Introduction: Due to the COVID-19 pandemic, the use of digitally delivered exercise classes to promote physical activity has become widespread amongst various populations as an alternative to in-person activities. Objectives: To examine the feasibility, acceptability, and participant engagement variables to delivering Qi Gong and Tai Chi programs through telehealth interventions.Methods: Ten databases (Seven English databases; three Chinese databases) were searched between October and November 2021. Studies published in English or Chinese, or having translations in English or Chinese, were included. Titles and abstracts of identified articles were screened, relevant studies were then retrieved for full -text screening. Study selection, assessment of methodological quality, data extraction, data transformation, and data synthesis were completed following a convergent integrated approach to mixed method systematic reviews.Results: Seven articles were included in review. Digital literacy of both participants and providers was found to be a significant hurdle towards digital program implementation. There were no notable issues pertaining to access to an internet connection, participant safety, program costs, or connectivity. A major theme for sustaining program engagement was found to be individual perceived relevance for intervention involvement. Online social involvement was noted to be both a facilitator for participant acceptability and engagement. Overall, participants expressed satisfaction with the use of telehealth, while providers expressed acceptability concerns regarding quality of care.Conclusion: It is recommended that planned measures be taken prior to program commencement to decrease digital literacy requirements while also including a participatory approach to encourage uptake. During the program, provision of technical support alongside appropriate social-environmental engagement facilitators would promote sustained adherence.

BackgroundThe results of rehabilitation trials are often not fully attained when the intervention is implemented beyond the initial trial. One of the key reasons is that a patients' ability and/or capacity to take part in their own healthcare is not considered in the trial design yet has significant impact on the outcomes during the implementation phase.Body of textWe propose a shift from a therapist-focus to patient-focus in trial design, through addressing patient engagement as a core consideration in trials. We argue that engaging patients in any rehabilitation program is a process of behavioural change. Exercise prescription is used as an example to illustrate how the Behaviour Change Wheel can be applied to analyse barriers and facilitators associated with patients' capabilities, opportunities and motivations in integrating trial interventions into their daily life. We propose a framework to assist in this shift.ConclusionA core part of implementing rehabilitation interventions at the primary care level requires patient engagement. Related aspects of interventions should be identified and assessed using the COM-B model at the outset of trial design to ensure that the results are realistic, meaningful and transferable, so as to enable real impact.

BACKGROUND:Success at the elite level in sport is often attributed to physical prowess, technical skill, and mental attitude. However, underpinning these factors are various lifestyle, support and social factors that may contribute to successful performance, but which may be absent from athlete development programs.METHODS:An online survey was used to investigate athlete perceptions of lifestyle practices and support services amongst 135 Australian Olympic, Paralympic, National, and state-level athletes across 25 Olympic sports.RESULTS:International athletes perceived psychological skills and attributes, along with strong interpersonal relationships as vital to their success, and they also rated 'Recovery practices' as very important and made extensive use of available support services. These athletes also indicated that they would have liked access to these services earlier in their careers, a wish that was reiterated by the sub-elite athletes. Furthermore, athletes wanted greater knowledge, mentoring, and autonomy earlier in their careers, and the importance of 'athlete wellbeing' as well as 'athletic performance' was evident in a number of contexts.CONCLUSIONS:An athlete development system into which these are included may assist in generating an environment that facilitates athlete success, repeated podium performances, retain athletes in high-performance sport for longer, encourage human-flourishing, wellbeing and smooth transitions for retiring athletes.

