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Objective: To explore the relationships between participant characteristics, perceptions of a short educational video about osteoarthritis and its management, and immediate changes in behavioural determinants for effective self-management behaviours., Methods: Seventy-eight participants with knee OA (77% female, mean age 63.0 ± 8.7) watched the 9-min video that included evidence-based content and was designed to foster empowerment to self-manage effectively. Data were collected by online questionnaire at baseline and immediately after watching the video. Associations were tested between baseline health and information processing characteristics (health literacy, need for cognition), perceptions of the video (enjoyment, helpfulness, believability, novelty and relevance) and pre-post changes in behavioural determinants (self-efficacy for managing arthritis, attitude to self-management or 'activation', and importance/confidence for physical activity)., Results: All behavioural determinants improved immediately after watching the video. Positive perceptions were associated with greater improvements in self-efficacy for arthritis (Spearman's rho, ρ = 0.26-0.47). Greater perceived relevance was associated with increased self-rated importance of being physically active (ρ = 0.43). There were small positive associations between health literacy domains related to health information and positive viewer perceptions of the video. People with higher need for cognition may achieve greater improvement in confidence to be physically active (ρ = 0.27)., Conclusion: The educational video may help achieve outcomes important for increasing self-management behaviours in people with knee osteoarthritis. Positive perceptions appear to be important in achieving these improvements. People with lower health literacy and lower need for cognition may respond less well to this information about knee osteoarthritis delivered in this way., (© 2021. The Author(s).)

Objective: This study aimed to examine barriers and facilitators to the dissemination of efficacious self-directed digital health tools for adults affected by cancer, and quantify funding used to develop and evaluate these digital health tools., Methods: We conducted: (1) a systematic literature review to identify efficacious self-directed digital health tools for adults affected by cancer, published between 2009 and 2019 and (2) an author survey to identify barriers and facilitators to dissemination of those tools, grant funding and the user centredness of their design (UCD) process., Results: Of 1314 screened articles, 29 articles describing 26 tools met the inclusion criteria. From 26 surveys sent, 12 were completed, 6 of which described disseminated tools. Whilst researchers' motivation and infrastructure support facilitate tool dissemination, limited funds, lack of infrastructure and limited research timelines are the most common barriers. A median of AUD$250,000 was spent on tools not disseminated to end-users., Conclusion: Although incorporating UCD processes in the development of digital health tools is important, it is imperative to integrate implementation processes into the planning stages of tool development to ensure dissemination., Practice Implications: Researchers, academic institutions, funding agencies and government and non-government organisations all have roles to play to support long-term implementation., Competing Interests: Declarations of interest None., (Copyright © 2021 Elsevier B.V. All rights reserved.)

A vast body of evidence regarding eHealth interventions for nutrition, physical activity, sedentary behavior, and obesity exists. This scoping review of systematic reviews aimed to evaluate the current level of evidence in this growing field. Seven electronic databases were searched for systematic reviews published until October 27, 2019. The systematic reviews must have included adult participants only and have evaluated eHealth behavioral interventions with the primary aim of changing nutrition, physical activity, and sedentary behavior or treating or preventing overweight and obesity. One hundred and six systematic reviews, published from 2006 to 2019, were included. Almost all (n = 98) reviews evaluated the efficacy of interventions. Over half (n = 61) included interventions focused on physical activity, followed by treatment of obesity (n = 28), nutrition (n = 22), prevention of obesity (n = 18), and sedentary behavior (n = 6). Many reviews (n = 46) evaluated one type of eHealth intervention only, while 60 included two or more types. Most reviews (n = 67) were rated as being of critically low methodological quality. This scoping review identified an increasing volume of systematic reviews evaluating eHealth interventions. It highlights several evidence gaps (e.g., evaluation of other outcomes, such as reach, engagement, or cost effectiveness), guiding future research efforts in this area., (© 2021 World Obesity Federation.)

