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Background: Researchers and policy-makers have highlighted that the potential for organized sports to promote health has been underexploited. Sports clubs have limited capacity to promote health due to their voluntary nature and have called for support from their national sports federations. The present article provides guidelines, based on the theoretical principles of health promoting sports clubs and an analysis of practical tools and proven strategies, to support national sports federations to invest in health promotion (HP). Methods: A qualitative iterative study was undertaken, based on five 2-h meetings of a group of 15 international researchers in HP in sports clubs. Notes and minutes from meetings, as well as shared outputs were analyzed based on the health promoting sports club framework. Results: Guidelines developed for national sports federations to promote health includes a definition of a health promoting sports federation (HPSF), a description of how the settings-based approach to HP adapts to national sports federations, as well as practical applications of health promoting sports club’s intervention strategies. The analysis of existing tools also demonstrated that most tools are centered on a single dimension of health (social, mental, physical, spiritual or community), and often on a specific health topic. Furthermore, they do not cover HP as a continuous long-lasting process, but are generally short-term programs. The HPSF clarifies theoretical concepts, their practical implementation via case studies and outlines intervention components and tools useful for sports federations in their implementation of HP. Conclusion: The guidelines developed in this study are intended to facilitate national sports federations to acknowledge/understand, reinforce/underpin and foster current and further investment in HP. peerReviewed

Background Sports clubs have requested support from national governing authorities to invest in health promotion (HP), by developing policies, guidelines and dedicated funding. This article outlines the development of a national audit tool to review policies development and implementation to support HP in sports clubs. Methods A five-step process was undertaken by an international project team: (i) a rapid literature review to identify items assessing policies in physical activity, HP and sports, (ii) a thematic analysis to categorize items, (iii) a Delphi method to analyze item relevance, country specificity, reformulation, validation and organization, (iv) face validity through an online survey and in-depth interviews with expert representatives on physical activity and sports and (v) audit tool finalization though project team consensus. Results Eight sources were reviewed with 269 items identified. Items were coded into 25 categories with 3 broad themes: policies, actors and settings-based approach. The Delphi study extracted and refined 50 items and categorized them into 10 sections. After revisions from 22 surveys and 8 interviews, consensus was reached by the international project team on 41 items categorized into 11 sections: Role of ministry or department; Policies; Communication; Implementation and Dissemination; Evaluation and Measurement methods; Sub-national-level policies; Funding and Coordination; Participative approach; Actors and Stakeholders; National sporting events; Case studies and Implicated stakeholders. Conclusion To progress HP in the sports club context it is necessary to understand existing national-level policies. This national audit tool will aid in monitoring and assessing national policies for health promoting sports clubs.

The symposium presents last findings on health promotion interventions in sports clubs. After a short introduction about the health promoting sports clubs (HPSC), five presentations (France, Sweden, Ireland, Finland and Netherlands) will reflect upon how sports clubs can be health promoting: in theory, from youth perspectives, by increasing physical activity level as outcome or enhancing sustainability of interventions, before opening the discussion with academic experts. Presentation 1 describes an iterative international process, implicating three groups (French sport students, French and Swedish experts) to create an intervention theory, based on the HPSC model. Presentation 2 focuses on a cross-sectional study investigating 123 Swedish youth's representation of sports clubs' role towards health promotion, identifying social dimension, environment, coaches, amount and ambition of practice as key factors. Presentation 3 is a longitudinal study among 366 adolescents, followed from age 15 to age 19, questioning the participation to organised sport practice and their orientation (leisure or competitive). Results have shown that by the age of 19, 33% of boys and 43% of girls have dropped out of organised sport, where 45% of boys and 26% of girls continued participation. Adolescents with a competitive goal orientation were more likely to continue participation. Presentation 4 is a longitudinal study among 131 youth measuring objective physical activity before and in the middle of a sport season. Principal results showed a significant change across time point, as well as differences between gender (a decrease in moderate to vigorous physical activity during games for boys and an increase for girls). Presentation 5 examined factors that influenced the sustainability of 14 Dutch sporting program aimed at increasing physical activity among inactive people 6.5 years after their implementation. Interviews with representatives of Dutch National Sports Federations and sports clubs helped to identify facilitating and impeding factors, like program adaptation, evaluation, financing and factors related to human resources. Question and Answer will be organised around the key ingredients and challenges facing the development of HPSC interventions, such as implementation of theoretical background, sport participants need consideration, complexity of outcomes evaluation of HPSC and program sustainability. nonPeerReviewed

