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Abstract Background Emerging work highlights the potential of community health workers (CHWs) to promote physical activity (PA) as a part of their role in preventing and managing non-communicable diseases. However, little is known about CHW preferences and desires towards receiving PA training. Methods Community health promoters (CHPs), a type of CHWs in South Africa, from seven health districts in Johannesburg participated in a day-long in-service training on PA and healthy eating. Prior to the training, CHPs completed a 22-item questionnaire assessing their PA attitudes, beliefs, past promotion efforts, and previous PA training. CHPs were divided into small focus groups to discuss their roles, amount and type of PA training they had received, perceived PA knowledge, and desire for future PA training. A mixed methods approach triangulated data from the questionnaire and the focus groups. Results Seventy-six CHPs attended the in-service training, completed the questionnaire, and participated in one of ten focus groups. CHPs were 38.5 (± 9.2) years of age, 58.7% were male, and 85.3% had > 2 years of experience. Nearly all felt PA was beneficial for health (89.5%) and that promoting it was a part of their job (85.3%). Most CHPs felt that they had sufficient PA knowledge (93.1%) and reported knowing global PA guidelines (90.5%). However, only 10.5% correctly identified the guidelines for aerobic activity or muscle-strengthening, and none correctly identified both. CHPs expressed great interest in receiving additional PA training (98.5%) and applying it in their work (97.1%). Five themes emerged from the focus groups: (1) roles and responsibilities in health promotion and disease prevention; (2) receiving ongoing training to enhance knowledge and skills; (3) increasing their PA training to foster healthier lifestyles in their communities; (4) desired structure of future PA trainings; and (5) strategies for applying the PA training. Conclusions This work provides further evidence for the potential of CHWs to take on a greater role in disease prevention, such as promoting PA. However, future research needs to explore strategies to: provide regular, ongoing PA training, enhance internal team dynamics, and integrate PA promotion as a regular part of their clinical responsibilities and community outreach.

Introduction The healthcare sector has great potential for promoting physical activity (PA) for chronic disease prevention, treatment and management; however, multiple adoption and implementation barriers exist, ranging from practice integration to information flow. In 2016, Exercise is Medicine Greenville (EIMG), a comprehensive clinic-to-community approach that involves PA assessment, recommendation and/or prescription and provider-based referral of patients to community-based PA programmes, was launched by Prisma Health in Greenville, South Carolina, USA. Since inception, variability has emerged in adoption and implementation, impacting patient reach, referral rates and engagement in the community-based PA programmes, highlighting the need for closer evaluation and refinement of strategies to maximise programme impact.Methods and analysis This pragmatic study will examine the adoption, implementation and reach of EIMG. 20 Prisma Health primary care clinics will be invited to adopt EIMG. In Phase I, adopting clinics will receive a standardised EIMG instructional video followed by EIMG activation, allowing providers to refer eligible patients to a 12-week evidence-informed PA programme offered at local community facilities. In Phase II, adopting clinics will receive a more in-depth EIMG onboard training. At adopting clinics, referral rates of eligible patients will be tracked over both phases (each lasting 4 months). A mixed-methods approach will explore factors related to EIMG adoption, achieving optimal implementation and reach, and patient enrolment in the PA programmes. The Reach, Effectiveness, Adoption, Implementation and Maintenance framework will inform the assessment of implementation outcomes, while the integrated Promoting Action on Research Implementation in Health Services framework will be used to explore contextual factors influencing patient-level and clinic-level outcomes.Ethics and dissemination We received ethical approval to conduct this study from the Prisma Health IRB Committee A (#1963762). The results of this study have the potential to significantly enhance clinical practice and improve health outcomes related to integrating a clinic-to-community PA model in health systems to connect patients with community-based PA resources. Information gained from this study will lead to the refinement of a generalisable approach to inform future implementation strategies on optimising and scaling up the integration of comprehensive PA models in US health systems and be disseminated through conference presentations, publication in peer-reviewed journals and direct work with health systems.Trial registration number NCT06073041.