Purpose: Healthy lifestyles are an important part of cancer survivorship, though survivors often do not adhere to recommended guidelines. As part of the co-design of a new online healthy living intervention, this study aimed to understand cancer survivors', oncology healthcare professionals' (HCP) and cancer non-government organisation (NGO) representatives' preferences regarding intervention content and format., Methods: Survivors, HCP and NGO representatives participated in focus groups and interviews exploring what healthy living means to survivors, their experience with past healthy living programs and their recommendations for future program content and delivery. Sessions were audio recorded, transcribed verbatim and analysed thematically., Results: Six focus groups and eight interviews were conducted including a total of 38 participants (21 survivors, 12 HCP, 5 NGO representatives). Two overarching messages emerged: (1) healthy living goes beyond physical health to include mental health and adjustment to a new normal and (2) healthy living programs should incorporate mental health strategies and peer support and offer direction in a flexible format with long-term accessibility. There was a high degree of consensus between participant groups across themes., Conclusions: These findings highlight the need for integration of physical and mental health interventions with flexibility in delivery. Future healthy living programs should investigate the potential for increased program adherence if mental health interventions and a hybrid of delivery options were included.

Background: Few individuals with metastatic prostate cancer have access to prostate cancer-specific exercise support, despite demonstrated benefits. eHealth tools, such as websites, may be viable options for increasing access. To be effective and acceptable, future eHealth websites need to consider end-users' perspectives, capacity and needs. We aim to provide insight into these factors by exploring daily priorities, activities and health literacy of individuals with metastatic prostate cancer and their perspectives towards exercise and exercise-based web-based eHealth interventions., Methods: Semi-structured interviews explored participant's experiences and understanding of their disease, exercise levels, advice received from health care providers, as well as acceptability of and suggested content for an eHealth tool. A thematic analysis was undertaken., Results: Interviews were conducted with eighteen Australians (55-83 years; M = 71.5, SD = 8.9) living with metastatic prostate cancer. Needing to perform daily responsibilities was a key priority. Participants had limited understanding of the benefits of prostate cancer-specific exercise, and less than half discussed exercise with their health team. Fourteen men felt they could report metastases location, but only four could provide detailed information, which has clinical implications for exercise prescription. A potential web-based intervention was considered acceptable by seventeen men for reasons such as affordability, accessibility and convenience. User-friendly design and practitioner support were important., Conclusions: Results identified key aspects useful for person-centred design of exercise programs. Participants were positive towards the proposed web-based tool and expressed the need for individualised, user-friendly and reliable information with support from a professional embedded. Lastly, not all participants could accurately report metastasis locations.

Objective: To evaluate responses by people with knee osteoarthritis to a brief educational video about their condition that aimed to empower and motivate effective self-management. The video content addressed psychosocial contributors to pain and barriers to behaviour change., Methods: A mixed methods design, including a survey and semi-structured interviews, was used to collect data from 118 people (46-83 years, 78% female) with knee osteoarthritis., Results: Quantitative data analysis showed the video was rated positively on 0-6 scales for enjoyability (mean 5.0), helpfulness (4.9), relevance (5.0) and believability (5.4). The majority would recommend the video (89%), learned new information (78%) and/or reported intentions to change behaviour (78%). A minority disliked aspects of the video (23%). The thematic analyses identified three main themes: Reactions to the video, including emotions; Learning from the video, including new knowledge and empowerment, but also unmet information needs or disagreement; and Intentions, including behaviour changes, cognitive changes and help seeking., Conclusion: Education about knee osteoarthritis with a focus on empowerment is well received by people with the condition, although some discordant views emerged., Practice Implications: The educational video about knee osteoarthritis can be recommended to promote effective self-management and counteract potential drawbacks associated with biomedical-based education., Competing Interests: Declaration of Competing Interest I confirm all patient/personal identifiers have been removed or disguised so the patient/person(s) described are not identifiable and cannot be identified through the details of the story., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Acceptability is a core concept in digital health. Available frameworks have not clearly articulated why and how researchers, practitioners and policy makers may wish to study the concept of acceptability. Here, we aim to discuss (i) the ways in which acceptability might differ from closely related concepts, including user engagement; (ii) the utility of the concept of acceptability in digital health research and practice; (iii) social and cultural norms that influence acceptability; and (iv) pragmatic means of measuring acceptability, within and beyond the research process. Our intention is not to offer solutions to these open questions but to initiate a debate within the digital health community. We conducted a narrative review of theoretical and empirical examples from the literature. First, we argue that acceptability may usefully be considered an emergent property of a complex, adaptive system of interacting components (e.g., affective attitude, beliefs), which in turn influences (and is influenced by) user engagement. Second, acceptability is important due to its ability to predict and explain key outcomes of interest, including user engagement and intervention effectiveness. Third, precisely what people find acceptable is deeply contextualized and interlinked with prevailing social and cultural norms. Understanding and designing for such norms (e.g., through drawing on principles of user centered design) is therefore key. Finally, there is a lack of standard acceptability measures and thresholds. Star ratings coupled with free-text responses may provide a pragmatic means of capturing acceptability. Acceptability is a multifaceted concept, which may usefully be studied with a complexity science lens., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Society of Behavioral Medicine.)

