BACKGROUND:There is a need to scale up effective physical activity interventions among the general population, particularly those incorporating resistance training. Ecofit is a community-based, multicomponent intervention promoting resistance and aerobic physical activity through smartphone technology, the outdoor built environment, and social support. This study aimed to scale up ecofit by comparing Low versus Moderate implementation support on the reach (outdoor gym use) of ecofit within two large regional municipalities. METHODS:A hybrid type 3 implementation-effectiveness trial was conducted across two large municipalities in eastern Australia. Outdoor gyms (n = 18) were randomized to Low (ecofit app only) or Moderate [ecofit app, QR (quick response) codes on equipment, face-to-face workout sessions] implementation support. The primary outcome of "reach" was defined as the baseline-adjusted difference in the number of outdoor gym users (i.e. adults using outdoor gym equipment for resistance training) between groups. Reach was measured at baseline and 3-month follow-up using a modified System for Observing Play and Recreation in Communities tool, with blinded assessors observing community members perceived to be ≥18 years [categorized as Adults (aged 18-59) or Seniors (aged ≥60)]. Secondary outcomes included app uptake, dose received, implementation fidelity, and acceptability, feasibility, and dose-satisfaction regarding the app and guided sessions. RESULTS:There was no significant difference in people using outdoor gym equipment for resistance training between Low and Moderate support groups at 3-month follow-up [incidence rate ratio (IRR) = 1.68, 95% CI: 0.96-2.94]. Among adults (aged 18-59), the Moderate support group showed significantly higher outdoor gym use at follow-up (IRR = 1.83, 95% CI: 1.01-3.31) compared to the Low support group. Over 6 months, 1273 users registered for the app, completing 503 workouts, 62% of which occurred indoors. CONCLUSIONS:Ecofit shows promise for promoting resistance training, particularly among adults. Broader marketing and enhanced engagement strategies may be required to increase outdoor gym use and sustain participation over time.

BACKGROUND:Exercise is essential for chronic disease management, but intervention implementation in rural populations remains unclear. This review aimed to synthesize the characteristics and impact of exercise interventions delivered to adults living with chronic conditions in rural areas. METHODS:Six databases (MEDLINE, Embase, Emcare, Scopus, CINAHL, and SPORTDiscus) were searched from inception to September 2025 for interventional studies evaluating exercise training interventions of ≥2 weeks among adults with chronic conditions living in rural areas across all countries. Data were extracted on study characteristics, exercise prescription, delivery methods, engagement strategies, and effectiveness outcomes related to physical activity and physical function. RESULTS:Twenty-seven studies (n = 2846 participants; 13 randomized controlled trials [RCT], 14 non-RCT) were included. The most common condition groups were musculoskeletal, cancer (acute or survivorship), respiratory, and metabolic/endocrine. Interventions were predominantly supervised and delivered in person (37%) or via telehealth (33%), most often by exercise professionals (37%). Combined aerobic and resistance (48%), aerobic only (22%), and resistance only (15%) training were commonly prescribed. Most studies prescribed 2 to 3 weekly sessions (57%), lasting 30 to 60 minutes (67%). Rural adaptations included telehealth delivery, upskilling nonexercise professionals, minimal or no equipment use, and delivery in existing healthcare settings. Evidence for intervention effectiveness was mixed; positive effects were observed for physical function outcomes (2 RCT and 5 non-RCT), while evidence for improvements in physical activity behavior (4 RCT and 1 non-RCT) and aerobic fitness (2 RCT and 6 non-RCT) were inconsistent. CONCLUSIONS:Interventions were generally supervised and incorporated rural adaptations. While physical function outcomes showed promising improvements, evidence for increasing physical activity and aerobic fitness remains inconclusive.