Introduction and Objectives: Structured physical activity (PA) programs help to prevent and manage chronic diseases, yet systematic approaches to identify and enroll patients in these programs are lacking. Exercise is Medicine Greenville (EIMG) is a novel clinic-to-community model that identifies patients with chronic diseases in primary care settings and connects them to a structured, evidence-informed, community-based PA program. This study assessed influences on PA program enrollment using a mixed methods design. Methods: Data were collected from 12 clinics over 18 months. Electronic health record data were used to quantitively compare the characteristics of referred patients who did versus did not enroll. Semi-structured interviews were conducted with a subset of non-enrollees to elucidate barriers and facilitators to enrollment. Results: Of the 217 referred patients who were eligible, 84 (38.7%) enrolled in the PA program. A greater percentage of enrollees had a history of high cholesterol (73.8%) relative to non-enrollees (57.9%, χ 2 (1, N = 217) = 5.66, P = .02). Twenty-six patients completed qualitative interviews. Three themes emerged from interviews: (1) positive referral experiences with opportunity for enhanced information sharing and improved flow; (2) strong patient motivation, perceived capability, and social support; and (3) external barriers, such as cost and time, that prevented enrollment. Conclusions: Findings can guide improvements to the EIMG model, thus increasing its positive impact on individual- and community-level health. Findings can also inform efforts to build similar clinic-to-community PA models at other health systems.

Abstract Background Low-and-middle income countries face a disproportionate burden of non-communicable diseases (NCDs) that threaten to overwhelm under-resourced health systems. Community health workers (CHWs) can promote NCD prevention, reach patients, and connect them to local community health resources; however, little has been done to examine how referrals to these resources are utilized by community members. The purpose of this study is to examine the use of referrals to community-based health resources and investigate the factors influencing patient utilization of referrals connecting them to appropriate health resources for elevated blood pressure (BP). Methods CHWs conducted home visits, which included BP screening and brief counseling, with community members in Soweto, South Africa. Participants with elevated (systolic BP: 121–139/ diastolic BP: 81–89 mmHg) or high (≥ 140/90 mmHg) BP were referred to either a local, community-based physical activity (PA) program managed by a non-governmental organization or local health clinics. The number of participants that received and utilized their referrals was tracked. Follow-up interviews were conducted with individuals given a referral who: (1) went to the PA program, (2) did not go to the PA program, (3) went to a clinic, and (4) did not go to a clinic. Interviews were transcribed and analyzed to identify common themes and differences between groups regarding their decisions to utilize the referrals. Results CHWs visited 1056 homes, with 1001 community members consenting to the screening; 29.2% (n = 292) of adults were classified as having optimal BP (≤120/80 mmHg), 35.8% (n = 359) had elevated BP, and 35.0% (n = 350) had high BP. One hundred and seventy-three participants accepted a referral to the PA program with 46 (26.6%) enrolling. Five themes emerged from the interviews: (1) prior knowledge and thoughts on BP, (2) psychosocial factors associated with BP control, (3) perception about receiving the referral, (4) contextual factors influencing referral utilization, and (5) perceived benefits of utilizing the referral. Conclusion CHWs can successfully increase community members’ access to health resources by providing appropriate referrals. However, greater attention needs to address community members’ barriers and hesitancy to utilize health resources.

Physical activity (PA) effectively prevents and treats non-communicable diseases in clinical settings. PA promotion needs to be more consistent, especially in busy primary care. Sports scientists have the potential to support PA promotion in primary care. The Physical Activity with Sports Scientist (PASS) programme is created to personalise PA promotion led by a sports scientist in a primary care clinic. A pragmatic randomised controlled trial with two parallel groups will be conducted at a family medicine clinic. Physically inactive participants aged 35–70 years who have type 2 diabetes mellitus, hypertension or dyslipidaemia will be invited. The control group (n=60) will receive usual care. The intervention group (n=60) will receive the PASS programme and usual care. The PASS programme will consist of a tailored PA prescription after the physician’s consultation at the first visit and monthly phone follow-ups. The primary outcome is the proportion of participants who have achieved the PA goal defined as aerobic activity (≥150 min/week of moderate to vigorous-intensity PA), muscle-strengthening activity (≥2 days/week of moderate or greater intensity) and multicomponent PA (≥2 days/week of moderate or greater intensity). Secondary outcomes are body composition and physical fitness. The primary and secondary outcomes will be measured and compared between the control and intervention groups at visit 1 (month 0: baseline measurements), visit 2 (months 3–4: follow-up measurements), visit 3 (months 6–8: end-point measurements) and visit 4 (months 9–12: continuing measurements). The study protocol was registered with the Thai Clinical Trials Registry.Trial registration number: TCTR20240314001.