Background: Digital health interventions such as tailored websites are emerging as valuable tools to provide individualized exercise and behavioral change information for individuals diagnosed with cancer., Objective: The aim of this study is to investigate and iteratively refine the acceptability and usability of a web-based exercise intervention (ExerciseGuide) for men with metastatic prostate cancer and determine how well individuals can replicate the video-based exercise prescription., Methods: A laboratory-based multi-methods design was used, incorporating questionnaires, think-aloud tests, interviews, and movement screening among 11 men aged 63 to 82 years with metastatic prostate cancer. Overall, 9 participants were undergoing androgen deprivation therapy, and 2 were completing chemotherapy. Data were collected in two waves, with changes made for quality improvement after participant 5., Results: The intervention's usability score was deemed moderate overall but improved after modifications (from 60, SD 2.9 to 69.6, SD 2.2 out of 100). Overall, the participants found the intervention acceptable, with scores improving from wave 1 (24.2, SD 1.1 out of 30) to wave 2 (26.3, SD 2.1 out of 30). The personalized multimodal exercise prescription and computer-tailored education were seen as valuable. After wave 1, website navigation videos were added, medical terminology was simplified, and a telehealth component was included after expert real-time telehealth support was requested. Wave 2 changes included the added variety for aerobic exercise modes, reduced computer-tailoring question loads, and improved consistency of style and grammar. Finally, the participants could replicate the resistance exercise videos to a satisfactory level as judged by the movement screen; however, additional technique cueing within the videos is recommended to address safety concerns., Conclusions: The acceptability and usability of ExerciseGuide were deemed satisfactory. Various problems were identified and resolved. Notably, the participants requested the inclusion of personalized expert support through telehealth. The resistance training algorithms were shown to provide appropriate content safely, and the users could replicate the exercise technique unaided to a satisfactory level. This study has optimized the ExerciseGuide intervention for further investigation in this population., Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618001978257; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001978257., (©Holly EL Evans, Cynthia C Forbes, Daniel A Galvão, Corneel Vandelanotte, Robert U Newton, Gary Wittert, Suzanne Chambers, Andrew D Vincent, Ganessan Kichenadasse, Danielle Girard, Nicholas Brook, Camille E Short. Originally published in JMIR Cancer (https://cancer.jmir.org), 28.07.2021.)

The coronaviral spike is the dominant viral antigen and the target of neutralizing antibodies. We show that SARS-CoV-2 spike binds biliverdin and bilirubin, the tetrapyrrole products of heme metabolism, with nanomolar affinity. Using cryo-electron microscopy and x-ray crystallography, we mapped the tetrapyrrole interaction pocket to a deep cleft on the spike N-terminal domain (NTD). At physiological concentrations, biliverdin significantly dampened the reactivity of SARS-CoV-2 spike with immune sera and inhibited a subset of neutralizing antibodies. Access to the tetrapyrrole-sensitive epitope is gated by a flexible loop on the distal face of the NTD. Accompanied by profound conformational changes in the NTD, antibody binding requires relocation of the gating loop, which folds into the cleft vacated by the metabolite. Our results indicate that SARS-CoV-2 spike NTD harbors a dominant epitope, access to which can be controlled by an allosteric mechanism that is regulated through recruitment of a metabolite., (Copyright © 2021 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works. Distributed under a Creative Commons Attribution License 4.0 (CC BY).)