INTRODUCTION:The transition from military-to-civilian life is associated with challenges including shifts in identity and employment, reestablishment of family and personal relationships, and financial hardship. To better support transition, it is important to explore the perspectives of those who have transitioned from the Australian Defence Force (ADF) into civilian life. Thus, the study aims to explore how occupational participation during military service influences the experience of transitioning to civilian life. METHODS:A narrative inquiry methodology with two phases of interviews was used to collect data from 12 former serving Australian Defence Force members. Thematic analysis was used to interpret the data. CONSUMER AND COMMUNITY INVOLVEMENT:The first author is a former ADF member. The second interview was intended to check and enhance participant participation in the study. There was no further consumer and community involvement. FINDINGS:Two themes were developed. (1) Being in the 'bubble' described how occupational participation is experienced in military service. The military bubble created occupational imbalance and was heavily reliant on work and devoid of leisure. (2) 'The bubble pops and the real-world begins' describes how the loss of the military occupations including peers and the collective culture, challenged their occupational participation in civilian life. Most participants sought to establish occupational balance, to varying degrees of success. CONCLUSION:Imbalanced occupational participation during military service can hinder the transition to civilian life. Supporting this shift requires strategies that promote engagement in community and leisure activities. Future research should focus on how to support occupational participation in civilian roles and activities to facilitate smoother transitions.

This review evaluated the efficacy of resistance training mHealth interventions for improving neuromuscular fitness and resistance training participation. It also explored how resistance training is prescribed through mHealth, and the theoretical frameworks and behavior change techniques (BCTs) employed. MEDLINE (OVID), Embase (OVID), Emcare (OVID), SPORTDiscus, Web of Science, Scopus and Cochrane (CINAHL) were searched from January 2010 to February 2025. Randomized controlled trials published in English, targeting adults, that prescribed resistance training via an mHealth platform and measured at least one outcome of neuromuscular fitness or resistance training participation were included. From the 12,059 records identified, 32 RCTs were included. mHealth-delivered resistance training interventions produced a small, statistically significant improvement in neuromuscular fitness compared with no intervention/usual care (Cohen’s d = 0.18, 95

INTRODUCTION:Scalable physical activity interventions are crucial in addressing the widespread issue of global physical inactivity. Outdoor gyms present as a promising setting to deliver physical activity interventions that can be scaled to engage significant proportions of the population. This systematic review aims to analyze how interventions conducted in outdoor gym settings to date have been delivered, identify their target populations, and describe the types of equipment and exercises used. METHODS:A systematic search of peer-reviewed English-language articles was conducted using the following databases: EBSCO, Embase, MEDLINE, ProQuest, Scopus, and Web of Science. Studies that employed experimental pre-post designs, including randomized controlled trials and single-group designs, and promoted physical activity through outdoor gyms were eligible for inclusion. RESULTS:Seventeen studies met the inclusion criteria for this review. Most interventions were fully supervised by exercise professionals, with a primary focus on older adults. Although males and females were equally targeted in most studies, female participants tended to be overrepresented. Variability existed in terms of intervention dosage, with session frequency ranging from fortnightly to 3 each week. Studies often only included 1 outdoor gym location, with the amount and type of equipment available varying between studies. CONCLUSION:More robust experimental trials using appropriate frameworks are required to guide scalable, population-based programs. This review aids researchers, practitioners, and planners by mapping program characteristics, providing evidence, and identifying gaps for future large-scale studies and initiatives.

INTRODUCTION:Outdoor gyms present an opportunity to promote resistance training (RT) among the general population, however, there is a lack of reliable tools that can measure outdoor gym usage. We developed a modified version of the System of Observing Play and Recreation in Communities to assess Resistance Training using outdoor gyms (SOPARC-RT). METHODS:Paired assessors completed observations (N = 24) across 4 outdoor gyms. The interrater reliability was assessed using Bland-Altman plots, intraclass correlation coefficients, and weighted kappa coefficients based on distribution of the data. RESULTS:The SOPARC-RT tool demonstrated excellent interrater reliability for all users overall (intraclass correlation coefficients = .96; 95% confidence interval, .91-.99), as well as youth (children and adolescents), adults and seniors. CONCLUSIONS:SOPARC-RT is a reliable tool that can be utilized by researchers and local government agencies interested in measuring RT using outdoor gym equipment among the general population.