Community violence is a global public health problem that is associated with mental health disorders. Physical activity can enhance mental health and may play an important role in the relationship between exposure to community violence and mental health. We systematically reviewed the literature to better understand the potential role of physical activity in this relationship. In this review, we searched the databases PubMed, Embase, Web of Science, Cochrane Central, PsycInfo, and SPORTdiscus, and conducted a grey literature search of one clinical trials registry and four organizations’ websites. The review included quantitative observational studies, intervention studies, and qualitative studies published by November 30, 2022 and that involved generally healthy individuals across the lifespan. Eligible studies included measures of community violence, mental health, and physical activity. Five studies met the inclusion criteria for the review. Four studies were conducted in high-income countries, only two minority populations were represented in the studies, and none of the studies included older adults or children. Studies defined and measured community violence, mental health, and physical activity in different ways. In most studies, physical activity was not a primary focus but assessed as one item within a larger construct. The role of physical activity was examined differently across the studies and only one study found a significant role (mediator) of physical activity. This review revealed that few studies have specifically examined physical activity’s role in the relationship between exposure to community violence and mental health. Further research is needed involving low-income countries, diverse minority populations, and children.

Abstract Introduction Chronic diseases account for approximately 70% of deaths in the U.S. annually. Though physicians are uniquely positioned to provide behavior change counseling for chronic disease prevention, they often lack the necessary training and self-efficacy. This study examined medical student interest in receiving chronic disease prevention training as a formal part of their education as part of an effort to enhance their ability to provide guidance to patients in the future. Methods A 23-question, online survey was sent to all undergraduate medical students enrolled in a large medical education program. The survey assessed medical student interest in receiving training related to chronic disease prevention. Survey topics included student awareness of primary prevention programs, perceived importance of receiving training and applied experience in chronic disease prevention, and preferences for how and when to receive this training. Results Of 793 eligible medical students, 432 completed the survey (54.5%). Overall, 92.4% of students reported receiving formal training in physical activity, public health, nutrition, obesity, smoking cessation, and chronic diseases was of “very high” or “high” importance. Despite this level of importance, students most frequently reported receiving no or 1–5 h of formal training in a number of topics, including physical activity (35.4% and 47.0%, respectively) and nutrition (16.9% and 56.3%, respectively). The level of importance given to public health training was significantly greater across degree type (p = 0.0001) and future specialty (p = 0.03) for MD/MPH students and those interested in primary care, respectively. Conclusions While medical students perceive chronic disease prevention as an important topic, most reported receiving little to no formal training. To address the growing prevalence of chronic disease across our society, programs schools should place greater emphasis on integrating training in physical activity, nutrition, and obesity-related content into the medical education curriculum.

Abstract Background Physical activity (PA) may best be promoted to patients during clinical consultations. Few studies investigated the practice of PA advice given by physicians, especially in China. This study aimed to investigate the prevalence and contents of PA advice given by physicians in China and its association with patients’ characteristics. Methods Face-to-face questionnaire asking the prevalence and contents of PA advice given by physicians was administered to adult patients in three major hospitals in Shenzhen, China. Attitude of compliance, stature, PA level, and socio-demographic information were also collected. Data was analyzed via descriptive statistics and binary logistic regression. Results Of the 454 eligible patients (Age: 47.0 ± 14.4 years), only 19.2% (n = 87) reported receiving PA advice, whereas 21.8%, 23.0%, 32.2%, and 55.2% of patients received advices on PA frequency, duration, intensity, and type, respectively. Male patients were more likely to receive PA advice from physicians [odds ratio (OR): 1.81; 95% confidence interval (CI): 1.08–3.05], whereas patients who were unemployed (OR: 0.16; 95% CI: 0.04–0.67), and who already achieved adequate amount of PA (OR: 0.29; 95% CI: 0.12–0.71) were less likely to receive PA advice. Conclusions Prevalence of physicians providing physical activity advice to patients is low, there is a pressing need to take intervention measures to educate healthcare providers.

