guidance frequently cautions against chest binding during exercise due to perceived health risks, yet evidence supporting physiological risk or acute effects on performance is lacking. The aim of this study was to determine whether chest binding alters maximal aerobic and strength performance, respiratory function, range of motion (ROM), or perceptual responses to maximal exertion in binder-naive people. METHODS: A randomised counterbalanced crossover design evaluated acute responses to exercise performed in binder and non-binder conditions. The primary outcome was VO₂max, with secondary outcomes including maximal muscle strength (1RM bench press, lat pulldown), respiratory function (FEV1, maximal VT and VE), spine and shoulder flexion and perceptual ratings of comfort, dyspnoea, and exertion. Analyses examined within-participant differences across conditions and consistency of physiological and perceptual responses. RESULTS: Twenty-one participants (mean age 30.67± 5.41 years) completed all testing, with anthropometric diversity evident across chest girth, body composition, and binder size. No significant differences were found between conditions for VO₂max, 1RM bench press and lat pulldown strength, maximal VE and VT, FEV1, or ROM, and all effect sizes were small (d<0.3) with strong within-participant agreement for key physiological measures (r=0.89-0.95, p<0.001). Perceptual outcomes demonstrated no between-condition differences, with moderate to strong correlations across trials (r<0.5). CONCLUSION: Chest binding did not alter maximal aerobic or strength performance, respiratory function at rest or maximal exertion, ROM or perceptions during maximal exertion. Given the lack of change in physiological or perceptual function, chest binding, acutely, is unlikely to contribute to changes in risk profile associated with activity. These findings challenge the precautionary advice currently given, indicating it provides an unnecessary barrier to exercise participation.

Clinical exercise professionals (CEPs) play a key role in supporting people with mental and physical health challenges. Yet access to services is inequitable, especially for ‘hard to reach’ or underserved populations such as people who have experienced trauma and social disadvantage, who could benefit most from exercise support. Through a socio-ecological lens, we discuss how limited referral pathways, variable workforce preparedness, and a lack of exercise integration within safe, equity-oriented systems of care contribute to underutilisation of CEPs. To deliver equitable care, we discuss strengthening workforce capacity through cultural responsiveness and trauma- and violence-informed care training. Partnerships and models of collaborative, community-based services are presented. We call to action various stakeholders to support activation of the CEP workforce to create appropriate physical activity opportunities for underserved populations.

INTRODUCTION: While exercise services are increasingly embedded in mental healthcare, evidence to guide implementation and sustainability of supported exercise therapy remains limited. This effectiveness–implementation trial compared in-person and remotely supported exercise therapy within an outpatient, transdiagnostic mental health hospital service. METHODS: Participants were allocated to either an in-person or remotely supported 12-week exercise intervention, targeting 150 minutes per week of moderate-intensity activity. Implementation outcomes were assessed using quantitative indicators (including adoption and adherence) and qualitative interviews exploring participant experiences. Effectiveness was evaluated through within- and between-group changes in physical health outcomes (e.g., cardiometabolic, muscle strength, cardiorespiratory fitness), lifestyle attitudes and behaviours, and quality of life. RESULTS: Forty-three participants were allocated to in-person (n=33) or remotely supported exercise (n = 10). In-person delivery resulted in significantly greater exercise adherence than remote delivery (mean difference=+485 minutes, p=.02, r=0.51). Within-group analyses showed reductions in waist circumference in the in-person group (d=−0.169, p=.01), while the remote group demonstrated a non-significant increase (d=0.139, p=.29). The remotely supported group showed larger effects for reducing sedentary time (d=−1.049, p=.10) and increasing general physical activity (d=0.767, p=.03), whereas the in-person group showed greater improvements in quality of life (d=0.466, p=.01). Across both interventions, lower quality of life and older age were negatively associated with adherence, while prioritising mental health improvement as a goal was associated with greater adherence (r=0.633, p=.001). Qualitative analysis identified the value of human connection, new experiences through exercise, practical and psychological barriers, and the influence of the hospital environment on implementation. CONCLUSION: In-person exercise achieved higher adherence, although both models increased overall exercise participation. In-person delivery may support greater physical health and quality of life gains, while remotely supported exercise may better influence activity behaviours. These findings offer practical insights to optimise exercise delivery in routine mental health care.