It is currently unknown how post-COVID-19 syndrome (PCS) may affect those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This longitudinal study includes healthcare staff who tested positive for SARS-CoV-2 between March and April 2020, with follow-up of their antibody titers and symptoms. More than half (21 of 38) had PCS after 7-8 months. There was no statistically significant difference between initial reverse-transcription polymerase chain reaction titers or serial antibody levels between those who did and those who did not develop PCS. This study highlights the relative commonality of PCS in healthcare workers and this should be considered in vaccination scheduling and workforce planning to allow adequate frontline staffing numbers., (© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America.)

Background: Physical activity during pregnancy is associated with several health benefits for the mother and child. However, very few women participate in regular physical activity during pregnancy. eHealth platforms (internet and mobile apps) have become an important information source for pregnant women. Although the use of pregnancy-related apps has significantly increased among pregnant women, very little is known about their theoretical underpinnings, including their utilization of behavior change techniques (BCTs). This is despite research suggesting that inclusion of BCTs in eHealth interventions are important for promoting healthy behaviors, including physical activity., Objective: The aim of this study was to conduct a systematic search and content analysis of app quality, features, and the presence of BCTs in apps designed to promote physical activity among pregnant women., Methods: A systematic search in the Australian App Store and Google Play store using search terms relating to exercise and pregnancy was performed. App quality and features were assessed using the 19-item Mobile App Rating Scale (MARS), and a taxonomy of BCTs was used to determine the presence of BCTs (26 items). BCTs previously demonstrating efficacy in behavior changes during pregnancy were also identified from a literature review. Spearman correlations were used to investigate the relationships between app quality, app features, and number of BCTs identified., Results: Nineteen exercise apps were deemed eligible for this review and they were accessed via Google Play (n=13) or App Store (n=6). The MARS overall quality scores indicated moderate app quality (mean 3.5 [SD 0.52]). Functionality was the highest scoring MARS domain (mean 4.2 [SD 0.5]), followed by aesthetics (mean 3.7 [SD 0.6]) and information quality (mean 3.16 [SD 0.42]). Subjective app quality (mean 2.54 [SD 0.64]) and likelihood for behavioral impact (mean 2.5 [SD 0.6]) were the lowest scoring MARS domains. All 19 apps were found to incorporate at least two BCTs (mean 4.74, SD 2.51; range 2-10). However, only 11 apps included BCTs that previously demonstrated efficacy for behavior change during pregnancy, the most common being provide opportunities for social comparison (n=8) and prompt self-monitoring of behavior (n=7). There was a significant positive correlation between the number of BCTs with engagement and aesthetics scores, but the number of BCTs was not significantly correlated with functionality, information quality, total MARS quality, or subjective quality., Conclusions: Our findings showed that apps designed to promote physical activity among pregnant women were functional and aesthetically pleasing, with overall moderate quality. However, the incorporation of BCTs was low, with limited prevalence of BCTs previously demonstrating efficacy in behavior change during pregnancy. Future app development should identify and adopt factors that enhance and encourage user engagement, including the use of BCTs, especially those that have demonstrated efficacy for promoting physical activity behavior change among pregnant women., (©Melanie Hayman, Kristie-Lee Alfrey, Summer Cannon, Stephanie Alley, Amanda L Rebar, Susan Williams, Camille E Short, Abby Altazan, Natalie Comardelle, Sinead Currie, Caitlin Denton, Cheryce L Harrison, Tayla Lamerton, Gabriela P Mena, Lisa Moran, Michelle Mottola, Taniya S Nagpal, Lisa Vincze, Stephanie Schoeppe. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 07.04.2021.)