International audience; Introduction Even if indications for mastectomy have been progressively reduced in loco-regional breast cancer (BC) treatment, the harmful effects of surgery are still numerous and can impact physical and psychological wellbeing of women. The RIPOSTE (Reconstruction, self-Image, Posture, Oncology, “Santé”-Health, Therapy, “Escrime”-Fencing) program aimed to propose adapted fencing to patients with BC. This study aims to investigate the effect and conditions of effectiveness of the RIPOSTE program. Methods and analysis This is a prospective randomized controlled trial including 24 patients with invasive BC who have just undergone surgery. The study will be proposed to the patient and if interested, the patient will be referred to a sports physician for a medico-sportive evaluation. At the end the evaluation, if the patient meets the inclusion criteria, she will be randomly assigned to one of the 2 groups based on a 1:1 principle: Early RIPOSTE group (receive one fencing session per week for 3 months immediately after their inclusion), Delayed RIPOSTE group (receive one fencing session per week for 3 months but within the 3 months following their inclusion). Patients will be included for 6 months with 3 follow-up times (0, 3, and 6 months) by a sport physician. The primary outcome is the evolution of quality of life score. Secondary outcomes are disability score, fatigue, anxiety-depression, cost-effectiveness and process evaluation. Ethics and dissemination The study protocol has been approved by a French ethics committee (CPP Sud Méditerranée IV, N°ID-RCB: 2020-A01916-33). Results will be submitted for publication, at scientific conferences and through press releases. Trial Registration NCT04627714.

IntroductionPhysical activity among children and adolescents remains insufficient, despite the substantial efforts made by researchers and policymakers. Identifying and furthering our understanding of potential modifiable determinants of physical activity behaviour (PAB) and sedentary behaviour (SB) is crucial for the development of interventions that promote a shift from SB to PAB. The current protocol details the process through which a series of systematic literature reviews and meta-analyses (MAs) will be conducted to produce a best-evidence statement (BESt) and inform policymakers. The overall aim is to identify modifiable determinants that are associated with changes in PAB and SB in children and adolescents (aged 5–19 years) and to quantify their effect on, or association with, PAB/SB.Methods and analysisA search will be performed in MEDLINE, SportDiscus, Web of Science, PsychINFO and Cochrane Central Register of Controlled Trials. Randomised controlled trials (RCTs) and controlled trials (CTs) that investigate the effect of interventions on PAB/SB and longitudinal studies that investigate the associations between modifiable determinants and PAB/SB at multiple time points will be sought. Risk of bias assessments will be performed using adapted versions of Cochrane’s RoB V.2.0 and ROBINS-I tools for RCTs and CTs, respectively, and an adapted version of the National Institute of Health’s tool for longitudinal studies. Data will be synthesised narratively and, where possible, MAs will be performed using frequentist and Bayesian statistics. Modifiable determinants will be discussed considering the settings in which they were investigated and the PAB/SB measurement methods used.Ethics and disseminationNo ethical approval is needed as no primary data will be collected. The findings will be disseminated in peer-reviewed publications and academic conferences where possible. The BESt will also be shared with policy makers within the DE-PASS consortium in the first instance.Systematic review registrationCRD42021282874.

International audience; Socioeconomic factors and physical activity (PA), have been recognized as key factors affecting survival and quality of life of cancer patients. Nevertheless, less is known about their interactions among cancer patients. A mapping systematic review was undertaken to identify gaps in the literature regarding the interactions of socioeconomic factors and PA and the identification of theoretical model to define this relationship. A search for peer-reviewed English articles published between January 2010 and March 2020 in Medline, PsycINFO, Web of Science and SportDiscus databases was realized using three keywords: physical activity, cancer, socioeconomic. Cancer location and time, socioeconomic factor measurement, PA measurement, intervention and theoretical model were analyzed. Of the 5163 articles found, 90 were included (86 observational studies and 4 interventions). While many studies evaluate socioeconomic factors and PA, authors often do not consider their interactions, but test them separately. Socioeconomic factors identified in the studies ranged among 12 categories(age, sex, ethnicity, education, income, occupation, residence, green space exposure, marital status, household, social support, Health insurance). A high diversity of measurements within each category led to a huge variation in the definition of socioeconomic factors and refrained comparison between studies. Similar conclusions could be drawn with regard to the diversity of PA measurements. Only few studies mobilized theoretical models, without considering the interactions between socioeconomic factors and PA. The definition of socioeconomic factors as well as theoretical modeling of how socioeconomic factors interact with PA among cancer patients needs to be clarified.