BACKGROUND:Despite the proven benefits of exercise rehabilitation for numerous health conditions, musculoskeletal injuries and recovery from surgery, patient adherence to such programs is reported to often be less than 35%. Increasing patient engagement therefore has the potential to improve patient health outcomes, benefiting the patient, their carers and the services that support them. The aims of this review were to identify the factors that contribute to 'patient' engagement in prescribed exercise rehabilitation using the COM-B (capability, opportunity, motivation-behaviour) framework of behavioural analysis.METHODS:Five electronic databases (PubMed, Embase, Cochrane, Web of Science, and ClinicalTrials.gov) were searched. 'COM-B' was the key word searched for specifically within titles and abstracts, combined with either 'physical activity' OR 'exercise' included using the 'AND' operation. Records were then filtered and excluded following full-text screening based on the predetermined eligibility criteria.RESULTS:Twenty studies were included in the review. The main COM-B themes highlighted for improving patient engagement were: capability-improving patient knowledge and cognitive skills for behavioural regulation, such as 'action planning' and 'action control', which could also benefit time-management; opportunity-a balanced life situation that enabled time to be devoted to the exercise program, social support, easily accessible and affordable resources and services; and motivation-increasing patient levels of self-efficacy and autonomous motivation, which were noted to be influenced by levels of perceived 'capability', additionally 'motivation' was noted to be influenced by patients perceiving the benefits of the exercise, and adherence to the program was promoted by 'goal-setting'. Other issues in the 'capability' domain included a fear and/or dislike of exercise.CONCLUSION:Patient engagement behavior has been shown to be influenced by both external (opportunity) and intrapersonal variables (capability and motivation). Those prescribing exercises within a rehabilitation program need to discuss these factors with their patients and co-design the exercise rehabilitation program in partnership with the patient, since this is likely to improve patient engagement, and thereby result in superior health outcomes. Furthermore, these factors need to be a consideration in clinical trials, if the findings from such trials are to translate into mainstream healthcare settings.

Introduction: Increasing physical activity among posttreatment breast cancer survivors is essential, as greater physical activity reduces the relative risk of cancer-specific mortality. This trial examines how a fitness tracker-based intervention changes the physical activity behaviour of inactive posttreatment breast cancer survivors. Methods: Seventeen physically inactive posttreatment breast cancer survivors participated in a randomised cross-over controlled trial. Participants underwent a 12-week intervention of a fitness tracker combined with a behavioural counselling and goal-setting session and 12 weeks of normal activity (control). The primary outcome was the change in physical activity assessed by accelerometry over seven days. Results: The intervention achieved a mean increase of 4.5 min/day of moderate-vigorous physical activity, representative of a small-moderate effect (d = 0.34). Changes in time spent as a proportion of the day in light physical activity (-8.3%) and in sedentary behaviour (7.9%), were both significantly different to baseline (t (16) = 3.522, p < 0.01; t (16) = -3.162, p < 0.01). Conclusion: Interindividual differences in the change of patterns of physical activity behaviour suggest that only for some, fitness trackers can achieve a change in the level of moderate-vigorous physical activity.

Long-term maintenance of changes in cardiovascular risk factors and physical capacity once patients leave the supervised program environment have not previously been reported. This study investigated the changes in physical capacity outcomes and cardiovascular risk factors in an Australian cardiac rehabilitation setting, and the maintenance of changes in these outcomes in the 12 months following cardiac rehabilitation attendance. Improvements in mean (95% CI) cardiorespiratory fitness (16.4% (13.2–19.6%), p < 0.001) and handgrip strength (8.0% (5.4–10.6%), p < 0.001) were observed over the course of the cardiac rehabilitation program, and these improvements were maintained in the 12 months following completion. Waist circumference (p = 0.003) and high-density lipoprotein cholesterol (p < 0.001) were the only traditional cardiovascular risk factors to improve during the cardiac rehabilitation program. Vigorous-intensity aerobic exercise was associated with significantly greater improvements in cardiorespiratory fitness, Framingham risk score, and waist circumference in comparison to moderate-intensity exercise. An increase in the intensity of the exercise prescribed during cardiac rehabilitation in Australia is recommended to induce larger improvements in physical capacity outcomes and cardiovascular risk. A standardized exercise test at the beginning of the rehabilitation program is recommended to facilitate appropriate prescription of exercise intensity.