While it is now widely accepted that host inflammatory responses contribute to lung injury, the pathways that drive severity and distinguish coronavirus disease 2019 (COVID-19) from other viral lung diseases remain poorly characterized. We analyzed plasma samples from 471 hospitalized patients recruited through the prospective multicenter ISARIC4C study and 39 outpatients with mild disease, enabling extensive characterization of responses across a full spectrum of COVID-19 severity. Progressive elevation of levels of numerous inflammatory cytokines and chemokines (including IL-6, CXCL10, and GM-CSF) were associated with severity and accompanied by elevated markers of endothelial injury and thrombosis. Principal component and network analyses demonstrated central roles for IL-6 and GM-CSF in COVID-19 pathogenesis. Comparing these profiles to archived samples from patients with fatal influenza, IL-6 was equally elevated in both conditions whereas GM-CSF was prominent only in COVID-19. These findings further identify the key inflammatory, thrombotic, and vascular factors that characterize and distinguish severe and fatal COVID-19., (Copyright © 2021, American Association for the Advancement of Science.)

Objectives: Some online, personally tailored, text-based physical activity interventions have proven effective. However, people tend to 'skim' and 'scan' web-based text rather than thoroughly read their contents. In contrast, online videos are more engaging and popular. We examined whether web-based personally tailored physical activity videos were more effective in promoting physical activity than personally tailored text and generic information., Methods: 501 adults were randomised into a video-tailored intervention, text-tailored intervention or control. Over a 3-month period, intervention groups received access to eight sessions of web-based personally tailored physical activity advice. Only the delivery method differed between intervention groups: tailored video versus tailored text. The primary outcome was 7-day ActiGraph-GT3X+ measured moderate-to-vigorous physical activity (MVPA) assessed at 0, 3 and 9 months. Secondary outcomes included self-reported MVPA and website engagement. Differences were examined using generalised linear mixed models with intention-to-treat and multiple imputation., Results: Accelerometer-assessed MVPA increased 23% in the control (1.23 (1.06, 1.43)), 12% in the text-tailored (1.12 (0.95, 1.32)) and 28% in the video-tailored (1.28 (1.06, 1.53)) groups at the 3-month follow-up only, though there were no significant between-group differences. Both text-tailored (1.77 (1.37, 2.28]) and video-tailored (1.37 (1.04, 1.79)) groups significantly increased self-reported MVPA more than the control group at 3 months only, but there were no differences between video-tailored and text-tailored groups. The video-tailored group spent significantly more time on the website compared with text-tailored participants (90 vs 77 min, p=0.02)., Conclusions: The personally tailored videos were not more effective than personally tailored text in increasing MVPA. The findings from this study conflict with pilot study outcomes and previous literature. Process evaluation and mediation analyses will provide further insights., Trial Registration Number: ACTRN12615000057583., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Understanding for whom behaviour change interventions work is important, however there is a lack of studies examining potential moderators in such interventions. This study investigated potential moderators on the effectiveness of a computer-tailored intervention to increase physical activity among Australian adults. People who had <150 min of moderate-vigorous physical activity (MVPA) a week, able to speak and read English, aged ≥18 years, lived in Australia, and had internet access were eligible to participate. Participants recruited through social media, emails, and third-party databases, were randomly assigned to either the control (n = 167) or intervention groups (n = 334). Physical activity was measured objectively by ActiGraph GT3X and also by self-report at baseline and three months. Three-way interaction terms were tested to identify moderators (i.e., demographic characteristics, BMI, and perceived neighbourhood walkability). The results showed that the three-way interaction was marginally significant for sex on accelerometer measured MVPA/week (p = 0.061) and steps/day (p = 0.047). The intervention appeared to be more effective for women compared to men. No significant three-way interactions were found for the other potential moderators. Strategies to improve levels of personalisation may be needed so that physical activity interventions can be better tailored to different subgroups, especially sex, and therefore improve intervention effectiveness., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Author(s).)