Background Trans young people report lower levels of physical activity than their cisgender peers, with one in four limiting exercise participation due to their gender. Exercise provision within gender-affirming services represents an underexplored strategy to support health and wellbeing. To inform the development of collaborative and responsive programs, this study engaged stakeholders—including trans young people, parents, and healthcare providers—to explore exercise experiences, beliefs, barriers, and support needs. Methods Participants were recruited through networks of trans youth, families, and professionals working in trans healthcare across Australia. Twenty individuals participated (six trans and gender diverse young people, two parents, and 12 healthcare providers). Semi-structured interviews were conducted and analysed using reflexive thematic analysis to identify patterns of shared meaning across accounts. Results Four themes were developed; navigating intersectionality in adolescence; binary nature of community sport and physical activity spaces; external pressures and societal marginalisation shaping participation; and inclusive exercise as a reimagined social practice. Conclusion Findings highlight the need for structural and cultural change within sport and exercise environments to better support trans young people’s physical activity participation. Embedding inclusive, gender-affirming exercise models within multidisciplinary services may enhance access, sustained engagement, and wellbeing, while providing a foundation for future research evaluating exercise-based health interventions.

Structured exercise programs for university students experiencing mental distress are underused, with limited research evidence regarding the links between exercise experiences and health indicators in these contexts. We sought to examine the between- and within-person associations between exercise enjoyment, depressive symptomatology, self-esteem, and perceptions of physical health for participants in a 12-week, on-campus, referral-based exercise program. Using an intensive repeated measures design, fortnightly over a 12-week period, participants (n = 93, Mage = 22.97, 69% female) self-reported perceptions of exercise enjoyment, and perceived health outcomes. There were 83% (n = 77) of participants who completed at least 2 assessments, 60% (n = 55) completed 4 or more assessments, and 40% (n = 37) completed 5 or 6 assessments. Multilevel modelling was used to test associations between variables at both between- and within-person levels. Depressive symptomatology decreased, while self-esteem and perceived physical health increased over time in the program. Students who, on average, reported relatively higher levels of exercise enjoyment had lower depressive symptomatology, higher self-esteem and perceived physical health (i.e., between-person associations). At times when students reported high levels of exercise enjoyment relative to their own average, this coincided with lower depressive symptomatology, and higher self-esteem and perceived physical health (i.e., within-person associations). These findings emphasise the value of incorporating program elements supportive of participants' exercise enjoyment.

People experiencing mental health problems often encounter fragmented systems of care in which physical and mental health needs are addressed separately. Physical activity is an evidence-based approach for improving both physical and mental health and integrating evidence-based psychosocial support with physical activity in community settings may offer a holistic and accessible approach. This study explored interest-holder perspectives on integrating the World Health Organization Doing What Matters in Times of Stress intervention within a trauma-informed, community-based physical activity service. A qualitative study was conducted within a free, community-based, university-run physical activity service in Sydney, Australia. Semi-structured interviews were undertaken with people with lived expertise of mental health challenges, Clinical Exercise Professionals, and mental health service providers. Data were analysed using thematic analysis guided by the Consolidated Framework for Implementation Research. Nineteen participants (11 people with lived expertise, four Clinical Exercise Professionals, and four service providers) took part. Participants generally viewed the future delivery of Doing What Matters in Times of Stress by exercise professionals as acceptable and potentially beneficial for supporting both mental and physical health. Existing rapport with exercise professionals, the disarming nature of physical activity, and practical stress-management strategies were identified as strengths of the model of future delivery. Participants viewed Clinical Exercise Professionals as potentially well-placed to facilitate Doing What Matters in Times of Stress alongside supervised physical activity, as long as it was supported by appropriate training, supervision, referral pathways, and clear professional boundaries. Trauma-informed, inclusive environments, tailoring the intervention, prioritizing service user choice and organisational support were also considered important factors for successful future implementation. Conclusions: Integrating Doing What Matters in Times of Stress within a trusted, community-based physical activity service was perceived as acceptable and potentially meaningful for people experiencing mental health challenges. Findings warrant further piloting and evaluation of integrated physical activity and psychosocial intervention models. ### Competing Interest Statement The authors have declared no competing interest. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: University of New South Wales Human Research Ethics Committee, iREC S5757 I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Due to the qualitative nature of this study and the potential for participant identification, the full interview transcripts cannot be made publicly available. Participants were recruited from a small, specific service context (Addi Moves) and the sample included small, potentially identifiable subgroups (Clinical Exercise Professionals, n=4; mental health service providers, n=4); given these group sizes and the rich, contextual nature of qualitative data, full transcripts could risk participant re-identification even if de-identified. Participant consent and ethical approval (UNSW Human Research Ethics Committee, iREC S5757) did not extend to public deposition of interview data. Illustrative de-identified quotations supporting the study's findings are included within the manuscript. Further information about the data may be requested from the corresponding author, subject to ethics committee approval and execution of a data sharing agreement. GK received funding for this project by the UNSW Women’s Wellbeing Academy. CM is funded by the UNSW Research Training Program (RTP) Scholarship (RSAP1000). SR is funded by an NHMRC EL2 fellowship (APP2017506). ST is funded by an NHMRC EL1 fellowship (APP2017302).