Objectives: The aim of this research was to understand the prevalence and impact of long COVID on adults with type 2 diabetes (T2D). Specifically, we sought to identify the proportion of adults with T2D who have had COVID-19 and experienced long COVID symptoms. We also explored how these ongoing symptoms impact diabetes management and physical activity participation. Methods: Our study was carried out using an online survey of adults in Australia with T2D who had confirmed COVID-19 >= 12 weeks before participation. Respondents were asked to report the presence (and severity) of long COVID symptoms, and, for those with long COVID, the impact of their symptoms on diabetes management (blood glucose, body weight) and physical activity participation (activities of daily living, work/study, exercise). Results: Survey responses were provided by 1,046 adults with T2D (median age 61.0 [interquartile range 49.8 to 70.0] years; 56.0% men, 42.1% women, and 1% nonbinary/transgender; median T2D duration 10.0 [5.0 to 18.0] years and median time since COVID-19 infection 33.0 [20.3 to 36.1] weeks). Almost one-third (30%) of respondents reported long COVID symptoms (present >= 12 weeks after most recent infection); 40% of respondents with long COVID symptoms reported a worsening of their diabetes management since their COVID-19 infection, with 29% reporting trouble controlling their blood glucose and 43% reporting a higher body weight. Two-thirds of respondents with ongoing symptoms reported that these symptoms moderately to severely impacted their ability to perform activities of daily living, work, and/or exercise. The majority of those with long COVID reported reducing the frequency, duration, and/or intensity of exercise since their COVID-19 infection, with 36.1% not yet returning to their preinfection exercise levels; 66% cited ongoing symptoms as the primary reason for these limitations. Conclusions: Physical activity is a crucial component of diabetes management. However, the high prev- alence of long COVID is hindering participation in this population, as well as deleteriously impacting diabetes management. Developing strategies to support adults with T2D and long COVID to recommence safe levels of physical activity is of critical importance. (c) 2024 The Author(s). Published on behalf of the Canadian Diabetes Association. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Internationally, there is recognition that the transition from military service to civilian life is challenged by a military identity. The aim of this study was to present the impact of an occupational military identity on the transition to civilian life from the perspective of former serving Australian Defence Force members. A narrative inquiry methodology was employed to explore the transition experience of the participants who each shared the story of their transition, presenting a narrative for data analysis. This analysis utilised Braun and Clarke's thematic analysis (2006, 2020), and the a priori theme of identity. The 12 participant narratives led to the presentation of four themes: 1) Transition and a military identity; 2) Military service and a military identity; 3) Military identity and separation type (voluntary and involuntary); and 4) Enabling transition and the military identity in civilian life. The participants' narratives highlighted how their occupational participation in military training and culture shaped an identity to challenge transition. Yet, they also highlighted the positive influence of a military identity, offering insights into how best to enable the transition from military service to civilian life.

IntroductionThe relationship between intervention engagement and behaviour change may vary depending on the specific engagement metric being examined. To counter this composite engagement measures may provide a deeper understanding of the relationship between engagement and behaviour change, though few studies have applied such multidimensional engagement metrics. The aim of this secondary analysis of RCT data was to examine how a composite engagement score mediates the effect of a web-based computer-tailored physical activity intervention.Methods501 inactive Australian adults were randomised to a no-treatment control or intervention group. Intervention participants received 8 sessions of web-based personalised physical activity advice over a 12-week intervention period and the ability to complete action plans. Change in physical activity was assessed using Actigraph accelerometers at baseline, 3-months and 9-months. Engagement with the intervention (i.e., a composite score including frequency, intensity, duration and type) was continuously assessed during the intervention period using website tracking software and database metrics. Generalised structural equation models were used to examine how a composite engagement score mediated intervention effects at 3 months and 9 months.ResultsAt 3 months, mediation analysis revealed that the intervention group had significantly higher engagement scores than the control group [a-path exp(b) = 6.462, 95% CI = 5.121–7.804, p < 0.001]. Further, increased engagement with the intervention platform was associated with an increased time spent in moderate-to-vigorous physical activity [ab-coefficient exp(b) = 1.008, 95% CI = 1.004–1.014, P < 0.001]; however, the magnitude of this effect was small. There were no significant mediation effects at the 9-month time point.DiscussionThe findings suggest that a composite intervention engagement score has a small positive influence on physical activity changes and that other factors (e.g., behaviour change techniques) are likely to be more important drivers of behaviour change.