Multimodal prehabilitation is increasingly recognized as an important component of the pre-operative pathway in oncology. It aims to optimize physical and psychological health through delivery of a series of tailored interventions including exercise, nutrition, and psychological support. At the core of this prescription is a need for considerable health behavior change, to ensure that patients are engaged with and adhere to these interventions and experience the associated benefits. To date the prehabilitation literature has focused on testing the efficacy of devised exercise and nutritional interventions with a primary focus on physiological and mechanistic outcomes with little consideration for the role of behavioral science, supporting individual behavior change or optimizing patient engagement. Changing health behavior is complex and to maximize success, prehabilitation programs should draw on latest insights from the field of behavioral science. Behavioral science offers extensive knowledge on theories and models of health behavior change to further advance intervention effectiveness. Similarly, interventions developed with a person-centered approach, taking into consideration individual needs and preferences will increase engagement. In this article, we will provide an overview of the extent to which the existing prehabilitation literature incorporates behavioral science, as well as studies that have explored patient's attitudes toward prehabilitation. We will go on to describe and critique ongoing trials in a variety of contexts within oncology prehabilitation and discuss how current scientific knowledge may be enhanced from a behavioral science perspective. We will also consider the role of "surgery schools" and detail practical recommendations that can be embedded in existing or emerging clinical settings., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Grimmett, Bradbury, Dalton, Fecher-Jones, Hoedjes, Varkonyi-Sepp and Short.)

At the start of the UK coronavirus disease 2019 epidemic, this rare point prevalence study revealed that one-third of patients (15 of 45) in a London inpatient rehabilitation unit were found to be infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) but asymptomatic. We report on 8 patients in detail, including their clinical stability, the evolution of their nasopharyngeal viral reverse-transcription polymerase chain reaction (RT-PCR) burden, and their antibody levels over time, revealing the infection dynamics by RT-PCR and serology during the acute phase. Notably, a novel serological test for antibodies against the receptor binding domain of SARS-CoV-2 showed that 100% of our asymptomatic cohort remained seropositive 3-6 weeks after diagnosis., (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.)

Introduction: Preliminary research has shown the effectiveness of supervised exercise-based interventions in alleviating sequela resulting from metastatic prostate cancer. Despite this, many individuals do not engage in sufficient exercise to gain the benefits. There are many barriers, which limit the uptake of face-to-face exercise in this population including lack of suitable facilities, remoteness, and access to experts, significant fatigue, urinary incontinence and motivation. Technology-enabled interventions offer a distance-based alternative. This protocol describes a pilot two-armed randomised controlled study that will investigate the feasibility and preliminary efficacy of an online exercise and behavioural change tool (ExerciseGuide) amongst individuals with metastatic prostate cancer., Methods: Sixty-six participants with histologically diagnosed metastatic prostate cancer will be randomised into either the 8-week intervention or a wait-list control. The intervention arm will have access to a tailored website, remote supervision, and tele-coaching sessions to enhance support and adherence. Algorithms will individually prescribe resistance and aerobic exercise based upon factors such as metastasis location, pain, fatigue, confidence and current exercise levels. Behavioural change strategies and education on exercise benefits, safety and lifestyle are also tailored through the website. The primary outcome will be intervention feasibility (safety, usability, acceptability, and adherence). Secondary exploratory outcomes include changes in physical activity, quality of life, sleep, and physical function. Outcomes will be measured at baseline and week 9., Discussion: The study aims to determine the potential feasibility of an online remotely monitored exercise intervention developed for individuals with metastatic prostate cancer. If feasible, this pilot intervention will inform the design and implementation of further distance-based interventions., Trial Registration: ANZCTR, ACTRN12614001268639 . Registered 10 December 2018, https://anzctr.org.au/ACTRN12618001979246.aspx.