INTRODUCTION: Mental health challenges and social isolation are increasingly prevalent among tertiary students. International students face additional vulnerabilities. At the University of New South Wales (UNSW), over 20000 mental health-related appointments occur annually, indicating the need for innovative strategies. Physical activity (PA) supports mental wellbeing, while peer-led programs can enhance social belonging. Stride is a peer-led individualised PA initiative for tertiary students experiencing mental health challenges (Mentees), led by Exercise Physiology students (Mentors) through work-integrated learning. This study builds on pilot work from the University of Western Australia, examining feasibility and acceptability at UNSW where international students represent 39%. METHODS: A mixed-methods pre-post design was used. Mentees completed DASS-21, AQoL and anthropometrics. Levels of satisfaction and work-integrated learning feedback were collected from Mentors post-program. Quantitative data were analysed using paired-samples t-tests and descriptive analysis. Open-ended responses were analysed inductively to explore perceived impacts. RESULTS: Thirty-nine Mentees (65% women; mean age 23 years; 74% international citizenship) enrolled; 33 completed post-measures with attendance at 78% of PA sessions. Feasibility was supported by strong enrolment (58% self-referrals; 42% referred via UNSW health service), high completion and attendance. Depressive, anxiety and stress symptoms decreased post-program (p < 0.05), and quality of life improved (p < 0.05). No significant anthropometric changes occurred. Qualitative data revealed benefits including increased social connection, routine and skill development. Twelve Mentors (33% women) participated. Mentors reported high satisfaction (m = 4.38/5). Qualitative analysis highlighted that Mentors valued observing Mentee improvements while fostering social connections. CONCLUSION: Preliminary findings demonstrate improvements in Mentees’ mental health outcomes and positive experiences for Mentors. High international student participation in underscores Stride’s potential as a wellbeing initiative for this group. Overall, Stride presents as feasible and acceptable in tertiary education. Future implementation will assess long-term outcomes and refine program delivery for students experiencing mental health challenges.

The declining mental health of youth in late adolescence and early adulthood represents a serious public health concern, resulting in substantial symptom burden, mortality, and societal cost. Despite this, youth with clinical mental illnesses show poor engagement with mental health services. Two drivers of poor youth engagement in mental health services are ineffective transitions between child/adolescent and adult mental health services, and a loss of youth-specific, needs-appropriate support within the adult mental health services after “ageing out” of child and adolescent services. Such disengagement has serious developmental and functional implications, and is linked to higher hospitalisation and mortality, underscoring the need for improved models of care.Youth often prefer services that help them manage their symptoms, improve their overall wellbeing, support them to participate within their community. In line with this, youth often express preference for, and show higher levels of engagement with recovery-oriented services.Exercise aligns with many tenets of recovery-oriented care by fostering engagement, social connectedness, self-efficacy, behavioural activation, and equipping youth with strategies to improve their wellbeing, manage stress and mental illness symptoms. As such, it represents a practical, accessible, and feasible strategy for engaging youth with clinical mental illness that could be deployed within or alongside existing mental health services. However, it remains underexplored as a vehicle for supporting youth to transition to and engage with adult mental health services. We review the literature in this field and offer suggestions for future research and clinical efforts that integrate exercise into transitional care pathways.