Pragmatic intervention for increasing self-directed exercise behaviour and improving important health outcomes in people with multiple sclerosis: a randomised controlled trial A randomized, controlled trial to study the effect of exercise consultation on the promotion of physical activity in people with Type 2 diabetes: a pilot study. Improved physical fitness of cancer survivors: A randomised controlled trial comparing physical training with physical and cognitive-behavioural training The effects of a low-to-moderate intensity pre-conditioning exercise programme linked with exercise counselling for sedentary haemodialysis patients in The Netherlands: results of a randomized clinical trial. A Web-based self-management exercise and diet intervention for breast cancer survivors: pilot randomized controlled trial. Four years of practice-based and exercise-supported behavioural medicine in one community of the German CINDI area. 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Improved functional ability and independence in activities of daily living for older adults at high risk of hospital readmission: a randomized controlled trial. Children, parents, and pets exercising together (CPET) randomised controlled trial: study rationale, design, and methods [One-year effect of health counseling on life style and risk factors of heart disease]. A HOME-BASED MULTIDIMENSIONAL EXERCISE PROGRAM REDUCED PHYSICAL IMPAIRMENT AND FEAR OF FALLING Can theory-based messages in combination with cognitive prompts promote exercise in classroom settings? The impact of an employee wellness programme in clothing/textile manufacturing companies: a randomised controlled trial A behaviour change intervention to reduce sedentary time in people with chronic obstructive pulmonary disease: protocol for a randomised controlled trial. Behavioural counselling in general practice for the promotion of healthy behaviour among adults at increased risk of coronary heart disease: randomised trial. Feasibility of a telephone and web-based physical activity intervention for women shift workers A brief intervention to increase physical activity in sedentary working women. Effects of a lifestyle intervention on endothelial function in men on long-term androgen deprivation therapy for prostate cancer Social-Ecological, Motivational and Volitional Factors for Initiating and Maintaining Physical Activity in the Context of HIV Lifestyle changes for improving disease-specific quality of life in sedentary men on long-term androgen-deprivation therapy for advanced prostate cancer: a randomised controlled trial. Promotion of self-management in vulnerable older people: a narrative literature review of outcomes of the Chronic Disease Self-Management Program (CDSMP) The Colon Health and Life-Long Exercise Change trial: a randomized trial of the National Cancer Institute of Canada Clinical Trials Group Using a combined motivational and volitional intervention to promote exercise and healthy dietary behaviour among undergraduates. Can practice nurses increase physical activity in the over 65s? Methodological considerations from a pilot study. Combining motivational and volitional interventions to promote exercise participation: protection motivation theory and implementation intentions. Health promotion for adolescents in primary care: randomised controlled trial Embedding sustainable physical activities into the everyday lives of adults with intellectual disabilities: a randomised controlled trial Exercise at an onsite facility with or without direct exercise supervision improves health‐related physical fitness and exercise participation: An 8‐week randomised controlled trial with 15‐month follow‐up Can the effects of implementation intentions on exercise be enhanced using text messages? Behavioural graded activity results in better exercise adherence and more physical activity than usual care in people with osteoarthritis: a cluster-randomised trial. Patient recruitment into a randomised controlled trial of supervised exercise therapy in sedentary women treated for breast cancer. At cancer diagnosis: a ‘window of opportunity’ for behavioural change towards physical activity. A randomised feasibility study in patients with colon and breast cancer Access to exercise referral schemes -- a population based analysis. The effectiveness of simple psychological and exercise interventions for high prevalence mental health problems in young people: a factorial randomised controlled trial An exercise-based randomized controlled trial on brain, cognition, physical health and mental health in overweight/obese children (ActiveBrains project): Rationale, design and methods. 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Evaluation of a combined cognitive-behavioural and exercise intervention to manage fear of falling among elderly residents in nursing homes Walk2Bactive: A randomised controlled trial of a physical activity-focused behavioural intervention beyond pulmonary rehabilitation in chronic obstructive pulmonary disease. Evaluation of exercise on individuals with dementia and their carers: a randomised controlled trial A Randomised Trial of a Weight Loss Intervention for Overweight and Obese People Diagnosed with Coronary Heart Disease and/or Type 2 Diabetes Strength exercises during physical education classes in secondary schools improve body composition: a cluster randomized controlled trial Applying the COM-B behaviour model and behaviour change wheel to develop an intervention to improve hearing-aid use in adult auditory rehabilitation Factors perceived to influence exercise adherence in women with breast cancer participating in an exercise programme during adjuvant chemotherapy: a focus group study. A randomized controlled study of the Arthritis Self-Management Programme in the UK. Impact of prolonged sitting on vascular function in young girls. Development of an exercise intervention to improve cognition in people with mild to moderate dementia: Dementia And Physical Activity (DAPA) Trial, registration ISRCTN32612072. Look After Your Heart programme: impact on health status, exercise knowledge, attitudes, and behaviour of retired women in England. Identifying the content of home-based health behaviour change interventions for frail older people: a systematic review protocol Exercise for people with cancer: a clinical practice guideline. How does change occur following a theoretically based self-management intervention for type 2 diabetes Intervention-related cognitive versus social mediators of exercise adherence in the elderly. Promoting physical activity: issues in primary health care. Study design and methods for the ACTIVity And TEchnology (ACTIVATE) trial. 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Five-year follow-up of participants in a randomised controlled trial showing benefits from exercise for breast cancer survivors during adjuvant treatment. Are there lasting effects? Acute aerobic exercise helps overcome emotion regulation deficits Preventing chronic back pain: evaluation of a theory-based cognitive-behavioural training programme for patients with subacute back pain. Land- and water-based exercise intervention in women with fibromyalgia: the al-andalus physical activity randomised controlled trial Preliminary support for a brief psychological intervention to improve first‐time hearing aid use among adults Exercise Interventions in Children with Cancer: A Review Effects of a 12-Month Randomized Controlled Trial of Aerobic or Resistance Exercise During and Following Cancer Treatment in Women The effect of exercise on behavioural and psychological symptoms of dementia: the EVIDEM-E randomised controlled clinical trial. Exercise facilitators and barriers from adoption to maintenance in the diabetes aerobic and resistance exercise trial. The Newcastle exercise project: a randomised controlled trial of methods to promote physical activity in primary care Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews A parent-based intervention to promote healthy eating and active behaviours in pre-school children: evaluation of the MEND 2-4 randomized controlled trial. Evaluation of a Web-based tailored intervention (TAVIE en santé) to support people living with HIV in the adoption of health promoting behaviours: an online randomized controlled trial protocol Exercise and diet interventions improve perceptions of self in middle-aged adults. Effect of exercise on reactivity and motor behaviour in patients with Parkinson's disease Correspondence of physical activity and fruit/vegetable consumption among prostate cancer survivors and their spouses. Physical activity intervention: a transtheoretical model-based intervention designed to help sedentary young adults become active. Does action planning moderate the intention-habit interaction in the exercise domain? A three-way interaction analysis investigation Physical Activity during Cancer Treatment (PACT) Study: design of a randomised clinical trial Results of a feasibility randomised controlled study of the guidelines for exercise in multiple sclerosis project. A randomised feasibility study to investigate the impact of education and the addition of prompts on the sedentary behaviour of office workers A randomised controlled trial of three pragmatic approaches to initiate increased physical activity in sedentary patients with risk factors for cardiovascular disease. How relevant are exercise capacity measures for evaluating treatment effects in chronic fatigue syndrome? Results from a prospective, multidisciplinary outcome study Randomized trial of exercise therapy in women treated for breast cancer. Health-related quality of life in patients with chronic fatigue syndrome: group cognitive behavioural therapy and graded exercise versus usual treatment. A randomised controlled trial with 1 year of follow-up Community based physiotherapeutic exercise in COPD self-management: a randomised controlled trial. What are the most effective behaviour change techniques to promote physical activity and/or reduce sedentary behaviour in inactive adults? A systematic review protocol Views and experiences of behaviour change techniques to encourage walking to work: a qualitative study The effects of a 16-week aerobic exercise programme on cognitive function in people living with HIV Comparing Physical Exercise in Groups to Group Cognitive Behaviour Therapy for the Treatment of Panic Disorder in a Randomized Controlled Trial Testing the effects of message framing, kernel state, and exercise guideline adherence on exercise intentions and resolve. The FAST study: Fertility ASsessment and advice Targeting lifestyle choices and behaviours: a pilot study. Exercise in a behavioural weight control programme for obese patients with Type 2 (non-insulin-dependent) diabetes Effects of a modular behavioural arthritis education programme: a pragmatic parallel-group randomized controlled trial. Women's behaviour, beliefs and information sources about physical exercise in pregnancy. 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Serum cartilage oligomeric matrix protein accumulation decreases significantly after 12 weeks of running but not swimming and cycling training - a randomised controlled trial. The contribution of lifestyle coaching of overweight patients in primary care to more autonomous motivation for physical activity and healthy dietary behaviour: results of a longitudinal study Cognitive and behavioural effects of music-based exercises in patients with dementia The impact of a self-management group programme on health behaviour and healthcare utilization among congestive heart failure patients. A comprehensive approach to rehabilitation interventions following breast cancer treatment - a systematic review of systematic reviews Aerobic and strength training exercise programme for cognitive impairment in people with mild to moderate dementia: the DAPA RCT. 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Dementia and Physical Activity (DAPA) - an exercise intervention to improve cognition in people with mild to moderate dementia: study protocol for a randomized controlled trial Using the mass-media to target obesity: an analysis of the characteristics and reported behaviour change of participants in the BBC's 'Fighting Fat, Fighting Fit' campaign. Physical activity and behavior in the elderly: a pilot study. Promoting early presentation of breast cancer: development of a psycho-educational intervention Silver Yoga Exercises Improved Physical Fitness of Transitional Frail Elders Improving sexual health in men with prostate cancer: randomised controlled trial of exercise and psychosexual therapies A small group aerobic exercise programme that reduces body weight is feasible in adults with severe chronic schizophrenia: a pilot study Too Sick Not to Exercise: Using a 6-Week, Home-Based Exercise Intervention for Cancer-Related Fatigue Self-management for Postsurgical Non–Small Cell Lung Cancer Patients Wearable Activity Technology And Action-Planning (WATAAP) to promote physical activity in cancer survivors: Randomised controlled trial protocol A randomized controlled trial of a cognitive behavioural patient education intervention vs a traditional information leaflet to address the cardiovascular aspects of rheumatoid disease. Help-seeking behaviour in men and women with common mental health problems: cross-sectional study. A randomised controlled trial of peer-adult-led intervention on improvement of knowledge, attitudes and behaviour of university students regarding HIV/AIDS in Malaysia. Does primary care referral to an exercise programme increase physical activity one year later? A randomized controlled trial. Simple lifestyle recommendations and the outcomes of gestational diabetes. A 2×2 factorial randomized trial Short term and long term effects of pulmonary rehabilitation on physical activity in COPD. The importance of self-efficacy in cardiovascular risk factor change Can primary care doctors prescribe exercise to improve fitness? The Step Test Exercise Prescription (STEP) project. Three versus six months of exercise training in breast cancer survivors Jumping combined exercise programs reduce fall risk and improve balance and life quality of elderly people who live in a long-term care facility. 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Background : Exercise programmes that can demonstrate evidence of long-lasting clinical effectiveness are needed for people with multiple sclerosis ( PwMS ) . Objective : The objective of this study was to assess the effects of a practically implemented exercise programme on self-directed exercise behaviour and important health outcomes in PwMS to nine months of follow-up . Methods : We conducted a parallel-arm , r and omised controlled trial : 120 PwMS ( Exp and ed Disability Status Scale ( EDSS ) 1.0–6.5 ) r and omised to a three-month exercise intervention plus usual care , or usual care only . Two supervised plus one home-exercise session ( weeks 1–6 ) were followed by one supervised and two home-exercise sessions ( weeks 7–12 ) . Cognitive-behavioural techniques promoted long-term exercise behaviour change . Outcomes were blindly assessed at baseline and at three and nine months after r and omisation . The primary outcome was self-reported exercise behaviour ( Godin Leisure Time Exercise Question naire ( GLTEQ ) ) . Secondary outcomes included fatigue and health-related quality of life ( HRQoL ) . Results : The intervention increased self-reported exercise ( 9.6 points ; 95 % CI : 2.0 to 17.3 points ; p = 0.01 ) and improved fatigue ( p < 0.0001 ) and many HRQoL domains ( p ≤ 0.03 ) at three months . The improvements in emotional well-being ( p = 0.01 ) , social function ( p = 0.004 ) and overall quality of life ( p = 0.001 ) were sustained for nine months . Conclusion : This pragmatic approach to implementing exercise increases self-reported exercise behaviour , improves fatigue and leads to a sustained enhancement of HRQoL domains in PwMS AIM To evaluate the effect of exercise consultation on promotion of physical activity in people with Type 2 diabetes . METHODS Twenty-six sedentary people with Type 2 diabetes were r and omly assigned to receive an exercise consultation and st and ard exercise information ( experimental ) or st and ard exercise information alone ( control ) . Exercise consultation is a one-to-one discussion , based on the transtheoretical model , design ed to educate , strengthen motivation and develop realistic strategies to promote physical activity . Changes from baseline at five weeks were assessed in ( a ) stage of exercise behaviour ( b ) physical activity levels ( 7-day recall question naire and an accelerometer ) ( c ) quality of life ( SF-36 Health Survey and 22-Item Well-Being Question naire ) . RESULTS 82 % ( 9/11 ) of participants receiving a consultation increased their stage of exercise behaviour compared to 33 % ( 4/12 ) of controls ( chi2 = 5.4 , P = 0.02 ) . Physical activity counts/week increased by 4 % ( 1636 067/1696 191 ) in the experimental group and decreased by 9 % ( 1560 960/1725 510 ) in controls . A significant difference was recorded for the change in activity counts per week from baseline to follow-up between the experimental and control group ( 98 % CI = 60 673 - 710 827 ) . The number of participants taking part in sport or leisure activity increased by 55 % ( 6/11 ) in the experimental group and decreased by 6 % ( 1/12 ) in controls . Positive changes were evident in the experimental group , compared to controls , in both quality of life question naires . CONCLUSION Exercise consultation is more effective in stimulating exercise behaviour change in the short term than a st and ard exercise leaflet We compared the effect of a group-based 12-week supervised exercise programme , i.e. aerobic and resistance exercise , and group sports , with that of the same programme combined with cognitive-behavioural training on physical fitness and activity of cancer survivors . One hundred and forty seven cancer survivors ( all cancer types , medical treatment ≥3 months ago ) were r and omly assigned to physical training ( PT , n=71 ) or PT plus cognitive-behavioural training ( PT+CBT , n=76 ) . Maximal aerobic capacity , muscle strength and physical activity were assessed at baseline and post-intervention . Analyses using multilevel linear mixed-effects models showed that cancer survivors ’ physical fitness increased significantly in PT and PT+CBT from baseline to post-intervention . Changes did not differ between PT and PT+CBT . Physical fitness of cancer survivors was improved following an intensive physical training programme . Adding a structured cognitive-behavioural intervention did not enhance the effect OBJECTIVES The purpose of this study is to determine whether a low-to-moderate intensity pre-conditioning exercise programme linked with exercise counselling could improve behavioural change , physical fitness , physiological condition and health-related quality of life of sedentary haemodialysis patients in The Netherl and s. METHODS Ninety-six haemodialysis patients of the Groningen Dialysis Center were r and omized into an exercise group ( n = 53 ) and a control group ( n = 43 ) . The exercise programme consists of cycling during dialysis together with a pre-dialysis strength training programme lasting 12 weeks . The intensity of the exercise programme is condition level 12 - 16 according to the rate of perceived exertion ( RPE ) . Motivational interviewing techniques were used for exercise counselling . Before and after the intervention , both groups were tested on behavioural change and physical fitness components such as reaction time , manual dexterity , lower extremity muscle strength and VO2 peak . Physiological conditions such as weight , blood pressure , haemoglobin and haematocrit values , cholesterol and Kt/V were obtained from the medical records . Health-related quality of life assessment included R AND -36 scores , symptoms and depression . RESULTS A group x time analysis with MANOVA ( repeated measures ) demonstrates that participation in a low-to-moderate intensity exercise programme linked with exercise counselling yields a significant increase in behavioural change , reaction time , lower extremity muscle strength , Kt/V and three components of quality of life , and no significant effects in the control group . CONCLUSION Participating in a low-to-moderate intensity pre-conditioning exercise programme showed beneficial effects on behavioural change , physical fitness , physiological conditions and health-related quality of life BACKGROUND Regular exercise and dietary practice s have been shown to affect the health-related quality of life ( HRQOL ) and survival of breast cancer patients . OBJECTIVE The current study aim ed to investigate whether the WSEDI was a feasible and primarily effective method for promoting exercise and dietary behaviours for breast cancer patients . DESIGN A 12-week r and omized , controlled trial . SETTING Oncology outpatient treatment clinics at 3 university hospitals and 1 National Cancer Center in South Korea . PARTICIPANTS Fifty-nine breast cancer patients who had received curative surgery and completed primary cancer treatment within 12 months prior to the study and who had been diagnosed with stage 0-III cancers within 2 years prior to the study were recruited . METHODS Participants were r and omly assigned to either the intervention group , which used a Web-based self-management exercise and diet intervention program incorporating transtheoretical model (TTM)-based strategies ( n=29 ) , or to the control group , which used a 50-page educational booklet on exercise and diet ( n=28 ) . The intervention efficacy was measured at the baseline and 12 weeks via a Web-based survey that addressed the promotion of exercise and consumption of 5 servings of fruits and vegetables ( F&V ) per day , dietary quality , HRQOL , anxiety , depression , fatigue , motivational readiness , and self-efficacy . RESULTS The proportion of subjects who performed at least moderate-intensity aerobic exercise for at least 150 min per week ; ate 5 servings of F&V per day ; and had overall improvements in dietary quality , physical functioning and appetite loss ( HRQOL ) , fatigue , and motivational readiness was greater in the intervention group than in the control group . The self-efficacy with respect to exercise and F&V consumption was greater in the intervention group than in the control group . A Web-based program that targets changes in exercise and dietary behaviours might be effective for breast cancer survivors if the TTM theory has been used to inform the program strategy , although further research with a larger sample size is required to enable definitive conclusions The main goal of the preventive intervention study in one community of the German CINDI ( Countrywide Integrated Non-Communicable Diseases Intervention programme of the WHO ) area was to improve cardiovascular health by reducing the risk factors smoking , hypertension , obesity , hypercholesterolaemia , and by changing sedentary lifestyle . The intervention was performed by using the special " Three-Level- Strategy " , which is characterised by activities of primary care physicians in the usual consulting hour ( 1st level ) , with patient groups in their practice s ( 2nd level ) , and at community level ( 3rd level ) where a special work group and a co-ordinating general practice are co-operating . To evaluate the occurrence of the risk factors in practice and the local population , four cross-sectional r and om sample s ( N(total ) = 4881 ) were carried out in seven practice s from 1992 to 1995 . On the community level , 23 special exercise-based health groups ( N(total ) = 600 ) were established and were investigated by means of a question naire , related to behaviour and health beliefs . A " Local Health Information System " facilitated the evaluation , the management of the data , and the organisation of the health programme . The results of the practice sample s showed a significant reduction of smoking ( -17.8 % ) and hypertension ( -31.5 % ) ( p < 0.01 ) . The exercise-based groups were combined with nutritional counselling or relaxation and were accepted very well by the participants ( 83.8 % ) . The participants considerably improved their health behaviour : 82 % discussed health in their family , 37.3 % stated an increase of healthy nutrition , 52 % of relaxation ; 86.2 % intended to regularly increase physical activity in leisure time and 82 % could not imagine regular health training without exercise meetings . We conclude that the practice -based " Three-Level- Strategy " provides a strong support for successful long-term prevention of cardiovascular risk , particularly , when exercise-based health training sessions are performed in order to change sedentary lifestyle . When organised on community level , they might have a positive impact on the health behaviour of the whole community . Physical activity can be used as a " prodrug " for health promotion in a holistic way Background : Adherence to self-care recommendations is associated with improved patient outcomes and improved quality of life for people living with heart failure .  The Home-Heart-Walk ( HHW ) is an intervention to promote physical activity adapting the elements of a six minute walk test , a reliable and valid measure . This adaptation was design ed to support self-monitoring of physical functioning and promote the self-care of people with heart failure . The primary outcome of the Home-Heart-Walk was perceived physical functioning and the secondary outcomes were six-minute walk test distance , health related quality of life , self-care behaviour , self-efficacy and physical activity level . Methods : A multicentre r and omized controlled trial . Participants ( N=132 ) were recruited from three academic hospitals in Sydney , Australia . Participants were r and omized to either the  Home-Heart-Walk group or the control group . Perceived physical functioning , health related quality of life , self-care behaviour , exercise self-efficacy and physical activity level were measured at baseline and at three- and six-month follow-up . Results : After adjusting for baseline scores , there were no statistically significant between-group differences in perceived physical functioning , six-minute walk test distance , health related quality of life and exercise self-efficacy at follow-up . The intervention group had improvement in self-care behaviour ( F(1,129 ) = 4.75 , p = 0.031 ) and physical activity level ( U = 1713 , z = −2.12 , p = 0.034 ) at the six-month follow-up compared with the control group . Conclusion : The Home-Heart-Walk did not improve the perceived physical functioning of the intervention group . Although the feasibility and acceptability of this strategy to support self-monitoring and improve self-care behaviour was demonstrated , self-reported adherence was unreliable ; newer technologies may offer better assessment of adherence OBJECTIVE To examine in previously sedentary older women the effects of exercise mode and a behavioural intervention on short and long-term retention and adherence . METHODS Healthy , sedentary women aged 50 - 70 years ( N=116 ) were r and omly assigned to a supervised 6-month swimming or walking program 3 sessions a week . They were further r and omised to usual care or a behavioural intervention . The same program was further continued unsupervised for 6 months . We assessed retention , adherence , stage of exercise behaviour and changes in fitness . RESULTS One hundred women ( 86 % ) completed 6 months and 86 ( 74 % ) continued for 12 months . Retention rates were similar for both exercise modes at 6 and 12 months . Adherence to swimming or walking was similar after 6 months ( 76.3 ( 95 % CI : 69.5 , 83.1)% vs. 74.3 ( 67.7 , 80.9)% ) and 12 months ( 65.8 ( 57.9 , 73.8)% vs. 62.2 ( 54.6 , 70.0)% ) . The behavioural intervention did not enhance retention or adherence . Fitness improved for both exercise modes after 6 months and was maintained at 12 months . CONCLUSIONS Either swimming or walking programs initiated with careful supervision over 6 months result ed in similar high retention and adherence rates by highly motivated older women over 12 months . Behavioural intervention in this setting did not improve these rates further Recovering from cancer treatment can be a difficult experience , both physically and psychologically . This paper describes a r and omized controlled trial that evaluates the effects of exercise therapy upon quality of life in 120 women who have had breast cancer . To facilitate behaviour change , exercise counselling is also included as an integral component in the exercise therapy intervention .  Participants are r and omized to one of three groups : exercise therapy , body conditioning ( placebo control ) or a normal care control group .  The supervised exercise therapy and body conditioning sessions take place 3 times per week for 8 weeks . Outcome measures include quality of life , physical self-perceptions , depression , satisfaction with life , exercise behaviour , aerobic capacity and percentage body fat . All outcomes are assessed at baseline , 4 weeks during the intervention and at the end of the 8-week intervention . Follow-up assessment s of outcomes take place at 3 and 6 months post-intervention . As the number of women surviving breast cancer is increasing and cancer treatment is linked to reduced quality of life , it is critical to evaluate treatments that improve the quality of life of this population or hasten recovery following treatment OBJECTIVES The purpose of this study was to examine the effectiveness of a theoretical integrated persuasive message on exercise motivation in college students . METHOD Four hundred and fifty introductory psychology students ( M age = 20.02 years ; SD = 3.94 ) were r and omly assigned to reading positively or negatively framed strong messages advocating exercise . The messages were attributed to a credible source , a non-credible source or to a no- source control condition .  Theory of planned behaviour ( TPB ) constructs ( i.e. attitude , subjective norm , perceived behavioural control ) and cognitive responses ( i.e. thought listing ) were measured immediately and 2 weeks following the delivery of the intervention . RESULTS Unfortunately , the results did not corroborate previous research , as we did not find any significant effects between experimental groups on any psychological or behavioural variable . CONCLUSIONS There may be several potential explanations for the lack of effects , including the interaction between the type of persuasive information ( TPB implication s ) and sources of persuasion and how these persuasive messages are processed ( elaboration likelihood model/cognitive response implication s ) . The theoretical implication s of this research are discussed with a view towards future directions for exercise promotion initiatives using theoretically driven interventions BACKGROUND nearly 61 % of older adults do not maintain recommended exercise levels emphasising the need for interventions that promote exercise . OBJECTIVES to compare self-reported exercise behaviour and functional outcomes over 1 year across three groups of older adults : a cognitive-behavioural therapy group , an attention-control education group and a control group . DESIGN r and omised intervention . SETTING community exercise facilities . PARTICIPANTS three hundred and thirty-two older adults ( mean age = 71.8 ± 5.1 years ) . METHODS all three groups received exercise training three times per week for 2 weeks and then one time per week for 8 weeks , during which time the therapy and education groups received their interventions . Blinded data collectors measured follow-up exercise behaviour and functional outcomes at 3-month intervals . RESULTS after controlling for previous year exercise behaviour , results showed that relative to the control group , the therapy and education groups increased their strengthening exercises over time ( 0.05 and 0.06 h/week higher , respectively ) ; only the therapy group 's change was significant . Also , relative to the control group , the therapy and education groups significantly reduced their 6-min walking distances over time ( -1.6 m , P = 0.030 and -1.5 m , P = 0.026 , respectively ) . CONCLUSIONS although the therapy group increased their strength training , they reduced their 6-min walking distance We describe adherence to a three group r and omised controlled trial that involved aerobic exercise therapy  ( N=34 ) and exercise-placebo intervention  ( N=36 ) or usual care  ( N=38 ) in women treated for breast cancer . We also investigated relationships between routes of trial recruitment , socio-economic characteristics , health behaviours , cancer treatment regimen(s ) and subsequent adherence to the interventions . Women who had completed breast cancer treatment 12 - 36 months previously were r and omised to one of the groups . The intervention groups attended an exercise facility three times per week for eight weeks . A total of 77 % of the aerobic exercise therapy and 88.9 % of the exercise-placebo groups attended at least 70 % of prescribed sessions . The percentage of women achieving 30min of aerobic exercise per session steadily increased during the intervention but many women were not able to achieve this goal . Routes of trial recruitment , socio-economic characteristics , health behaviours and cancer treatment regimen(s ) were not related to intervention . Exercise therapy participants were able to comply with the progressive nature of the aerobic exercise intervention , although some women were not able to achieve 30min of aerobic exercise per session by intervention completion . Research is still required to tease out all the potential determinants of exercise in this population Many have studied the effects of different lifestyles on disease , mortality or risk factors for a disease , but little is known about how behaviour is changed in the population . We studied the need for counselling and its effect on willingness and ability to change lifestyle , and subsequent changes in CHD risk factors .  