Progression of prescribed exercise is important to facilitate attainment of optimal physical capacity during cardiac rehabilitation. However, it is not clear how often exercise is progressed or to what extent. This study evaluated whether exercise progression during clinical cardiac rehabilitation was different between cardiovascular treatment, age, or initial physical capacity. The prescribed exercise of sixty patients who completed 12 sessions of outpatient cardiac rehabilitation at a major Australian metropolitan hospital was evaluated. The prescribed aerobic exercise dose was progressed using intensity rather than duration, while repetitions and weight lifted were utilised to progress resistance training dose. Cardiovascular treatment or age did not influence exercise progression, while initial physical capacity and strength did. Aerobic exercise intensity relative to initial physical capacity was progressed from the first session to the last session for those with high (from mean (95%CI) 44.6% (42.2–47.0) to 68.3% (63.5–73.1); p < 0.001) and moderate physical capacity at admission (from 53.0% (50.7–55.3) to 76.3% (71.2–81.4); p < 0.001), but not in those with low physical capacity (from 67.3% (63.7–70.9) to 85.0% (73.7–96.2); p = 0.336). The initial prescription for those with low physical capacity was proportionately higher than for those with high capacity (p < 0.001). Exercise testing should be recommended in guidelines to facilitate appropriate exercise prescription and progression.

1. Aims Reviews of workplace physical activity interventions indicate limited effects of these programs on employee health (1) and fitness (2). Supervised exercise supervision has shown greater health and fitness benefits compared to unsupervised and home-based exercise in clinical populations. This randomised controlled trial compared the effectiveness of personal, non-personal and no-exercise supervision in the workplace to improve cardiorespiratory fitness (CRF), muscular strength and body composition.

Interval exercise training is increasingly recommended to improve health and fitness; however, it is not known if cardiovascular risk is different from continuous exercise protocols. This systematic review with meta-analyses assessed the effect of a single bout of interval exercise on cardiovascular responses that indicate risk of cardiac fibrillation and infarction compared to continuous exercise. Electronic databases Medline, CINAHL, Embase, Scopus and Cochrane were searched. Key inclusion criteria were: (1) intervals of the same intensity and duration followed by a recovery period and (2) reporting at least one of blood pressure, heart rate variability, arterial stiffness or function. Cochrane Risk of Bias tool and GRADE approach were used. Meta-analyses found that systolic blood pressure responses to interval exercise did not differ from responses to continuous exercise immediately (MD 8 mmHg [95% CI -32, 47], p = 0.71) or at 60 min following exercise (MD 0 mmHg [95% CI -2, 1], p = 0.79). However, reductions in diastolic blood pressure and flow-mediated dilation with interval exercise were observed 10-15 min post-exercise. The available evidence indicates that interval exercise does not convey higher cardiovascular risk than continuous exercise. Further investigation is required to establish the safety of interval exercise for clinical populations.

Objective:To examine whether a fitness tracker (FT) intervention changes physical activity (PA) behavior compared to a control condition or compared to an alternative intervention.Data Source:Searches between January 01, 2010, and January 01, 2019, were conducted in PubMed, CINAHL, Cochrane CENTRAL, EMBASE, and PsycINFO.Inclusion/Exclusion Criteria:Randomized clinical trials of adults using an FT to change PA behavior were included. Nonclinical trials, studies that included the delivery of structured exercise, and/or studies that only used the FT to assess PA were excluded.Data Extraction:Extracted features included characteristics of the study population, intervention components, PA outcomes, and results.Data Synthesis:Papers were pooled in a statistical meta-analysis using a fixed effects model. Where statistical pooling was not possible, standardized mean difference (SMD) and 95% confidence intervals (CI) were calculated. Findings were presented in a narrative form and tables.Results:Of 2076 articles found, 21 were included in the review. A small yet significant positive effect (SMD = 0.25, 95% CI = 0.17-0.32; P < .01; I2= 56.9%; P = .03) was found in step count for interventions compared to control. A small yet significant negative effect (SMD = −0.11, 95% CI = −0.20 to −0.02; P = .02; I2= 58.2%; P = 0.03) was found in moderate-to-vigorous PA for interventions compared to an alternative intervention.Conclusion:Trackers may enhance PA interventions, as a general positive effect is found in step count compared to a control. However, there is no evidence of a positive effect when interventions are compared to an alternative intervention. It is unknown whether results are due to other intervention components and/or clinical heterogeneity.