The new World Health Organization (WHO) 2020 guidelines on physical activity (PA) and sedentary behavior include recommendations for adults with chronic conditions. The guidelines provide adaptable and general recommendations for people living with chronic medical conditions. This article summarizes the content and provides suggestions for the application of the guidelines for patients with essential hypertension in primary care. The WHO 2020 PA guidelines recommend broad advice for adults and older adults with chronic conditions. The key recommendations are consistent with other hypertension guidelines. A systemic approach to promote PA in primary care (i.e., PA assessment, safety considerations, PA prescription, behavioral counseling, and referral) along with applying the WHO guidelines is required. Health risk assessment and safety issues related to hypertension (e.g., current PA levels, level of blood pressure, treatment plans, comorbidities) should be concerned. The FITT Pro (frequency, intensity, time, type, and progression) can be adopted as a framework to break down the guidelines into specific PA prescription. The WHO 2020 PA guidelines address the importance of PA in clinical populations. The guidelines can be adapted for patients with hypertension in primary care settings.

Abstract Background Whether physical activity can reduce cardiometabolic risk particularly in understudied populations such as US Hispanics/Latinos is of public health interest. We prospectively examined the association of physical activity and cardiometabolic biomarkers in n = 8049 participants of the Hispanic Community Health Study/Study of Latinos, a community-based cohort study of 16,415 adults aged 18–74 yr who self-identified as Hispanic/Latino from four US urban centers. Methods We assessed physical activity using accelerometry in 2008–2011 at visit 1. We assessed cardiometabolic biomarkers twice: once at visit 1 and collected a second measure in 2014–2017 at visit 2. We used survey linear regression models with changes in cardiometabolic markers as the dependent variables and quartiles of sedentary behavior or whether adults met guidelines for moderate-to-vigorous physical activity as the independent variables. Results In normoglycemic adults without cardiovascular disease, but not in adults with evidence of cardiometabolic disease, those who were in the lowest quartile for sedentary behavior (

The objective of this study was to examine the prevalence and patterns of alcohol use among U.S. Hispanic/Latino adults of diverse backgrounds. The population-based Hispanic Community Health Study/ Study of Latinos (HCHS/SOL) enrolled a cohort of Hispanic/Latino adults (N = 16,415) ages 18-74 years at time of recruitment, from four US metropolitan areas between 2008-11. Drinking patterns and socio-demographics questionnaires were administered as part of the baseline examination. The relationship between age, sex, socio-demographics, acculturation, current alcohol use, and alcohol risk disorder, defined by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) [no risk (i.e., never drinker), low risk (i.e., women7 drinks/week; men>14 drinks/week)] were assessed in unadjusted and adjusted multinomial logistic regression analyses. Men reported a higher prevalence than women of at-risk drinking. For women, increased odds of at-risk alcohol use was associated with: a younger age, greater education, full-time employment, and acculturation after adjustment. For men, having a lower income (vs. higher income) or a higher income (vs. not reported) and being employed fulltime (vs. retired) was associated with at-risk alcohol use. For both men and women, there were variations in odds of at-risk drinking across Hispanic/Latino heritage backgrounds, after adjustment. Exact values, odds ratios and p-values are reported within the text. Common factors across sex associated with at-risk drinking included being of Mexican background and being employed full-time. Intervention strategies should consider diversity within the Hispanic/Latino community when designing alcohol abuse prevention programs.