All 152 male employees in a computer company , 25 - 45 years of age , were invited to participate . Subjects were r and omized into an intervention group ( I-group ) and a control group . The I-group was divided into subgroups based on baseline behaviour and risk factor status . Changes were evaluated after 1 year . After an initial health examination , participants from the I-group were counselled at baseline and after 5 months . Eighty-five ( 56 % ) males participated . Twenty-nine were assigned to a control group and 56 to an intervention group ( I-group ) ( dropout = 8) . An exercise group ( E-group ) was advised to exercise aerobically three times/week , a diet group to reduce the intake of saturated fat and increase fish products , and smokers to quit smoking . Forty subjects were recommended one or more behavioural changes and eight had no need . Thirty-four were willing to make behavioural changes . Compared to the control group , the fitness level increased ( P < 0.01 ) and body weight decreased in the I-group ( P < 0.05 ) . It may be concluded that individual counselling promotes regular exercise with subsequent improvements in CHD risk factors . The diet- and smoking counselling models were less successful in terms of adherence This study investigated : ( a ) whether moderate intensity aerobic exercise exerted a significant affective influence during , and postexercise , ( b ) the nature of the affective response to exercise in relation to positive and negative affects , and affects associated with physiological distress , and ( c ) whether exercise induced affect was significantly influenced by exercise behaviour . Habitual exercisers ( n = 15 ) and sedentary participants ( n = 13 ) undertook three r and omly allocated interventions ; ( a ) exercise ( EX ; i.e. , 20 min of cycling at 60 % estimated VO2max ) , ( b ) normal workstation duties for 60 min ( WRK ) , and ( c ) a 60 min sedentary lunch break ( SED ) . Affect was measured pre , post , and 90 min postintervention , as well as every 5 min during exercise , using the Subjective Exercise Experiences Scale ( SEES ; McAuley & Courneya , 1994 ) . Exercise behaviour had no significant affect on affective responses to exercise in this study ( p > .05 ) . Significant ( p < .05 ) postintervention increases in positive affect were found for EX compared to WRK and SED indicating that exercise did produce a positive affective influence . Despite enduring postexercise ( i.e. , 90 min ) improvements in both positive and negative affects , and affects related to fatigue , the affective response during exercise was characterised by significant ( p < .05 ) decreases in levels of positive affect and increased levels of affects related to fatigue OBJECTIVE During hospitalization older people often experience functional decline which impacts on their future independence . The objective of this study was to evaluate a multifaceted transitional care intervention including home-based exercise strategies for at-risk older people on functional status , independence in activities of daily living ( ADLs ) and walking ability . METHODS A r and omized controlled trial was undertaken in a metropolitan hospital in Australia with 128 patients ( 64 intervention , 64 control ) aged over 65 years with an acute medical admission and at least one risk factor for hospital readmission . The intervention group received an individually tailored programme for exercise and follow-up care which was commenced in hospital and included regular visits in hospital by a physiotherapist and a registered nurse , a home visit following discharge and regular telephone follow-up for 24 weeks following discharge . The programme was design ed to improve health-promoting behaviours , strength , stability , endurance and mobility . Data were collected at baseline , then 4 , 12 and 24 weeks following discharge using the Index of ADL , Instrumental Activities of Daily Living ( IADL ) and the Walking Impairment Question naire ( WIQ ; modified ) . RESULTS Significant improvements were found in the intervention group in IADL scores ( P < 0.001 ) , ADL scores ( P < 0.001 ) and WIQ scale scores ( P < 0.001 ) in comparison to the control group . The greatest improvements were found in the first 4 weeks following discharge . CONCLUSIONS Early introduction of a transitional model of care incorporating a tailored exercise programme and regular telephone follow-up for hospitalized at-risk older adults can improve independence and functional ability Background Objective ly measured physical activity is low in British children , and declines as childhood progresses . Observational studies suggest that dog-walking might be a useful approach to physical activity promotion in children and adults , but there are no published public health interventions based on dog-walking with children . The Children , Parents , and Pets Exercising Together Study aims to develop and evaluate a theory driven , generalisable , family-based , dog walking intervention for 9 - 11 year olds . Methods / design The Children , Parents , and Pets Exercising Together Study is an exploratory , assessor-blinded , r and omised controlled trial as defined in the UK MRC Framework on the development and evaluation of complex interventions in public health . The trial will follow CONSORT guidance . Approximately 40 dog-owning families will be allocated r and omly in a ratio of 1.5:1 to receive a simple behavioural intervention lasting for 10 weeks or to a ' waiting list ' control group . The primary outcome is change in objective ly measured child physical activity using Actigraph accelerometry . Secondary outcomes in the child , included in part to shape a future more definitive r and omised controlled trial , are : total time spent sedentary and patterning of sedentary behaviour ( Actigraph accelerometry ) ; body composition and bone health from dual energy x-ray absorptiometry ; body weight , height and BMI ; and finally , health-related quality of life using the PedsQL . Secondary outcomes in parents and dogs are : changes in body weight ; changes in Actigraph accelerometry measured physical activity and sedentary behaviour . Process evaluation will consist of assessment of simultaneous child , parent , and dog accelerometry data and brief interviews with participating families . Discussion The Children , Parents , and Pets Exercising Together trial should be the first r and omised controlled study to establish and evaluate an intervention aim ed at dog-based physical activity promotion in families . It should advance our underst and ing of whether and how to use  pet dogs to promote physical activity and /or to reduce sedentary behaviour in children and adults . The trial is intended to lead to a subsequent more definitive r and omised controlled trial , and the work should inform future dog-based public health interventions such as secondary prevention interventions in children or adults . Trial registration numberIS RCT INTRODUCTION We examined the need for counselling and the effect on willingness and ability to change life-style , and subsequent changes in risk factors for CHD . MATERIAL AND METHODS All 152 male employees in a computer company , 25 - 45 years of age , were invited to participate in a controlled intervention study over one year . The subjects were r and omised to an intervention group ( I group ) and a control group . The I group was divided into subgroups based on baseline behaviour and risk factor status . Changes were evaluated after one year . After an initial health examination , participants in the I group were counselled at baseline and at 5 months . RESULTS Eighty-five ( 56 % ) men participated . Twenty-nine were assigned to a control group and 56 to an intervention group ( I group ) ( dropouts = 8) . An exercise group ( E group ) was advised to take up aerobics exercise three times/week , a diet group to reduce the intake of saturated fat and increase fish products , and smokers to stop smoking . Forty were recommended one or more behavioural changes and eight had no need . Thirty-four were willing to make behavioural changes . Compared to the control group , the fitness level increased ( p < 0.01 ) and body weight decreased in the I group ( p < 0.05 ) . DISCUSSION Individual counselling promotes regular exercise with subsequent improvements in CHD risk factors . The diet and smoking counselling models were less successful in terms of compliance Abstract Objective . To investigate the efficacy of a guided and grade d home-based exercise program for improving a range of physical outcomes in older people . Design . Controlled clinical trial of 16 weeks Setting . Two geographical areas in Gent , Belgium Participants . 66 independent-living older people ( age : 71 - 98 ) with a history of falls and moderate physical impairment Intervention . Twenty-four 30-minute training sessions were given by a trained physiotherapist over a period of 16 weeks in the participant ’s home . Different types of exercises on balance , aerobic performance , flexibility , and muscle strength were provided . Main outcome measures . Muscle strength , static and dynamic balance , aerobic performance , activities in daily living , fear of falling and avoidance of daily activities were assessed at baseline and after 16 weeks intervention . Results : At baseline , there were no significant differences in the measured variables between exercise and control groups . After 16 weeks , the exercise group showed significantly improved ankle muscle strength , balance performance and aerobic capacity , and decreased fear of falling , dependency in daily activities and avoidance of daily activities compared to the control group . The improvements in knee muscle strength , timed chair st and s , and functional reach were not significant . Conclusion : The home-based , individualized exercise program was effective in reducing several physical factors associated with falls in community-dwelling older people with moderate physical impairment . The decrease in fear of falling and other behavioural variables needs to be considered with care and needs further investigation A r and omised control trial evaluated the effectiveness of a theory-based persuasive leaflet design ed to encourage students to undertake at least one additional physical exercise session a week . Participants were 503 secondary school students attending a school in South-East Engl and . The leaflet was written to target potentially modifiable cognitive antecedents of exercise specified by the Theory of Planned Behaviour . It was separately augmented with two cognitive change techniques , result ing in three intervention conditions , leaflet alone ; leaflet plus motivational quiz , and leaflet plus implementation intention prompt , as well as a no-leaflet control condition .  Cognitions and behaviour were measured immediately before and 3 weeks after intervention . The results showed that all three-leaflet interventions significantly increased reported exercise , intention to exercise and related cognitions , compared to the control condition , but did not differ in their impact . Mediation analysis showed that intervention effects on exercise were partially mediated by intentions and perceived behavioural control Background The prevalence of health risk behaviours is growing amongst South African employees . Health risk behaviours have been identified as a major contributor to reduced health related quality of life ( HRQoL ) and the increased prevalence of non-communicable diseases . Worksite wellness programmes promise to promote behaviour changes amongst employees and to improve their HRQoL. The aim of this study was to evaluate the short-term effects of an  employee wellness programme  on HRQoL , health behaviour change , body mass index ( BMI ) and absenteeism amongst clothing and textile manufacturing employees . Methods The study used a r and omised control trial design . The sample consisted of 80 subjects from three clothing manufacturing companies in Cape Town , South Africa . The experimental group was subjected to a wellness programme based on the principles of cognitive behaviour therapy ( CBT ) as well as weekly supervised exercise classes over six weeks . The control group received a once-off health promotion talk and various educational pamphlets , with no further intervention . Measurements were recorded at baseline and at six weeks post-intervention . Outcome measures included the EQ-5D , Stanford Exercise Behaviours Scale , body mass index and absenteeism . Data was analysed with the Statistica-8 software program . Non-parametric tests were used to evaluate the differences in the medians between the two groups and to determine the level of significance . The Sign test was used to determine the within group changes . The Mann – Whitney U test was used to determine the difference between the two groups . Results At six weeks post intervention the experimental group ( 39 subjects ) demonstrated improvement in almost every parameter . In contrast , apart from an overall decrease in time off work and a reduction in BMI for all study participants , there was no significant change noted in the behaviour of the control group ( 41 subjects ) . Seventy percent of the experimental group had improved HRQoL EQ-5D VAS scores post intervention , indicating improved perceived HRQoL. In comparison , only 58 % of the control group had improved HRQoL EQ-5D VAS scores post intervention . There was no significant difference between the two groups at baseline or at six weeks post intervention . Conclusion An employee wellness programme based on the principles of CBT combined with weekly aerobic exercise class was beneficial in improving the perceived HRQoL and changing health-related behaviours of clothing manufacturing employees . However , it can not be concluded that the EWP was more effective than the once off health promotion talk as no significant changes were noted between the two groups at 6-weeks post intervention . This trial has been registered with Clinical Trials.gov ( trial registration number NCT01625039 ) INTRODUCTION Replacing sedentary behaviour with light intensity physical activity ( ie , activities classified as less than three metabolic equivalents , such as slow-paced walking ) may be a more realistic strategy for reducing cardiometabolic risk in people with chronic obstructive pulmonary disease than only aim ing to increase levels of moderate-vigorous intensity physical activity . Behaviour change interventions to reduce sedentary behaviour in people with chronic obstructive pulmonary disease have not yet been developed or tested . RESEARCH QUESTIONS Is a 6-week behaviour change intervention effective and feasible in reducing sedentary time in people with chronic obstructive pulmonary disease ? DESIGN This study will be a multi-centre , r and omised , controlled trial with concealed allocation , assessor blinding , and intention-to-treat analysis , comparing a 6-week behaviour change intervention aim ed at reducing sedentary time with a sham intervention in people with chronic obstructive pulmonary disease . PARTICIPANTS AND SETTING Seventy participants will be recruited from the waiting lists for pulmonary rehabilitation programs at Royal Prince Alfred Hospital and Prince of Wales Hospital , Sydney , Australia . INTERVENTION The behaviour change intervention aims to reduce sedentary time through a process of guided goal setting with participants to achieve two target behaviours : ( 1 ) replace sitting and lying down with light-intensity physical activity where possible , and ( 2 ) st and up and move for 2minutes after 30minutes of continuous sedentary time . Three face-to-face sessions and three phone sessions will be held with a physiotherapist over the 6-week intervention period . The ' capability ' , ' opportunity ' , ' motivation ' and ' behaviour ' ( COM-B ) model will be applied to each participant to determine which components of behaviour ( capability , opportunity or motivation ) need to change in order to reduce sedentary time . Based on this ' behavioural diagnosis ' , the Behaviour Change Wheel will be used to systematic ally select appropriate behaviour change techniques to assist participants in achieving their weekly goals . Behaviour change techniques will include providing information about the health consequences of sedentary behaviour , self-monitoring and review of weekly goals , problem-solving of barriers to achieving weekly goals , and providing feedback on sedentary time using the Jawbone UP3 activity monitor . CONTROL The sham intervention will consist of weekly phone calls for 6 weeks , to enquire whether the participants ' health status has changed over the intervention period ( eg , hospitalised for an acute exacerbation ) . No instructions regarding physical activity or exercise will be given . MEASUREMENTS Outcomes will be assessed at baseline , at the end of the 6-week intervention period , and at the 3-month follow-up . Primary outcome measures will be : ( 1 ) total sedentary time , including the pattern of accumulation of sedentary time , assessed by the activPAL3 activity monitor , and ( 2 ) feasibility of the intervention assessed by uptake and retention of participants , participant compliance , self-reported achievement of weekly goals , and adverse events . Secondary outcome measures will include functional exercise capacity , health-related quality of life , domain-specific and behaviour-specific sedentary time , patient activation , and anxiety and depression .  Semi-structured interviews will be conducted with participants who receive the behaviour change intervention to explore acceptability and satisfaction with the different components of the intervention . ANALYSIS Analysis of covariance ( ANCOVA ) will be used to calculate between-group comparisons of total sedentary time and the number of bouts of sedentary time>30minutes after adjusting baseline values . Uncertainty about the size of the mean between-group differences will be quantified with 95 % CI . Within-group comparisons will be examined using paired t-tests and described as mean differences with 95 % CIs . Secondary outcome measures will be analysed similarly . The feasibility measures will be analysed descriptively . Semi-structured interviews will be conducted until data saturation is achieved and there are no new emerging themes . De-identified interview transcripts will be coded independently by two research ers and analysed alongside data collection using the COM-B model as a thematic framework . DISCUSSION / SIGNIFICANCE If behaviour change interventions are found to be an effective and feasible method for reducing sedentary time , such interventions may be used to reduce cardiometabolic risk in people with chronic obstructive pulmonary disease . An approach that emphasises participation in light-intensity physical activity may increase the confidence and willingness of people with chronic obstructive pulmonary disease to engage in more intense physical activity , and may serve as an intermediate goal to increase uptake of pulmonary rehabilitation Abstract Objective : To measure the effect of behaviourally oriented counselling in general practice on healthy behaviour and biological risk factors in patients at increased risk of coronary heart disease . Design : Cluster r and omised controlled trial . Participants : 883 men and women selected for the presence of one or more modifiable risk factors : regular cigarette smoking , high serum cholesterol concentration ( 6.5 - 9.0 mmol/l ) , and high body mass index ( 25 - 35 ) combined with low physical activity . Intervention : Brief behavioural counselling , on the basis of the stage of change model , carried out by practice nurses to reduce smoking and dietary fat intake and to increase regular physical activity . Main outcome measures : Question naire measures of diet , exercise , and smoking habits , and blood pressure , serum total cholesterol concentration , weight , body mass index , and smoking cessation ( with biochemical validation ) at 4 and 12 months . Results : Favourable differences were recorded in the intervention group for dietary fat intake , regular exercise , and cigarettes smoked per day at 4 and 12 months . Systolic blood pressure was reduced to a greater extent in the intervention group at 4 but not at 12 months No differences were found between groups in changes in total serum cholesterol concentration , weight , body mass index , diastolic pressure , or smoking cessation . Conclusions : Brief behavioural counselling by practice nurses led to improvements in healthy behaviour . More extended counselling to help patients sustain and build on behaviour changes may be required before differences in biological risk factors emerge INTRODUCTION Shift work ( an occupation requiring work between 2200 and 0500H ) comprises approximately 20 % of the workforce in Europe and North America [ 1 ] . This is likely to increase , with many shift workers ( SWs ) in emergency services , retail , hospitality , healthcare , transportation and manufacturing [ 2 ] . SWs are at increased risk for negative health outcomes , including cancer and other chronic diseases [ 3 , 4 ] . Biological changes from poor lifestyle habits related to shift work ( e.g. low physical activity ( PA ) , poor nutrition , obesity ) are thought to contribute to this risk ; these factors are also amenable to lifestyle intervention [ 5 ] . PA in particular , reduces cancer risk [ 6 ] , and has many positive physical and psychological benefits [ 7 ] . It is a simple , cost-effective strategy that may be implemented by individual workers or within workplaces to mitigate risk . Unfortunately , SWs are unlikely to engage in regular PA [ 8 ] . In Canada , only 15.9 % of SWsmeet the PA guidelines and have lower levels of aerobic fitness than those of day workers [ 9 ] . Few behavioural interventions improving health outcomes in SWs have been published [ 10 ] . In a targeted PA intervention , nurses r and omised to 4 months of supervised PA  improved aerobic fitness , muscular strength , fatigue and musculoskeletal symptoms . However , authors reported low adherence and large loss to follow-up , perhaps due to the supervised scheduled sessions [ 11 , 12 ] . Sustained behaviour change is a challenge and requires targeted efforts to encourage individuals to reach an adequate dose of PA to change health outcomes [ 13 ] . Due to irregular schedules and time constraints , SWs may be less likely to adhere to a traditional supervised PA intervention with face-to-face behavioural support [ 12 ] . Women SWs cite work schedule interference and lack of time as PA barriers and report scheduling flexibility as the most important in PA [ 14 ] . This highlights the need for a creative and innovative programming to promote PA in SWs . Distance-based interventions , in which individuals exercise independent of study staff or participants , may include telephone counselling and website or smart phone app-based technology . These interventions are highly flexible and may help overcome barriers related to timing and scheduling that are important for SWs . In a review of telephone-based PA interventions , 14 of 17 found evidence for behaviour change [ 15 ] . These may be a way to implement scalable , individuallytailored interventions in SWs . The primary objective of this study was to test the feasibility of a distance-based PA intervention in women SWs . Feasibility studies are important for establishing effective processes and underst and ing re sources required before attempting a r and omised controlled trial ( RCT ) , in order to put forward interventions that are most likely to be efficacious [ 16 ] . As this work was funded by a grant to examine the role of lifestyle in reducing breast cancer risk in SWs , only women were included . A secondary objective was to conduct a preliminary evaluation of intervention efficacy , to estimate effect size for future studies The purpose of this study was to determine whether a brief , tailored counselling intervention is effective for increasing physical activity in sedentary women when delivered in the workplace . This prospect i ve r and omized trial used a brief intervention based on the Transtheoretical Model . The intervention group received health screening , a brief intervention , and , 2 weeks later , a booster telephone call from a nurse practitioner . The intervention was tailored to each woman 's reported exercise behaviour . The 134 women r and omized to the intervention were compared with 153 women in a control group who received health counselling not tailored to their exercise behaviour and no telephone call . Six weeks later , the intervention group , when compared to baseline , had significantly improved their physical activity , increasing their amount of weekend physical activity as well as minutes walked for exercise , on err and s , total walking , and total daily blocks walked . When compared to controls , they showed significantly greater gains . This test of a brief , tailored strategy provides a critical contribution to the search for efficient , effective ways for nurses to deliver workplace health promotion interventions Background : Treatment of prostate cancer with and rogen deprivation therapy ( ADT ) is associated with metabolic changes that have been linked to an increase in cardiovascular risk . Methods : This r and omised controlled trial investigated the effects of a 12-week lifestyle intervention that included supervised exercise training and dietary advice on markers of cardiovascular risk in 50 men on long-term ADT recruited to an on-going study investigating the effects of such a lifestyle intervention on quality of life . Participants were r and omly allocated to receive the intervention or usual care . Cardiovascular outcomes included endothelial function ( flow-mediated dilatation ( FMD ) of the brachial artery ) , blood pressure , body composition and serum lipids . Additional outcomes included treadmill walk time and exercise and dietary behaviours . Outcomes were assessed before r and omisation ( baseline ) , and 6 , 12 and 24 weeks after r and omisation . Results : At 12 weeks , the difference in mean relative FMD was 2.2 % ( 95 % confidence interval ( CI ) 0.1–4.3 , P=0.04 ) with an effect size of 0.60 ( 95 % CI < 0.01–1.18 ) favouring the intervention group . Improvements in skeletal muscle mass , treadmill walk time and exercise behaviour also occurred in the intervention group over that duration ( P<0.05 ) . At 24 weeks , only the difference in treadmill walk time was maintained . Conclusions : This study demonstrates that lifestyle changes can improve endothelial function in men on long-term ADT for prostate cancer . The implication s for cardiovascular health need further investigation in larger studies over longer duration Sport and exercise can have several health benefits for people living with HIV . These benefits can be achieved through different types of physical activity , adapting to disease progression , motivation and social-ecological options . However , physical activity levels and adherence to exercise are generally low in people living with HIV . At the same time , high drop-out rates in intervention studies are prevalent ; even though they often entail more favourable conditions than interventions in the natural setting s. Thus , in the framework of an intervention study , the present study aims to explore social-ecological , motivational and volitional correlates of South African women living with HIV with regard to physical activity and participation in a sport and exercise health promotion programme . The qualitative data was produced in the framework of a non-r and omised pre-post intervention study that evaluated structure , processes and outcomes of a 10-week sport and exercise programme .  All 25 participants of the programme were included in this analysis , independent of compliance . Data was produced through question naires , participatory group discussion s , body image pictures , research diaries and individual semi-structured interviews . All participants lived in a low socioeconomic , disadvantaged setting . Hence , the psychological correlates are context ualised and social-ecological influences on perception and behaviour are discussed . The results show the importance of considering social-cultural and environmental influences on individual motives , perceptions and expectancies , the fear of disclosure and stigmatisation , sport and exercise-specific group dynamics and self-supporting processes . Opportunities and strategies to augment physical activity and participation in sport and exercise programmes in the context of HIV are discussed BACKGROUND Prostate cancer is a key driver of cancer-related global disability-adjusted life-years . And rogen-deprivation therapy ( ADT ) for advanced disease is linked to fatigue , reduced physical function , and quality of life ( QoL ) . OBJECTIVE To evaluate the effect of a lifestyle intervention on disease-specific QoL , diastolic blood pressure , and cancer-related fatigue in sedentary men receiving long-term ADT for advanced prostate cancer . DESIGN , SETTING , AND PARTICIPANTS A total of 100 hundred sedentary men with locally advanced or metastatic prostate cancer on long-term ADT were r and omised to an intervention or usual care group . INTERVENTION A 12-wk lifestyle intervention consisting of aerobic and resistance exercise with parallel dietary advice . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Disease-specific QoL was measured using the Functional Assessment of Cancer Therapy-Prostate ( FACT-P ) and Functional Assessment of Cancer Therapy-Fatigue ( FACT-F ) question naires at 12 wk postintervention and at 6 mo following withdrawal of support . Analysis of covariance and mixed regression were conducted . RESULTS AND LIMITATIONS Clinical ly relevant improvements in FACT-P were seen at 12 wk in the intervention group compared with controls ( mean difference : 8.9 points ; 95 % confidence interval [ CI ] , 3.7 - 14.2 ; adjusted p=0.001 ) . No difference was apparent at 6 mo ( mean difference : 3.3 points ; 95 % CI , -2.6 to 9.3 ; adjusted p=0.27 ) . No difference in diastolic blood pressure was seen at either follow-up ( all p > 0.05 ) . Clinical ly relevant improvements in FACT-F were seen at 12 wk ( mean difference : 5.3 points ; 95 % CI , 2.7 - 7.9 ; adjusted p<0.001 ) and maintained following withdrawal of supervision ( mean difference : 3.9 points ; 95 % CI , 1.1 - 6.8 ; adjusted p=0.007 ) . Improvements in exercise tolerance and behaviour were maintained at 6 mo ( adjusted p<0.001 and 0.038 ) . CONCLUSIONS A lifestyle intervention result ed in a clinical ly meaningful improvement in disease-specific QoL that was not maintained postintervention . No effect on blood pressure occurred . Durability of response was seen in fatigue and exercise behaviour . Further evaluation of support structures is essential . TRIAL REGISTRATION IS RCT N88605738 With ageing , older people can become frail , and this has been shown to be associated with a decrease in well-being . Observational studies provide evidence of a positive effect of coping re sources on well-being . The question is : can coping re sources be improved in vulnerable older people ? The Chronic Disease Self-Management Program ( CDSMP ) is a target group-specific intervention which aims to promote the self-management of older people who are confronted with deteriorating health . The aim of this study was to review intervention studies focusing on the CDSMP and to draw conclusions on the benefits of the program . A systematic search was conducted in PubMed and PsychINFO to identify r and omized controlled trials ( RCTs ) focusing on the CDSMP .  Nine RCTs focusing on relatively young older adults , 75 % of whom with an average age between 49 and 65 years , were included . We found that the CDSMP was consistently beneficial for Health behaviour , especially with regard to the variables of exercise and self-care . For Health status , the majority of studies only showed improvement in the domain of health distress . Most of the studies that investigated Self-efficacy showed convincing improvement in self-efficacy , cognitive symptom management and mental stress management . In Health care utilization , there was no significant decrease . On the whole , the studies showed that CDSMP led to an increase in physical exercise , a decrease in health distress , an improvement in self-care , and it had a beneficial effect on self-efficacy BACKGROUND Observational studies indicate that physical activity ( PA ) is strongly associated with improved disease outcomes in colon cancer survivors , but a r and omized controlled trial is needed to determine whether the association is causal and whether new policies to promote exercise are justified . PURPOSE The co.21 Colon Health and Life-Long Exercise Change ( challenge ) trial undertaken by the National Cancer Institute of Canada Clinical Trials Group ( NCIC CTG ) is design ed to determine the effects of a structured pa intervention on outcomes for survivors of high-risk stage II or III colon cancer who have completed adjuvant therapy within the previous 2 - 6 months . METHODS Trial participants ( n = 962 ) will be stratified by centre , disease stage , body mass index , and performance status , and will be r and omly assigned to a structured pa intervention or to general health education material s. The pa intervention will consist of a behavioural support program and supervised pa sessions delivered over a 3-year period , beginning with regular face-to-face sessions and tapering to less frequent face-to-face or telephone sessions . The primary endpoint is disease-free survival . Important secondary endpoints include multiple patient-reported outcomes , objective physical functioning , biologic correlative markers , and an economic analysis . SUMMARY Cancer survivors and cancer care professionals are interested in the potential role of PA to improve multiple disease-related outcomes , but a r and omized controlled trial is needed to provide compelling evidence to justify changes in health care policies and practice AIMS This study tested the impact of combining a motivational intervention based on protection motivation theory ( PMT , Rogers , 1983 [ 18 ] ) plus a volitional intervention based on action planning and coping planning , as a way to promote the prevention of type 2 diabetes among UK undergraduates . METHODS Eighty-four participants were r and omly assigned to either a control group or one of three experimental conditions : motivational intervention ( PMT ) , volitional intervention ( APCP ) , or combined motivational and volitional intervention ( PMT&APCP ) . PMT variables , dietary and exercise behaviours were measured at three time-points over a four-week period . RESULTS The motivational intervention significantly changed PMT variables . The combined motivational and volitional intervention  significantly decreased fat intake and increased the frequency of exercise relative to all other groups , and significantly increased the amount of fruit and vegetables consumed relative to control and volitional intervention groups . CONCLUSIONS These results suggest that motivational intervention is effective at changing cognitions but changing behaviour requires an intervention based on both motivation and volition There is ample evidence of the benefits of exercise for older people . Less is known about the most effective strategies for promoting the participation of older people in exercise regimes . An approach whereby practice nurses  used motivational interviewing , based on Prochaska and Di Clemente 's model of behaviour change , was piloted in two general practice s. The strategy appeared feasible and will be tested further in a large controlled trial OBJECTIVE This study compared a motivational intervention based on protection motivation theory ( PMT , Rogers , 1975 , 1983 ) with the same motivational intervention augmented by a volitional intervention based on implementation intentions ( Gollwitzer , 1993 ) . DESIGN The study had a longitudinal design , involving three waves of data collection over a 2-week period , incorporating an experimental manipulation of PMT variables at Time 1 and a volitional , implementation intention intervention at Time 2 . METHOD Participants ( N=248 ) were r and omly allocated to a control group or one of two intervention groups .  Cognitions and exercise behaviour were measured at three time-points over a 2-week period . RESULTS The motivational intervention significantly increased threat and coping appraisal and intentions to engage in exercise but did not bring about a significant increase in subsequent exercise behaviour . In contrast , the combined protection motivation theory/implementation intention intervention had a dramatic effect on subsequent exercise behaviour . This volitional intervention did not influence behavioural intention or any other motivational variables . CONCLUSIONS It is concluded that supplementing PMT with implementation intentions strengthens the ability of the model to explain behaviour . This has implication s for health education programmes , which should aim to increase both participants ' motivation and their volition Abstract Objectives : To evaluate the effectiveness of inviting teenagers to  general practice consultations to discuss health behaviour concerns and appropriate follow up care . Design : R and omised controlled trial , with participants r and omised to a consultation ( intervention ) or usual care ( control ) . Question naires completed at baseline , 3 months , and 12 months . Setting : Eight general practice s in Hertfordshire , Engl and . Participants : 1516 teenagers aged 14 - 15 years . Intervention : Consultations with practice nurses to discuss health concerns and develop plans for healthier lifestyles . Main outcome measures : Mental and physical health , “ stage of change ” for health related behaviour , and use of health services . Results : At baseline 970 teenagers completed question naires ; 23 % smoked , 35 % had been drunk in the previous three months , 64 % considered they ate unhealthily , 39 % took little exercise , and 36 % had possible depression . 41 % ( 304 ) of teenagers invited attended for a consultation ; over one third ( 112 ) were offered follow up care . More intervention group teenagers reported positive movement in stage of change for diet and exercise and in at least one of four behaviours ( diet , exercise , smoking , drinking alcohol ) at 3 months ( 41 % v 31 % , P<0.01 ) , but this did not persist at 12 months . There was marginally more positive change in actual behaviour by intervention teenagers at 3 months ( 16 % v 12 % , P=0.06 ) . Recognition of possible depression result ed in improved mental health outcomes at 3 and 12 months . 97 % of attenders said they would recommend the intervention to a friend . Conclusions : Change in behaviour was slight but encouraging , and the intervention was well received and relatively cheap Background Adults with intellectual disability ( ID ) are physically very inactive . This study will compare two approaches to increasing physical activity in adults with ID : a lifestyle physical activity ( light-moderate intensity ) approach and a structured exercise ( moderate-vigorous intensity ) approach . The trial will compare the short-term ( 3-month ) and long-term ( 9-month ) outcomes and sustainability of each approach with a usual-care control group . Methods / Design A three-arm r and omised controlled trial ( RCT ) will be conducted . Ninety adults with ID aged 18 - 55 will be r and omly assigned to one of three groups : 1 ) a lifestyle physical activity group ( n = 30 ) , 2 ) a structured exercise group ( n = 30 ) , or 3 ) a usual care control group ( n = 30 ) . Participants in both groups will receive a 12-week intervention delivered by exercise specialists in the community with disability service staff , after which intervention will continue for 6 months , delivered by disability service staff only . Primary outcomes are aerobic fitness , 12-hour energy expenditure , and proxy-reported everyday physical activity . Secondary outcomes include objective ly assessed physical activity and sedentary behaviour , intervention compliance , functional walking capacity , participation in domestic activities , muscle strength , body composition , psychosocial outcomes , quality of life and health care costs . Discussion The trial results will determine the effectiveness and sustainability of two approaches to increasing physical activity and exercise among adults with ID.Trial registration IS RCT N77889248 ( 18 April 2012 ) 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 r and omly 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 Implementation intentions planning in advance the situation in which one will act , have been proposed to be an effective self-regulatory technique for changing health behaviour . Encouraging people to receive text message reminders of their implementation intentions should enhance their strength and , thus , it was predicted that this combined approach would be particularly effective in increasing exercise .  