Excess fat on the body impacts obesity-related co-morbidity risk; however, the location of fat stores affects the severity of these risks. The purpose of this study was to examine segmental fat accumulation patterns by sex and ethnicity using international datasets. An amalgamated and cross-calibrated dataset of dual x-ray absorptiometry (DXA)-measured variables compiled segmental mass for bone mineral content (BMC), lean mass (LM), and fat mass (FM) for each participant; percentage of segment fat (PSF) was calculated as PSFsegment = (FMsegment/(BMCsegment + LMsegment + FMsegment)) × 100. A total of 30 587 adults (N = 16 490 females) from 13 datasets were included. A regression model was used to examine differences in regional fat mass and PSF. All populations followed the same segmental fat mass accumulation in the ascending order with statistical significance (arms < legs < trunk), except for Hispanic/Latinx males (arms < [legs = trunk]). Relative fat accumulation patterns differed between those with greater PSF in the appendages (Arab, Mexican, Asian, Black, American Caucasian, European Caucasian, and Australasian Caucasian females; Black males) and those with greater PSF in the trunk (Mexican, Asian, American Caucasian, European Caucasian, and Australasian Caucasian males). Greater absolute and relative fat accumulation in the trunk could place males of most ethnicities in this study at a higher risk of visceral fat deposition and associated co-morbidities.

Introduction Several barriers can preclude people with type 2 diabetes (T2D) from in-person exercise session participation. Telehealth may be an alternative mode of service delivery to increase uptake. We evaluated the feasibility, safety and preliminary efficacy of delivering group exercise via telehealth for people with T2D.Methods Sixteen people with T2D (age 59.9 +/- 12.7 years, 63% male, duration of T2D 11.5 +/- 11.1 years) underwent an 8-week telehealth-delivered group exercise intervention. Weekly supervised sessions incorporated whole-body aerobic and resistance exercises, followed by education. Feasibility was evaluated by recruitment, enrolment, attendance and attrition rates, the practicality of telehealth delivery, and participant feedback. Adverse events were monitored throughout (safety). Preliminary efficacy was determined from changes in glycaemic control, body composition, blood pressure, exercise capacity, neuromuscular strength/fitness, quality of life and physical activity levels. The agreement/reliability of in-person clinician-measured versus telehealth-supervised participant-self-measured assessments was also evaluated.Results Feasibility was supported by high attendance (97.1%) and low attrition (81%). All (100%) participants reported they would participate in telehealth-delivered exercise interventions in the future and would recommend them to other people with T2D. No serious adverse events were reported. There were improvements in hip circumference (Cohen's d -0.50), diastolic blood pressure (-0.75), exercise capacity (1.72), upper body strength (1.14), grip strength (0.58), health-related quality of life (0.76-0.81) and self-reported physical activity (1.14). Participant-self-measured assessment of body weight, 2-min step test and 30-sec sit-to-stand test were deemed acceptable.Discussion Telehealth-delivered group exercise appears feasible, safe and efficacious for people with T2D. These findings warrant further exploration in a powered trial.Trial Registration Australian New Zealand Clinical Trials Registry (ACTRN12622000379718).

Background: Few mobile health resistance-based physical activity interventions have targeted community-dwelling adults. "Ecofit" is a multicomponent intervention that promotes resistance and aerobic activities using smartphone technology, outdoor gyms, and social support. This study evaluated process evaluation outcomes of the ecofit randomized controlled trial: (1) the acceptability and usability of the ecofit smartphone app and app user workouts; (2) perceptions of factors influencing outdoor gym use; and (3) the fidelity, reach, recruitment, and dose received of the ecofit program. Methods: Process data were collected through program evaluation surveys at 3 months, and app usage data were collected via the intervention platform for up to 3 months. Data were analyzed using descriptive statistics. Results: The survey was completed by 57% (n = 69) of eligible participants. The majority (93%) believed the app provided them with sufficient information to perform muscle-strengthening activities. Approximately half (51%) agreed that the goal -setting function encouraged them to complete their workouts, and 42% agreed that the self-assessment helped them monitor progress. "Proximity" to outdoor gyms emerged as the most important factor for choosing locations to workout (mean = 5.5, SD = 1.1). Participants logged a median of 5.5 (interquartile range = 19) workouts and 1 (interquartile range =1) upperand lower-body muscular fitness self-assessment. Conclusions: The ecofit app provided participants with sufficient skills to perform unsupervised resistance training exercises using mobile health. Only half of the participants regarded self-assessments and goal setting as useful, suggesting a need for modifications to how these are implemented. Mobile health remains a promising delivery platform to promote unsupervised resistance training, although more research is needed to improve uptake.