This study investigated the influence of cardiac intervention and physical capacity of individuals attending an Australian outpatient cardiac rehabilitation program on the initial exercise prescription. A total of 85 patients commencing outpatient cardiac rehabilitation at a major metropolitan hospital had their physical capacity assessed by an incremental shuttle walk test, and the initial aerobic exercise intensity and resistance training load prescribed were recorded. Physical capacity was lower in surgical patients than nonsurgical patients. While physical capacity was higher in younger compared with older surgical patients, there was no difference between younger and older nonsurgical patients. The initial exercise intensity did not differ between surgical and nonsurgical patients. This study highlights the importance of preprogram exercise testing to enable exercise prescription to be individualized according to actual physical capacity, rather than symptoms, comorbidities and age, in order to maximize the benefit of cardiac rehabilitation.

A survey is a research tool that gathers information from a relatively large sample of people to help provide inferences about a wider population. To ensure data gathered from this type of research are reliable and of quality, researchers are required to ensure that systematic and thoughtful planning is given to the design, delivery and reporting of the survey. While there is no universal standard for best practice, there are certain steps that should be followed when sampling, designing and reporting the results. This chapter introduces the reader to survey research and offers guidance on the design of a survey, the sampling and recruitment process and the ethical considerations. The chapter also briefly describes how researchers can best report their results in health and physical activity research.

ISSUE ADDRESSED:Physical activity and exercise participation is limited by a perceived lack of time, poor access to facilities and low motivation. The aim was to assess whether providing an exercise program to be completed at the workplace with or without direct supervision was effective for promoting health-related physical fitness and exercise participation.METHODS:Fifty university employees aged (Mean ± SD) 42.5 ± 11.1 years were prescribed a moderate- to vigorous-intensity aerobic and resistance exercise program to be completed at an onsite facility for 8 weeks. Participants were randomly allocated to receive direct exercise supervision or not. Cardiorespiratory fitness (V̇O2max ) and maximal muscular strength were assessed at baseline and 8 weeks. Self-report physical activity was assessed at baseline, 8 weeks and 15 months post-intervention.RESULTS:Attendance or exercise session volume were not different between groups. Cardiorespiratory fitness (Mean ± 95% CI); +1.9 ± 0.7 mL·kg·min-1 ; P < .001), relative knee flexion (+7.4 ± 3.5 Nm·kg-1 %; P < .001) and extension (+7.4 ± 4.6 Nm·kg-1 %; P < .01) strength increased, irrespective of intervention group. Self-reported vigorous-intensity physical activity increased over the intervention (mean ± 95% CI; +450 ± 222 MET·minutes per week; P < .001), but did not remain elevated at 15 months (+192 ± 276 MET·minutes per week).CONCLUSION:Providing a workplace exercise facility to complete an individually-prescribed 8-week exercise program is sufficient to improve health-related physical fitness in the short-term independent to the level of supervision provided, but does not influence long-term participation. SO WHAT?: Lower cost onsite exercise facility supervision is as effective at improving physical health and fitness as directly supervised exercise, however ongoing support may be required for sustained physical activity behaviour change.