Participants ( N = 155 ) were r and omly allocated to one of five conditions ( implementation intentions and SMS , implementation intention , SMS or one of two control groups ) then completed self-report measures of exercise behaviour and motivation . Four weeks later , they responded to similar items . Results suggested that the combined intervention increased exercise frequency significantly more than the other strategies including the implementation intention group . It is proposed , therefore , that implementation intention effects can be enhanced via plan reminders QUESTION Does behavioural grade d activity result in better exercise adherence and more physical activity than usual care in people with osteoarthritis of the hip or knee ? DESIGN Analysis of secondary outcomes of a cluster-r and omised trial with concealed allocation , assessor blinding , and intention-to-treat analysis . PARTICIPANTS Two hundred patients with hip and /or knee osteoarthritis . INTERVENTION Experimental group received 18 sessions of behavioural grade d activity over 12 weeks and up to 7 booster sessions over the next year . The control group received 18 sessions of usual care over 12 weeks according to the Dutch physiotherapy guideline . OUTCOME MEASURES Exercise adherence was measured using a question naire and physical activity was measured using the SQUASH question naire at baseline , 13 , and 65 weeks . RESULTS Adherence to recommended exercises was significantly higher in the experimental group than in the control group at 13 weeks ( OR 4.3 , 95 % CI 2.1 to 9.0 ) and at 65 weeks ( OR 3.0 , 95 % CI 1.5 to 6.0 ) . Significantly more of the experimental than the control group met the recommendations for physical activity at 13 weeks ( OR 5.3 , 95 % CI 1.9 to 14.8 ) and at 65 weeks ( OR 2.9 , 95 % CI 1.2 to 6.7 ) . CONCLUSION Behavioural grade d activity results in better exercise adherence and more physical activity than usual care in people with osteoarthritis of the hip or knee , both in the short- and long-term . TRIAL REGISTRATION NCT00522106 BACKGROUND The purpose of this study was to determine the effectiveness of different recruitment strategies used to recruit patients into the Sheffield Exercise and Breast Cancer Trial ( SHERBERT ) , which involved exercise as a therapy , in sedentary women treated for breast cancer . We also evaluated whether the routes of recruitment distinguished patients participating in the trial in terms of socio-economic characteristics , lifestyle behaviours , cancer treatment(s ) , treatment side effects , length of treatment and time since treatment was completed . METHODS SHERBERT aim ed to recruit at least 114 sedentary women , aged 18 - 65 years , who had been treated for breast cancer between 1 and 3 years previously , to receive exercise therapy , an equal contact exercise-placebo intervention or usual care .  Potentially eligible patients were recruited by postal invitation letters from their treating clinician ( i.e. oncologist/surgeon ) or by a range of community strategies . RESULTS We identified 572 potentially eligible patients via our various recruitment strategies . The response rate to clinician invitation letters was 39.3 % ( N=148/377 ) , of patients who responded and remained available and interested ( N=112 ) 46.4 % ( N=52 ) were eligible to be r and omised . The community strategies derived a total of 195 interested responses , of these 66 patients ( 33.8 % ) were eligible to be r and omised . On the basis of recruitment via clinician invitation letter we estimated the trial recruitment rate amongst eligible patients to be 28.6 % . A total of 108 patients were eventually r and omised . Responders to clinician invitation letters were more affluent compared to non-responders . R and omised patients recruited via different strategies did not vary significantly in terms of their socio-economic characteristics , lifestyle behaviours or variables related to cancer treatment . CONCLUSIONS The number of patients r and omised was marginally lower than anticipated . We were able to identify and highlight valuable information for planning the recruitment of future trials involving similar population Introduction Challenges exist in identifying , recruiting and motivating sedentary patients with cancer to initiate physical activity towards recommended levels . We hypothesise that the onset period of adjuvant chemotherapy can be ‘ the open window of opportunity ’ to identify and motivate sedentary patients with breast and colon cancers , at risk for developing coronary heart disease , to initiate and sustain lifestyle changes . Aims To investigate the feasibility of oncologists/nurses screening for physical inactivity , in order to identify and recruit an at-risk population of sedentary patients with breast or colon cancer at the onset of adjuvant chemotherapy . Furthermore , the study will examine the adherence to one of two multimodal exercise interventions lasting 12 weeks ; ( 1 ) hospital-based , high intensity , group exercise intervention ( 2 ) home-based , low intensity , individual , pedometer intervention . Both arms will be compared with a control group . Methods and analyses All newly referred patients will be screened for sedentary behaviour , using national recommendations . Testing at baseline , 6 , 12 and 39 weeks will include ; ( 1 ) physiological testing ( VO2-peak , one repetition maximum muscle strength and lung function ( 2 ) fasting full body dual-energy X-ray absorptiometry scan ( 3 ) fasting blood glucose , insulin , lipids and cholesterols , ( 4 ) psychometric question naires ( general well-being , quality of life , anxiety and depression , motivational readiness ) . The r and omised controlled trial feasibility design is selected in order to examine barriers for recruitment , programme adherence , safety aspects and potential efficacy to the interventions during adjuvant chemotherapy . Ethics and dissemination The Scientific Committee of the Capital Region ( case No. H-1 - 2011 - 131 ) and the Danish Data Protection Agency ( j. No. 2011 - 41 - 6349 ) approved the study . Data will be entered and locked into a data base hosted by the Copenhagen Trial Unit , Rigshosptialet . Data will be available for analyses to project members and the trial statistician after the 45 included patients have completed the 12-week test . Results will be published in peer- review ed scientific journals . Trial registration Current Controlled Trials IS RCT N24901641 BACKGROUND Sedentary behaviour is a public health priority in many countries . Hundreds of community-based exercise referral schemes have been established in Europe and USA , to increase physical activity . Experimental evidence questions the effectiveness of these schemes . No previous evaluations have considered a population approach nor provide detailed information on the types of people accessing these schemes . This is of concern given increasing health inequalities in other areas of care . Our register-based study quantified the numbers and characteristics of patients referred and accessing a district-wide exercise referral scheme .  The analysis considers the effectiveness of these schemes to a geographically defined population . METHODS Data were collected prospect ively from a patient register for referrals made to a district-wide exercise referral scheme in north-west Engl and . Analysis examined referral rates and the influence of practitioner and patient characteristics on access to the scheme . RESULTS Over 5 years , 6,610 adults were referred from 125 general practice s , with 60.8 per cent female and a mean age of 51.3 years ( SD 12.6 ) . This represents 4 per cent of the adult sedentary population in that district . The most common reason for referral was musculoskeletal or cardiovascular risk . Overall , 79 per cent attended at least the first appointment , with statistically significant predictors by age and reason for referral . Those referred for ' fitness ' or ' mental health ' were most likely to attend . Patients in the youngest and oldest age groups were least likely to attend . Patient 's sex and deprivation and the number of patients referred by each general practice did not influence attendance . CONCLUSIONS Primary -care patients seem to view the concept of exercise referral schemes positively but practitioners remain reluctant to refer many of their sedentary patients . There is doubt that exercise referral schemes like this will influence population levels of sedentary behaviour , when considered alongside their impact on physical activity in the longer term Background The prevalence of mental illness in young people is the highest of any age group , with the onset of depression , anxiety and substance use peaking between 18 and 24 years . Effective treatments that target sub-threshold or mild to moderate levels of disorder in young people are required to reduce the risk of persistence and recurrence . The aims of this study are to evaluate whether treatments that are less intensive than cognitive-behaviour therapy , such as problem solving therapy and exercise treatments , are acceptable and effective in managing depression and anxiety symptoms in young people and to identify possible attributes in those who are likely to respond to these treatments . Methods / design This is a factorial r and omised controlled trial conducted at a large , metropolitan youth mental health service . Participants are young help-seekers aged 15 - 25 years with sub-threshold or mild to moderate levels of depression and anxiety ( with or without comorbid substance use ) . The interventions comprise 4 treatment combinations delivered by psychologists over 6 sessions on a weekly basis : a psychological intervention ( problem solving therapy versus supportive counselling ) and an exercise intervention ( behavioural exercise versus psychoeducation ) . Structured assessment s occur at baseline , mid-point , end-point ( 6 weeks ) and at a 6- and 12-month follow-up . The primary outcomes are depression and anxiety symptoms as measured by the Beck Depression and Anxiety Inventories . Secondary outcomes include remission ( defined as no longer meeting the diagnostic criteria for a disorder if threshold level was reached at baseline , or no longer scoring in the clinical range on scale scores if sub-threshold at baseline ) , substance use , and functioning . Discussion The effectiveness of less complex psychological and exercise interventions in young help-seekers with sub-threshold or mild to moderate presentations of high prevalence disorders is yet to be explored . This study has been design ed to examine the effectiveness of these interventions delivered alone , or in combination , in a youth-specific service . If effective , the interventions have the potential to prevent the progression of early symptoms and distress to later and potentially more serious stages of mental disorder and reduce the likelihood of ongoing problems associated with the risk of persistence and recurrence . Trial registration Australian New Zeal and Clinical Trials Registry The new and recent advances in neuroelectric and neuroimaging technologies provide a new era for further exploring and underst and ing how brain and cognition function can be stimulated by environmental factors , such as exercise , and particularly to study whether physical exercise influences brain development in early ages . The present study , namely the ActiveBrains project , aims to examine the effects of a physical exercise programme on brain and cognition , as well as on selected physical and mental health outcomes in overweight/obese children . A total of 100 participants aged 8 to 11 years are r and omized into an exercise group ( N=50 ) or a control group ( N=50 ) . The intervention lasts 20-weeks , with 3 - 5 sessions per week of 90 min each , and is mainly focused on high-intensity aerobic exercise yet also includes muscle-strengthening exercises . The extent to what the intervention effect remains 8-months after the exercise programme finishes is also studied in a sub sample . Brain structure and function and cognitive performance are assessed using structural and functional magnetic resonance imaging and electroencephalographic recordings . Secondary outcomes include physical health outcomes ( e.g. physical fitness , body fatness , bone mass and lipid-metabolic factors ) and mental health outcomes ( e.g. chronic stress indicators and overall behavioural and personality measurements such as anxiety or depression ) . This project will substantially contribute to the existing knowledge and will have an impact on societies , since early stimulation of brain development might have long lasting consequences on cognitive performance , academic achievement and in the prevention of behavioural problems and the promotion of psychological adjustment and mental health . Clinical trials . Gov identifier : NCT02295072 Objective : To evaluate the effects of a physical exercise programme for children with asthma on an outpatient basis . Design : Intervention study : a r and omized pretest – post-test control group design . Setting and subjects : Forty-seven children with clinical ly diagnosed asthma participated in the intervention study , including 34 boys and 13 girls , from 8 to 13 years of age ( mean age 10.6 ) . Interventions : The physical exercise programme consisted of regular group exercises and home exercises for a period of three months . It was based on a theoretical model describing the relationships between physical competence ( condition ) , perceived physical competence , self-esteem and coping behaviour . Main outcome measures : Maximum incremental exercise test , endurance test , the Self-Perception Profile for Children ( CBSK ) , the Asthma Coping Test ( ACBT ) , lung function and exercise-induced bronchoconstriction . Results : The results showed significant effects of the intervention programme on physical condition . There was a significant improvement of 15 W on the maximal workload ( Wmax ) ( p < 0.001 ) , of 7 % on VO 2max ( oxygen uptake ) ( p = 0.002 ) and a significant decrease on heart rate submaximal of 6 % ( p = 0.001 ) . There was also a significant improvement of 50 % in running time measured with the endurance test ( p = 0.021 ) . Furthermore , a significant effect of the intervention was seen on coping with asthma ( p = 0.003 ) . Conclusion : It was concluded that participation in the physical exercise programme not only enhanced physical fitness , but also improved coping behaviour with asthma Introduction Chronic obstructive pulmonary disease ( COPD ) is associated with exercise limitation and physical inactivity , which are believed to have significant long-term negative health consequences for patients . While a number of COPD treatments and exercise training programmes increase exercise capacity , there is limited evidence for their effects on physical activity levels , with no clear association between exercise capacity and physical activity in clinical trials . Physical activity depends on a number of behaviour , environmental and physiological factors . We describe the design of the PHYSACTO trial , which is investigating the effects of bronchodilators , either alone or with exercise training , in combination with a st and ardised behaviour-change self-management programme , on exercise capacity and physical activity in patients with COPD . It is hypothesised that bronchodilators in conjunction with a behaviour-change self-management programme will improve physical activity and that this effect will be amplified by the addition of exercise training . Methods and analysis Patients are being recruited from 34 sites in Australia , New Zeal and , the USA , Canada and Europe . Patients receiving a multicomponent intervention design ed to support behaviour change related to physical activity are r and omised to four treatment arms : placebo , tiotropium , tiotropium+olo date rol , and tiotropium+olo date rol+exercise training . The primary outcome is improvement in exercise capacity after 8 weeks , measured by endurance time during a shuttle walk test . The secondary outcome is improvement in physical activity , including objective accelerometer assessment and patient-reported functioning using the Functional Performance Inventory — Short Form and the novel hybrid PROactive instrument . Additionally , the influence of moderating variables ( ie , factors influencing a patient 's choice to be physically active ) on increases in physical activity is also explored . Ethics and dissemination The study has been approved by the relevant Institutional Review Boards , Independent Ethics Committee and Competent Authority according to national and international regulations . The findings of the trial will be disseminated through relevant peer- review ed journals and international conference presentations . Trial registration number NCT02085161 Background Regular physical activity is known to help prevent and treat numerous non-communicable diseases . Smartphone applications ( apps ) have been shown to increase physical activity in primary care but little is known regarding the views of patients using such technology or how such technology may change behaviour . Aim To explore patients ’ views and experiences of using smartphones to promote physical activity in primary care . Design and setting This qualitative study was embedded within the SMART MOVE r and omised controlled trial , which used an app ( Accupedo-Pro Pedometer ) to promote physical activity in three primary care centres in the west of Irel and . Method Taped and transcribed semi-structured interviews with a purpose ful sample of 12 participants formed the basis of the investigation . Framework analysis was used to analyse the data . Results Four themes emerged from the analysis : transforming relationships with exercise ; persuasive technology tools ; usability ; and the cascade effect . The app appeared to facilitate a sequential and synergistic process of positive change , which occurred in the relationship between the participants and their exercise behaviour ; the study has termed this the ‘ Know-Check-Move ’ effect . Usability challenges included increased battery consumption and adjusting to carrying the smartphone on their person . There was also evidence of a cascade effect involving the families and communities of participants . Conclusion Notwithst and ing technological challenges , an app has the potential to positively transform , in a unique way , participants ’ relationships with exercise . Such interventions can also have an associated cascade effect within their wider families and communities The combination of low physical activity rates and increased cardiovascular deaths indicate the overwhelming need for behaviour change interventions that can effectively promote physical activity among sedentary women . This 11-week r and omised controlled trial examined the effects of an implementation intentions intervention on sedentary women 's walking behaviour . Seventy-five women ( M age = 48.17 ) were r and omly assigned to either a control group where they were required to self-monitor their daily pedometer-determined step count or to an experimental group where they were asked to form specific walking plans ( i.e. implementation intentions ) every 6 weeks and to self-monitor their daily pedometer-determined step count .  Measures of  exercise intentions , perceived behavioural control , scheduling and barrier self-efficacy were administered at baseline , week 6 and week 11 . Analyses indicated higher step counts over the first 6 weeks for women in the experimental condition ( p < 0.02 ) . Furthermore , higher self-efficacy to schedule ( p < 0.01 ) and overcome walking barriers ( p < 0.03 ) , as well as higher perceptions of behavioural control ( p < 0.02 ) were found at week 11 for women in the experimental versus control condition . However , none of the control beliefs were found to mediate the effects of the intervention on the women 's walking behaviour . Furthermore , the intervention did not have any effect on the strength of the goal intention – behaviour relationship . The findings suggest implementation intentions are an effective strategy for initiating leisure-time walking within sedentary women OBJECTIVE : To promote weight loss in Samoan church communities through an exercise program and nutrition education . METHODS : A quasi-experimental design was used to assess weight change , over 1 y , in cohorts of people aged 20–77 y from three non-r and omised Samoan church communities ( two intervention , n=365 and one control , n=106 ) in Auckl and , New Zeal and . The intervention churches received aerobics sessions and nutrition education about dietary fat . RESULTS : Baseline body mass index for the intervention and control churches was ( mean±s.e . ) 34.8±0.4 and 34.3±0.9 kg/m2 , respectively . The intervention churches lost an average of 0.4±0.3 kg compared to a 1.3±0.6 kg weight gain in the control church ( P=0.039 , adjusted for confounders ) . The number of people who were vigorously active increased by 10 % in the intervention churches compared to a 5 % decline in the control church ( P=0.007 ) . Nutrition education had little apparent impact on knowledge or behaviour . CONCLUSION : Samoan communities in New Zeal and are very obese and have high rates of annual weight gain . A community-based intervention program arrested this weight gain in the short term Background To help patients with coronary artery disease ( CAD ) benefit from the positive health effects attained by exercise-based cardiac rehabilitation ( CR ) , adherence to these programmes according to international guidelines is important . Strategies to increase adherence to exercise-based CR are mainly an unexplored area . The objective of this study is to investigate the effects of a behavioural medicine intervention in physiotherapy , containing goal - setting , self-monitoring and feedback , with the aim of improving rehabilitation outcomes for exercise-based CR , compared with usual care . Methods This is a r and omised , controlled trial . A total of 160 patients with CAD will be included consecutively at the Coronary Care Unit at a university hospital in Sweden . Patients are r and omised 1:1 using sealed envelopes to usual care or a behavioural medicine intervention in physiotherapy , in addition to usual care for 4 months . Outcome assessment at baseline , 4 and 12 months includes submaximal aerobic capacity ( primary outcome ) , exercise adherence , muscle endurance , level of physical activity , biomarkers , anxiety and depression , health-related quality of life , patient enablement and self-efficacy ( secondary outcomes ) . Discussion This is the first study to evaluate the role of an integrated behavioural medicine intervention in exercise-based CR in the effects of rehabilitation outcomes . The results of this study will provide valuable information about the effect of these interventions in exercise-based CR and it has the potential to inform and assist in further treatment in secondary prevention for patients with CAD.Trial registration The study include all items from the World Health Organization Trial Registration Data Set . Trial registration number : NCT02895451 , 2016 - 08 - 16 , retrospectively registered OBJECTIVE The objective of the current investigation was to examine if the effects of a group-mediated cognitive behavioural counselling plus exercise intervention were superior to the effects of a st and ard exercise care condition on postnatal mothers ' self-regulatory efficacy ( SRE ) , outcome expectations ( OEs ) and self-directed physical activity ( PA ) . DESIGN The design of the study consisted of two intervention conditions ; group-mediated cognitive behavioural counselling plus exercise ( GMCB ) and st and ard exercise ( SE ) . Each condition consisted of two phases ; a 4-week supervised , centre-based intensive exercise training phase followed by a 4-week home-based phase . METHODS Participants were 57 postnatal women r and omly assigned to conditions ( SE : N=31 ; GMCB : N=26 ) .  Measures of SRE and OEs were assessed prior to and following the centre-based aspect of the intervention . Physical activity was measured following the intensive exercise training phase as well as the home-based phase . RESULTS GMCB participants ' SRE and OEs were sustained during the intervention whereas those of SE participants declined . GMCB participants also reported significantly greater time spent engaging in self-directed PA at the conclusion of the intensive and home-based phases . Mediation analysis revealed that SRE partially mediated the relationship between intervention condition and post home-based PA as confirmed by a significant sobel test . CONCLUSIONS These findings suggest that a theory-based GMCB counselling plus exercise intervention is superior to the SE condition in sustaining SRE and OEs , and in promoting greater self-directed PA . SRE partially mediated the relationship between intervention condition and post home-based PA supporting the targeting of that variable for change as part of the intervention Objectives : Although the fear of falling is common among elderly residents in long-term care facilities , interventions developed for fear of falling management is very rare . Of these limited interventions , most were exercise interventions with only limited testing . The cognitive-behavioural intervention can decrease the fear of falling ; however no intervention of the kind was developed and assessed to decrease fear of falling among the elderly in long-term care facilities . The purpose of this study was to examine the effectiveness of cognitive-behavioural strategies either with or without exercise in reducing fear of falling among elderly residents in nursing homes . Method : A prospect i ve r and omized control trial was conducted in six nursing homes in northern Taiwan . Seventy-five elderly participants were r and omly assigned to one of the three groups : the comparison group , the cognitive-behavioural strategies with or without exercise group . The fear of falling , falls , depressive inclination , mobility , and muscle strength of extremities were collected at the two-month and five-month follow-up sessions , in which the progress of the patients were assessed . Results : The mixed model analysis revealed that elderly adults in the combination experimental group had significant improvements compared with the other two groups on fear of falling , depressive inclination , mobility , and muscle strength at five months . The incidences of falls , post intervention , in both experimental groups were significantly lower than those in the comparison group . Conclusions : The results suggest that the combination intervention helped elderly residents manage their fear of falling and falls , decrease their depressive inclination , and enhance their mobility and muscle strength The aim of this study was to investigate the impact of a physical activity (PA)-focused behavioural intervention during and after  pulmonary rehabilitation ( PR ) on PA levels ( primary aim ) , health-related outcomes and self-efficacy ( secondary aims ) of patients with COPD . Thirty-two patients were r and omly assigned to an experimental group ( EG ) or control group ( CG ) . The EG received a PA-focused behavioural intervention during PR ( 3 months ) and follow-up support ( 3 months ) . The CG received PR ( 3 months ) . Daily PA was collected : number of steps ; time spent in moderate-to-vigorous PA ( MVPA ) , total PA and sedentary activities ( SA ) . Secondary outcomes comprised exercise capacity , muscle strength , health-related quality of life ( HRQOL ) and self-efficacy . Measures were collected at baseline , 3 and 6 months . Compared with the CG , the EG improved the number of steps ( p = 0.006 ) and time spent in MVPA ( p = 0.007 ) , total PA ( p = 0.014 ) and SA ( p = 0.018 ) at 3 months . Differences were maintained after follow-up support ( 0.025 ≤ p ≤ 0.040 ) , except for SA ( p = 0.781 ) . Exercise capacity , muscle strength and HRQOL were increased at 3 and 6 months ( p ≤ 0.002 ) with no between-group differences ( 0.148 ≤ p ≤ 0.987 ) . No changes were observed in self-efficacy ( p = 0.899 ) . A PA-focused behavioural intervention during and after PR may improve patients ' PA levels . Further research is warranted to assess the sustainability of the findings Background Almost all of the 820,000 people in the UK with dementia will experience Behavioural and Psychological Symptoms of Dementia ( BPSD ) . However , research has traditionally focused on treating cognitive symptoms , thus neglecting core clinical symptoms that often have a more profound impact on living with dementia . Recent evidence ( Kales et al , 2007 ; Ballard et al , 2009 ) indicates that the popular approach to managing BPSD - prescription of anti-psychotic medication - can increase mortality and the risk of stroke in people with dementia as well as impair quality of life and accelerate cognitive decline . Consequently , there is a need to evaluate the impact that non-pharmacological interventions have on BPSD ; we believe physical exercise is a particularly promising approach . Methods / Design We will carry out a pragmatic , r and omised , single-blind controlled trial to evaluate the effectiveness of exercise ( planned walking )  on the behavioural and psychological symptoms of individuals with dementia . We aim to recruit 146 people with dementia and their carers to be r and omized into two groups ; one will be trained in a structured , tailored walking programme , while the other will continue with treatment as usual . The primary outcome ( BPSD ) will be assessed with the Neuropsychiatric Inventory ( NPI ) along with relevant secondary outcomes at baseline , 6 and 12 weeks . Discussion Design ing this study has been challenging both ethically and method ologically . In particular to design an intervention that is simple , measurable , safe , non-invasive and enjoyable has been testing and has required a lot of thought . Throughout the design , we have attempted to balance method ological rigour with study feasibility . We will discuss the challenges that were faced and overcome in this paper . Trial Registration IS RCT Background Weight reduction limits disease progression in obese people with coronary heart disease ( CHD ) and /or type 2 diabetes mellitus ( T2DM ) . Purpose To test a 16-week group-based weight reduction intervention combining exercise , diet and behaviour change strategies aim ed to increase self-efficacy  ( Healthy Eating and Exercise Lifestyle Program — HEELP ) on weight , body mass index ( BMI ) , waist circumference and exercise . Methods Participants with CHD and /or T2DM and BMI between 27 to 39 kg/m2 were r and omised to HEELP  ( n = 83 ) or usual care ( n = 65 ) . Results Participants were aged a mean 63.47 years ( SD 8.9 ) , male ( 58 % ) and Caucasian ( 79 % ) . HEELP participants lost significantly more weight , BMI and waist circumference and exercised more days/week for a longer duration /week than usual care . Clinical ly significant weight loss ( ≥5 % ) was more common in HEELP than usual care . Conclusion The HEELP result ed in weight loss and improved exercise behaviour in obese people with CHD and T2DM Background Metabolic health in people with obesity is determined by body composition . In this study , we examined the influence of a combined strength exercise and motivational programme –embedded in the school curriculum– on  adolescents body composition and daily physical activity . Methods A total of 695 adolescents ( 11 - 15y ) from nine Dutch secondary schools participated in a one year cluster r and omised controlled trial ( RCT ) . In the intervention schools , physical education teachers were instructed to spend 15–30 min of all physical education lessons ( 2 × per week ) on strength exercises . Monthly motivational lessons were given to stimulate students to be more physically active . Control schools followed their usual curriculum . The primary outcome measure was body composition assessed by the deuterium dilution technique . Daily physical activity and sedentary behaviour measured by accelerometry served as a secondary outcome . Results After 1 year , a 1.6 % fat mass difference was found in favour of the intervention group ( p = .007 ) . This reflected a 0.9 kg difference in fat free mass ( intervention > control ; p = .041 ) and 0.7 kg difference in fat mass ( intervention < control ; p = .054 ) . Daily physical activity decreased from baseline to posttest in both groups , but less so in the intervention group ( p = .049 ) . After 1 year , a difference of 0.4 % was found for moderate to vigorous physical activities in favour of the intervention group ( p = .046 ) . No differences in sedentary behaviour , or light physical activity were found between groups . Conclusion In 11–15 year olds , the combination of strength exercises plus motivational lessons contributed to an improvement in body composition and a smaller decrease in physical activity level . Trial registration ID(NTR5676 – retrospectively registered 8 February 2016 ; enrolment of first participant : 2 March 2015 ) Abstract Objectives : To introduce a psychological model of behaviour ; the COM-B model and describe how this has been used in combination with the behaviour change wheel ( BCW ) in developing an intervention which aims to promote regular , long-term use of hearing aids by adults with acquired hearing loss . Design : Qualitative structured interview study using the COM-B model to identify the determinants of behavioural planning on the part of audiologists ; a potentially important factor in encouraging long-term hearing-aid use . Study sample : Ten audiologists drawn from a r and om sample of five English audiology departments . Results : The analysis suggests that behavioural planning might be more likely to occur if audiologists ’ psychological capability , physical and social opportunity , and reflective and automatic motivation were addressed . This analysis forms the basis of an intervention design , using the BCW , to encourage behavioural planning by audiologists and subsequent hearing-aid use by people with hearing loss . Conclusions : The COM-B model and BCW can be applied successfully in the context of audiology to analyse the behaviour of both people with hearing loss and professionals working with them , supplying information that is being used in intervention design . The effectiveness of the intervention will be tested in a clinical trial AIMS AND OBJECTIVES To explore factors influencing exercise adherence  among women with breast cancer while following an exercise programme .  