OBJECTIVE:To perform a systematic review of completion rates of cardiac rehabilitation (CR) in adults aged 18 to 50 yr and describe how core components were reported, measured, and tailored to those under 50 yr. REVIEW METHODS:Database search of MEDLINE, Embase, Emcare, PsycINFO, CINAHL, Scopus, and the Cochrane Library based on keywords, including articles from January 1, 1990. The last search was performed on April 21, 2023. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses protocol, eligible articles contained adults (aged between 18 and 50 yr) who had participated in a CR program. SUMMARY:Out of the articles screened (n = 24,517), 33 reports across 31 independent studies were considered eligible (n = 1958 patients aged ≤50 yr). Cardiac rehabilitation completion rates ranged from 64% to 100%; however, only 5 studies presented a completion rate definition. The length of the program ranged from 7 d to 20 wk, with most (65%) ranging between 6 and 12 wk. While the studies included in this systematic review indicated relatively high rates of completing CR, these are likely to overrepresent the true completion rates as few definitions were provided that could be compared to completion rates used in clinical practice. This systematic review also found that all interventions prescribed exercise (eg, aerobic alone or combined with resistance training or yoga) but had very limited inclusion or description of other integral components of CR (eg, initial assessment and smoking cessation) or how they were assessed and individualized to meet the needs of younger attendees.

Background This paper outlines the protocol for the ecofit implementation-effectiveness trial, a multi-component mobile Health (mHealth) intervention that aims to increase resistance and aerobic physical activity in primary care-based adults with type 2 diabetes (T2D). This study will be conducted as part of the Diabetes Alliance Program Plus (DAP+), a large-scale integrated health service intervention in a large health district in Australia. The ecofit program has previously demonstrated efficacy and effectiveness in insufficiently active people with (or at risk of) T2D and community dwelling-adults, respectively. The aim of this study is to assess the reach (primary outcome), adoption, appropriateness, feasibility and fidelity of the implementation of ecofit and the overall effectiveness of the intervention. Research design and methods Prospective participants are adults diagnosed with T2D, who attend primary care settings enrolled in DAP+, and are identified and referred to ecofit by a primary care clinician. To support the implementation of ecofit a host of strategies will be utilised, which includes the education and upskilling of primary care clinicians enrolled in DAP+ using brief training sessions, the supply of an information package and access to professional development. The co-primary outcomes of reach will be defined as the number of participant registrations on the ecofit platform and the number of primary care clinicians who have been introduced to ecofit. Conclusion This study will evaluate the implementation of ecofit among adults with T2D within the primary care setting. The results may help improve T2D lifestyle interventions in primary care settings across Australia.

AIMS The efficacy of high intensity exercise for improving symptoms of chronic idiopathic constipation, a highly prevalent disorder of gut brain interaction (DGBI), remains uncertain. The aim of this case report was to investigate the feasibility, safety, and efficacy of 8-weeks of combined high-intensity interval training (C-HIIT) for a person (female, 23 years old) with chronic constipation. METHODS The participant enrolled in the C-HIIT for DGBI controlled trial that aims to recruit 32 participants with DGBI. Following comprehensive assessments of gastrointestinal symptoms, neuromuscular fitness, cardiorespiratory fitness and mental health, the participant completed an 8-week intervention consisting of thrice weekly 26-minute C-HIIT sessions. These consisted of a 3-minute aerobic warm-up (treadmill; 50-60% peak heart rate [HRpeak]) followed by 4-minutes of high-intensity aerobic exercise at ≥85% HRpeak. After 1-minute rest, eight whole body resistance exercises were performed. These involved continuous repetitions with good technique for 1-minute at an ≥8/10 (very hard) rating of perceived exertion; 1-minute rest separated each exercise. Adverse events were recorded throughout the intervention. RESULTS The participant adhered to the intervention, attending 100% of sessions and reaching the prescribed intensity for 100% of aerobic and 80% of resistance exercises. Efficacy of the exercise training was indicated by a reduction in the severity of gastrointestinal symptoms measured via the irritable bowel syndrome-symptom severity scale (from 111 to 100) and the structured assessment of gastroIntestinal symptoms (39 to 12). There were some improvements in neuromuscular fitness (handgrip strength: 27 to 29.5 kg, 30-second sit to stands: 12 to 10 repetitions) and cardiorespiratory fitness (VO2max: 36.7 to 38.2 mL/kg/min). No changes were observed in mental health (Hospital Anxiety and Depression scale), and one non-serious adverse event (nausea post-eating), which was deemed not related to the intervention. CONCLUSION The C-HIIT intervention in a person with DGBI was feasible, efficacious and safe.