Excessive sedentary behavior is associated with negative health outcomes independent of physical activity. Objective estimates of time spent in sedentary behaviors are lacking among adults from diverse Hispanic/Latino backgrounds. The objective of this study was to describe accelerometer-assessed sedentary time in a large, representative sample of Hispanic/Latino adults living in the United States, and compare sedentary estimates by Hispanic/Latino background, sociodemographic characteristics and weight categories. This study utilized baseline data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) that included adults aged 18–74 years from four metropolitan areas (N = 16,415). Measured with the Actical accelerometer over 6 days, 76.9% (n = 12,631) of participants had >10 h/day and >3 days of data. Participants spent 11.9 h/day (SD 3.0), or 74% of their monitored time in sedentary behaviors. Adjusting for differences in wear time, adults of Mexican background were the least (11.6 h/day), whereas adults of Dominican background were the most (12.3 h/day), sedentary. Women were more sedentary than men, and older adults were more sedentary than younger adults. Household income was positively associated, whereas employment was negatively associated, with sedentary time. There were no differences in sedentary time by weight categories, marital status, or proxies of acculturation. To reduce sedentariness among these populations, future research should examine how the accumulation of various sedentary behaviors differs by background and region, and which sedentary behaviors are amenable to intervention.

BackgroundCardiovascular disease (CVD) risk factor control is a cornerstone of diabetes mellitus management. Little is known about relationships of objectively measured sedentary time and physical activity with major CVD risk factor control in individuals with diabetes mellitus. We examined associations of objectively measured sedentary time and moderate‐to‐vigorous physical activity with reaching major CVD risk factor control goals among US Hispanic/Latino adults with diabetes mellitus. Methods and ResultsThis cross‐sectional analysis included 1699 participants with diabetes mellitus from the Hispanic Community Health Study/Study of Latinos (2008–2011). Logistic regression models were used to estimate the odds ratios (ORs) of meeting the following 5 major CVD risk factor control goals: hemoglobin A1c 40/50 mg/dL for men/women. After adjustment for covariates including moderate‐to‐vigorous physical activity, less sedentary time was associated with increased odds of reaching hemoglobin A1c (OR=1.76 [95% CI: 1.10, 2.82]) and triglyceride control goals (OR=2.16 [1.36, 3.46]), and reaching ≥3 CVD risk factor control goals (OR=2.08 [1.34, 3.23]) (all ORs for comparisons of extreme tertiles of sedentary time). Moderate‐to‐vigorous physical activity was not associated with reaching any CVD risk factor control goals. Substituting 60‐min/day of sedentary time with light‐intensity physical activity was associated with increased odds of reaching hemoglobin A1c (OR=1.18 [1.04, 1.35]), high‐density lipoprotein cholesterol (OR=1.17 [1.04, 1.32]), and triglyceride (OR=1.20 [1.05, 1.36]) control goals. ConclusionsAmong US Hispanic/Latino adults with diabetes mellitus, less sedentary time, but not moderate‐to‐vigorous physical activity, was associated with improved CVD risk factor control, specifically in reaching hemoglobin A1c and triglyceride control goals.

PURPOSE:To examine the associations between overweight/obesity and occupation among Hispanics/Latinos, the largest minority population in the U.S. METHODS:This study included 7,409 employed individuals in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a prospective study of Hispanic/Latino individuals aged 18-74 in four communities in the U.S. We independently examined the relationships between BMI, Occupational Activity (OA), and Total Hours Worked, quantified via self-reported hours worked per week and occupation-assigned Metabolic Equivalents (METs). RESULTS:More than three quarters of the participants were either overweight (39.3%) or obese (37.8%). Individuals with a primary occupation and those employed in a secondary occupation worked an average of 36.8 and 14.6 hrs/wk, respectively. The overall adjusted odds for being obese compared to normal weight were 3.2% (AOR = 1.03, 95% CI 1.01, 1.05) and 14.4% (AOR = 1.14 95% Cl 1.07, 1.23) greater for each 10 MET•hrs/wk unit of increased OA, and each 10-hrs/wk unit of Total Hours Worked, respectively. CONCLUSION:This study presents the first findings on the association between OA with overweight/obesity among Hispanic/Latino individuals in the U.S. Increasing OA and Total Hours Worked per week were independently associated with increasing odds of overweight/obesity suggesting that the workplace is only one part of the overall energy expenditure dynamic. Our findings point to the need to emphasize engaging employed individuals in greater levels of PA outside of the work environment to impact overweight/obesity.