BACKGROUND Earlier research shows that women with breast cancer decrease physical activity following the cancer diagnosis and that adhering to exercise interventions can be a challenge . Research is needed to identify motivational factors and barriers for exercise adherence among women during treatment for breast cancer . DESIGN This was a qualitative study to explore patient 's perceptions of the challenges to exercise adherence during a r and omised , controlled trial . METHODS Twenty-seven women with early-stage breast cancer were purposively sample d for focus group interviews during 2011 - 2012 from their participation in the exercise intervention group during 2010 - 2012 . Five focus groups were performed , and data analysis was completed using the systematic text condensation method . RESULTS During the focus group study , five main themes were identified , which described factors participants perceived to influence their adherence to exercise during chemotherapy : ' side effects of breast cancer treatment as a barrier to exercise ' , ' restoring and maintaining normality in daily life motivates exercise ' , ' other valued activities compete with exercise ' , ' constructive support enhances exercise ' and ' positive beliefs about efficacy and outcomes motivate exercise ' . CONCLUSION Adherence to exercise in women with breast cancer is challenged by internal and external conditions and may be improved by attention to the impact of treatment side effects and by supporting patient self-efficacy towards changing health behaviour . RELEVANCE TO CLINICAL PRACTICE Nurses should be aware that exercise adherence could be a challenge among women with breast cancer . They should help identify obstacles to exercise for women and ways to overcome them , as well as support them in their beliefs that they are capable of changing their health behaviour The objective of this study was to determine whether the Arthritis Self-Management Programme ( ASMP ) improves perceptions of control , health behaviours and health status , and changes use of health care re sources . The design was a pragmatic r and omized controlled study ; participants were allocated to ASMP ( Intervention Group ) or a 4-month waiting-list Control Group . The Intervention Group completed a 12-month follow-up . In total , 544 people with arthritis were recruited from the community--311 in the Intervention Group and 233 in the Control Group . Main outcome measures included : arthritis self-efficacy , health behaviours ( exercise , cognitive symptom management , diet and relaxation ) and health status ( pain , fatigue , anxiety , depression and positive affect ) . At 4 months follow-up , the ASMP had a significant effect on arthritis self-efficacy for other symptoms and pain subscales . Performance of a range of health behaviours ( cognitive symptom management , communication with physicians , dietary habit , exercise and relaxation ) was significantly greater among the Intervention Group . The Intervention Group were significantly less depressed and had greater positive mood . In addition , trends towards decreases on fatigue and anxiety were noted . Physical functioning , pain and GP visits remained stable at 4 months . A similar pattern of findings was found at 12 months follow-up for the Intervention Group . Furthermore , a significant improvement was found on pain and visits to GPs had decreased . Apart from a small improvement on physical functioning among the Intervention Group participants with osteoarthritis 12 months , all effects were independent of the type of arthritis . The findings suggest that the ASMP is effective in promoting improvements in perception of control , health behaviours and health status , when delivered in UK setting NEW FINDINGS What is the central question of this study ? Children are spending more than 60 % of their waking day sedentary . The consequences of excessive sedentary behaviour are not well understood in the child , but there is growing evidence that with increasing sedentary time , cardiovascular risk in childhood also increases . What is the main finding and its importance ? Our findings show that a 3 h period of uninterrupted sitting causes a profound ( 33 % ) reduction in vascular function in young girls . Importantly , we also demonstrate that breaking up sitting with regular exercise breaks can prevent this . Excessive sedentary behaviour has serious clinical and public health implication s ; however , the physiological changes that accompany prolonged sitting in the child are not completely understood . Herein , we examined the acute effect a prolonged period of sitting has upon superficial femoral artery function in 7- to 10-year-old girls and the impact of interrupting prolonged sitting with exercise breaks . Superficial femoral artery endothelium-dependent flow-mediated dilatation , total shear rate , antero grade and retro grade shear rates and oscillatory shear index were assessed before and after two experimental conditions : a 3 h uninterrupted period of sitting ( SIT ) and a 3 h period of sitting interrupted each hour with 10 min of moderate-intensity exercise ( EX ) . A mixed-model analysis of variance was used to compare between-condition and within-condition main effects , controlling for the within-subject nature of the experiment by including r and om effects for participant . Superficial femoral artery endothelium-dependent flow-mediated dilatation decreased significantly from pre- to post-SIT ( mean difference 2.2 % flow-mediated dilatation ; 95 % confidence interval = 0.60 - 2.94 % , P < 0.001 ) . This relative decline of 33 % was abolished in the EX intervention . Shear rates were not significantly different within conditions . Our data demonstrate the effectiveness of short but regular exercise breaks in off setting the detrimental effects of uninterrupted sitting in young girls More than 800000 people in the UK have dementia , and it is a government priority to improve dementia care . Drug treatment options are relatively limited . The Dementia And Physical Activity ( DAPA ) study is a r and omised trial which targets cognition in people with dementia , using an exercise programme . There is evidence to suggest that both aerobic and resistance exercise may be useful in improving cognition . Hence the intervention comprises a supervised part of twice-weekly exercise classes of one hour duration for 4 months , including aerobic exercise at moderate intensity on static bicycles , and resistance ( weight training ) exercise using weight vests , weight belts and dumbbells . Thereafter participants progress to unsupervised , independent exercise . Aids to behaviour modification have been incorporated into the intervention . The DAPA intervention has been design ed to maximise likelihood of effectiveness and cost-effectiveness , and for delivery in the UK National Health Service OBJECTIVES --To evaluate the impact of the Health Education Authority 's 20 hour Look After Your Heart health promotion course on a large group of retired women . DESIGN --Three groups of retired women were compared : group 1 women , drawn from 12 retirement groups , participated in the programme ; group 2 , drawn r and omly from the same groups , declined ; group 3 , selected r and omly from 12 different retirement groups matched for geographical area , were not offered the course . SETTING --Twenty four retirement groups established by a major national retail company in Engl and . SUBJECTS -- A total of 739 women with a mean age of 66 years participated . Altogether 200 women were in group 1 , 192 in group 2 , and 347 in group 3 . MAIN OUTCOME MEASURE -- The Nottingham Health Profile was administered and exercise knowledge , attitudes , and behaviour of the three groups were assessed using a vali date d , reliable question naire . RESULTS --Group 1 had significantly better self-perceived health , indicated by lower Nottingham Health Profile scores , more exercise knowledge , and positive exercise attitudes and they did more exercise than the other two groups . The responses of groups 2 and 3 were similar . Time since completion of the programme did not have any effect on Nottingham Health Profile scores , exercise knowledge , and behaviour . CONCLUSION --The Look After Your Heart programme is associated with beneficial and persistent effects in retired women . Detailed studies are needed to confirm whether these associations are due to the programme or reflect the selection of fitter , healthier subjects Background Meeting the needs of the growing number of older people is a challenge for health and social care services . Home-based interventions aim ing to modify health-related behaviours of frail older people have the potential to improve functioning and well-being . Previous review s have focused on whether such interventions are effective , rather than what might make them effective . Recent advances in behavioural science make possible the identification of potential ‘ active ingredients ’ of effective interventions , such as component behaviour change techniques ( BCTs ) , and intended intervention functions ( IFs ; e.g. to educate , to impart skills ) . This paper reports a protocol for a systematic review that seeks to ( a ) identify health behaviour change interventions for older frail people , ( b ) describe the content of these interventions , and ( c ) explore links between intervention content and effectiveness . The protocol is reported in accordance with Preferred Reporting Items for Systematic Review s and Meta-Analyses Protocol s ( PRISMA -P ) 2015 guidelines . Methods / design Studies will be identified through a systematic search of 15 electronic data bases , supplemented by citation tracking . Studies will be retained for review where they report r and omised controlled trials focusing on home-based health promotion delivered by a health professional for frail older people in community setting s , written in English , and either published from 1980 onwards , or , for registered trials only , unpublished but completed with results obtainable from authors . Interventions will be coded for their content ( BCTs , IFs ) and for evidence of effectiveness ( outcome data relating to behavioural and health outcomes ) . Analyses will describe characteristics of all interventions . Interventions for which effectiveness data are available will be categorised into those showing evidence of effectiveness versus those showing no such evidence . The potential for each intervention characteristic to contribute to change in behaviour or health outcomes will be estimated by calculating the percentage of all interventions featuring those characteristics that have shown effectiveness . Discussion Results will reveal the strategies that have been drawn on within home-based interventions to modify the health behaviours of frail older people , and highlight those more associated with positive changes in behaviour and health . Findings from this review will provide a useful basis for underst and ing , developing , and implementing behaviour change interventions in this field . Systematic review registration PROSPERO BACKGROUND Development of this guideline was undertaken by the Exercise for People with Cancer Guideline Development Group , a group organized by Cancer Care Ontario 's Program in Evidence -Based Care ( pebc ) . The purpose of the guideline was to provide guidance for clinicians with respect to exercise for patients living with cancer , focusing on the benefits of specific types of exercise , recommendations about screening requirements for new referrals , and safety concerns . METHODS Consistent with the pebc 's st and ardized approach , a systematic search was conducted for existing guidelines , and systematic literature search es were performed in medline and embase for both systematic review s and primary literature . Content and methodology experts performed an internal review , which was followed by an external review by targeted experts and intended users . RESULTS The search identified three guidelines , eighteen systematic review s , and twenty-nine r and omized controlled trials with relevance to the topic . The present guideline provides recommendations for the duration , frequency , and intensity of exercise appropriate for people living with cancer . It also provides recommendations for pre-exercise assessment , safety concerns , and delivery models . CONCLUSIONS There is sufficient evidence to show that exercise provides benefits in quality of life and muscular and aerobic fitness for people with cancer both during and after treatment , and that it does not cause harm . The present guideline is intended to support the Canadian Society for Exercise Physiology 's Canadian physical activity guidelines . The recommendations are intended for clinicians and institutions treating cancer patients in Ontario , and for policymakers and program planners involved in the delivery of exercise programs for cancer patients The purpose of this study was to test the extent that constructs from two theoretical models ( self-regulatory theory and social cognitive theory ) mediated change in outcomes following a self-management intervention .  One hundred and twenty four individuals with type 2 diabetes who had participated in a r and omised controlled trial of a diabetes self-management programme  were analysed for the extent that illness beliefs and self-efficacy mediated change in self-management behaviours and illness specific quality of life . Exercise specific self-efficacy significantly mediated change in exercise  at three months ( B = .03 ; .01 , p < .05 ) while  monitoring specific self-efficacy mediated change in monitoring behaviour at both three ( B = .04 ; .01 , p < .01 ) and nine months follow-up ( B = 5.97 ; 1.01 , p < .01 ) . Belief in control over diabetes mediated change in illness specific quality of life at three months ( B = −.07 ; .28 , p < .05 ) and nine months ( B = .79 ; .28 , p < .01 ) follow-ups , as well as change in exercise behaviour at immediately post-intervention ( B = −.12 ; .17 , p < .05 ) . Behaviour-specific self-efficacy may have a stronger role in mediating self-management behaviours than illness beliefs ; however , belief in control over diabetes may be important to manipulate for change in quality of life . This suggests different theoretical constructs may mediate change dependent on outcome CONTEXT Participation in regular physical activity is recognized as one of the most important health behaviors associated with the prevention of chronic disease and the promotion of health and well-being among the elderly . Although a number of cross-sectional studies have reported predictors of physical activity participation , few studies have assessed changes in intervention-related mediators associated with physical activity adherence in the elderly . OBJECTIVE The purpose of this study was to compare the relative abilities of cognitive mediating variables ( i.e. , self-efficacy beliefs and outcome expectancies/realizations ) versus a social mediating variable ( i.e. , exercise-related social support ) to examine mediators of a telephone-based , exercise-counseling intervention on exercise adherence during months 7 to 12 of an exercise intervention . METHOD Participants were 103 community-dwelling , healthy , sedentary , older adults ( 67 women and 36 men ) .  Self-efficacy for exercise , outcome expectancies/realizations , and social support for exercise were assessed at baseline , 6 months , and 12 months . Participants received telephone-based exercise counseling to promote exercise adherence during the course of two 12-month exercise programs ( i.e. , aerobic/strength or flexibility exercises ) . RESULTS Changes in cognitive mediators ( i.e. , self-efficacy and fitness outcome realizations ) were associated with 7- to 12-month  exercise adherence  while exercise-related social support was not . CONCLUSION Attention should be given to increasing confidence in the elderly to overcome barriers to exercise and achieve relevant fitness outcomes in exercise programs In the past few years , alliances between primary care and leisure services have become a popular strategy for exercise promotion in the Engl and . ' GP Referral Schemes ' typically involve referral to a local leisure centre by a General Practitioner ( GP ) , whereupon patients are inducted into a 10 - 12 week exercise programme at a reduced fee . Referred patients are usually white , middle aged and apparently healthy women , with the main reason for referral being overweight . The schemes are characterised by their lack of formal evaluation , making conclusions about effectiveness impossible . In the US , physicians advice to exercise has been the focus of interventions to date . Two controlled trials , one r and omised , have provided some evidence that exercise behaviour can be changed , at least in the short term . The ability to recruit sufficient numbers of patients , who have potentially the most to gain from increased physical activity , is the biggest barrier to primary care based interventions . One contributing factor to this problem , may be doctors and nurses ' knowledge about the benefits of physical activity BACKGROUND Physical activity is positively associated with survival and quality of life among breast cancer survivors . Despite these benefits , the majority of breast cancer survivors are insufficiently active . The potential health benefits of reducing sedentary behaviour ( sitting time ) in this population have not been extensively investigated . The ACTIVATE Trial will evaluate the efficacy of an intervention that combines wearable technology ( the Garmin Vivofit2 ® ) with traditional behavioural change approaches to increase physical activity and reduce sedentary behaviour performed by breast cancer survivors . METHODS / DESIGN This r and omised controlled trial includes inactive , postmenopausal women diagnosed with stage I-III breast cancer who have completed their primary treatment . Participants are r and omly assigned to the primary intervention group ( Garmin Vivofit2 ® ; behavioural feedback and goal setting session ; and , five telephone-delivered health coaching sessions ) or to the wait-list control group . The primary intervention is delivered over a 12-week period . The second 12-week period comprises a maintenance phase for the primary intervention group , and an abridged intervention ( Garmin Vivofit2 ® only ) for the wait-list control group . Moderate- to vigorous-intensity physical activity ( MVPA ) and sedentary behaviour are assessed by accelerometry at baseline ( T1 ) , end of intervention ( T2 ) , and end of maintenance phase ( T3 ) . DISCUSSION The ACTIVATE Trial is one of the first studies to incorporate wearable technology into an intervention for cancer survivors . If the use of wearable technology ( in combination with behaviour change strategies , or alone ) proves efficacious , it may become an inexpensive and sustainable addition to the health promotion strategies available to health care providers in the cancer survivorship context . TRIAL REGISTRATION ACTRN12616000175471 Background We aim ed to establish the support needs of people with heart failure and their caregivers and develop an intervention to improve their health-related quality of life . Methods We used intervention mapping to guide the development of our intervention . We identified “ targets for change ” by synthesis ing research evidence and international guidelines and consulting with patients , caregivers and health service providers . We then used behaviour change theory , expert opinion and a taxonomy of behaviour change techniques , to identify barriers to and facilitators of change and to match intervention strategies to each target . A patient and public involvement group helped to identify patient and caregiver needs , refine the intervention objectives and strategies and deliver training to the intervention facilitators . A feasibility study ( IS RCT N25032672 ) involving 23 patients , 12 caregivers and seven trained facilitators at four sites assessed the feasibility and acceptability of the intervention and quality of delivery and generated ideas to help refine the intervention . Results The Rehabilitation Enablement in Chronic Heart Failure ( REACH-HF ) intervention is a comprehensive self-care support programme comprising the “ Heart Failure Manual ” , a choice of two exercise programmes for patients , a “ Family and Friends Re source ” for caregivers , a “ Progress Tracker ” tool and a facilitator training course . The main targets for change are engaging in exercise training , monitoring for symptom deterioration , managing stress and anxiety , managing medications and underst and ing heart failure . Secondary targets include managing low mood and smoking cessation . The intervention is facilitated by trained healthcare professionals with specialist cardiac experience over 12 weeks , via home and telephone contacts . The feasibility study found high levels of satisfaction and engagement with the intervention from facilitators , patients and caregivers . Intervention fidelity analysis and stakeholder feedback suggested that there was room for improvement in several areas , especially in terms of addressing caregivers ’ needs . The REACH-HF material s were revised accordingly . Conclusions We have developed a comprehensive , evidence -informed , theoretically driven self-care and rehabilitation intervention that is grounded in the needs of patients and caregivers . A r and omised controlled trial is underway to assess the effectiveness and cost-effectiveness of the REACH-HF intervention in people with heart failure and their caregivers An influential review in 2010 concluded that non-pharmacological multi-component interventions have positive effects on cognitive functioning , activities of daily living , behaviour and mood of people with dementia . Our aim here is to provide an up-to- date overview of research into psychosocial interventions and their impact on psychosocial outcomes . We focused on r and omised controlled trials , controlled studies and review s published between October 2008 and August 2015 , since the earlier review . The search of PsychInfo , Medline and the Cochrane data base of systematic review s yielded 61 relevant articles , organised into four themes echoing key phases of the care pathway : Living at home with dementia ( five review s , eight studies ) , carer interventions ( three review s , four studies ) , interventions in residential care ( 16 review s , 12 studies ) and end-of-life care ( three review s , two studies ) , along with an additional group spanning community and institutional setting s ( six review s , two studies ) . Community findings suggested that appointment of dementia specialists and attention to case management can produce positive outcomes ;  physical therapies , cognitive training and modified cognitive behaviour therapy also had a range of benefits . There was more limited evidence of positive benefits for people with dementia through interventions with family carers . Thirty-two articles focused on the management of ‘ behavioural symptoms ’ through a range of interventions all of which had some evidence of benefit . Also a range of multi-component and specific interventions had benefits for cognitive , emotional and behavioural well-being of people with dementia in residential setting s , as well as for quality of life . Overall , interventions tended to be short term with impact only measured in the short term . We recommend further research on interventions to promote living well in the community post-diagnosis and to address end-of-life care . Development of psychosocial interventions would benefit from moving beyond the focus on control of behaviours to focus on wider aspects of life for people with dementia Objective This prospect i ve cohort study aim ed to determine the impact of a low cost , home-based physical activity and nutrition program for older adults at 6 months follow-up . Design A follow-up survey was conducted 6 months after program completion via computer-assisted telephone interviewing . The International Physical Activity Question naire and the Fat and Fibre Barometer were used to measure physical activity levels and dietary behaviours , respectively . Self-reported height , weight , waist and hip circumferences were obtained . Changes over three time points of data collection ( baseline , post-program , follow-up ) and differences between the intervention and control groups were assessed . The use of program material s was also evaluated . Setting Community and home-based . Participants Insufficiently active 60 to 70 year olds ( n = 176 , intervention and n = 198 , control ) residing in suburbs within the Perth metropolitan area . Results A sustained improvement was observed for the intervention group in terms of fat avoidance behaviours ( p interaction = .007 ) . Significant improvements were found for strength exercises , fibre intake , body mass index and waist-to-hip ratio at either post-program or follow-up , however the overall effect was not significant . At post-program , the intervention group increased time spent participating in moderate activity by 50 minutes ( p > .05 ) , which was followed by a significant decline at follow-up ( p < .05 ) . Among intervention group participants , males and females differed with respect to strength exercises and moderate physical activity . Conclusion This low-cost physical activity and nutrition intervention result ed in a sustained improvement in fat avoidance behaviours and overall short-term gains in physical activity . Future studies for older adults are recommended to investigate gender-specific behavioural barriers as well as booster interventions which focus on physical activity Background Low Back Pain ( LBP ) remains a common and costly problem . Psychological obstacles to recovery have been identified , but psychological and behavioural interventions have produced only moderate improvements . Review s of trials have suggested that the interventions lack clear theoretical basis , are often compromised by low dose , lack of fidelity , and delivery by non-experts . In addition , interventions do not directly target known risk mechanisms . We identified a theory driven intervention ( Contexual Cognitive Behavioural Therapy , CCBT ) that directly targets an evidence -based risk mechanism ( avoidance and ensured dose and delivery were optimised . This feasibility study was design ed to test the credibility and acceptability of optimised CCBT against physiotherapy for avoidant LBP patients , and to test recruitment , delivery of the intervention and response rates prior to moving to a full definitive trial . Methods A r and omised controlled feasibility trial with patients r and omised to receive CCBT or physiotherapy . CCBT was delivered by trained supervised psychologists on a one to one basis and comprised up to 8 one-hour sessions . Physiotherapy comprised back to fitness group exercises with at least 60 % of content exercise-based .  Patients were eligible to take part if they had back pain for more than 3 months , and scored above a threshold indicating fear avoidance , catastrophic beliefs and distress . Results 89 patients were recruited .  Uptake rates were above those predicted . Scores for credibility and acceptability of the interventions met the set criteria . Response rates at three and six months fell short of the 75 % target . Problems associated with poor response rates were identified and successfully resolved , rates increased to 77 % at 3 months , and 68 % at 6 months . Independent ratings of treatment sessions indicated that CCBT was delivered to fidelity . Numbers were too small for formal analysis . Although average scores for acceptance were higher in the CCBT group than in the group attending physiotherapy ( increase of 7.9 versus 5.1 ) and change in disability and pain from baseline to 6 months were greater in the CCBT group than in the physiotherapy group , these findings should be interpreted with caution . Conclusions CCBT is a credible and acceptable intervention for LBP patients who exhibit psychological obstacles to recovery . Trial registration IS RCT N43733490 , registered 15/12/2010 Introduction Chronic obstructive pulmonary disease is generally progressive and associated with reduced physical activity . Both pharmacological therapy and exercise training can improve exercise capacity ; however , these are often not sufficient to change the amount of daily physical activity a patient undertakes . Behaviour-change self-management programmes are design ed to address this , including setting motivational goals and providing social support . We present and discuss the necessary method ological considerations when integrating behaviour-change interventions into a multicentre study . Methods and analysis PHYSACTO is a 12-week phase IIIb study assessing the effects on exercise capacity and physical activity of once-daily tiotropium+olo date rol 5/5 µg with exercise training , tiotropium+olo date rol 5/5 µg without exercise training , tiotropium 5 µg or placebo , with all pharmacological interventions administered via the Respimat inhaler . Patients in all intervention arms receive a behaviour-change self-management programme to provide an optimal environment for translating improvements in exercise capacity into increases in daily physical activity . To maximise the likelihood of success , special attention is given in the programme to : ( 1 ) the Site Case Manager , with careful monitoring of programme delivery ; ( 2 ) the patient , incorporating patient-evaluation/programme-evaluation measures to guide the Site Case Manager in the self-management intervention ; and ( 3 ) quality assurance , to help identify and correct any problems or shortcomings in programme delivery and ensure the effectiveness of any corrective steps . This paper documents the comprehensive methods used to optimise and st and ardise the behaviour-change self-management programme used in the study to facilitate dialogue on the inclusion of this type of programme in multicentre studies . Ethics and dissemination The study has been approved by the relevant Institutional Review Boards , Independent Ethics Committee and Competent Authority according to national and international regulations . The results of this study will be disseminated through relevant , peer- review ed journals and international conference presentations . Trial registration number NCT02085161 Abstract Objective : To assess the net 5 year effects of intervention of a community based demonstration project , the Heartbeat Wales programme , on modifiable behavioural risks for prevention of cardiovascular disease . Design and setting : Quasi-experimental design comparing results from two independent cross sectional population surveys conducted in 1985 and 1990 in Wales and a matched reference area in north east Engl and . Subjects : R and om , stratified sample s of people aged 18 - 64 years ( 18 538 in 1985 and 13 045 in 1990 ) in Wales and in north east Engl and ( 1483 and 4534 , respectively ) . Intervention : A coordinated range of activities for heart health promotion in Wales entailing public education campaigns along with supportive policy and infrastructure change . In the reference area no additional community heart health promotion was planned , though considerable activity did take place , “ contaminating ” the reference area . Main outcome measures : Fifteen self reported behavioural indicators relating to dietary choice , smoking , frequency of exercise , and weight . Results : Positive changes ( for health ) in behavioural outcomes were observed among the population in Wales , including a reduction in reported smoking prevalence and improvements in dietary choice . There was no net intervention effect for the programme over and above observed change in the reference area . Conclusions : No definite conclusions can be drawn concerning the efficacy of the programme in terms of behavioural outcomes . With hindsight , the difficulties of evaluating such a complex multifaceted intervention were underestimated . Further debate on the most appropriate methods for assessing the effectiveness of community based health promotion programmes is called for . Key messages Heartbeat Wales was set up in 1985 as a community based programme to demonstrate risk reduction for cardiovascular disease Important changes were observed in modifiable risks for cardiovascular disease in Wales between 1985 and 1990 There was an unexpectedly rapid uptake of heart health promotion activity in the reference area No net intervention effects were found for the programme over and above changes in the reference area Improvements in methods of evaluation for community based health promotion programmes are Purpose of review This review highlights recent work evaluating the relationship between exercise , physical activity and physical and mental health . Both cross-sectional and longitudinal studies , as well as r and omized clinical trials , are included . Special attention is given to physical conditions , including obesity , cancer , cardiovascular disease and sexual dysfunction . Furthermore , studies relating physical activity to depression and other mood states are review ed . The studies include diverse ethnic population s , including men and women , as well as several age groups ( e.g. adolescents , middle-aged and older adults ) . Recent findings Results of the studies continue to support a growing literature suggesting that exercise , physical activity and physical-activity interventions have beneficial effects across several physical and mental-health outcomes . Generally , participants engaging in regular physical activity display more desirable health outcomes across a variety of physical conditions . Similarly , participants in r and omized clinical trials of physical-activity interventions show better health outcomes , including better general and health-related quality of life , better functional capacity and better mood states . Summary The studies have several implication s for clinical practice and research . Most work suggests that exercise and physical activity are associated with better quality of life and health outcomes . Therefore , assessment and promotion of exercise and physical activity may be beneficial in achieving desired benefits across several population s. Several limitations were noted , particularly in research involving r and omized clinical trials . These trials tend to involve limited sample sizes with short follow-up periods , thus limiting the clinical implication s of the benefits associated with physical activity . Abbreviations CAD : coronary artery disease ; COPD : chronic obstructive pulmonary disease ; CRP : cardiac rehabilitation program ; CVD : cardiovascular disease ; GMCB : group-mediated cognitive – behavioural ; HRQOL : health-related quality of life Background Although obesity surgery is currently the most effective method for achieving weight loss , not all patients lose the desired amount of weight and some show weight regain . Previous research shows that successful weight loss may be associated with the amount of investment the patient feels that they have made in their operation . For example , those who feel that it has taken more time and effort to organise , has cost more money , has been more disruptive to their lives and has caused pain are more likely to lose weight after their operation . Therefore , it seems as if the greater the sense of investment , the greater the motivation to make the operation a success . The present study aims to build on these findings by encouraging weight loss surgery patients to focus on the investment they have made , thus making their investment more salient to them and a means to improve weight loss outcomes . Methods The study involves an open r and omised parallel group control trial with patients allocated either to the control or investment intervention group . Using third party blinded r and omization , half the patients will be asked to rate and describe the investment they have made in their operation just before surgery then 3 and 6 months after surgery . All patients will record their weight , beliefs about food , intentions to change and actual eating and exercise behaviour at baseline then 3 , 6 and 12 months follow up . Patients will be recruited from the bariatric surgery pre- assessment clinic at University College Hospital , London . The primary outcome is to explore the impact of the investment based intervention on patient ’s weight and BMI , with secondary outcomes of patients ’ beliefs about foods , behavioural intentions and diet and exercise behaviours . Discussion It is predicted that the investment intervention will improve excess weight loss post-surgery , together with beliefs about food , intentions to change and actual change in diet and exercise behaviour . This has cost implication s for the NHS and other healthcare providers as improved effectiveness of bariatric surgery reduces the health costs of obese patients in the longer term and this simple , easy to administer and low cost intervention could become routine practice for bariatric patients .Trial registration Clinical Trials.gov identifier NCT02045628 ; December 2 , 2013 Arthritis is a common chronic disease causing pain and progressive disability to millions of people . The purpose of the study was to examine the effectiveness of group patient education for people with one form of arthritis , ankylosing spondylitis ( AS ) , in terms of change in : arthritis self-efficacy ; psychological well-being ; physical well-being ; and home exercise activities . The Self-Management Course-Ankylosing Spondylitis ( SMC-AS ) demonstrated positive effects on arthritis self-efficacy and psychological well-being at 6-month follow-up . Analysis of change over time in the intervention group showed improvements in depression , self-efficacy and severity at 3 weeks , with trends towards continued improvement evident at 6 months . In contrast , the positive effects on range and frequency of home exercise activities at 3 weeks were not maintained at 6 months . In conclusion , the effectiveness of short , intensive patient education courses was demonstrated . However , the need for strategies to sustain improvements in exercise behaviour need to be explored Background Due to early detection and advances in treatment , the number of women surviving breast cancer is increasing . Whilst there are many positive aspects of improved survival , breast cancer survival is associated with many long-term health and psychosocial sequelae . Engaging in regular physical activity post-diagnosis can reduce this burden . Despite this evidence , the majority of breast cancer survivors do not engage in regular physical activity . The challenge is to provide breast cancer survivors with appealing and effective physical activity support in a sustainable and cost-effective way . This article describes the protocol for the Move More for Life Study , which aims to assess the relative efficacy of two promising theory-based , print interventions design ed to promote regular physical activity amongst breast cancer survivors . Method and design Breast cancer survivors were recruited from across Australia . Participants will be r and omised into one of three groups : ( 1 ) A tailored-print intervention group , ( 2 ) a targeted-print intervention group , or ( 3 ) a st and ard recommendation control group . Participants in the tailored-print intervention group will receive 3 tailored newsletters in the mail over a three month period . Participants in the targeted-print group will receive a previously developed physical activity guidebook design ed specifically for breast cancer survivors immediately after baseline . Participants in the st and ard recommendation control will receive a brochure detailing the physical activity guidelines for Australian adults . All participants will be assessed at baseline , and at 4 and 10 months post-baseline . Intervention efficacy for changing the primary outcomes ( mins/wk aerobic physical activity ; sessions/exercises per week resistance physical activity ) and secondary outcomes ( steps per day , health-related quality life , compliance with physical activity guidelines , fatigue ) will be assessed . Mediation and moderation analyses will also be conducted . Discussion Given the growing number of cancer survivors , distance-based behaviour change programs addressing physical activity have the potential to make a significant public health impact . Trial registration Australian New Zeal and Clinical Trials Registry ( ANZCTR ) identifier : OBJECTIVE To determine the effects of adding stages of change-based counseling to an exercise prescription for older , sedentary adults in family practice . DESIGN The Step Test Exercise Prescription Stages of change counseling study was a 12-month cluster r and omized trial . SETTING Forty family practice s in 4 regions of Canada . PARTICIPANTS Healthy , community-dwelling men ( 48 % ) and women ( 52 % ) with a mean ( SD ) age of 64.9 ( 7.1 ) years ( range 55 to 85 years ) . There were a total of 193 participants in the intervention group and 167 in the control group . INTERVENTION Intervention physicians were trained to deliver a tailored exercise prescription and a transtheoretical behaviour change counseling program . Control physicians were trained to deliver the exercise prescription alone . MAIN OUTCOME MEASURES Predicted cardiorespiratory fitness , measured by predicted maximal oxygen consumption ( pVO2max ) , and energy expenditure , measured by 7-day physical activity recall . RESULTS Mean increase in pVO2max was significant for both the intervention ( 3.02 [ 95 % confidence interval 2.40 to 3.65 ] mL/kg/min ) and control ( 2.21 [ 95 % confidence interval 1.27 to 3.15 ] mL/kg/min ) groups at 12 months ( P < .001 ) ; however , there was no difference between groups . Women in the intervention group improved their fitness significantly more than women in the control group did ( 3.20 vs 1.23 mL/kg/min ) . The intervention group had a 4-mm Hg reduction in systolic blood pressure , while the control group 's mean reduction was 0.4 mm Hg ( P < .001 ) . The mean ( SD ) energy expended significantly increased and was higher in the intervention group than in the control group ( 69.06 [ 169.87 ] kcal/d vs -6.96 [ 157.06 ] kcal/d , P < .006 ) . Practice setting characteristics did not significantly affect the primary outcomes . CONCLUSION The Step Test Exercise Prescription Stages of change exercise and behavioural intervention improved fitness and activity and lowered systolic blood pressure across a range of Canadian practice s , but this was not significantly different from the control group , which received only the exercise prescription . Women in the intervention group showed higher levels of fitness than women