Background In this paper we outline the protocol for an implementation-effectiveness trial of ecofit, a multi-component mHealth intervention aimed at increasing participation in resistance and aerobic physical activity using the outdoor built environment (i.e., outdoor gyms) and social support. We have previously demonstrated the efficacy and effectiveness of the ecofit program in insufficiently active people with (or at risk of) type 2 diabetes and community-dwelling adults, respectively. The objective of this trial is to compare the effects of two implementation support models (i.e., ‘Low’ versus ‘Moderate’) on the reach (primary outcome), uptake, dose received, impact and fidelity of the ecofit program. Research design and methods This hybrid type III implementation-effectiveness study will be evaluated using a two-arm randomized controlled trial, including 16 outdoor gym locations in two large regional municipalities in New South Wales, Australia. Outdoor gym locations will be pair-matched, based on an established socio-economic status consensus-based index (high versus low), and randomized to the ‘Low’ (i.e., ecofit app only) or ‘Moderate’ (i.e., ecofit app, face-to-face workout sessions and QR codes) implementation support group. The primary outcome of ‘reach’ will be measured using a modified version of the ‘System for Observing Play and Recreation in Communities’, capturing outdoor gym use amongst community members. Conclusion This implementation-effectiveness trial will evaluate the effects of different levels of implementation support on participation in resistance-focused physical activity using mHealth and outdoor gyms across the broader community. This may guide widespread dissemination for councils (municipalities) nation-wide wanting to promote outdoor gym usage. Trial registry This trial was preregistered with the Australian and New Zealand Clinical Trial Registry (ACTRN12624000261516).

INTRODUCTION & AIMS Delivery of group-based tele-exercise is an emerging treatment option for people with type 2 diabetes (T2D), but best practice is not yet understood. We evaluated the results and experiential insights of a pilot study investigating this model of care. METHODS Sixteen people with T2D (age 58.7±12.6, 63% male, duration of T2D 10.0±8.4years) underwent an 8-week tele-exercise intervention. Participants were assessed at baseline (in-person and via telehealth; results compared using intra-class correlations coefficients) and post-intervention (in-person only). The program was delivered in groups of 3-5, by an Accredited Exercise Physiologist using Zoom. Sessions were held once weekly and incorporated whole-body aerobic and resistance exercise (45min) and health behaviour change education (15min), reflecting the structure of Medicare-subsidised group exercise physiology sessions. Semi-structured interviews were conducted to gain participant and clinician feedback. Adverse events were monitored throughout. RESULTS The intervention demonstrated efficacy, with improvements in HbA1c (mean change -0.3±0.5%), fasting glucose (-0.8±0.8mmol/L), systolic blood pressure (-6.4±8.4mmHg), waist circumference (-0.8±4.2cm), muscular strength (30sec sit-to-stand score 1.6±2.9; 30sec bicep curl score 5.6±3.0) and fitness (2min step test score 24.5±11.9). Clients could reliably self-assess outcomes such as waist circumference (ICC 0.98, 95%CI 0.95-0.99), 30sec sit-to-stand (0.94, 0.82-0.98), and 2min step test (0.96, 0.87-0.99) when supervised by the clinician via telehealth, negating the need for in-person consults. No serious adverse events were reported. Key experiential insights include 1) Technological issues were minimised by providing clients with a guide for using Zoom, and conducting individual Zoom familiarisation sessions, prior to program start. 2) Client confidentiality could be managed by using breakout rooms for private conversations. 3) Creative exercise selection (e.g., TheraBand anchor points, non-traditional equipment) allowed participants to envision exercising in their home, which assisted in self-management. CONCLUSION This study contributes practical insights to optimise the delivery of group-based tele-exercise interventions to people with T2