This chapter builds on some of the health issues presented in chapter 1. It commences with a consideration of some of the early beliefs in the benefits of exercise and then progresses to introduce some of the ground-breaking scientific research that initiated the accumulation of hard evidence in support of the association between physical activity and health. It also introduces the rationale for intervention studies that can determine the health benefits from the participation in exercise, and how these have contributed to the current recommendations by health and medical authorities. It then raises some of the current research questions and the need for ongoing research, as we have yet to identify how best to optimize exercise prescription for each individual and to fully understand how such physical activity interacts with other factors that impact upon health, such as nutrition and sedentary behaviour.

This chapter presents the context for the research methods, procedures and other activities outlined in other chapters in the book. It introduces some of the health issues prevalent in today's society, how these are related to a lack of physical activity, and why ongoing research into the relationship between physical activity and health is of significant importance. It introduces some of the concepts and factors that are associated with the reduction in daily physical activity that has become so pronounced in the last 60 years. It then indicates the potential for new technologies to assist the researcher in the collection and analyses of data, and why research methods will need to develop accordingly, whilst at the same time needing to combat the wealth of easily accessible misinformation and unsubstantiated opinions.

Purpose - Workplace exercise programmes have been shown to increase employee participation in physical activities and improve health and fitness in the short-term. However, the limited breadth of employee engagement across organisations combined with declining exercise adherence within individual studies indicates a need for better-informed programmes. The purpose of this paper is to investigate relationships between employee moderate-vigorous physical activity (exercise) participation and their perceived barriers and facilitators to engagement in onsite exercise, to inform the design and implementation of future workplace exercise interventions. Design/methodology/approach - An online survey identified employee demographics, exercise (International Physical Activity Questionnaire), perceived barriers (Corporate Exercise Barriers Scale) and facilitators to exercise at an Australian university. Findings - Of the 252 full-time employees who responded, most reported meeting (43.7 per cent) or exceeding (42.9 per cent) exercise guidelines over the previous week. A lack of time or reduced motivation (p < 0.001), exercise attitude (p < 0.05), internal (p < 0.01) and external (p < 0.01) barriers towards workplace exercise participation were all associated with failure to attain government-recommended volumes of weekly exercise. Personal training (particularly for insufficiently active employees) and group exercise classes were identified as potential exercise facilitators. Walking, gym (fitness centre), swimming and cycling were identified as the preferred modes of exercise training. Practical implications - Employees not meeting recommended volumes of exercise might require additional support such as individualised gym and cycling programmes with personal supervision to overcome reported exercise barriers to improve exercise participation, health and fitness. Originality/value - This study identifies specific barriers and facilitators to workplace exercise participation perceived by university employees. These findings can be used to inform the design and implementation of workplace exercise programmes aiming to achieve wider workplace engagement and greater exercise adherence, particularly of less active employees.

The goal of this study was to determine whether ultrasound measures of muscle architecture can be used to infer strength and functional capacity in older adults. Thirty-six healthy older adults (aged 68.2 ± 5.3 y) undertook isokinetic dynamometry for isometric and isokinetic concentric knee extensor strength, the 6-m fast walk, timed up and go, stair climb and descent and vertical jump tests. Longitudinal brightness-mode ultrasound scans (probe frequency, 10 MHz) of the vastus lateralis, vastus intermedius, rectus femoris and gastrocnemius medialis were obtained, and muscle architecture measures (thickness, fascicle pennation angle and fascicle length) were correlated with the aforementioned strength and functional measures. Quadriceps thickness was a significant (p < 0.05) independent predictor of isometric and isokinetic knee extensor strength (R2 ≥ 0.630). Gastrocnemius medialis thickness was a significant independent predictor of 6-m fast walk test (R2 = 0.216, p < 0.05), timed up and go test (R2 = 0.455, p < 0.01), stair climb power (R2 = 0.591, p < 0.01), stair descent power (R2 = 0.608, p < 0.01) and vertical jump height (R2 = 0.579, p < 0.01). Ultrasound is a safe, non-invasive and efficient tool for inferring the strength and functional capacity of older adults.