in the control group did ; men in both groups showed similar improvement Purpose Education-based interventions for cancer-related fatigue have shown promise in adults undergoing radiotherapy . Research on the cancer-related fatigue intervention trial ( CAN-FIT ) programme found that pre-radiotherapy fatigue information and support ( pre-RFES ) did not improve levels of fatigue , but was associated with improvements in activity-based outcomes . We aim ed to measure whether pre-RFES result ed in greater participant self-ratings of their performance of daily living activities , fatigue , quality of life and distress . Methods Thirty people undergoing radiotherapy and /or chemotherapy  were r and omly allocated to either a 1-h RFES session from the CAN-FIT programme ( delivered individually to participants and modified where necessary for patients undergoing chemotherapy ) or st and ard care . Measures were taken pre- and post-treatment and 6 weeks after completing treatment . Results There was no significant difference between groups on performance of daily living activities or ratings of distress . Further analysis found a significant difference between the control and treatment groups for EQ-5D health state visual analogue scale ( −9.05 [ −18.09 ; −0.018 ] ; p < 0.05 ) and physical fatigue ( 2.86 [ 0.58 ; 5.14 ] ; p < 0.02 ) with the treatment group rating their overall health state worse and their physical fatigue higher than the controls . Conclusions Pre-RFES delivered individually did not significantly improve participants ’ ratings of their performance of daily occupations and was unexpectedly associated with worse overall health state and higher physical fatigue . Future trials , ideally comparing individual and group education to exercise programmes or cognitive – behavioural approaches , are recommended to examine the broader question of whether discussing fatigue might actually make participants feel worse Background Two-thirds of people living with dementia live at home in the UK and many experience distressing behavioural and psychological symptoms . This systematic review evaluates the effectiveness of non-pharmacological interventions for behavioural and psychological symptoms among community-dwelling people living with dementia . Methods This two-stage review undertook an initial mapping of the literature followed by a systematic review of relevant r and omised controlled trials . We search ed electronic data bases for pertinent studies reporting outcomes from interventions from January 2000 to March 2015 and up date d search es in October 2016 . We included studies that considered behavioural and psychological symptom management for older people living with dementia who live at home and excluded studies conducted in long-term care setting s. This paper presents findings from a narrative synthesis of 48 r and omised controlled trials evaluating interventions for people living with dementia alone , family carers alone and patient-carer dyads . Results We retrieved 17,871 de-duplicated records and screened them for potential inclusion . Evidence from 48 r and omised controlled trials suggests that family carer training and educational programmes that target problem behaviours and potential triggers can improve outcomes . Nurses and occupational therapists appear to help people with dementia with behavioural and psychological symptoms , but professional comparisons are lacking and there is no shared language about or underst and ing of behavioural and psychological symptoms amongst professionals , or between professionals and family carers . Conclusions Future research should focus on the effectiveness of components of multi-faceted programmes and their cost effectiveness and include qualitative data to better target interventions for behavioural and psychological symptoms . It is important to consider family carer readiness to use non-pharmacological strategies and to develop a shared language about the inherent needs and communications of behavioural and psychological symptoms Exercise and diet are the cornerstones of management of non-insulin-dependent diabetes mellitus ( NIDDM ) . Many older people have difficulty in exercising , missing benefits on glycaemic control , weight , cardiac disease and mood . We report the outcomes of a 6 month structured exercise and support programme based on a health promotion model , on physical activity , glycaemic control and parameters of cardiovascular risk in non-exercisers , compared with st and ard outpatient clinic education . A total of 26 non-exercising patients were r and omised to an intervention or control group ( ten men , 16 women ; mean age ( + /- S.D. ) 60 + /- 8 years ) . Programme participation was not associated with any significant increase in activity . Glycated hemoglobin ( HbAtc ) levels tended to stabilise in the intervention group during the 6 month programme and to deteriorate in the control group ( P = 0.03 ) ; by 12 months HbA1C levels deteriorated to a similar level in both . Programme participation did not cause significant change in anthropometric or metabolic parameters . Examining the cohort as a whole , increased activity over 6 months was associated with improvements in weight , body mass index ( BMI ) , body fat and fasting insulin . Activity increases over 12 months were associated with improvements in weight and BMI . These changes could not be attributed to changes in energy intake or dietary composition . We conclude that while exercise can benefit older people with NIDDM , a programme based on a model of health promotion was not effective in increasing physical activity BACKGROUND Disease prevention and health promotion are important tasks in the daily practice of all general practitioners ( GPs ) . The objective of this study was to explore the knowledge and attitudes of European GPs in implementing evidence -based health promotion and disease prevention recommendations in primary care , to describe GPs ' perceived barriers to implementing these recommendations and to assess how GPs ' own health behaviors affect their work with their patients . METHODS A postal multinational survey was carried out from June to December 2000 in a r and om sample of GPs listed from national colleges of each country . RESULTS Eleven European countries participated in the study , giving a total of 2082 GPs . Although GPs believe they should advise preventive and health promotion activities , in practice , they are less likely to do so . About 56.02 % of the GPs answered that carrying-out prevention and health promotion activities are difficult . The two most important barriers reported were heavy workload/lack of time and no reimbursement . Associations between personal health behaviour and attitudes to health promotion or activities in prevention were found . GPs who smoked felt less effective in helping patients to reduce tobacco consumption than non-smoking GPs ( 39.34 % versus 48.18 % , P < 0.01 ) . GPs who exercised felt that they were more effective in helping patients to practice regular physical exercise than sedentary GPs ( 59.14 % versus 49.70 % , P < 0.01 ) . CONCLUSIONS Significant gaps between GP 's knowledge and practice s persist in the use of evidence -based recommendations for health promotion and disease prevention in primary care This article considers the evidence for effectiveness and timing of rehabilitation  for people with rheumatoid arthritis ( RA ) . The Cochrane Library , DARE , Medline , Embase , CINAHL and AMED were search ed to identify systematic review s and r and omized controlled trials evaluating rehabilitation interventions for people with rheumatoid arthritis . Many trials identified had method ological limitations ( e.g. short follow-up periods , small sample sizes ) . Evidence to date is that symptomatic relief results from thermotherapy , laser therapy , acupuncture and assistive devices . In the short-term , comprehensive occupational therapy ( in established rheumatoid arthritis ) , orthoses , and mind-body approaches can help maintain function . Over at least a one-year period , the following are effective in reducing pain and maintaining function :  patient education and joint protection training using behavioural approaches ; dynamic exercise therapy , h and exercises and hydrotherapy ; and cognitive-behavioural therapy ( in people with poorer psychological status ) . Many trials have recruited people with moderate to severe , established RA and relatively little is known about the long-term effectiveness of early rehabilitation , although this is becoming much more common in practice . Despite the increased availability of guidelines and systematic review s , most conclude there is insufficient evidence for many areas of rheumatology rehabilitation . Further well- design ed clinical trials are needed recruiting people with early disease using patient-centred outcomes A r and omised controlled trial was used to evaluate a theory-based health promotion intervention . The intervention , a healthy living booklet , was design ed to promote healthy eating and physical activity amongst people aged over 65 years attending hospital out-patient clinics . The booklet employed persuasive arguments targeting the most proximal cognitive antecedents of behaviour specified by the theory of planned behaviour , as well as goal setting prompts . Participants ( N = 252 , average age=82 ) were r and omly allocated to a control ( patient satisfaction question naire ) or intervention ( healthy living booklet ) group .  Cognitions and behaviour were measured pre-intervention and at a two week follow up . The intervention group made significantly higher gains in perceived behavioural control , intention and behaviour for both target behaviours , suggesting that the intervention was successful . Sixty three of those invited to set goals to eat more healthily ( e.g. , " to eat five portions of fruit and vegetables a day " ) did so , and 67 % of those who set such goals reported 100 % success in acting on them . By contrast , only 34 % of intervention participants set an activity goal ( e.g. , " a five minute walk everyday " ) , and only 51 % reported 100 % success in enacting these goals . Results suggest that the observed behavioural effects of the healthy eating booklet could be attributed to goal setting as well as changes in perceived behavioural control and intention Purpose In an earlier r and omised controlled trial , we showed that early stage breast cancer patients who received a supervised exercise programme , with discussion of behaviour change techniques , had psychological and functional benefits 6 months after the intervention . The purpose of this study was to determine if benefits observed at 6 months persisted 18 and 60 months later . Methods Women who were in the original trial were contacted at 18 and 60 months after intervention . Original measures were repeated . Results Of the 148 women from the original study who agreed to be contacted again , 114 attended for follow-up at 18 months and 87 at 60 months . Women in the original intervention group reported more leisure time physical activity and more positive moods at 60 months than women in the original control group . Irrespective of original group allocation , women who were more active consistently reported lower levels of depression and increased quality of life compared to those who were less active . Conclusions We have shown that there are lasting benefits to an exercise intervention delivered during treatment to breast cancer survivors . Regular activity should be encouraged for women with early stage breast cancer as this can have lasting implication s for physical and psychological functioning ABSTRACT Although colloquial wisdom and some studies suggest an association between regular aerobic exercise and emotional well-being , the nature of this link remains poorly understood . We hypothesised that aerobic exercise may change the way people respond to their emotions . Specifically , we tested whether individuals experiencing difficulties with emotion regulation would benefit from a previous session of exercise and show swifter recovery than their counterparts who did not exercise . Participants ( N = 80 ) completed measures of emotion response tendencies , mood , and anxiety , and were r and omly assigned to either stretch or jog for 30 minutes . All participants then underwent the same negative and positive mood inductions , and reported their emotional responses . Analyses showed that more perceived difficulty generating regulatory strategies and engaging in goal -directed behaviours after the negative mood induction predicted more intense and persistent negative affect in response to the stressor , as would be expected . Interactions revealed that aerobic exercise attenuated these effects . Moderate aerobic exercise may help attenuate negative emotions for participants initially experiencing regulatory difficulties . This study contributes to the literature on aerobic exercise ’s therapeutic effects with experimental data , specifically in the realm of emotional processing OBJECTIVE For long-term treatment effects , patients with subacute back pain need to adhere to treatment recommendations beyond the prescribed exercise treatment . Adherence rates are as low as 30 % , so we developed a cognitive-behavioural training programme to enhance patients ' self-efficacy , maximise severity perceptions and reduce barrier perceptions . METHOD A 2 x 4 ( group x time ) repeated measurement design was applied . Forty-seven patients with non-specific , subacute back pain were r and omly assigned to a training group ( exercise treatment plus cognitive-behavioural training programme ) or a control group ( exercise treatment only ) . RESULTS Repeated measures ANOVA revealed significant main and interaction effects ; the training group reported enhanced self-efficacy and severity perceptions , reduced barrier perceptions , and self-reported that they exercised more often than the control group over time . However , no group differences regarding pain intensity emerged . CONCLUSION Our findings demonstrate that a short and inexpensive cognitive-behavioural training programme is an effective tool to enable back pain patients to follow treatment recommendations on a regular basis . PRACTICE IMPLICATION S The short and simple intervention can easily be conducted by personnel , other than psychologists , i.e. , physiotherapists Background The al- And alus physical activity intervention study is a r and omised control trial to investigate the effectiveness of a l and - and water-based exercise intervention for reducing the overall impact of fibromyalgia ( primary outcome ) , and for improving tenderness and pain-related measures , body composition , functional capacity , physical activity and sedentary behaviour , fatigue , sleep quality , health-related quality of life , and cognitive function ( secondary outcomes ) in women with fibromyalgia . Methods / Design One hundred eighty women with fibromyalgia ( age range : 35 - 65 years ) will be recruited from local associations of fibromyalgia patients in And alucía ( Southern Spain ) . Patients will be r and omly assigned to a usual care ( control ) group ( n = 60 ) , a water-based exercise intervention group ( n = 60 ) or a l and -based exercise intervention group ( n = 60 ) . Participants in the usual care group will receive general physical activity guidelines and participants allocated in the intervention groups will attend three non-consecutive training sessions ( 60 min each ) per week during 24 weeks . Both exercise interventions will consist of aerobic , muscular strength and flexibility exercises . We will also study the effect of a detraining period ( i.e. , 12 weeks with no exercise intervention ) on the studied variables . Discussion Our study attempts to reduce the impact of fibromyalgia and improve patients ' health status by implementing two types of exercise interventions . Results from this study will help to assess the efficacy of  exercise interventions for the treatment of fibromyalgia . If the interventions would be effective , this study will provide low-cost and feasible alternatives for health professionals in the management of fibromyalgia . Results from the al- And alus physical activity intervention will help to better underst and the potential of regular physical activity for improving the well-being of women with fibromyalgia . Trial registration Clinical Trials.gov ID : Objectives Suboptimal hearing aid use extorts significant social , health , and economic costs . The aims of this study were to ( 1 ) test the novel hypothesis that the threat associated with being diagnosed with hearing loss could be ameliorated with a self‐affirmation manipulation and ( 2 ) gauge the feasibility of deploying the manipulation in routine clinical practice . Design Parallel groups r and omized controlled trial with 10‐week follow‐up . Method Fifty people , newly prescribed with a hearing aid , completed either a question naire that included a brief self‐affirming exercise or an identical question naire with no self‐affirming exercise . The main outcome measure was derived from data logging automatically stored by the hearing aid . Perceived threat ( ‘ anxiety about ageing ’ ) , behavioural intention , and self‐efficacy were measured as potential mediators . Results Objective ly measured hours of daily hearing aid use were marginally higher in the intervention group compared with the control group ( between‐group difference = 1.94 hr , 95%CI = −1.24 , 5.12 , d = 0.43 ) . At follow‐up , participants in the intervention group were significantly less anxious about ageing and more accepting of older people than were participants in the control group ( between‐group difference = 0.75 , 95%CI = 0.26 , 1.22 , d = 0.87 ) . There was no statistically significant effect of the intervention on behavioural intention or self‐efficacy . Conclusions Although not statistically significant , the magnitude of the effect of the intervention on hearing aid use ( d = 0.43 ) suggests that it would be worthwhile working towards a fully powered r and omized controlled trial . The ability to reduce anxieties about ageing with this brief intervention could have far‐reaching benefits for multiple patient and general population groups . Statement of contribution What is already known on this subject ? Hearing impairment is more disabling than diabetes , yet hearing aid use is suboptimal . Anxieties about ageing may undermine hearing aid use . What does this study add ? The study tests a brief theory‐based psychological intervention to reduce anxiety about ageing and promote hearing aid use . Results show that the brief psychological intervention  reduced anxiety and marginally increased objective hearing aid use . Further work is required to identify other situations in which anxieties about ageing undermine behaviour change efforts . The very brief , flexible nature of the intervention means it could be adapted and deployed in numerous other health care setting The purpose of this review is to summarize literature that describes the impact of exercise on health and physical function among children during and after treatment for cancer . Relevant studies were identified by entering the following search terms into Pubmed : aerobic training ; resistance training ; stretching ; pediatric ; children ; AND cancer . Reference lists in retrieved manuscripts were also review ed to identify additional trials . We include fifteen intervention trials published between 1993 and 2011 that included children younger than age 21 years with cancer diagnoses . Nine included children with an acute lymphoblastic leukemia ( ALL ) diagnosis , and six children with mixed cancer diagnoses . Generally , interventions tested were either in-hospital supervised exercise training or home based programs design ed to promote physical activity . Early evidence from small studies indicates that the effects of exercise include increased cardiopulmonary fitness , improved muscle strength and flexibility , reduced fatigue and improved physical function . Generalizations to the entire childhood cancer and childhood cancer survivor population s are difficult as most of the work has been done in children during treatment for and among survivors of ALL . Additional r and omized studies are needed to confirm these benefits in larger population s of children with ALL , and in population s with cancer diagnoses other than ALL Abstract Weight gain is common during and following cancer treatment and contributes to many adverse health consequences and increased risk of recurrence for cancer survivors . The purpose of this longitudinal r and omized controlled trial was to compare differences in weight change and body composition among newly diagnosed cancer survivors receiving chemotherapy who were r and omly assigned to usual care control , aerobic exercise , or resistance exercise interventions .  It was hypothesized that cancer survivors become more sedentary during treatment , leading to positive energy balance that in turn worsens body composition . One hundred one subjects completed the 12-month study . Data collected included body composition ( body weight and dual energy x-ray absorptiometry scan ) , aerobic capacity ( 12-minute walk ) , and muscle strength ( 1 repetition maximum ) . Aerobic exercisers were found to have significant improvements in body composition , aerobic capacity , and muscle strength . Resistance exercisers also benefitted , but were less compliant with the intervention over time . Thus , exercise during and following cancer treatment is an important intervention to maintain and perhaps improve body composition of cancer survivors , which may improve survival , reduce comorbidities , and improve quality of life OBJECTIVE The objective of this study is to evaluate the effectiveness of a simple  dyadic ( person with dementia and their main carer ) exercise regimen as a therapy for the behavioural and psychological symptoms of dementia . METHOD A two arm , pragmatic , r and omised , controlled , single-blind , parallel-group trial of a dyadic exercise regimen ( individually tailored walking regimen design ed to become progressively intensive and last between 20 - 30 min , at least five times per week).Community-dwelling individuals with ICD-10 confirmed dementia with the following : clinical ly significant behavioural and psychological symptoms , a carer willing and able to co-participate in the exercise regimen , and no physical conditions or symptoms that would preclude exercise participation were invited by mental health or primary care services into the study . RESULTS One hundred and thirty-one dyads were recruited to this study . There was no significant difference in Behavioural and Psychological Symptoms as measured by the Neuropsychiatric Inventory at week 12 between the group receiving the dyadic exercise regimen and those that did not ( adjusted difference in means ( intervention minus control ) = -1.53 , p = 0.6 , 95 % CI [ -7.37 , 4.32 ] ) . There was a significant between-group difference in caregiver 's burden as measured by the Zarit Caregiver Burden Inventory at week 12 ( OR = 0.18 , p = 0.01 , CI [ 0.05 , 0.69 ] ) favouring the exercise group . CONCLUSIONS This study found that regular simple exercise does not appear to improve the behavioural and psychological symptoms of dementia , but did seem to attenuate caregiver burden . Further study to improve exercise uptake are needed OBJECTIVE We conducted a qualitative investigation of patients with type 2 diabetes to determine their perceived facilitators and barriers to exercise at multiple time points while enrolled in a r and omized exercise trial including aerobic , resistance or combined exercise .  We explored differences in these themes over time , between intervention groups and by adherence level after intervention . METHODS Interviews were conducted by telephone at 3 weeks ( run-in period ) , and at 3 ( midintervention ) , 6 ( end of intervention ) and 9 months ( maintenance ) after enrollment to assess factors that facilitated and hampered adherence to the exercise program . Audiotapes were transcribed verbatim and subjected to content analysis . RESULTS Participants ( n=28 ) with type 2 diabetes engaged in the interviews . Social support from family and the trainer , future health benefits , a sense of well-being and perceived fitness improvements were exercise facilitators . Experiencing illness or injury , work commitments and inclement weather were highlighted barriers . A sense of well-being , fitness improvements and enjoyment frequently were expressed by participants assigned to the combined and resistance exercise conditions . Participants who maintained prescribed exercise levels tended to be engaged in resistance exercise , and spoke of support from their personal trainers , the importance of strategies and enjoyment more frequently than those who did not maintain their exercise level . Exercise maintainers also cited more facilitators ; no differences were found for barriers . CONCLUSIONS Patients with type 2 diabetes require social support , including continued contact with exercise specialists . Patients need assistance with motivational enhancement and strategies to increase facilitators to maintain exercise behaviour . Incorporating resistance exercise improves well-being and enjoyment-2 important factors linked to exercise maintenance Abstract Objective : To evaluate the effectiveness of combinations of three methods to promote physical activity . Design : R and omised controlled trial . Baseline assessment with post-intervention follow up at 12 weeks and 1 year . Setting : One urban general practice , 1995 - 7 . Participants : 523 adults aged 40 to 64 years , r and omised to four intervention groups and a control group . Interventions : Brief ( one interview ) or intensive ( six interviews over 12 weeks ) motivational interviewing based on the stages of change model of behaviour change , with or without financial incentive ( 30 vouchers entitling free access to leisure facilities ) . Main outcome measures : Physical activity score ; sessions of moderate and vigorous activity in the preceding four weeks . Results : Response rate was 81 % at 12 weeks and 85 % at one year . More participants in the intervention group reported increased physical activity scores at 12 weeks than controls ( 38 % v 16 % , difference 22 % , 95 % confidence interval for difference 13 % to 32 % ) , with a 55 % increase observed in those offered six interviews plus vouchers . Vigorous activity increased in 29 % of intervention participants and 11 % of controls ( difference 18 % , 10 % to 26 % ) , but differences between the intervention groups were not significant . Short term increases in activity were not sustained , regardless of intensity of intervention . Conclusions : The most effective intervention for promoting adoption of exercise was the most intensive . Even this did not promote long term adherence to exercise . Brief interventions promoting physical activity that are used by many schemes in the United Kingdom are of question able effectiveness . Key messages Schemes promoting physical activity are currently popular in general practice in Britain , but few have been rigorously evaluated and their effectiveness is unknown . In this study , the most effective intervention for promoting adoption of physical activity was the most intensive , involving six motivational interviews and a financial incentive A comparatively brief intervention ( one interview ) was only effective in the short term in around a third of participants Short term increases in physical activity were not maintained at one year follow up and even the most intensive intervention was ineffective in promoting long term adherence to increased physical activity . National and local government , health authorities , and primary healthcare teams should be cautious about current and future expenditure on , and implementation of , exercise prescription or referral Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made BACKGROUND There is a paucity of studies evaluating targeted obesity prevention interventions in pre-school children . OBJECTIVES We conducted a r and omized controlled trial to evaluate the efficacy of a  parent-based obesity prevention intervention for pre-schoolers - MEND ( Mind , Exercise , Nutrition … Do It ! ) 2 - 4 on child diet , eating habits , physical activity/sedentary behaviours , and body mass index ( BMI ) . METHODS Parent-child dyads attended 10 weekly 90-min workshops relating to nutrition , physical activity and behaviours , including guided active play and healthy snack time . Assessment s were conducted at baseline , immediately post-intervention , and 6 and 12 months post-intervention ; child intake of vegetables , fruit , beverages , processed snack foods , fussiness , satiety responsiveness , physical activity , sedentary behaviour and neophobia were assessed via parent proxy report . Parent and child height and weight were measured . RESULTS Two hundred one parent-child dyads were r and omized to intervention ( n = 104 ) and control ( n = 97 ) . Baseline mean child age was 2.7 ( st and ard deviation [ SD ] 0.6 ) years , and child BMI -for-age z-score ( World Health Organization ) was 0.66 ( SD 0.88 ) . We found significant positive group effects for vegetable ( P = 0.01 ) and snack food ( P = 0.03 ) intake , and satiety responsiveness ( P = 0.047 ) immediately post-intervention . At 12 months follow-up , intervention children exhibited less neophobia ( P = 0.03 ) than controls . CONCLUSION Future research should focus on additional strategies to support parents to continue positive behaviour change . ACTRN12610000200088 Background Long-term use of antiretroviral therapy , normal aging , and presence of certain risk factors are associated with metabolic disorders that predispose persons living with HIV to diabetes and cardiovascular diseases . The emergence and progression of these disorders can be prevented by adopting healthy behaviours . Based on the theory of planned behaviour , the Web-based tailored intervention TAVIE en santé was developed . The aim of this study is to evaluate the effectiveness of TAVIE en santé in order to support people living with HIV in the adoption of health promoting behaviours . Methods / Design An online r and omized controlled trial with parallel-groups will be conducted across Canada . To participate in this study , people living with HIV must be : ≥ 18 years , able to read/underst and French or English , have access to the Internet . A convenience sample of 750 participants will be r and omly assigned either to an experimental group ( TAVIE en santé , n = 375 ) or to a control group ( websites , n = 375 ) ( 1:1 allocation ratio ) . The TAVIE en santé intervention is composed of seven interactive computer sessions , lasting between 5 and 10 min . The sessions , hosted by a virtual nurse , aim to develop and strengthen skills required for behaviour change . The control group will receive a vali date d list of five predetermined conventional health-related Websites  . The adoption of health behaviour ( smoking cessation or physical activity or healthy eating ) is the principal outcome . Cognitions ( intention , attitude , perceived behavioral control ) are the secondary outcomes . Health indicators will also be assessed . All outcomes will be measured with a self-administered online question naire and collected three times : at baseline , 3 and 6 months after . The principal analyses will focus on differences between the two trial groups using Intention-to-Treat analysis . Discussion This study will yield new results about the efficacy of Web-based tailored health behaviours change interventions in the context of chronic disease . The TAVIE en santé intervention could constitute an accessible complementary service in support of existing specialized services to support people living with HIV adopt health behaviors . Trial registration NCT02378766 , assigned on March 3th 2015 The effect of a 1-year exercise and diet intervention program on global self-concept , perceptions of the body , physical competence , exercise mastery , social competence , social comfort , and fitness was examined with 208 healthy individuals ( 191 males , 17 females ) aged 39 - 49 years ( mean age 44.9 ) with elevated risk factors for cardiovascular disease . The relative utility of the skill development versus the self-enhancement model of the self-concept/behaviour relationship was tested . The participants were r and omized into four groups : diet ( n = 53 ) , diet and exercise ( n = 64 ) , exercise ( n = 48 ) and no active intervention ( n = 43 ) . Measurements were made by the Harter adult self perception profile ( HASPP ) and the self-perception in exercise question naire ( SPEQ ) . Two-way ANOVA analyses revealed that exercise participation , with or without diet , enhanced self-perceptions of physical mastery and ability , body perception , fitness and social comfort . The unique contribution of diet indicated enhanced body perception . No effect was found of diet or exercise on global self-concept . Exercise participation had a positive effect on perceptions of the self , and the higher the compliance with the exercise program , the stronger were the effects on the self-perceptions . This supported the skill development model of the self-concept/behaviour relationship . As the pretest self-concept scores did not predict exercise compliance , the self-enhancement model of the self-concept/behaviour relationship was not supported Background Following cued levodopa ( LD ) intake , endurance exercise showed a beneficial effect on scored motor performance in patients with Parkinson 's disease ( PD ) in comparison with rest . This may result from an exercise induced increase in endogenous dopamine synthesis . As a result , beneficial effects on movement and reactivity may occur . Objectives To measure reactivity and motor performance in a repeated fashion with instrumental tasks after cued administration of soluble 200 mg of LD/50 mg of benserazide . Design PD patients consecutively performed paradigms , which assess reactivity and movement performance , after a st and ardised period of rest or of age-related , heart rate adapted endurance exercise  on two consecutive days in a r and om order . Results Reactivity and execution of simple and complex motion series were significantly better following exercise than after rest . Discussion Endurance exercise has a beneficial effect on reactivity and movement behaviour in PD patients following cued application of LD probably due to an augmented synthesis and release of dopamine and other catecholamines and release in the prefrontal cortex , the nucleus accumbens and the basal ganglia . Small changes in catecholamine modulation of prefrontal cortex cells can have profound effects on the ability of the prefrontal cortex to guide behaviour . Previous exercise may also improve pedunculopontine nucleus function , which is involved in motor-related attention processes A healthy diet and physical activity are recommended for prostate cancer survivors . Interdependence theory suggests that the spousal relationship influences those health behaviours and the degree of correspondence may be an indicator of this influence . This study evaluated the correspondence between prostate cancer survivors and spouses regarding  physical activity and fruit/vegetable consumption .  Baseline data from an ongoing r and omised control trial were utilised . Men who had been treated for prostate cancer within the past year and their partners ( N = 132 couples ) completed self-report measures of physical activity , fruit/vegetable consumption , relationship satisfaction and support for partner 's healthy diet and physical activity .  Couples reported similar fruit/vegetable consumption and physical activity as indicated by high levels of correspondence . Greater fruit/vegetable correspondence was related to higher relationship satisfaction ( F = 4.14 , P = 0.018 ) and greater patient ( F = 13.29 , P < 0.001 ) and spouse-rated support ( F = 7.2 , P < 0.001 ) . Greater physical activity correspondence was related to greater patient ( F = 3.57 , P = 0.028 ) and spouse-rated support ( F = 4.59 , P = 0.031 ) . Prostate cancer survivors and spouses may influence each other 's  diet and exercise behaviours . Couple-based interventions may promote healthy behaviours among this population Physical activity levels in young adults are low . Research supports the use of the Transtheoretical Model of behaviour change ( TM ) in design ing physical activity interventions . This study used a pre-post r and omized control design to investigate the effectiveness of a self-instructional intervention for helping sedentary young adults to initiate physical activity . Post-intervention , significantly more of the experimental group ( 80 % ) , in comparison to the control group ( 68 % ) , improved their exercise stage of change ( SOC ) from baseline ( P < 0.05 ) . Discriminant analyses revealed that discrimination between stage improvement/non-improvement was possible using the processes of change data . Stage improvers scored significantly higher on all of the behavioral and four out of five of the cognitive processes of change . For stage improvers , the processes of self-re-evaluation and self-liberation were most frequently used , whilst social liberation was used significantly more by the experimental than the control group . This inexpensive , self-instructional intervention , based on the TM and the ' active living message ' , is an effective method of assisting sedentary young adults to progress through the exercise SOC Both habit strength and action planning have been found to moderate the intention-exercise behaviour relationship , but no research exists that has investigated how habit strength and action planning simultaneously influence this relationship . The present study was design ed to explore this issue in a prospect i ve sample of undergraduate students ( N = 415 ) :  action planning , habit strength , intention , attitudes , subjective norms and perceived behavioural control were assessed at baseline and exercise behaviour was assessed 2 weeks later . Both habit strength and action planning moderated the intention-exercise relationship , with stronger relationship at higher levels of planning or habit strength . Decomposing a significant action planning × habit strength × intention interaction showed that the strength of the intention-exercise relationship progressed linearly through levels of action planning and habit strength . These novel results show that action planning strengthens the intention-habit strength interaction in the exercise domain : exercise interventions should therefore focus on simultaneously bolstering action planning and habit strength Background Fatigue is a major problem of cancer patients . Thirty percent of cancer survivors report serious fatigue three years after finishing treatment . There is evidence that physical exercise during cancer treatment reduces fatigue . This may also lead to an improvement of quality of life . Such findings may result in a decrease of healthcare related expenditures and societal costs due to sick leave . However , no studies are known that investigated these hypotheses . Therefore , the primary aim of our study is to assess the effect of exercise during cancer treatment on reducing complaints of fatigue and on reducing health service utilisation and sick leave . Methods / Design The Physical Activity during Cancer Treatment study is a multicentre r and omised controlled trial in 150 breast and 150 colon cancer patients undergoing cancer treatment . Participants will be r and omised to an  exercise or a control group .  