International audience; Problem Statement: Previous works have questioned the function of assessing and its influence on students' perception of the assessment. Depending on whether the assessment is summative or formative, the impact on learning and emotions may be different. However, few studies have been conducted in a physical education context where learning could be both cognitive and motor. Purpose: The purpose of this pilot study is to compare the effects of summative and formative assessments on students' state-anxiety, and shot-put performance in physical education. Method: Twenty-one high school students in a formative assessment class (M age = 14.95; SD age = .50) and twenty-two in a summative assessment class (M age = 15.14; SD age = .64) participated in the study. The students' characteristics between the two classes were not statistically different. Students filled out questionnaires measuring trait-anxiety and state-anxiety. State-anxiety was measured at the beginning of the lesson. Performance was evaluated through one shot-put attempt at the end of the lesson. Data collection was carried out in three phases: during the first lesson (i.e., beginning of the learning cycle), during the fifth lesson (i.e, end of the learning cycle), and during a deferred evaluation (i.e., four months later). Non-parametric tests were performed. Results: There was no difference in trait-anxiety between the two classes. At the beginning of the learning cycle, there was no difference in state-anxiety or performance. Results show that at the end of the learning cycle, both classes improved their performance. The formative assessment class felt less anxiety than the summative assessment class.Four months later, the summative assessment class's performance had improved, whereas the formative assessment class's performance had remained at the same level. Additionally, the summative assessment class's anxiety remained at the same level, whereas the formative assessment class's anxiety improved. Conclusion: These results can help physical education teachers to design more successful learning and emotional experiences during the learning cycle, focusing more on providing formative assessment. This paper also adds to the debate around formative good/summative bad, questioning the short-and medium-term benefits and drawbacks of formative and summative assessment.

International audience; BACKGROUND:Many effective physical activity (PA) interventions have focused on individual factors or a single theoretical model, limiting our understanding of the determinants of PA practice and their interactions in the cancer trajectory. The present mixed-method study aims to capture social and psychological determinants of PA practice from diagnosis to remission among cancer patients, and to identify key levers for PA practice.METHODS/DESIGN:A nested sequential mixed-method design QUAN (QUAL+QUAL) will be used, with qualitative studies embedded in the quantitative study to broaden our understanding of the determinants of PA practice. The design is sequential, since qualitative data on medical staff will be collected before patient inclusion (Phase 1), followed by quantitative patient data collection lasting one year (Phase 2) and a final qualitative data collection one year after inclusion (Phase 3). Phase 1 will be a case study in the two hospitals involved in the study, exploring knowledge of and support for PA practice among medical staff. Through interviews and documental analyses, the PA support dynamic will be evaluated with regard to PA prescription. Phase 2 will be a one-year observational study among 693 cancer patients. Quantitative medical, social, dispositional and psychological data, PA practices and preferences, will be collected at diagnosis, and six months and one year thereafter. Phase 3 will be a retrospective study, evaluating societal and policy factors, as well as unexpected factors playing a role in PA levels and preferences among cancer patients. For this phase thirty patients will be identified six months after inclusion on the basis of their PA profiles. Quantitative data will provide the main dataset, whilst qualitative data will complete the picture, enabling determinants of PA practice and their interactions to be captured throughout the cancer trajectory.DISCUSSION:The present study aims to identify key levers and typical trajectories for PA practice among cancer patients, adapted to different times in the course of cancer and taking into account "what works", "for whom", "where" and "how". The challenge is the tailoring of PA interventions to patients at different times in their cancer trajectory, and the implication of medical staff support.TRIAL REGISTRATION:Clinical Trial NCT03919149 , 18 April 2019. Prospectively registered.