Background: Type 2 diabetes is a major cause of illness and disability and physical activity reduces these risks. The SMART Health study aim was to compare the efficacy of a multicomponent intervention to promote aerobic physical activity and resistance training in schoolteachers at risk of or diagnosed with type 2 diabetes, with and without a technology-based behavior change package. Methods: We randomized participants (N = 104) into 3 groups: "wait-list" control group, 5 face-to-face visits with a psychologist and exercise specialist (SH group), or 5 face-to-face visits over a 3-month period with a psychologist and exercise specialist, plus a technology-based behavior change package for an additional 6 months (SH+ group). Physical activity was the primary outcome (daily steps measured by pedometers). Systolic and diastolic blood pressure, waist circumference, body mass index, fasting blood glucose, glycosylated hemoglobin, plasma lipids, self-reported resistance training, anxiety and depression were also assessed at 3 and 9 months (primary time point). Linear mixed models were used to assess the intervention efficacy of SH and SH+ compared with wait-list control. Results: There were no significant group-by-time effects for steps in the SH or SH+ groups compared to the wait-list control group. Self-reported participation in monthly minutes of resistance training significantly increased at 3-month postbaseline in both groups (SH: 136 min, P < .01, d = 0.33 and SH+: 145 min P < .001, d = 0.4) versus the control group. The improvements were maintained for the SH group at 9 months. There was also a meaningful effect (P < .06, d = -0.23) for reducing anxiety for SH group at 9 months. Conclusions: SMART Health was a feasible, multicomponent intervention, which increased self-reported resistance training but no other secondary outcomes.

Aims Dietary modification is essential for the secondary prevention of cardiovascular disease. However, there are limited published evidence syntheses to guide practice in the cardiac rehabilitation (CR) setting. This systematic review's objective was to assess effectiveness and reporting of nutrition interventions to optimize dietary intake in adults attending CR. Methods and results Randomized controlled trials (RCTs) of nutrition interventions within CR were eligible for inclusion and had to have measured change in dietary intake. MEDLINE, Embase, Emcare, PsycINFO, CINAHL, Scopus, and The Cochrane Library were searched from 2000 to June 2020, limited to publications in English. Evidence from included RCTs was synthesized descriptively. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool. This review is registered on PROSPERO; CRD42020188723. Of 13 048 unique articles identified, 11 were eligible. Randomized controlled trials were conducted in 10 different countries, included 1542 participants, and evaluated 29 distinct dietary intake outcomes. Five studies reported statistically significant changes in diet across 13 outcomes. Most nutrition interventions were not reported in a manner that allowed replication in clinical practice or future research. Conclusion There is a gap in research testing high-quality nutrition interventions in CR settings. Findings should be interpreted in the light of limitations, given the overall body of evidence was heterogenous across outcomes and study quality; 6 of 11 studies were conducted more than 10 years old. Future research should investigate strategies to optimize and maintain nutrition improvements for patients attending CR. Registration PROSPERO; CRD42020188723.

It is well recognised that the transition from the military to civilian life can create challenges. This study explores the multiple and dynamic experiences former serving Australian Defence Force members report in their transition to civilian life. A narrative inquiry methodology with two rounds of interviews was used to collect the data from 12 former serving Australian Defence Force members. Narrative thematic analysis was used to interpret the data. Our results indicate that transition for each participant is a unique experience that continues in the years following separation. For those who joined in early adulthood and served in high-tempo and/or combat roles, transitioning was complicated by military identity challenges. Their ongoing transition was related to the need to develop an individual civilian identity for civil society, challenged by the development of a collective identity as a member of the Australian Defence Force. We conclude that transition is the process of identifying as an individual following a collective identity, and for those still transitioning, was best supported by their military peers.