In addition to the usual care , the exercise group will participate in an 18-week supervised group exercise programme . The control group will be asked to maintain their habitual physical activity pattern . Study endpoints will be assessed after 18 weeks ( short term ) and after 9 months ( long term ) . Vali date d question naires will be used . Primary outcome : fatigue ( Multidimensional Fatigue Inventory and Fatigue Quality List ) and cost-effectiveness , health service utilisation and sick leave . Secondary outcome : health related quality of life ( European Organisation Research and Treatment of Cancer- Quality of Life question naire-C30 , Short Form 36 healthy survey ) , impact on functioning and autonomy ( Impact on functioning and autonomy question naire ) , anxiety and depression ( Hospital Anxiety and Depression Scale ) , physical fitness ( aerobic peak capacity , muscle strength ) , body composition and cognitive-behavioural aspects . To register health service utilisation and sick leave , participants will keep diaries including the EuroQuol-5D . Physical activity level will be measured using the Short Question naire to Assess Health-Enhancing Physical Activity and will be monitored with an exercise log and a pedometer . Discussion This study investigates the (cost)-effectiveness of exercise during adjuvant treatment of patients with breast or colon cancer . If early physical exercise proves to be ( cost ) effective , establishing st and ardised physical exercise programmes during cancer treatment will be planned . Trial registration Current Controlled trials IS RCT N43801571 , Dutch Trial Register There is increasing recognition that exercise is an efficacious strategy for managing many consequences of multiple sclerosis ( MS ) , yet persons with MS are not engaging in sufficient exercise for accruing health benefits . Poor exercise uptake might be associated with the design of previous research . We conducted a r and omised controlled trial ( RCT ) for examining the feasibility of a 4-month home-based , exercise-training program design ed based on recent physical activity guidelines for MS and supplemented by behavioural strategies for compliance . Feasibility was assessed in the domains of process ( e.g. , recruitment ) , re source ( e.g. , monetary costs ) , management ( e.g. , personnel time requirements ) and scientific outcomes ( e.g. , treatment effect ) . We recruited persons with mild-to-moderate MS who were r and omised into an intervention or wait-list control condition . Intervention participants received a pedometer , elastic resistance b and s , DVD , training manual , calendars , log-book , video coaching calls and newsletters . Participants in both conditions completed home-based assessment s before and after the 4-month period . Ninety-nine persons with MS were assessed for eligibility , and 57 were r and omised . Fifty-one persons completed the study ( 90 % ) . Total costs of the study were US $ 5331.03 . Personnel time to conduct the study totaled 263h . Participants in the intervention group complied fully with 71 % of all exercise sessions . There was a moderate increase in self-reported exercise behaviour of the intervention participants as measured by the Godin Leisure-Time Exercise Question naire ( d≥0.5 ) . The results support the feasibility and acceptability of a home-based exercise intervention based on physical activity guidelines and supplemented with behavioural strategies for adults with mild-to-moderate MS Background Office workers have been identified as being at risk of accumulating high amounts of sedentary time in prolonged events during work hours , which has been associated with increased risk of a number of long-term health conditions . There is some evidence that providing advice to st and at regular intervals during the working day , and using computer-based prompts , can reduce sedentary behaviour  in office workers . However , evidence of effectiveness , feasibility and acceptability for these types of intervention is currently limited . Methods A 2-arm , parallel group , cluster-r and omised feasibility trial to assess the acceptability of prompts to break up sedentary behaviour was conducted with office workers in a commercial bank ( n = 21 ) . Participants were assigned to an  education only group ( EG ) or prompt and education group  ( PG  ) . Both groups received education on reducing and breaking up sitting at work , and the PG also received hourly prompts , delivered by Microsoft Outlook over 10 weeks , reminding them to st and . Objective measurements of sedentary behaviour were made using activPAL monitors worn at three time points : baseline , in the last 2 weeks of the intervention period and 12 weeks after the intervention . Focus groups were conducted to explore the acceptability of the intervention and the motivations and barriers to changing sedentary behaviour . Results R and omly generated , customised prompts , delivered by Microsoft Outlook , with messages about breaking up sitting , proved to be a feasible and acceptable way of delivering prompts to office workers . Participants in both groups reduced their sitting , but changes were not maintained at follow-up . The education session seemed to increase outcome expectations of the benefits of changing sedentary behaviour and promote self-regulation of behaviour in some participants . However , low self-efficacy and a desire to conform to cultural norms were barriers to changing behaviour . Conclusions Prompts delivered by Microsoft Outlook were a feasible , low-cost way of prompting office workers to break up their sedentary behaviour , although further research is needed to determine whether this has an additional impact on sedentary behaviour , to education alone . The role of cultural norms , and promoting self-efficacy , should be considered in the design of future interventions .Trial registration This study was registered retrospectively as a clinical trial on Clinical Trials.gov ( ID no. NCT02609282 ) on 23 March 2015 BACKGROUND Physical activity is a major modifiable risk factor for cardiovascular disease , but it is unclear what combination of feasible approaches , using existing re sources in primary care , work best to initiate increased physical activity . AIM To assess three approaches to initiate increased physical activity . DESIGN OF STUDY R and omised controlled ( 2 X 2 X 2 ) factorial trial . SETTING Four general practice s. METHOD One hundred and fifty-one sedentary patients with computer documented risk factors for cardiovascular disease were r and omised to eight groups defined by three factors :  prescription by general practitioners ( GPs ) for brisk exercise not requiring a leisure facility ( for example , walking ) 30 minutes per day , 5 days per week ; counselling by practice nurses , based on psychological theory to modify intentions and perceived control of behaviour , and using behavioural implementation techniques ( for example , contracting , ' rehearsal ' ) ; use of the Health Education Authority booklet ' Getting active , feeling fit ' . RESULTS Single interventions had modest effects . There was a trend from the least intensive interventions ( control + /- booklet ) to the more intensive interventions ( prescription and counselling combined + /- booklet ) for both increased physical activity and fitness ( test for trend , P = 0.02 and P = 0.05 , respectively ) . Only with the most intense intervention ( prescription and counselling combined ) were there significant increases in both physical activity and fitness from baseline ( Godin score = 14.4 , 95 % confidence interval [ CI ] = 7.8 to 21 , which was equivalent to three 15-minute sessions of brisk exercise and a 6-minute walking distance = 28.5 m , respectively , 95 % CI = 11.1 to 45.8 ) . Counselling only made a difference among those individuals with lower intention at baseline . CONCLUSION Feasible interventions using available staff , which combine exercise prescription and counselling explicitly based on psychological theory , can probably initiate important increases in physical activity Objective : To evaluate the outcome of a multidisciplinary treatment programme for patients with chronic fatigue syndrome , including health-related quality of life ( HRQoL ) and psychosocial variables , and exercise capacity measures . Design : A six-month prospect i ve outcome study . Setting : University outpatient rehabilitation clinic ; group setting . Subjects : One hundred and sixteen women fulfilling chronic fatigue syndrome criteria . Interventions : Cognitive behaviourally and grade d exercise-based strategies ; emphasis on adaptive lifestyle changes . Measures : Short Form General Health Survey ( SF-36 ) ; Symptom Checklist ( SCL-90 ) ; Causal Attribution List ( CAL ) ; Self-Efficacy Scale ( SE ) ; maximum progressive bicycle ergometer test with respiratory gas analysis ; and isokinetic leg strength test  , before and after treatment . Results : The total group significantly improved on nearly all reported HRQoL/ psychosocial variables . Changes in exercise capacity measures were rather modest and did not correlate or only weakly correlated with HRQoL/psychosocial variables . Subgroup analyses indicated that less fit patients improved significantly more on exercise capacity measures than their more fit counterparts . Patients who were fitter at baseline scored better on pretreatment HRQoL/psychosocial variables , but both subgroups improved similarly on these variables . Conclusions : Health-related quality of life and psychosocial functioning in patients with chronic fatigue syndrome improves after a six-month cognitive behaviourally and grade d exercise-based multidisciplinary treatment programme . Increase in exercise capacity measures is not a necessary condition for reported improvements , except for less fit patients PURPOSE To examine the effects of aerobic exercise therapy on quality of life ( QoL ) and associated outcomes in women treated for breast cancer . Evidence suggests that exercise may be beneficial , but no trial has included an exercise-placebo and a usual-care group to control for the attention effects that might be associated with aerobic exercise interventions in cancer patients . PATIENTS AND METHODS A total of 108 women who had been treated for breast cancer 12 to 36 months previously were r and omly assigned to supervised aerobic exercise therapy ( n = 34 ) , exercise-placebo ( body conditioning ; n = 36 ) , or usual care ( n = 38 ) . Exercise therapy and exercise-placebo sessions took place three times per week for 8 weeks . Outcomes included QoL , depression , exercise behavior , aerobic fitness ; outcomes were assessed at baseline and at the 8- and 24-week follow-up . RESULTS Analyses of covariance revealed a significant mean difference of 9.8 units in Functional Assessment of Cancer Therapy-General ( primary outcome ) favoring aerobic exercise therapy at 8 weeks , relative to usual care . Significant differences that favored aerobic exercise therapy relative to usual care were recorded for Functional Assessment of Cancer Therapy-Breast , social/family well-being , functional well-being , and breast cancer subscale scores at 8-week follow-up . Psychological health outcomes improved modestly for both intervention groups ; these improvements were sustained for several end points . CONCLUSION Exercise therapy had large , clinical ly meaningful , short-term beneficial effects on QoL in women treated for breast cancer ; this finding can not be attributable to attention , given that the exercise-placebo group did not report similar effects relative to usual care Chronic fatigue syndrome ( CFS ) produces physical and neurocognitive disability that significantly affects health-related quality of life ( HRQL ) .  Multidisciplinary treatment combining grade d exercise therapy ( GET ) cognitive behavioural therapy ( CBT ) and pharmacological treatment has shown only short-term improvements . To compare the effects on HRQL of ( 1 ) multidisciplinary treatment combining CBT , GET , and pharmacological treatment , and ( 2 ) usual treatment ( exercise counselling and pharmacological treatment ) at 12 months of follow-up . Prospect i ve , r and omized controlled trial with a follow-up of 12 months after the end of treatment . Patients consecutively diagnosed with CFS ( Fukuda criteria ) were r and omly assigned to intervention ( n = 60 ) or usual treatment ( n = 60 ) groups . HRQL was assessed at baseline and 12 months by the Medical Outcomes Study Short-Form question naire ( SF-36 ) . Secondary outcomes included functional capacity for activities of daily living measured by the Stanford Health Assessment Question naire ( HAQ ) and comorbidities . At baseline , the two groups were similar , except for lower SF-36 emotional role scores in the intervention group . At 12 months , the intervention did not improve HRQL scores , with worse SF-36 physical function and bodily pain scores in the intervention group . Multidisciplinary treatment was not superior to usual treatment at 12 months in terms of HRQL . The possible benefits of GET as part of multidisciplinary treatment for CFS should be assessed on an individual patient basis Little is known about effects of community-based physiotherapeutic exercise programmes incorporated in COPD self-management programmes . In a r and omised trial , the effect of such a programme ( COPE-active ) on exercise capacity and various secondary outcomes including daily activity as a marker of behaviour change was evaluated . All patients attended four 2-h self-management sessions . In addition the intervention group participated in the COPE-active programme offered by physiotherapists of private practice s , consisting of a 6-month " compulsory " period ( 3 sessions/week ) and subsequently a 5-month " optional " period ( 2 sessions/week ) . Because COPE-active was intended to change behaviour with regard to exercise , one session/week in both periods consisted of unsupervised home-based exercise training .  Of 153 patients , 74 intervention and 68 control patients completed the one-year follow-up . Statistically significant between-group differences in incremental shuttle walk test-distance ( 35.1 m ; 95 % CI ( 8.4 ; 61.8 ) ) and daily activity ( 1190 steps/day ; 95 % CI ( 256 ; 2125 ) ) were found in favour of the intervention group . Over the 12-month period a significant difference of the chronic respiratory question naire ( CRQ ) dyspnoea-score ( 0.33 points ; 95 % CI ( 0.01 ; 0.64 ) ) and a non-significant difference of the endurance shuttle walk test ( 135 m ( 95 % CI ( -29 ; 298 ) ) was found . No differences were found in the other CRQ-components , anxiety and depression scores and percentage of fat free mass . This study demonstrates that a community-based reactivation programme improves exercise capacity in patients with moderately to severe COPD . Even more important , the programme improves actual daily activity after one-year which indicates behaviour change with regard to daily exercise . Registered trail number : IS RCT N81447311 Introduction Large proportions of the population are not meeting recommended levels of physical activity and have increasingly sedentary lifestyles . Low levels of physical activity are predictive of poor health outcomes and time spent sedentary is related to a host of risk factors independently of physical activity levels . Building an evidence base of the best approaches to intervene in the lifestyles of inactive individuals is crucial in preventing long-term disease , disability and higher mortality rates . Methods and analysis Systematic search es will be conducted on all relevant data bases ( eg , PubMed , Scopus , CINAHL , PsycINFO ) . Studies will be included if they assess interventions aim ed at changing physical activity or sedentary behaviour levels in adults ( over 18 ) who are inactive and do not suffer from chronic conditions . Studies must also be r and omised controlled trials ( RCTs ) , have a primary outcome of physical activity or sedentary behaviour , and measure outcomes at least 6 months after intervention completion . Studies will be coded using the Behaviour Change Technique ( BCT ) taxonomy v1 and Template for Intervention Description and Replication ( TIDieR ) guidelines . 2 review ers will independently screen full-text articles and extract data on study characteristics , participants , BCTs , intervention features and outcome measures . Study quality will also be assessed independently by 2 review ers using the Cochrane risk of bias tool . A meta- analysis will be considered if there is sufficient homogeneity across outcomes . GRADE criteria will be used to assess quality of evidence . Dissemination This will be the first review to systematic ally appraise interventions aim ed at changing the physical activity or sedentary behaviour of inactive individuals using RCT design s with a 6-month follow-up post-intervention . This review will better inform intervention design ers targeting inactive population s and inform the design of a future complex intervention . Review registration number This protocol was registered with the International Prospect i ve Register of Systematic Review s ( PROSPERO ) on 17 October 2014 ( registration number : CRD42014014321 ) Background High levels of physical inactivity are linked to several chronic diseases including coronary heart disease , type-2 diabetes , obesity , some cancers and poor mental health . Encouraging people to be more active has proven difficult . One way to incorporate physical activity into the daily routine is through the journey to and from work . Although behaviour change techniques ( BCTs ) are considered valuable in promoting behaviour change , there is very little in the published literature about the views and experiences of those encouraged to use them . Methods The Walk to Work study was a feasibility study incorporating an exploratory cluster r and omised controlled trial . The 10-week intervention involved training workplace-based Walk to Work promoters ( volunteers or nominated by participating employers ) to encourage colleagues to increase walking during their daily commute . The intervention used nine specific BCTs : Intention formation , barrier identification , specific goal setting , instruction , general encouragement , self-monitoring of behaviour social support , review of behavioural goals and relapse prevention . Digitally recorded interviews were undertaken with 22 employees , eight of whom were Walk to Work promoters to underst and their views and experiences of using these techniques . The Framework method of data management and constant comparison were used to analyse the data and identify key themes . Results For each individual BCT , there appeared to be people who found it useful in helping them to increase walking to work and others who did not . Following training , the Walk to Work promoters varied in the extent to which they were able to fulfil their role : additional support and encouragement during the 10-week intervention may be required for the promoters to maintain motivation . Wider context ual ( economic climate , unprecedented wet weather ) and organisational ( workload , car parking facilities ) issues were identified that influenced the delivery of , and response to , the intervention . Conclusions Walk to work interventions employing BCTs should include sufficient techniques to enable participants to choose a ‘ package ’ to suit their needs . Additional support at organisational level should also be encouraged , and consideration given to wider context ual factors that impinge on the delivery of , and response to , the intervention . Trial registration IS RCT N72882329 ABSTRACT High levels of cardiovascular fitness and physical activity are associated with higher levels of cognitive function in people with HIV , thus , they may reduce the risk of developing HIV-associated neurocognitive disorder ( H AND ) . This study aim ed to investigate the effects of a 16-week aerobic exercise intervention on cognitive function in people with HIV . Eleven participants living with HIV were recruited into the study . Participants were r and omised into either an exercise group ( n = 5 ) , that completed a 16-week aerobic exercise programme training , 3 times per week ( 2 supervised sessions and one unsupervised session ) or a control group ( n = 6 ) that received no intervention . Outcomes measured included cognitive function ( Montreal cognitive assessment ( MOCA ) and the Trail making tests A and B ) , aerobic fitness ( modified Bruce protocol ) , sleep quality ( Pittsburgh sleep quality index ; PSQI ) and physical activity levels ( seven-day accelerometry ) . At baseline , higher levels of moderate physical activity were positively correlated with higher MOCA scores and levels of aerobic fitness were negatively associated with Trail A scores ( P = 0.04 and P = 0.001 respectively ) . However , exercise training did not induce any significant improvements in cognitive function or aerobic fitness . The overall mean adherence rate to the exercise programme was 60 % . In conclusion , in the present study a 16-week aerobic exercise intervention did not affect the cognitive function of participants with HIV . It is likely that longer intervention periods and /or higher adherence rates to exercise might be needed for an aerobic exercise programme to be effective in improving cognitive function in a cohort with no baseline cognitive impairments Background : Previous studies have suggested that physical exercise can reduce symptoms for subjects suffering from panic disorder ( PD ) . The efficacy of this intervention has so far not been compared to an established psychotherapy , such as cognitive behaviour therapy ( CBT ) . Assessment of controlled long-term effects and the clinical significance of the treatment are also lacking . Aim : To compare physical exercise to CBT as treatment for PD , and assess controlled long-term and clinical ly significant effects . Method : PD- patients were r and omized to either three weekly sessions of physical exercise ( n = 17 ) , or one weekly session of CBT ( n = 19 ) . Both treatments ran for 12 weeks , were manualized and administered in groups . Patients were assessed twice before the start of treatment , at post-treatment and at 6 and 12 months thereafter . Primary outcome - measures consisted of the Mobility Inventory ( MI ) , the Agoraphobia Cognitions Question naire ( ACQ ) and the Body Sensations Question naire ( BSQ ) . Results : A two-way repeated measures MANOVA of these measures demonstrated a significant effect of time , F(16 , 544 ) = 7.28 , p < .01 , as well as a significant interaction effect , F(16 , 544 ) = 1.71 , p < .05 , in favour of CBT . This finding was supported by the assessment of clinical ly significant changes of avoidant behaviour and of treatment-seeking one year later . Conclusion : Group CBT is more effective than group physical exercise as treatment of panic disorder , both immediately following treatment and at follow-up assessment OBJECTIVES To study the effects of framed messages on  exercise intention and resolve . DESIGN Two ( type of frame : gain or loss ) × 2 ( type of kernel state : desirable or undesirable outcome ) post-test study . METHODS Participants were recruited online and question ed about their previous exercise behaviour and their exercise risk perception . After this , they were r and omly allocated to one of four messages that were different in terms of positive or negative outcomes ( type of frame ) and in terms of attained or avoided outcomes ( type of kernel state ) . After reading the message , participants indicated their intention and resolve to engage in sufficient exercise . RESULTS No effects were found for intention . For resolve , there was a significant interaction between type of frame , type of kernel state , and exercise adherence . Those who did not adhere to the exercise guideline and read the loss-framed message with attained outcomes reported significantly higher resolve than all other participants . CONCLUSIONS This study indicates the relevance of including attained outcomes in message framing exercise interventions as well as a focus on exercise resolve . STATEMENT OF CONTRIBUTION What is already known on this subject ? Message framing is commonly used to increase exercise intentions and behaviour . Meta-analyses do not provide consistent support for this theory . Very little attention has been paid to resolve and message factors on framing effects . What does this study add ? Framed messages have an effect on exercise resolve , but not on intention . Loss-framed messages with attained outcomes are most persuasive for those who do not adhere to exercise guidelines . Exercise framing studies should include behavioural resolve next to intention . BACKGROUND Lifestyle has been shown to affect fertility in both males and females , with compelling evidence that smoking and being under or overweight impairs natural and assisted fertility , and other factors such as stress and caffeine have also been implicated . The objective of this study was to determine whether providing infertile couples with individualized lifestyle assessment s and ongoing support facilitates positive lifestyle changes enhancing healthy fertility . METHODS We conducted a prospect i ve cohort pilot study of 23 infertile couples attending an Adelaide-based fertility clinic for advice and treatment relating to infertility . The intervention was a comprehensive assessment interview with the couple , focused on health and lifestyle . Motivational interviewing techniques were used and ongoing support provided . The assessment was repeated after 4 months and included an exit question naire . The main outcome measure(s ) was self-reported lifestyle changes , including increased exercise , modified diet , reduced caffeine and alcohol consumption , ceased or reduced smoking and decreased psychological stress . RESULTS Following the initial lifestyle assessment interview , all participants reported adverse lifestyle behaviour . CONCLUSIONS The results suggest that the FAST ( Fertility ASsessment and advice Targeting lifestyle choices and behaviours ) approach of an individualized assessment of current lifestyle practice followed by ongoing one to two weekly telephone support is effective in promoting healthy lifestyle change . Larger studies using this methodology are now required Summary Two studies were conducted to determine whether adding exercise to a diet programme promotes weight loss or glycaemic control in Type 2 ( non-insulin-dependent ) diabetic subjects . In Study 1 , 25 subjects were r and omly assigned to diet plus moderate exercise or diet plus placebo exercise .  All subjects exercised twice a week as a group and once a week on their own ; the diet plus moderate exercise group walked a 3-mile route at each session while the diet plus placebo exercise group did very low intensity exercises such as stretching and light calisthenics . All subjects followed a calorie-counting diet and were taught behaviour modification strategies . Weight losses and improvements in glycaemic control did not differ significantly between the two treatment groups at the end of the 10-week treatment or at 1-year follow-up . In Study 2 , more extreme conditions were compared : a diet only group and a diet plus exercise group . The diet plus exercise group walked a 3-mile route with the group 3 times/week and once a week on their own , while the diet only group was instructed to maintain their current low level of activity . Both groups received comparable diet and behaviour modification instruction and therapist contacts . The diet plus exercise group had significantly ( p<0.01 ) better weight losses than the diet only condition at the end of the 10 week programme ( −9.3 kg vs −5.6 kg ) and at 1 year follow-up ( −7.9 kg vs −3.8 kg ) . Both groups had similar improvements in glycosylated haemoglobin , but reductions in medication were more frequent and greater in magnitude in the diet plus exercise group . Finally , analyses were conducted collapsing across studies and across treatment groups and comparing subjects who reported low , medium , or high levels of exercise at 1 year . Self-reported exercise was related to weight loss and to improvements in glycosylated haemoglobin , even after adjusting for weight loss . These data suggest that the combination of diet and exercise  improves weight loss and glycaemic control compared to diet only in Type 2 diabetic patients OBJECTIVES Rheumatology guidelines recommend people with RA receive behavioural self-management education . This study developed a modular behavioural group programme and evaluated its longer term effects on pain , physical and psychological status . METHODS People with RA or PsA were r and omized to a modular behavioural or st and ard information-focused education programme , both delivered by experienced rheumatology health professionals at one large district general hospital . Outcome measures were pain , self-efficacy , fatigue , functional ability , psychological status and use of health behaviours ( exercise , joint protection , fatigue and cognitive symptom management ) . Using an intent-to-treat analysis outcomes were compared at 6 and 12 months with analysis of covariance . RESULTS Out of 498 referred patients , 218 agreed to participate , met entry criteria and were r and omized ; 51 withdrew before education . Of the remaining patients , 86 attended the behavioural and 81 the st and ard programmes .  Participants were aged 55.4 yrs ( s.d . 12.42 ) with disease duration of 7.39 ( s.d . 6.88 ) yrs ( 53 % < 5 yrs ) . At 6 months , the behavioural group had better pain ( P = 0.01 ) , fatigue ( P = 0.01 ) , functional ability ( P = 0.05 ) and self-efficacy ( P = 0.01 ) scores and greater use of health behaviours . At 12 months , they continued to have better pain ( P = 0.03 ) , self-efficacy ( P = 0.001 ) and psychological status ( P = 0.0001 ) scores and greater use of some health behaviours . CONCLUSION Attending a modular behavioural education programme is effective for at least 1 yr in enabling people with RA and PsA to reduce pain , improve psychological status and self-manage their condition OBJECTIVE To examine the potential effect of low-risk pregnancy on women 's recreational activity patterns and to explore pregnant women 's beliefs and information sources regarding physical exercise participation . DESIGN Preliminary , prospect i ve survey SETTING Participants ' homes in the East Midl and s , UK . PARTICIPANTS Fifty-seven nulliparous , pregnant women . MEASUREMENTS Levels of  maternal physical activity participation were assessed by semi-structured interview at 16 , 25 , 34 and 38 weeks gestation . The modified Baecke question naire provided a measure of women 's habitual sport and leisure activities in the 12 months prior to pregnancy . A 10-item scale assessed maternal beliefs regarding the importance of physical activity in pregnancy . The fetal health locus of control scale measured the extent to which women believed their own behaviour , the behaviour of others and /or chance would influence fetal health . Open-ended questions assessed women 's information sources . FINDINGS Fourteen of the 36 ( 39 % ) women who reported participating in some form of weekly exercise before pregnancy did not report pursuing any similar activities during pregnancy .  Rest and relaxation  were perceived as being significantly more important during pregnancy than was regular exercise or the maintenance of an active lifestyle . Fifty-five respondents ( 96 % ) indicated that they had received advice about physical activity at least once during pregnancy . At 16 weeks gestation , women obtained most of their information from books and magazines . Between 25 and 38 weeks gestation , most advice came from family and friends . Participants who reported receiving this advice were significantly older , more educated and of a higher activity level pre-pregnancy . KEY CONCLUSIONS Levels of maternal exercise  may decline during pregnancy both as a result of the physical changes of pregnancy and from a combination of social and psychological factors . Present health education may be failing to correct inaccurate perceptions of the risks associated with physical exercise in pregnancy . IMPLICATION S FOR PRACTICE Improving the quantity and quality of information related to physical exercise has the potential to correct inaccurate perceptions and confer several benefits on maternal and fetal health . Effective intervention strategies should focus not only on the pregnant woman but also extend to her family , friends and exercise provider OBJECTIVE To investigate whether 12 weeks of grade d exercise with pacing would improve specific physiological , psychological and cognitive functions in people with chronic fatigue syndrome ( CFS ) . DESIGN R and omised controlled trial . SETTING Human performance laboratory at the University of Western Australia . PARTICIPANTS 61 patients aged between 16 and 74 years diagnosed with CFS . INTERVENTIONS Either grade d exercise with pacing ( 32 patients ) or relaxation/flexibility therapy ( 29 patients ) performed twice a day over 12 weeks . MAIN OUTCOME MEASURES Changes in any of the physiological , psychological or cognitive variables assessed . RESULTS Following the grade d exercise intervention , scores were improved for resting systolic blood pressure ( P = 0.018 ) , work capacity ( W.kg(-1 ) ) ( P = 0.019 ) , net blood lactate production ( P = 0.036 ) , depression ( P = 0.027 ) and performance on a modified Stroop Colour Word test ( P = 0.029 ) . Rating of perceived exertion scores , associated with an exercise test , was lower after grade d exercise ( P = 0.013 ) . No such changes were observed in the relaxation/flexibility condition , which served as an attention-placebo control . CONCLUSIONS Grade d exercise was associated with improvements in physical work capacity , as well as in specific psychological and cognitive variables . Improvements may be associated with the ab and onment of avoidance behaviours Abstract Objectives . To analyse costs and consequences of changing physical activity behaviour due to the “ Physical Activity on Prescription ” ( PAP ) programme . Design . A r and omized controlled trial with a four-month intervention , with comparison between intervention and control group . Intervention . The PAP programme , with exercise twice a week , education , and motivational counselling . Subjects . 