International audience

International audience; BACKGROUND: Connected health devices and applications (referred to hereafter as "SDApps" - Smart devices and applications) are being portrayed as a new way for prevention, with the promise of accessibility, effectiveness and personalization. Many effectiveness evaluations (experimental designs) with strong internal validity exist. While effectiveness does appear to vary, the mechanisms used by these devices have not yet been thoroughly investigated. This article seeks to unpack this black box, and describes the process of elaboration of an intervention theory for healthy eating and physical activity SDApps. It includes a set of requirements relative to their impact on social health inequalities.METHODS: To build this theory, we drew on theory-driven approaches and in particular on the theory of change (ToC) method. To this end, we developed a cumulative and iterative process combining scientific data from the literature with knowledge from experts (researchers and practitioners) and from patients or users. It was a 3-step process, as follows: 1 - identifying the evidence base; 2 - developing the theory through design intervention and creating realistic expectations, including in our case specific work on social health inequalities (SHIs); 3 - modeling process and outcome.RESULTS: We produced an evidence-based theory according to the ToC model, based on scientific evidence and knowledge from experts and users. It sets out a causal pathway leveraging 11 key mechanisms - theoretical domains - with which 50 behavior change techniques can be used towards 3 ultimate goals: Capacity, Opportunity, Motivation - Behavior (COM-B). Furthermore, the theory specifically integrates requirements relative to the impact on SHIs.CONCLUSIONS: This theory is an aid to SDAapp design and evaluation and it can be used to consider the question of the possible impact of SDApps on the increase in inequalities. Firstly, it enables developers to adopt a more overarching and thorough approach to supporting behavior change, and secondly it encourages comprehensive and contributive evaluations of existing SDApps. Lastly, it allows health inequalities to be fully considered.

International audience

Implementation and evaluation of a health promotion program in sport clubs: "Promoting Adolescent Physical Activity" The benefits of sport participation have been demonstrated (OMS, 1995). Despite this statement, not all participants have a positive sport experience. To foster this type of experience, this doctoral thesis is composed of three aims : (1) an analysis of sport clubs contribution to health promotion (HP), (2) the evaluation of the effects and (3) process of an intervention based on self-determination and achievement goal theories to foster positive and long term sport involvement: the “Promoting Adolescent Physical Activity” intervention. Two studies have been realised to better understand the role sport clubs can play to HP. The first analyse the representation of sport clubs HP actions and mission of 125 grassroots coaches, underlining that sport clubs could be more active concerning HP policies and practices. The second question the contribution of sport participation to help 331 youth football players to reach WHO's physical activity (PA) recommendations (2010), showing that sport participation might favour participants' PA. The effects of the intervention have been evaluated trough a cluster-randomised trial including 617 players (339 in the experimental group and 278 in the control group). Results have shown that in comparison to the control group, players in the experimental condition have a more positive evolution of their motivational climate, the satisfaction of their competence need, a self-determination index (SDI) and self-esteem, as well as a decrease of their dropout intentions and behaviours. Controlling for Time 1, the intervention has an effect on sport experience fully mediated by the climate, which is partially mediated by basic needs satisfaction and a SDI. The process evaluation has shown that coach expert training to deliver our intervention was effective, that the intervention has no effect at the organisational level, but a correct implementation score. The individual implementation score is moderate., Implémentation et évaluation d'un programme de promotion de la santé au sein de clubs sportifs : « Promouvoir l'Activité Physique des Adolescents » La pratique sportive est considérée comme bénéfique pour la santé (OMS, 1995). Malgré ce constat, tous les jeunes ne bénéficient pas d'expérience sportive positive. Pour encourager ce type d'expérience, ce travail doctoral est composé de trois parties : (1) une analyse de la contribution du club sportif à la promotion de la santé, (2) l'évaluation des effets et (3) du processus d'implémentation d'une intervention basée sur la théorie de l'autodétermination et la théorie des buts d'accomplissement visant une expérience sportive positive et durable : le programme « Promouvoir l'Activité Physique des Adolescents ». Pour apprécier la contribution du club sportif à la promotion de la santé, 2 études ont été réalisées. La première analyse les représentations de 125 éducateurs des missions et actions de promotion de la santé des clubs sportifs, concluant que le club pourrait être plus actif en termes de politique et de pratiques. La seconde, évaluant la contribution de la pratique sportive pour atteindre les recommandations en termes d'activité physique (AP ; OMS, 2010) auprès de 331 jeunes footballeurs, observe que la pratique sportive semble favoriser la pratique d'AP. L'évaluation des effets de l'intervention a été réalisée à l'aide d'une étude contrôlée randomisée auprès de 617 joueurs (339 du groupe expérimental et 278 du groupe expérimental). Les résultats montrent qu'en comparaison au groupe contrôle, les joueurs entraînés par un éducateur formé ont une évolution plus positive de la perception du climat motivationnel, de la satisfaction du besoin de compétence, de leur motivation autodéterminée, de l'estime de soi, et de moindres intentions et un taux d'abandon plus faible. En contrôlant le niveau au 1er temps de mesure, la formation a un effet sur l'expérience sportive médiatisée complètement par le climat motivationnel qui est partiellement médiatisé par la satisfaction de besoins et la motivation. L'évaluation du processus montre que la formation de formateurs pour délivrer notre intervention est efficace, que l'intervention un taux correct d'implémentation. Le taux d'implémentation individuel est modéré.