525 sedentary individuals , 20–80 years ( intervention group n = 268 , control group n = 257 ) , with lifestyle-related health problems . A total of 245 returned for the four-month assessment . Main outcome measure . Programme costs based on intention-to-treat estimations , direct and indirect costs of inactivity , and physical activity behaviour analysed with IPAQ ( International Physical Activity Question naire ) , self-reported physical activity , and measures of functional capacity . Results . The intention-to-treat programme costs for the four-month programme period was SEK ( Swedish Kronor ) 6475 ( € [ Euro ] 684 ) for the intervention group and SEK 3038 ( € 321 ) for the control group . Of this , healthcare providers ’ costs were 24 % in the intervention group , and 31 % in the control group . The physical activity behaviour was significantly improved in both groups , but no differences were found between the groups . Implication s. The largest share of the  PAP programme costs was the participants ’ costs . Significant improvements were shown in physical activity behaviour in both groups , but no differences were found between the intervention and control groups . Due to many non-completers , the potential for improvements of the motivating assignment with sedentary individuals in primary healthcare is obvious . Long-term follow-up can determine the sustainability of the results , and can be used in a future cost-effectiveness analysis Background Reaction time , coordination , and cognition performance typically diminish in older adults , which may lead to gait impairments , falls , and injuries . Regular strength – balance exercises are highly recommended to reduce this problem and to improve health , well-being , and independence in old age . However , many older people face a lack of motivation in addition to other strong barriers to exercise . We developed ActiveLifestyle , an information technology (IT)-based system for active and healthy aging aim ing at improving balance and strength . ActiveLifestyle is a training app that runs on a tablet and assists , monitors , and motivates older people to follow personalized training plans autonomously at home . Objective The objectives were to ( 1 ) investigate which IT-mediated motivation strategies increase adherence to physical exercise training plans in older people , ( 2 ) assess the impact of ActiveLifestyle on physical activity behavior change , and ( 3 ) demonstrate the effectiveness of the ActiveLifestyle training to improve gait speed . Methods A total of 44 older adults followed personalized , 12-week strength and balance training plans . All participants performed the exercises autonomously at home . Question naires were used to assess the technological familiarity and stage of behavior change , as well as the effectiveness of the motivation instruments adopted by ActiveLifestyle . Adherence to the exercise plan was evaluated using performance data collected by the app and through information given by the participants during the study . Pretests and posttests were performed to evaluate gait speed of the participants before and after the study . Results Participants were 75 years ( SD 6 ) , predominantly female ( 64 % ) , held a trade or professional diploma ( 54 % ) , and their past profession was in a sitting position ( 43 % ) . Of the 44 participants who enrolled , 33 ( 75 % ) completed the study . The app proved to assist and motivate independently living and healthy older adults to autonomously perform strength – balance exercises ( median 6 on a 7-point Likert scale ) . Social motivation strategies proved more effective than individual strategies to stimulate the participants to comply with the training plan , as well as to change their behavior permanently toward a more physically active lifestyle . The exercises were effective to improve preferred and fast gait speed . Conclusions ActiveLifestyle assisted and motivated independently living and healthy older people to autonomously perform strength – balance exercises over 12 weeks and had low dropout rates . The social motivation strategies were more effective to stimulate the participants to comply with the training plan and remain on the intervention . The adoption of assistive technology devices for physical intervention tends to motivate and retain older people exercising for longer periods of time Objective : To evaluate whether enhanced secondary prevention more significantly influences readiness to change health behaviour after minor stroke/transient ischaemic attack , compared with conventional stroke secondary prevention . Design : Single-blind r and omized control trial . Setting : Rural district general hospital outpatient clinic . Subjects : Fifteen women and 37 men with a mean age of 68.3 years with first minor stroke or transient ischaemic attack . Interventions : The intervention group received ‘ enhanced secondary prevention ’ ( additional advice , motivational interviewing and telephone support ) to change health behaviour . Both groups received ‘ conventional care ’ which included advice given during routine care . Main measures : The primary outcome was ‘ readiness to change behaviour ’ measured using a vali date d stroke specific score based on the transtheoretical model . Secondary outcomes were the Hospital Anxiety and Depression Scale , and self-reported alcohol consumption , smoking behaviour , exercise frequency , and fruit and vegetable consumption . Results : Analysis of the data for the 52 participants showed no statistical difference in the groups for the primary outcome of readiness to change behaviour . Statistically significant improvements for change in self-reported exercise were demonstrated ( P = 0.007 ) ; to 2—3 times per week in the intervention group compared to 0—1 times per week in the control group , and in fruit and vegetable consumption ( P = 0.033 ) ; to 10 portions of fruit and vegetables consumed per week in the intervention group compared to 1 or 2 portions a week for the control group . No evidence of a difference between groups was seen for alcohol consumption or Hospital Anxiety and Depression Scale . Conclusions : While no difference was demonstrated between the groups for readiness to change behaviour , a clinical ly significant effect in reported exercise behaviour and diet were demonstrated in the intervention group . This interesting finding indicates a dissonance between the behaviour scale and actual behaviour change , potentially indicating a lack of sensitivity of the scale to detect a change in this patient group AIM To examine the effectiveness of cognitive-behavioural strategies with/without intense Tai Chi exercise in reducing fear of falling among community-dwelling elderly adults . Background . Fear of falling is a major health problem among community-dwelling older persons . The prevalence of this fear ranges from 29 % to 77 % , indicating the importance of developing effective strategies to reduce fear of falling among elderly adults . METHODS Data were collected from January to December 2007 . A r and omized controlled trial with three groups ( control , cognitive-behavioural and cognitive-behavioural with Tai Chi ) . Participants were assessed at baseline for  demographic data , falls-related history , and fear of falling . Data on these variables plus falls , mobility , social support behaviour and satisfaction , and quality of life were also collected at 2 and 5 months after interventions . RESULTS Participants in the three groups differed significantly in both measures of fear of falling ( F = 20·89 , P < 0·001 ; F = 6·09 , P < 0·001 ) and mobility ( F = 30·33 , P < 0·001 ) , social support behaviour and satisfaction ( F = 3·32 , P < 0·05 and F = 6·35 , P < 0·001 , respectively ) , and quality of life ( F = 16·66 , P < 0·001 ) . In addition , participants who received the cognitive-behavioural intervention with Tai Chi had significantly lower fear of falling scores ( P < 0·001 ) and higher mobility ( P < 0·001 ) , social support satisfaction ( P < 0·01 ) and quality of life ( P < 0·001 ) than the cognitive-behavioural alone and control groups at 5 months . The three groups did not differ significantly in falls . CONCLUSION The results of this trial suggest that the cognitive-behavioural intervention with Tai Chi exercise helped community-dwelling elderly adults to enhance their mobility , to manage their fear of falling and to increase their quality of life L ots of small observational studies have suggested that yoga , exercise , and other mind – body techniques can reduce the stress and side effects of cancer treatment . But little compelling evidence has been available to support their use and most oncologists do n’t include such alternative medicine approaches in treatment plans . That could be changing , though . Large r and omized trials of yoga have recently been concluded or are under way , and some cancer centers are beginning to offer complementary treatments in-house . Professional and patient groups have given space on their websites to these methods for coping with symptoms . And professional meetings are giving more time to complementary , or “ integrative medicine , ” approaches for symptom management . Linda Sutton , M.D. , medical director of the Duke Oncology Network in Durham , N.C. , has observed the recent change in attitude in the oncology community toward exercise and other complementary techniques as part of treatment plans . At the 2009 San Antonio Breast Cancer meeting , she noted that for the fi rst time the session on exercise and nutrition had a prominent place in the program . “ I think that there ’s a building body of evidence that ’s emerging in the mainstream cancer world regarding some of the add-on approaches to patients with breast cancer , ” Sutton said . Sutton attributes much of the recent interest in yoga and other exercise interventions to the increased emphasis on cancer survivorship and the well-documented fact that many people have lingering symptoms such as fatigue , sleep disturbances , and joint pain that are often inadequately addressed with conventional approaches . And cancer patients themselves have pushed for alternatives . More than half regularly use complementary techniques in an attempt to treat symptoms or boost their immune systems , according to the 2007 National Health Interview Survey of nearly 24,000 participants , which included 1,471 cancer survivors . In her experience , Sutton said , physicians are not so much against the use of , for example , yoga or meditation practice s , as they are uncomfortable recommending these approaches because of a lack of clear data about who will benefi t. “ I think there ’s still a lot of unanswered questions and more so than we are used to when we talk about giving tamoxifen or giving chemotherapy , where we have clear criteria as to who should get it , ” she said AIM This paper reports a study of the effects of aquatic exercise on physical fitness ( flexibility , strength and aerobic fitness ) , self-reported physical functioning and pain in adults with osteoarthritis of the hip or knee . BACKGROUND Osteoarthritis is a common cause of disability and a primary reason for hip and knee joint replacement . Exercise is important for preventing and /or managing the functional limitations associated with joint disease . Aquatic exercise is thought to be beneficial and is often recommended for people with osteoarthritis ; however , few studies have examined the effects on people with osteoarthritis , and these have yielded inconsistent results . METHODS A two-group r and omized controlled trial with a convenience sample was used . Participants were recruited from community sources and r and omly assigned to a 12-week aquatic programme or a non-exercise control condition . Data for 38 participants were collected at baseline , week 6 , and week 12 during 2003 and 2004 . Instruments were a st and ard plastic goniometer , a h and held dynamometer , the 6-minute walk test , the multidimensional Health Assessment Question naire , and a visual analogue scale for pain . RESULTS Repeated measures analysis of variance showed that aquatic exercise statistically significantly improved knee and hip flexibility , strength and aerobic fitness , but had no effect on self-reported physical functioning and pain . The exercise adherence rate was 81.7 % , and no exercise-related adverse effect was observed or reported . CONCLUSIONS Beneficial short-term effects of aquatic exercise were found in adults with osteoarthritis of the hip or knee . Although the programme may not offer pain relief or self-reported improvements in physical functioning , results suggest that aquatic exercise does not worsen the joint condition or result in injury . Nurses engaging in disease management and health promotion for these patients should consider recommending or implementing aquatic classes for patients BACKGROUND Acute effects of physical exercise on the deformational behaviour of articular cartilage and changes in cartilage oligomeric matrix protein ( COMP ) are definite . However , conclusive positive effects of fitness exercise on functional adaptation of articular cartilage have not been proved . AIM Therefore , in this parallel-group r and omised controlled trial , we tested the hypothesis that adequate amount of physical exercise with enough impact would be able to stimulate the functional behaviour of articular cartilage . METHODS We evaluated 44 healthy males for their physical-fitness levels and their blood sample s were obtained before , immediately after and 0.5h after a 30-min walking exercise . Thereafter , participants were assigned to the running , the cycling , the swimming and the control groups . At the end of 12weeks of intervention , the same measurement procedures were applied . Mixed repeated- measures analysis of variance ( ANOVA ) design was used for statistics . ( LEVEL OF EVIDENCE 2 ) . RESULTS Pre-test measurements showed that 30min of walking significantly increased serum-COMP levels in all groups . The post-tests revealed that the COMP level of all groups , except running , showed an increase after a 30-min walking activity . CONCLUSION Overall , it was concluded that , 12weeks of regular , weight-bearing , high-impact physical exercise ( i.e. , running ) decreases the deformational effect of walking activity . This finding is an evidence of functional adaptation of articular cartilage to specific environmental requirements Background Combined lifestyle interventions ( CLIs ) have been advocated as an effective instrument in efforts to reduce overweight and obesity . The odds of maintaining higher levels of  physical activity ( PA ) and healthier dietary behaviour improve when people are more intrinsically motivated to change their behaviour . To promote the shift towards more autonomous types of motivation , facilitator led CLIs have been developed including lifestyle coaching as key element . The present study examined the shift in types of motivation to increase  PA  and  healthy dieting  among participants of a primary care CLI , and the contribution of lifestyle coaching to potential changes in motivational quality . Methods This prospect i ve cohort study included participants of 29 general practice s in the Netherl and s that implemented a CLI named ‘ BeweegKuur ’ .  Question naires including items on demographics , lifestyle coaching and motivation were sent at baseline and after 4 months . Aspects of motivation were assessed with the  Behavioural Regulation and Exercise Question naire ( BREQ-2 ) and the  Regulation of Eating Behaviour Question  naire ( REBS ) . We performed a drop out analysis to identify selective drop-out . Changes in motivation were analysed with t-tests and effect size interpretations ( Cohen ’s d ) , and multivariate regression analysis was used to identify predictors of motivational change . Results For physical activity , changes in motivational regulation were fully in line with the tenets of Self Determination Theory and Motivational Interviewing : participants made a shift towards a more autonomous type of motivation ( i.e. controlled types of motivation decreased and autonomous types increased ) . Moreover , an autonomy supportive coaching style was generally found to predict a larger shift in autonomous types of motivation . For healthy dietary behaviour , however , except for a small decrease in external motivation , no favourable changes in different types of motivation were observed . The relation between coaching and motivation appeared to be influenced by the presence of physical activity guidance in the programme . Conclusions Motivation of participants of a real life primary care CLI had changed towards a more autonomous motivation after 4 months of intervention . Autonomy-supportive lifestyle coaching contributed to this change with respect to physical activity . Lifestyle coaching for healthy diet requires thorough knowledge about the problem of unhealthy dieting and solid coaching skills Objective : To evaluate the effect of a musical exercise programme on mood state and cognitive function in women with dementia . Design : R and omized controlled trial . Setting : Public Psychiatric Hospital Rekem , Belgium . Patients : Twenty-five patients with dementia . Interventions : Fifteen patients attended exercise training for three months , which consisted of daily physical exercises supported by music for 30 min/session . They were compared with a group of 10 control patients , who received an equal amount of attention through daily conversation . Main measures : The effect on cognition was measured by the Mini-Mental State Examination ( MMSE ) and the Amsterdam Dementia Screening Test 6 ( ADS 6 ) . Behaviour was evaluated with the abbreviated Stockton Geriatric Rating Scale ( BOP scale ) . The assessment s were made before , after six weeks of intervention and immediately after the three-month experimental period . Results : The exercise group showed a significant improvement in cognition . This was documented by an increased MMSE mean score of 12.87 - 15.53 , and by a higher median score , rising from 10 to 14 points , on the subset ‘ fluency ’ ( ADS 6 test ) . The control group showed no significant improvement , either on the MMSE ( mean score of 10.80 -11.00 ) or on the fluency subtest of the ADS 6 ( median scores were 6.5 - 7 points ) . The effects on behavioural changes were not significant . Conclusion : The present study suggests a beneficial effect of cognition using a music-based exercise programme in a group of patients with moderate to severe dementia . Further studies are needed to confirm these findings AIMS The ' Chronic Disease Self-Management Programme ' ( CDSMP ) emphasizes patients ' responsibility for the day-to-day management of their condition(s ) and has shown favourable effects on health behaviour and healthcare utilization among various groups of patients with chronic conditions . However , the effects of the CDSMP among congestive heart failure ( CHF ) patients are unknown . We therefore aim ed to assess the effects of the CDSMP on health behaviour and healthcare utilization in patients with CHF . METHODS AND RESULTS This r and omized , controlled trial with 12 months of follow-up included 317 CHF patients with a slight to marked limitation of physical activity . Control patients ( n = 131 ) received usual care , consisting of regular checkups at an outpatient clinic . Intervention group patients ( n = 186 ) received usual care and participated in a 6-week self-management group programme .  Favourable effects on walking for exercise and other physical activities such as aerobic , stretching , and strength exercises , sports , and gardening were reported in the intervention group immediately after completion of the programme . The effect of the programme on other physical activities extended to 6 months of follow-up . No favourable effects were found for the other outcomes . CONCLUSION The CDSMP significantly improved physical activity  among CHF patients for up to 6 months after the end of the programme ; however , it did not affect other health behaviour outcomes or healthcare utilization Background Breast cancer ( BC ) is the most common type of cancer in women worldwide . Post-treatment , patients suffer from side effects and have various rehabilitation needs , which means that individualization is fundamental for optimal rehabilitation . This systematic review ( SR ) of SRs aims to evaluate the current evidence on rehabilitation interventions in female patients following BC treatment . Methods Full-text SRs published in English from 2009 were search ed in Embase , PubMed , Cinahl Complete , PsycINFO , AMED , SCOPUS , and Cochrane Library . Inclusion criteria : SRs of r and omized or non-r and omized controlled trials investigating the effects of  rehabilitation interventions in women following BC treatment . All outcomes were considered . Method ological quality was evaluated using the AMSTAR 2 tool and interrater agreement was evaluated . Out of 1269 citations retrieved , 37 SRs were included . Results Five rehabilitation areas were identified : exercise and physical activity ( PA ) , complementary and alternative medicine ( CAM ) , yoga , lymphoedema treatment , and psychosocial interventions . The most solid evidence was found in exercise/PA and yoga . Exercise interventions improved outcomes such as shoulder mobility , lymphoedema , pain , fatigue and quality of life ( QoL ) . Effects of yoga were shown on QoL , anxiety , depression , sleep disturbance , fatigue and gastrointestinal symptoms . The effect of CAM was shown on nausea , pain , fatigue , anger and anxiety but these results need to be interpreted with caution because of low method ological quality in included studies in the SRs . Among the lymphoedema treatments , positive effects were seen for resistance training on volume reduction and muscle strength and psychosocial interventions such as cognitive behavioural therapy had positive effects on QoL , anxiety , depression and mood disturbance . Conclusions This SR of SRs show solid positive effects of exercise/PA and yoga for women following BC treatment , and provides extended knowledge of the effects of CAM , yoga , lymphoedema treatment and psychosocial interventions . It is evident that more than one intervention could have positive effects on a specific symptom and that the effects depend not only on intervention type but also on how and when the intervention is provided . The results can be used as a foundation for individualized rehabilitation and aid health care professionals in meeting patients ’ individual needs and preferences . Trial registration PROSPERO ( CRD42017060912 ) BACKGROUND Approximately 670,000 people in the UK have dementia . Previous literature suggests that physical exercise could slow dementia symptom progression . OBJECTIVES To estimate the clinical effectiveness and cost-effectiveness of a bespoke exercise programme , in addition to usual care , on the cognitive impairment ( primary outcome ) , function and health-related quality of life ( HRQoL ) of people with mild to moderate dementia ( MMD ) and carer burden and HRQoL. DESIGN Intervention development , systematic review , multicentred , r and omised controlled trial ( RCT ) with a parallel economic evaluation and qualitative study . SETTING 15 English regions . PARTICIPANTS People with MMD living in the community . INTERVENTION A 4-month moderate- to high-intensity , structured exercise programme design ed specifically for people with MMD , with support to continue unsupervised physical activity thereafter . Exercises were individually prescribed and progressed , and participants were supervised in groups . The comparator was usual practice . MAIN OUTCOME MEASURES The primary outcome was the Alzheimer 's Disease Assessment Scale - Cognitive Subscale ( ADAS-Cog ) . The secondary outcomes were function [ as measured using the Bristol Activities of Daily Living Scale ( BADLS ) ] , generic HRQoL [ as measured using the EuroQol-5 Dimensions , three-level version ( EQ-5D-3L ) ] , dementia-related QoL [ as measured using the Quality of Life in Alzheimer 's Disease ( QoL-AD ) scale ] , behavioural symptoms [ as measured using the Neuropsychiatric Inventory ( NPI ) ] , falls and fractures , physical fitness ( as measured using the 6-minute walk test ) and muscle strength . Carer outcomes were HRQoL ( Quality of Life in Alzheimer 's Disease ) ( as measured using the EQ-5D-3L ) and carer burden ( as measured using the Zarit Burden Interview ) . The economic evaluation was expressed in terms of incremental cost per quality -adjusted life-year ( QALY ) gained from a NHS and Personal Social Services perspective . We measured health and social care use with the Client Services Receipt Inventory . Participants were followed up for 12 months . RESULTS Between February 2013 and June 2015 , 494 participants were r and omised with an intentional unequal allocation ratio : 165 to usual care and 329 to the intervention . The mean age of participants was 77 years [ st and ard deviation ( SD ) 7.9 years ] , 39 % ( 193/494 ) were female and the mean baseline ADAS-Cog score was 21.5 ( SD 9.0 ) . Participants in the intervention arm achieved high compliance rates , with 65 % ( 214/329 ) attending between 75 % and 100 % of sessions . Outcome data were obtained for 85 % ( 418/494 ) of participants at 12 months , at which point a small , statistically significant negative treatment effect was found in the primary outcome , ADAS-Cog ( patient reported ) , with a mean difference of -1.4 [ 95 % confidence interval ( CI ) -2.62 to -0.17 ] . There were no treatment effects for any of the other secondary outcome measures for participants or carers : for the BADLS there was a mean difference of -0.6 ( 95 % CI -2.05 to 0.78 ) , for the EQ-5D-3L a mean difference of -0.002 ( 95 % CI -0.04 to 0.04 ) , for the QoL-AD scale a mean difference of 0.7 ( 95 % CI -0.21 to 1.65 ) and for the NPI a mean difference of -2.1 ( 95 % CI -4.83 to 0.65 ) . Four serious adverse events were reported . The exercise intervention was dominated in health economic terms . LIMITATIONS In the absence of definitive guidance and rationale , we used a mixed exercise programme . Neither intervention providers nor participants could be masked to treatment allocation . CONCLUSIONS This is a large well-conducted RCT , with good compliance to exercise and research procedures . A structured exercise programme did not produce any clinical ly meaningful benefit in function or HRQoL in people with dementia or on carer burden . FUTURE WORK Future work should concentrate on approaches other than exercise to influence cognitive impairment in dementia . TRIAL REGISTRATION Current Controlled Trials IS RCT N32612072 . FUNDING This project was funded by the National Institute for Health Research ( NIHR ) Health Technology Assessment programme and will be published in full programme and will be published in full in Health Technology Assessment Vol . 22 , No. 28 . See the NIHR Journals Library website for further project information . Additional funding was provided by the Oxford NIHR Biomedical Research Centre and the Oxford NIHR Collaboration for Leadership in Applied Health Research and Care Background Growing evidence exists that living with an ICD can lead to fear and avoidance behaviour including the avoidance of physical activity . It has been suggested that psychological stress can increase the risk of shock and predict death . Small studies have indicated a beneficial effect arising from exercise training and psychological intervention , therefore a large-scale rehabilitation programme was set up . Methods / Design A mixed methods embedded experimental design was chosen to include both quantitative and qualitative measures . A r and omised clinical trial is its primary component . 196 patients ( power-calculated ) were block r and omised to either a control group or intervention group at a single centre . The intervention consists of a 1-year psycho-educational component provided by two nurses and a 12-week exercise training component provided by two physiotherapists . Our hypothesis is that the COPE-ICD programme will reduce avoidance behaviour , sexual dysfunction and increase quality of life , increase physical capability , reduce the number of treatment-dem and ing arrhythmias , reduce mortality and acute re-hospitalisation , reduce sickness leading to absence from work and be cost-effective . A blinded investigator will perform all physical tests and data collection . Discussion Most participants are men ( 79 % ) with a mean age of 58 ( range 20 - 85 ) . Most ICD implantations are on primary prophylactic indication ( 66 % ) . 44 % is NYHA II . Mean walk capacity ( 6MWT ) is 417 m. Mean perception of General Health ( SF-36 ) is PCS 42.6 and MCS 47.1.A large-scale ICD rehabilitation trial including psycho-educational intervention and exercise training has been initiated and will report findings starting in 2011.Trial Registration Clinical Trials.gov : Physical exercise is expected to improve and maintain physical function in older people , thus promoting health and preventing or postponing the onset of disability in later life . The Sendai Silver Center Trial ( SSCT ) was a r and omized controlled trial design ed to evaluate the efficacy of exercise training among healthy free-living older people . Sixty-five eligible participants , aged from 60 to 81 years , were r and omly allocated to an exercise group or a control group . The subjects in the exercise group were asked to attend training classes at the Sendai Silver Center , a municipal health and welfare facility in the center of Sendai City , at least twice a week for 25 weeks . Each training class , lasting two hours , started with a warm-up session , followed by an endurance session with a bicycle ergometer , and a resistance exercise training session using rubber films , and ended with a cool-down session . The subjects in the control group were asked to attend recreational classes at the Center twice a month . There were no drop-outs or accidents during the intervention . Comparison of maximum oxygen consumption ( VO2max ) before and after the 25-week intervention revealed a significant increase in the exercise group ( 2.1 ml/kg/min ) but no significant change in the control group . Our result is equivalent to the participants becoming younger in aerobic capacity by five years after six months of exercise training Background Frailty is common in older age , and is associated with important adverse health outcomes including increased risk of disability and admission to hospital or long-term care .  Exercise interventions for frail older people have the potential to reduce the risk of these adverse outcomes by increasing muscle strength and improving mobility . Methods / Design The Home-Based Older People 's Exercise ( HOPE ) trial is a two arm , assessor blind pilot r and omised controlled trial ( RCT ) to assess the effectiveness of a 12 week exercise intervention ( the HOPE programme ) design ed to improve the mobility and functional abilities of frail older people living at home , compared with usual care . The primary outcome is the timed-up- and -go test ( TUGT ) , measured at baseline and 14 weeks post-r and omisation . Secondary outcomes include the Barthel Index of activities of daily living ( ADL ) , EuroQol Group 5-Dimension Self-Report Question naire ( EQ-5D ) quality of life measure and the geriatric depression scale ( GDS ) , measured at baseline and 14 weeks post-r and omisation . We will record baseline frailty using the Edmonton Frail Scale ( EFS ) , record falls and document muscle/joint pain . We will test the feasibility of collection of data to identify therapy re sources required for delivery of the intervention . Discussion The HOPE trial will explore and evaluate a home-based exercise intervention for frail older people . Although previous RCTs have used operationalised , non-vali date d methods of measuring frailty , the HOPE trial is , to our knowledge , the first RCT of an exercise intervention for frail older people that includes a vali date d method of frailty assessment at baseline . Trial registration IS RCT N : IS RCT Background Cognitive decline is one of the most prominent healthcare issues of the 21st century . Within the context of combating cognitive decline through behavioural interventions , physical activity is a promising approach . There is a dearth of health economic data in the area of behavioural interventions for dementia prevention . Yet , economic evaluations are essential for providing information to policy makers for re source allocation . It is essential we first address population and intervention-specific method ological challenges prior to building a larger evidence base . We use a cost-utility analysis conducted alongside the exercise for cognition and everyday living ( EXCEL ) study to illustrate method ological challenges specific to assessing the cost-effectiveness of behavioural interventions aim ed at older adults at risk of cognitive decline . Methods A cost-utility analysis conducted concurrently with a 6-month , three-arm r and omised controlled trial ( ie , the EXCEL study ) was used as an example to identify and discuss method ological challenges . Results Both the aerobic training and resistance training interventions were less costly than twice weekly balance and tone classes . In critically evaluating the economic evaluation of the EXCEL study we identified four category-specific challenges : ( 1 ) analysing costs ; ( 2 ) assessing quality -adjusted life-years ; ( 3 ) Incomplete data ; and ( 4 ) ‘ Intervention ’ activities of the control group . Conclusions Resistance training and aerobic training result ed in healthcare cost saving and were equally effective to balance and tone classes after only 6 months of intervention . To ensure this population is treated fairly in terms of cl aims on re sources , we first need to identify areas for method ological improvement This two-group pretest and posttest quasi-experimental study aim ed to evaluate the effects of a Tai Chi exercise programme on exercise behaviour and blood pressure ( BP ) in out patients with hypertension . The experimental group ( n = 27 ) received the Yang-style Tai Chi exercise programme three times a week for 8 weeks . The control group ( n = 31 ) received routine care with no Tai Chi exercise .  Exercise behaviour and exercise time using Routine Health Care Behaviour scale and BP were assessed at baseline and 8 weeks . The experimental group had a significant improvement on exercise behaviour ( t = 2.11 , P < 0.001 ) and exercise time ( t = 1.44 , P = 0.003 ) , and a significant reduction in systolic BP ( t = 2.57 , P < 0.001 ) and diastolic BPs ( t = 2.86 , P < 0.001 ) compared with those of the control group . Tai Chi is an inexpensive and viable exercise and can improve exercise behaviour and BP control in out patients with hypertension . Tai Chi exercise might offer out patients with hypertension additional options , such as an adjunct to formal cardiac rehabilitation or as an exercise alternative in their management of hypertension . Nursing staff can easily learn and incorporate this exercise in patient education or care planning in the care of patients with hypertension in outpatient setting BACKGROUND Exercise for Health was a pragmatic , r and omised , controlled trial comparing the effect of an eight-month exercise intervention on function , treatment-related side effects and quality of life following breast cancer , compared with usual care . The intervention commenced six weeks post-surgery , and two modes of delivering the same intervention was compared with usual care . The purpose of this paper is to describe the study design , along with outcomes related to recruitment , retention and representativeness , and intervention participation . METHODS Women newly diagnosed with breast cancer and residing in a major metropolitan city of Queensl and , Australia , were eligible to participate . Consenting women were r and omised to a face-to-face-delivered exercise group  ( FtF , n = 67 ) , telephone-delivered exercise group ( Tel , n = 67 ) or usual care group ( UC , n = 60 ) and were assessed pre-intervention ( 5-weeks post-surgery ) , mid-intervention ( 6 months post-surgery ) and 10 weeks post-intervention ( 12 months post-surgery ) . Each intervention arm entailed 16 sessions with an Exercise Physiologist . RESULTS Of 318 potentially eligible women , 63 % ( n = 200 ) agreed to participate , with a 12-month retention rate of 93 % . Participants were similar to the Queensl and breast cancer population with respect to disease characteristics , and the r and omisation procedure was mostly successful at attaining group balance , with the few minor imbalances observed unlikely to influence intervention effects given balance in other related characteristics . Median participation was 14 ( min and max : 0 and 16 ) and 13 ( min and max : 3 and 16 ) intervention sessions for the FtF and Tel , respectively , with 68 % of those in Tel and 82 % in FtF participating in at least 75 % of sessions . DISCUSSION Participation in both intervention arms during and following treatment for breast cancer was feasible and acceptable to women . Future work , design ed to inform translation into practice , will evaluate the quality of life , clinical , psychosocial and behavioural outcomes associated with each mode of delivery A survey was conducted to assess the potential for an  exercise and weight control program  for persons with Type II diabetes . Question naires were sent to 1,000 individuals with diabetes , who were r and omly selected from the provincial health records office .  Physicians and dietitians were the primary sources of information about both exercise and diet . Although few respondents participated in organized ( 7.7 % ) or informal ( 36.8 % ) exercise programs , or expressed an interest in participating ( 36.8 % ) , the majority ( 84.0 % ) believed that they should get more exercise . This points to a gap between attitude and behaviour . Activity preferences were similar to those reported previously for all Canadians , however , barriers to participation differed in the present group . It was concluded that barriers must be assessed , and behaviour modification included , if diet and exercise programs are to be successful in this population Background Dementia is more common in older than in younger people , and as a result of the ageing of the population in developed countries , it is becoming more prevalent . Drug treatments for dementia are limited , and the main support offered to people with dementia and their families is generally services to mitigate against loss of function . Physical exercise is a c and i date non-pharmacological treatment for dementia . Methods / Design DAPA is a r and omised controlled trial funded by the National Institute for Health Research Health Technology Assessment programme to estimate the effect of a 4-month , moderate- to hard-intensity exercise training programme and subsequent advice to remain active , on cognition ( primary outcome ) at 12 months in people with mild to moderate dementia . Community-dwelling participants ( with their carers where possible ) , who are able to walk 3 metres without human assistance , able to undertake an exercise programme and do not have any unstable or terminal illness are recruited . Participants are then r and omised by an independent statistician using a computerised r and om number generator to usual care or exercise at a 2:1 ratio in favour of exercise . The exercise intervention comprises 29 , 1-hour-long exercise classes , run twice weekly at suitable venues such as leisure centres , which include aerobic exercise ( on static bikes ) and resistance exercise ( using weights ) . Goals for independent exercise are set while the classes are still running , and supported thereafter with phone calls . The primary outcome is measured using ADAS-cog . Secondary outcome measures include behavioural symptoms , functional ability , quality of life and carer burden . Primary and secondary outcomes will be measured at baseline and at 6 and 12 months after r and omisation , by research ers masked to participant r and omisation in the participants ’ own homes . An economic evaluation will be carried out in parallel to the RCT , as will a qualitative study capturing the experiences of participants , carers and staff delivering the intervention . Discussion The DAPA study will be the first large , r and omised trial of the cognitive effects of exercise on people with dementia . The intervention is design ed to be capable of being delivered within the constraints of NHS service provision , and the economic evaluation will allow assessment of its cost-effectiveness . Trial registration DAPA was registered with the IS RCT N data base on 29 July 2011 , registration number IS RCT N32612072 The study aim ed to assess the characteristics and reported behaviour change of participants in the BBC 's ' Fighting Fat , Fighting Fit ' ( FFFF ) campaign .  A postal question naire survey was sent to a r and om sample of 6000 adults registering with the FFFF campaign at the start of the campaign and 5 months later .  Demographic characteristics , weight , eating behaviour and activity patterns were assessed . In total , 3661 respondents completed the baseline question naire and 2112 ( 58 % ) of these completed a follow-up evaluation question naire 5 months later . The majority of evaluation participants were women and classified as ' overweight ' or ' obese ' . Participants reported significant reductions in weight , and in fat and snack intake , and significant increases in exercise levels , and in fruit , vegetable and starch intake during the 6 months of the campaign . These effects remained significant if non-responders were assumed to have made no change . These results show that mass-media campaigns might make a contribution to weight control at the population level , but particular subgroups such as men and people under 25 may require specifically targeted campaigns . In addition , whilst such campaigns may initially attract obese people , they may be more likely to drop out of the campaign than overweight and normal weight individuals Although exercise is usually promoted for weight loss and better heart health , there is growing evidence that regular physical activity helps people preserve their mental ability . We describe the results of a pilot longitudinal study addressing the impact of a moderate intensity exercise program on behavioral problems  of frail , elderly , demented patients living in nursing home . Overall , patients in the treatment group ( combination of aerobic/endurance activities , strength training , balance , and flexibility training ) showed a statistically significant reduction in the behavioral problems , such as w and ering , physical and verbal abuse , and in the sleep disorders . As a consequence , a significant reduction in the use of antipsychotic and hypnotic medications was observed in subjects of the treated group . In conclusion , our preliminary results suggest that engaging in regular physical activity , among other health benefits , may delay or prevent the onset of behavior problems in demented frail elderly people living in nursing home Objectives : Women who delay presenting with breast cancer have a reduced chance of survival .  Older women , who are at greater risk of developing breast cancer , are more likely to delay presenting with the disease . The aim of this developmental work was to design a psycho-educational intervention to promote early help-seeking by older women with breast cancer symptoms . We also aim ed to demonstrate the feasibility of implementing the intervention with women attending for their final invited mammogram in the National Health Service ( NHS ) Breast Screening Programme . Methods : The intervention was design ed to address the factors associated with delayed presentation by women with breast cancer . These risk factors were placed in a theoretical framework to underst and patient delay . The intervention incorporated behavioural change techniques that , according to previous research , have been demonstrated to be effective . Results : The intervention was developed in two formats to be delivered by diagnostic radiographers : a booklet alone and a brief interview plus the booklet . The intervention was acceptable to both older women and healthcare professionals in the NHS Breast Screening Programme . Discussion : The intervention will be tested ultimately in a multicentre r and omized controlled trial to determine whether it can reduce the proportion of  older women who delay their presentation  and thereby save lives Background : Promoting the health of transitional frail elders ( e.g. , through therapeutic-based yoga exercises ) is essential to reduce healthcare expenditures caused by chronic health problems . Objective : The purpose of this study was to determine the efficacy of 24 weeks of the senior-tailored silver yoga ( SY ) exercise program for transitional frail elders . Methods : A convenience sample of 69 elders in assisted living facilities were assigned r and omly to the  SY group ( n = 38 ) or to the  control group ( n = 31 ) on the basis of the facilities where they resided , and 55 of them completed this quasi-experimental pretest and posttest study . Intervention was conducted three times per week , 70 minutes per session , for 24 weeks . Physical fitness ( body composition , cardiovascular-respiratory functions , body flexibility , muscle power and endurance , balance , and agility ) were examined at baseline , at 12 weeks , and at the end of the 24th week of the study . Results : At the end of the study , the physical fitness indicators of participants in the SY group had improved significantly , and they had better physical fitness than participants in the control group ( all p values < .05 ) . Discussion : It was recommended that the SY exercises be incorporated as an activity program in assisted living facilities to promote the physical fitness of transitional frail elders Background Despite being a critical survivorship care issue , there is a clear gap in current knowledge of the optimal treatment of  sexual dysfunction in men with prostate cancer . There is sound theoretical rationale and emerging evidence that exercise may be an innovative therapy to counteract sexual dysfunction in men with prostate cancer . Furthermore , despite the multidimensional aetiology of sexual dysfunction , there is a paucity of research investigating the efficacy of integrated treatment models . Therefore , the purpose of this study is to : 1 ) examine the efficacy of exercise as a therapy to aid in the management of sexual dysfunction in men with prostate cancer ; 2 ) determine if combining exercise and brief psychosexual intervention results in more pronounced improvements in sexual health ; and 3 ) assess if any benefit of exercise and psychosexual intervention on sexual dysfunction is sustained long term . Methods / Design A three-arm , multi-site r and omised controlled trial involving 240 prostate cancer survivors will be implemented . Participants will be r and omised to : 1 ) ‘ Exercise ’ intervention ; 2 ) ‘ Exercise + Psychosexual ’ intervention ; or 3 ) ‘ Usual Care ’ . The Exercise group will receive a 6-month , group based , supervised resistance and aerobic exercise intervention . The Exercise + Psychosexual group will receive the same exercise intervention plus a brief psychosexual self-management intervention that addresses psychological and sexual well-being . The Usual Care group will maintain st and ard care for 6 months . Measurements for primary and secondary endpoints will take place at baseline , 6 months ( post-intervention ) and 1 year follow-up . The primary endpoint is sexual health and secondary endpoints include key factors associated with sexual health in men with prostate cancer . Discussion Sexual dysfunction is one of the most prevalent and distressing consequences of prostate cancer . Despite this , very little is known about the management of sexual dysfunction and current health care services do not adequately meet sexual health needs of survivors . This project will examine the potential role of exercise in the management of sexual dysfunction and evaluate a potential best- practice management approach by integrating pharmacological , physiological and psychological treatment modalities to address the complex and multifaceted aetiology of sexual dysfunction following cancer . Trial registration Australian New Zeal and Clinical Trials Registry ACTRN12613001179729 Purpose . To evaluate the feasibility and effects of an exercise programme on people with severe , chronic schizophrenia . Method . A single-group , pre-post pilot study incorporating a baseline familiarisation phase was followed by a 24-week , small-group aerobic exercise programme for up to 30-min each session , twice a week and a 30-min weekly walking session . Adherence was assessed by attendance , and by analysing the exercise supervisor 's comments in a programme diary and in each participant 's exercise logbook . Body weight , cardio-respiratory fitness ( VO2 max ) , walking endurance ( 6-min walk test ) and psychiatric symptoms ( the Positive and Negative Syndrome Scale ) were measured at each time point . Results . Eight participants ( 6 men , 2 women ; mean age 45 years , 9 months ( SD 10 years , 1 month ) ; mean body mass index 27.0 ( SD 4.2 ) ) attended a mean of 73%% of the scheduled exercise sessions , and 83%% of the walking sessions , with no adverse events and no dropouts . All participants displayed positive and negative behaviours during training sessions . There were significant reductions in weight ( 2.4%% ) and body mass index ( 2.2%% ) , but no changes in other measures . Conclusions . It was feasible and safe to conduct a small-group aerobic exercise programme for adults with severe chronic schizophrenia that reduced body weight Background : Two prevalent unmet supportive care needs reported by the non – small cell lung cancer ( NSCLC ) population include the need to manage fatigue and attain adequate exercise to meet the physical dem and s of daily living . Yet , there are no guidelines for routine rehabilitative support to address fatigue and exercise for persons with NSCLC during the critical transition from hospital to home after thoracotomy . Objective : The objective of this study was to evaluate the feasibility , acceptability , safety , and changes in study end points of a home-based exercise intervention to enhance perceived self-efficacy for cancer-related fatigue ( CRF ) self-management for persons after thoracotomy for NSCLC transitioning from hospital to home . Interventions / Methods : Guided by the principles of the Transitional Care Model and the Theory of Symptom Self-management , a single-arm design composed of 7 participants with early-stage NSCLC performed light-intensity walking and balance exercises in a virtual reality environment with the Nintendo Wii Fit Plus . Exercise started the first week after hospitalization for thoracotomy and continued for 6 weeks . Results : The intervention positively impacted end points such as CRF severity ; perceived self-efficacy for fatigue self-management , walking , and balance ; CRF self-management behaviors ( walking and balance exercises ) ; and functional performance ( number of steps taken per day ) . Conclusions : A home-based , light-intensity exercise intervention for patients after thoracotomy for NSCLC is feasible , safe , well tolerated , and highly acceptable showing positive changes in CRF self-management . Implication s for Practice : Beginning evidence suggests that a light-intensity in-home walking and balance intervention after hospitalization for thoracotomy for NSCLC is a potentially effective rehabilitative CRF self-management intervention . Next steps include testing of this health-promoting self-management intervention in a larger-scale r and omized controlled trial Background / Objective : Colorectal and gynecologic cancer survivors are at cardiovascular risk due to comorbidities and sedentary behaviour , warranting a feasible intervention to increase physical activity . The Health Action Process Approach ( HAPA ) is a promising theoretical framework for health behaviour change , and wearable physical activity trackers offer a novel means of self-monitoring physical activity for cancer survivors . Method : Sixty-eight survivors of colorectal and gynecologic cancer will be r and omised into 12-week intervention and control groups . Intervention group participants will receive : a Fitbit Alta ™ to monitor physical activity , HAPA-based group sessions , booklet , and support phone-call . Participants in the control group will only receive the HAPA-based booklet . Physical activity ( using accelerometers ) , blood pressure , BMI , and HAPA constructs will be assessed at baseline , 12-weeks ( post-intervention ) and 24-weeks ( follow-up ) . Data analysis will use the Group x Time interaction from a General Linear Mixed Model analysis . Conclusions : Physical activity interventions that are acceptable and have robust theoretical underpinnings show promise for improving the health of cancer survivors OBJECTIVES Cardiovascular disease ( CVD ) is responsible for 50 % of the excess mortality for patients with RA . This study aim ed to evaluate a novel 8-week cognitive behavioural patient education intervention design ed to effect behavioural change with regard to modifiable CVD risk factors in people with RA . METHODS This was a non-blinded r and omized controlled trial with a delayed intervention arm . Participants were r and omly assigned to receive the cognitive behavioural education intervention or a control information leaflet at a ratio of 1:1 . The primary outcome measure was patient 's knowledge of CVD in RA ; secondary measures were psychological measures relating to effecting behaviour change , actual behaviour changes and clinical risk factors . Data were collected at baseline , 2 and 6 months . RESULTS A total of 110 participants consented ( 52 in the intervention group and 58 in the control group ) to participate in the study . At 6 months , those in the intervention group had significantly higher knowledge scores ( P < 0.001 ) ; improved behavioural intentions to increase exercise ( P < 0.001 ) , eat a low-fat diet ( P = 0.01 ) and lose weight ( P = 0.06 ) ; and lower mean diastolic blood pressure by 3.7 mmHg , whereas the control group 's mean diastolic blood pressure increased by 0.8 mmHg . There was no difference between the groups on actual behaviours . CONCLUSIONS Patient education has a significant role to play in CVD risk factor modification for patients with RA , and the detailed development of this programme probably contributed to its successful results . It is disappointing that behaviours , as we measured them , did not change . The challenge , as always , is how to translate behavioural intentions into action . Larger studies , powered specifically to look at behavioural changes , are required . Trial registration . National Institute for Health Research , UKCRN 4566 BACKGROUND Many people with mental health problems do not seek professional help but their use of other sources of help is unclear . AIMS To investigate patterns of lay and professional help-seeking in men and women aged 16 - 64 years in relation to severity of symptoms and socio-demographic variables . METHOD Postal question naire survey , including the 12-item General Health Question naire ( GHQ-12 ) , sent to a stratified r and om sample ( n=15,222 ) of the population of Somerset . RESULTS The response rate was 76 % . Only 28 % of people with extremely high GHQ-12 scores ( > or = 8) had sought help from their general practitioner but most ( 78 % ) had sought some form of help . Males , young people and people living in affluent areas were the least likely to seek help . CONCLUSIONS Health promotion interventions to encourage appropriate help-seeking behaviour in young people , particularly in men , may lead to improvements in the mental health of this group of the population INTRODUCTION The aim of this study was to investigate the knowledge , attitudes and behaviour of university students regarding acquired immunodeficiency syndrome ( AIDS ) and the human immunodeficiency virus ( HIV ) . METHODS A r and omised controlled trial of 530 university students was done using  peer-adult facilitators . Participants completed a question naire before and after the intervention , which was a four-hour group session . A prevention programme was developed by local experts , health educators and peer facilitators . The peer-adult-led programme was design ed to provide a conceptual model of HIV risk reduction through information , motivational and behavioural skills , a harm reduction module and health promotion theme . RESULTS The main outcome measured was the level of knowledge , attitudes and behaviour scores . The results suggest that relative to the control group , participants in the intervention group had higher levels of knowledge ( 30.37 vs. 25.40 ; p-value is 0.001 ) and a better attitude ( 12.27 vs. 10.84 ; p-value is 0.001 ) . However , there was no difference in the behavioural score ( 9.47 vs. 9.41 ; p-value is 0.530 ) . The correlation between the level of knowledge and age and the level of education was found in the intervention group , but not in the control group ( p-value is 0.01 ) . Attitude and gender were found to be correlated in the intervention group only ( p-value is 0.01 ) . CONCLUSION Our programme was successful in increasing knowledge and improving attitudes towards AIDS and HIV . However , it did not improve risk-taking behaviour .  Peer-adult-led educational programmes for youth using various interactional activities , such as small group discussion s , poster activity and empathy exercises , can be successful in changing the prevailing youth perceptions of AIDS and HIV OBJECTIVE To assess the effectiveness of a primary care referral scheme on increasing physical activity at 1 year from referral . Design Two-group r and omized controlled trial recruiting primary care referrals to a borough-based exercise scheme . Setting A local authority borough in the north-west of Engl and . Participants 545 patients defined as sedentary by a primary care practitioner . Intervention Referral to a local-authority exercise referral scheme and written information compared with written information only . Main outcome measures Meeting physical activity target at 12 months following referral , with a secondary outcome measured at 6 months from referral . RESULTS At 12 months , a non-significant increase of 5 per cent was observed in the intervention compared with control group , for participation in at least 90 minutes of moderate/vigorous activity per week ( 25.8 versus 20.4 per cent , OR 1.45 , 0.84 to 2.50 , p = 0.18 ) . At 6 months , a 10 per cent treatment effect was observed which was significant ( 22.6 versus 13.6 per cent , OR 1.67 , 1.08 to 2.60 , p = 0.05 ) . The intervention increased satisfaction with information but this did not influence adherence with physical activity . CONCLUSION Community-based physical activity referral schemes have some impact on reducing sedentary behaviour in the short-term , but which is unlikely to be sustained and lead to benefits in terms of health The benefits of exercise and behavioural recommendations in gestational diabetes mellitus ( GDM ) are controversial . In a r and omized trial with a 2 × 2 factorial design , we examined the effect of exercise and behavioural recommendations on metabolic variables , and maternal/neonatal outcomes in 200 GDM patients . All women were given the same diet : group D received dietary recommendations only ; group E was advised to briskly walk 20‐min/day ; group B received behavioural dietary recommendations ; group BE was prescribed the same as B + E.  Dietary habits improved in all groups . In a multivariable regression model , fasting glucose did not change . Exercise , but not behavioural recommendations , was associated with the reduction of postpr and ial glucose ( p < 0001 ) , glycated haemoglobin ( HbA1c ; p < 0.001 ) , triglycerides ( p = 0.02 ) and C‐reactive protein ( CRP ; p < 0.001 ) and reduced any maternal/neonatal complications ( OR = 0.50 ; 95%CI=0.28–0.89;p = 0.02 ) . In GDM patients  a simple exercise programme reduced maternal postpr and ial glucose , HbA1c , CRP , triglycerides and any maternal/neonatal complications , but not fasting glucose values UNLABELLED The central purpose of pulmonary rehabilitation is to reduce morbidity by improving functional capacity through exercise . It is still unknown if improvements in functional capacity are maintained in the long-term and if this leads to increased physical activity levels as measured by a free-living activity monitor . The hypothesis of this study was that pulmonary rehabilitation would lead to a sustained increase in st and ard outcome measures and in daily physical activity . METHODS A prospect i ve study of 47 subjects with COPD was performed , registered at Clinical Trials.gov ( Clinical Trial Number NCT 0112943 ) . The primary outcome was a maintained improvement in st and ard outcome measures with a secondary aim of an increase in daily physical activity . A convenient sample of the cohort ( n = 17 ) was re-evaluated at a third time point at 1 year . RESULTS A seven week hospital based outpatient pulmonary rehabilitation program led to a significant reduction in total energy expenditure ( p < 0.044 ) and breathlessness ( Borg , p < 0.011 ) and improved exercise capacity ( ISWT , p > 0.001 , 6MWT , p > 0.002 ) PiMax ( p > 0.007 ) and quality of life scores ( SGRQ , p > 0.001 , EQ5D , 0.025 ) . However , pulmonary rehabilitation did not significantly change the average number of daily steps taken , time spent sedentary activity , METs consumed or daily physical activity . Indeed , all of the st and ard and freeliving values had returned towards the baseline value at 1 year . DISCUSSION These findings show that while pulmonary rehabilitation increased exercise capacity this was not transmitted into increased daily physical activity . Hence , alternative methods to alter/affect behavioural change need to be addressed Subjects and design : The study was based on the total patient sample ( n=110 ) of a r and omized controlled trial comparing two intervention methods advising cardiovascular high-risk men of lifestyle changes in general practice . Behaviour and risk factor changes during the one-year intervention study were analysed using multiple regression and logistic regression analyses with the above-mentioned independent variables . Setting : Twenty-two general practice centres in the county of Hordal and , western Norway . Results : Self-efficacy of increased physical exercise was the only variable significantly related to exercise change . Age and self-efficacy were statistical significant predictors of smoking cessation success . None of the independent variables was statistically significantly related to blood pressure or cholesterol change . Educational level related negatively , although statistically insignificantly , with total risk change . Conclusion : The study confirms the importance of self-efficacy in both human behaviour and motivation for behaviour change . Objectives : The objectives of the study were to explore the impact of possible predictors for cardiovascular risk behaviour change ; predictors such as education , age , self-efficacy , doctors ' interpersonal skills , and number of appointments BACKGROUND Sedentary lifestyle is associated with adverse health outcomes . Available evidence suggests that , despite positive attitudes toward regular exercise in promoting a healthy lifestyle , few physicians actually prescribe exercise for their patients . Barriers include lack of skills and st and ard office instruments . Because primary care physicians have regular contact with a large proportion of the population , the impact of preventive health interventions may be great . OBJECTIVES To determine the effect of an exercise prescription instrument ( i.e. , Step Test Exercise Prescription [ STEP ] ) , compared to usual-care exercise counseling delivered by primary care doctors on fitness and exercise self-efficacy among elderly community-dwelling patients . DESIGN R and omized controlled trial ; baseline assessment and intervention delivery with postintervention follow-up at 3 , 6 , and 12 months . SETTING Four large ( > 5000 active patient files ) academic , primary care practice s : three in urban setting s and one in a rural setting , each with four primary care physicians ; two clinics provided the STEP intervention and two provided usual care control . PARTICIPANTS A total of 284 healthy community-dwelling patients ( 72 per clinic ) aged > 65 years were recruited in 1998 - 1999 . INTERVENTION STEP included exercise counseling and prescription of an exercise training heart rate . MAIN OUTCOME MEASURES The primary outcome measure was aerobic fitness ( VO(2max ) ) . Secondary outcomes included predicted VO(2max ) from the STEP test , exercise self-efficacy ( ESE ) , and clinical anthropometric parameters . RESULTS A total of 241 subjects ( 131 intervention , 110 control ) completed the trial .  VO(2max ) was significantly increased in the STEP intervention group ( 11 % ; 21.3 to 24ml/kg/min ) compared to the control group ( 4 % ; 22 to 23ml/kg/min ) over 6 months ( p < 0.001 ) , and 14 % ( 21.3 to 24.9ml/kg/min ) and 3 % ( 22.1 to 22.8ml/kg/min ) , respectively , at 12 months ( p < 0.001 ) . A similar significant increase in ESE ( 32 % ; 4.6 vs 6.8 ) was observed for the STEP group compared to the control group ( 22 % ; 4.2 vs 5.4 ) at 12 months ( p < 0.001 ) . Systolic blood pressure decreased 7.3 % and body mass index decreased 7.4 % in the STEP group , with no significant change in the control group ( p < 0.05 ) . Exercise counseling time was significantly ( p < 0.02 ) longer in the STEP ( 11.7+/-3.0 min ) compared to the control group ( 7.1+/-7.0 min ) , but more ( p < 0.05 ) subjects completed > or = 80 % of available exercise opportunities in the STEP group . CONCLUSIONS Primary care physicians can improve fitness and exercise confidence of their elderly patients using a tailored exercise prescription ( e.g. , STEP ) . Further , STEP appears to maintain benefits to 12 months and may improve exercise adherence . Future study should determine the impact of combining cognitive/behavior change strategies with STEP Breast cancer is the most prevalent type of cancer in American women .  Exercise appears to diminish many of the side effects result ing from breast cancer and its treatment . Very little research , however , has compared the outcomes of varying lengths of combined aerobic and resistance training exercise interventions on physiological and psychological parameters in breast cancer survivors . The purpose of this study was to compare the physiological and psychological outcomes following 3 and 6 months of exercise in breast cancer survivors . Breast cancer survivors ( N = 114 ) participated in either 3 months of prescriptive , individualized exercise ( 3 M ; n = 29 ) , 6 months of prescriptive , individualized exercise ( 6 M ; n = 68 ) , or served as sedentary controls  ( C ; n = 17 ) . Cancer survivors completed a medical evaluation and assessment at baseline followed by a predetermined 3- or 6-month exercise intervention .  Cancer survivors in the control group performed no exercise between the initial assessment and 6-month re assessment . Cardiovascular endurance , pulmonary function , muscular endurance , fatigue , and symptoms of depression were assessed at baseline and post intervention . Repeated measures ANCOVA revealed improvements ( P < 0.05 ) in cardiovascular endurance , fatigue , and symptoms of depression in breast cancer survivors undergoing 3- and 6-month individualized exercise interventions . Breast cancer survivors exercising for 6 months showed additional improvements ( P < 0.05 ) in pulmonary function and muscular endurance . Cancer survivors in the control group did not improve in cardiovascular endurance , pulmonary function , muscular endurance , or fatigue . Three months of individualized , prescriptive exercise leads to improved cardiovascular endurance , fatigue , and symptoms of depression in breast cancer survivors . Additional benefits are seen if exercise is continued for a total of 6 months AIM The objective of this study was to determine whether regular combined exercise program , which consists strength , stretching and aerobic exercises and additional jumping training , improve balance , fall risk , quality of life and depression status of older people living in a residential care . METHODS A total of 168 residents who live in a long term care facility were screened . The trial began with 78 eligible participants and they were r and omly grouped as combined exercises program ( COM ) group that includes stretching , strength and aerobic exercises , and COM plus jumping ( COMpJ ) group . 66 of the participants finished the trial . The groups were convened three times a week for six weeks . Each group had a warm-up , effective training and a cooling down periods . The total exercising time was no longer than 45 minutes in each group . Berg balance test and Biodex Balance System for the assessment of the dynamic balance and fall risk , short form 36 ( SF 36 ) for the health related quality of life and Geriatric Depression Scale ( GDS ) for evaluation of the depression status were used . RESULTS The balance improvement and fall risk reduction were observed in both of the groups at the end of the trial ; however , the improvements were statistically better in jumping combined group . Also health related quality of life improved in both groups . CONCLUSION Regular group exercise in a long term care facility have several beneficial effects on the elderly residents in regard to balance improvement , fall risk reduction and quality of life . The addition of jumping to strength , stretching and aerobic exercises provides important contributions to balance improvement and fall risk reduction Background Type 2 diabetes is a major public health problem in Australia with prevalence increasing in parallel with increasing obesity . Prevention is an essential component of strategies to reduce the diabetes burden . There is strong and consistent evidence from r and omised controlled trials that type 2 diabetes can be prevented or delayed through lifestyle modification which improves diet , increases physical activity and achieves weight loss in at risk people . The current challenge is to translate this evidence into routine community setting s , determine feasible and effective ways of delivering the intervention and providing on-going support to sustain successful behavioural changes . Methods / Design The Sydney Diabetes Prevention Program ( SDPP ) is a translational study which will be conducted in 1,550 participants aged 50 - 65 years ( including 100 indigenous people aged 18 years and older ) at high risk of future development of diabetes . Participants will be identified through a screening and recruitment program delivered through primary care and will be offered a community-based lifestyle modification intervention . The intervention comprises an initial individual session and three group sessions based on behaviour change principles and focuses on five goals : 5 % weight loss , 210 min/week physical activity ( aerobic and strength training exercise ) , limit dietary fat and saturated fat to less than 30 % and 10 % of energy intake respectively , and at least 15 g/1000 kcal dietary fibre . This is followed by 3-monthly contact with participants to review progress and offer ongoing lifestyle advice for 12 months . The effectiveness and costs of the program on diabetes-related risk factors will be evaluated . Main outcomes include changes in weight , physical activity , and dietary changes ( fat , saturated fat and fibre intake ) . Secondary outcomes include changes in waist circumference , fasting plasma glucose , blood pressure , lipids , quality of life , psychological well being , medication use and health service utilization . Discussion This translational study will ascertain the reach , feasibility , effectiveness and cost-effectiveness of a lifestyle modification program delivered in a community setting through primary health care . If demonstrated to be effective , it will result in recommendations for policy change and practical methods for a wider community program for preventing or delaying the onset of type 2 diabetes in high risk people Background Modifiable behavioural risk factors — including exercise , obesity and smoking — have been causally associated with  colorectal cancer mortality . However , results have been inconsistent and undiagnosed cancers may affect baseline risk factors , distorting the temporal relationship that is observed between them . Objective To determine whether risk factors for colorectal cancers available in the Whitehall I study were predictive of colonic or rectal cancer mortality . Methods Prospect i ve cohort study over 40 years on Whitehall I men aged 40–69 on entry between 1967 and 1970 . Associations between baseline risk factors and cause-specific mortality were tested with Cox proportional hazards models . Events within the first 10 years of follow-up were excluded to minimise ‘ reverse causality . ’ Results 329 colon and 121 rectal cancer deaths occurred among 17 949 men followed up for a total of 472 523 person-years . Age and smoking were associated with increased mortality from colorectal cancers . Compared with never-smokers , current smoking was associated with age-adjusted HRs for colon and rectal cancers of 1.45 ( 95 % CI 1.03 to 2.03 ) and 1.97 ( 95 % CI 1.02 to 3.80 ) , respectively . A significant effect of current smoking on rectal cancer mortality was only apparent after events in the first 10 years of follow-up were excluded . No convincing evidence was found that body mass index , diabetes mellitus , blood pressure or physical activity were associated with colorectal cancer mortality . Conclusion Smoking significantly increases mortality from colorectal cancer  and its decreasing prevalence in the UK may partly explain falling mortality from the disease . Changes in health behaviours in response to early cancer symptoms may result in differential misclassification or ‘ reverse causality ’ unless early events are excluded . Although many individual cohort studies have not shown significant relationships between behavioural risk factors and colorectal cancer mortality , their contribution to meta-analyses remains important OBJECTIVES The purpose of this study was to evaluate the effects of multicomponent school based intervention constituted of diet modification , regular exercise and psychosocial consultation on body status in overweight and obese children and adolescents . And to come up with an appropriate intervention protocol for controlling children and adolescents obesity in Shantou city . METHODS Two schools were r and omised to intervention group and control group respectively . A total of 41 students enrolled were diagnosed as overweight or obese . Twenty-six students of the intervention group completed the one-year intervention programme consisted of diet modification , regular exercise and psychological consultation except two of them were transferred to another school . The differences of BMI , anthropometric measures , metabolic profile and the scores of question naire and the scale were compared to evaluate the effects of the intervention programme . RESULTS After one-year intervention , it observed in the intervention group that BMI -Z score , WHR and WHtR had significant improvements , and there was a nonsignificant trend ( P=0.053 ) for a decrease in BMI -P. Fasting plasma glucose , cholesterol ( CH ) and low-density-lipoprotein cholesterol ( LDL-C ) levels in the intervention group showed nonsignificant trend for a decrease ( PFPG=0.084 , PCH=0.057 , PLDLC=0.098 ) , compared with a significant increase of triglycerides ( TG ) and LDL-C levels in the control group ( PTG=0.041 , PLDL-C=0.038 ) . There were some positive dietary , physical activity , or sedentary behaviour changes found in the students of the intervention group as the scores of the question naire got significant improvement ( P=0.04 ) . CONCLUSIONS Our one-year multicomponent school-based intervention programme did have positive effects to some extents on health state and lifestyle behaviour of overweight and obese children and adolescents , which indicated that it is feasible and important to implement such a school-based intervention programme in Shantou city
Interventions to promote exercise in cancer survivors who report better levels of adherence share some common behaviour change techniques .
These involve setting programme goals , prompting practise and self-monitoring and encouraging participants to attempt to generalise behaviours learned in supervised exercise environments to other , non-supervised context s. However , expecting most sedentary survivors to achieve current guideline recommendations of at least 150 minutes per week of aerobic exercise is likely to be unrealistic .
BACKGROUND The beneficial effects of regular exercise for people living with or beyond cancer are becoming apparent .
However , how to promote exercise behaviour in sedentary cancer cohorts is not as well understood .
A large majority of people living with or recovering from cancer do not meet exercise recommendations .
Hence , review ing the evidence on how to promote and sustain exercise behaviour is important .
OBJECTIVES To assess the effects of interventions to promote exercise behaviour in sedentary people living with and beyond cancer and to address the following questions : Which interventions are most effective in improving aerobic fitness and skeletal muscle strength and endurance ?
What adverse effects are attributed to different exercise interventions ?
Which interventions are most effective in improving exercise behaviour amongst patients with different cancers ?
Which interventions are most likely to promote long-term ( 12 months or longer ) exercise behaviour ?
What frequency of contact with exercise professionals is associated with increased exercise behaviour ?
What theoretical basis is most often associated with increased exercise behaviour ?
What behaviour change techniques are most often associated with increased exercise behaviour ?