Introduction: Physical activity among children and adolescents remains insufficient, despite the substantial efforts made by researchers and policymakers. Identifying and furthering our understanding of potential modifiable determinants of physical activity behaviour (PAB) and sedentary behaviour (SB) is crucial for the development of interventions that promote a shift from SB to PAB. The current protocol details the process through which a series of systematic literature reviews (SLRs) and meta-analyses (MAs) will be conducted to produce a best-evidence statement (BESt) and inform policy makers. The overall aim is to identify modifiable determinants that are associated with changes in PAB and SB in children and adolescents (aged 5-19 years) and to quantify their effect on, or association with, PAB/SB.\ud \ud Methods and analysis: A search will be performed in MEDLINE, SportDiscus, Web of Science, PsychINFO and Cochrane Central Register of Controlled Trials. Randomized controlled trials (RCTs) and controlled trials (CTs) that investigate the effect of interventions on PAB/SB and longitudinal studies that investigate the associations between modifiable determinants and PAB/SB at multiple time points will be sought. Risk of bias assessments will be performed using adapted versions of Cochrane’s RoB 2.0 and ROBINS-I tools for RCTs and CTs, respectively, and an adapted version of the National Institute of Health’s tool for longitudinal studies. Data will be synthesised narratively and, where possible, MAs will be performed using frequentist and Bayesian statistics. Modifiable determinants will be discussed considering the settings in which they were investigated and the PAB/SB measurement methods used.\ud \ud Ethics and dissemination: No ethical approval is needed as no primary data will be collected. The findings will be disseminated in peer-reviewed publications and academic conferences where possible. The BESt will also be shared with policy makers within the DE-PASS consortium in the first instance. \ud \ud Systematic review registration: CRD42021282874

The objective of this review was to analyse how researchers conducting studies about mobile health applications (MHApps) effectiveness assess the conditions of this effectiveness.A scoping review according to PRIMSA-ScR checklist.We conducted a scoping review of efficacy/effectiveness conditions in high internal validity studies assessing the efficacy of MHApps in changing physical activity behaviours and eating habits. We used the PubMed, Web of Science, SPORTDiscus and PsycINFO databases and processed the review according to the O'Malley and PRISMA-ScR recommendations. We selected studies with high internal validity methodologies (randomised controlled trials, quasi-experimental studies, systematic reviews and meta-analyses), dealing with dietary and/or physical activity behaviours; covering primary, secondary or tertiary prevention and dealing with behaviour change (uptake, maintenance). We excluded articles on MHApps relating to high-level sport and telemedicine. The process for selecting studies followed a set protocol with two authors who independently appraised the studies.Twenty-two articles were finally selected and analysed. We noted that the mechanisms and techniques to support behaviour changes were poorly reported and studied. There was no explanation of how these MHApps work and how they could be transferred or not. Indeed, the main efficacy conditions reported by authors refer to practical aspects of the tools. Moreover, the issue of social inequalities was essentially reduced to access to the technology (the shrinking access divide), and literacy was poorly studied, even though it is an important consideration in digital prevention. All in all, even when they dealt with behaviours, the evaluations were tool-focused rather than intervention-focused and did not allow a comprehensive assessment of MHApps.To understand the added value of MHApps in supporting behaviour changes, it seems important to draw on the paradigms relating to health technology assessment considering the characteristics of the technologies and on the evaluation of complex interventions considering the characteristics of prevention. This combined approach may help to clarify how these patient-focused MHApps work and is a condition for improved assessment of MHApps in terms of effectiveness, transferability and scalability.