Objective: To identify the patterns of activity, sitting and sleep that adults engage in, the demographic and biological correlates of activity-sleep patterns and the relationship between identified patterns and self-rated health., Design and Setting: Online panel of randomly selected Australian adults (n = 2034) completing a cross-sectional survey in October-November 2013., Participants: Panel members who provided complete data on all variables were included (n = 1532)., Measurements: Participants self-reported their demographic characteristics, height, weight, self-rated health, duration of physical activity, frequency of resistance training, sitting time, sleep duration, sleep quality, and variability in bed and wake times. Activity-sleep patterns were determined using latent class analysis. Latent class regression was used to examine the relationships between identified patterns, demographic and biological characteristics, and self-rated health., Results: A 4-class model fit the data best, characterized by very active good sleepers, inactive good sleepers, inactive poor sleepers, moderately active good sleepers, representing 38.2%, 22.2%, 21.2%, and 18.4% of the sample, respectively. Relative to the very active good sleepers, the inactive poor sleepers, and inactive good sleepers were more likely to report being female, lower education, higher body mass index, and lower self-rated health, the moderately active good sleepers were more likely to be older, report lower education, higher body mass index and lower self-rated health. Associations between activity-sleep pattern and self-rated health were the largest in the inactive poor sleepers., Conclusions: The 4 activity-sleep patterns identified had distinct behavioral profiles, sociodemographic correlates, and relationships with self-rated health. Many adults could benefit from behavioral interventions targeting improvements in physical activity and sleep., (Copyright © 2020 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Web-based computer-tailored interventions can assist prostate cancer survivors to become more physically active by providing personally relevant behaviour change support. This study aimed to explore how changing the website architecture (free choice vs. tunnelled) impacted engagement within a physical activity computer-tailored intervention targeting prostate cancer survivors., Methods: On a 2:2:1 ratio, 71 Australian prostate cancer survivors with local or locally advanced disease (mean age: 66.6 years ± 9.66) were randomised into either a free-choice (N = 27), tunnelled (N = 27) or minimal intervention control arm (N =17). The primary outcome was differences in usage of the physical activity self-monitoring and feedback modules between the two intervention arms. Differences in usage of other website components between the two intervention groups were explored as secondary outcomes. Further, secondary outcomes involving comparisons between all study groups (including the control) included usability, personal relevance, and behaviour change., Results: The average number of physical activity self-monitoring and feedback modules accessed was higher in the tunnelled arm (M 2.6 SD 1.3) compared to the free-choice arm (M 1.5 SD 1.4), p = 0.01. However, free-choice participants were significantly more likely to have engaged with the social support ( p = 0.008) and habit formation ( p = 0.003) 'once-off' modules compared to the standard tunnelled arm. There were no other between-group differences found for any other study outcomes., Conclusion: This study indicated that website architecture influences behavioural engagement. Further research is needed to examine the impact of differential usage on mechanisms of action and behaviour change.

Background: Dual process theories propose that the brain uses 2 types of thinking to influence behavior: automatic processing and reflective processing. Automatic processing is fast, immediate, nonconscious, and unintentional, whereas reflective processing focuses on logical reasoning, and it is slow, step by step, and intentional. Most digital psychological health interventions tend to solely target the reflective system, although the automatic processing pathway can have strong influences on behavior. Laboratory-based research has highlighted that automatic processing tasks can create behavior change; however, there are substantial gaps in the field on the design, implementation, and delivery of automatic processing tasks in real-world settings. It is important to identify and summarize the existing literature in this area to inform the translation of laboratory-based research to real-world settings., Objective: This scoping review aims to explore the effectiveness of automatic training tasks, types of training tasks commonly used, mode of delivery, and impacts of gamification on automatic processing tasks designed for digital psychological health interventions in real-world settings among adults., Methods: The scoping review methodology proposed by Arskey and O'Malley and Colquhoun was applied. A scoping review was chosen because of the novelty of the digital automatic processing field and to encompass a broad review of the existing evidence base. Electronic databases and gray literature databases were searched with the search terms "automatic processing," "computerised technologies," "health intervention," "real-world," and "adults" and synonyms of these words. The search was up to date until September 2018. A manual search was also completed on the reference lists of the included studies., Results: A total of 14 studies met all inclusion criteria. There was a wide variety of health conditions targeted, with the most prevalent being alcohol abuse followed by social anxiety. Attention bias modification tasks were the most prevalent type of automatic processing task, and the majority of tasks were most commonly delivered over the web via a personal computer. Of the 14 studies included in the review, 8 demonstrated significant changes to automatic processes and 4 demonstrated significant behavioral changes as a result of changed automatic processes., Conclusions: This is the first review to synthesize the evidence on automatic processing tasks in real-world settings targeting adults. This review has highlighted promising, albeit limited, research demonstrating that automatic processing tasks may be used effectively in a real-world setting to influence behavior change., (©Harshani Jayasinghe, Camille E Short, Annette Braunack-Mayer, Ashley Merkin, Clare Hume. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 29.07.2020.)

Background: Poor diet and physical inactivity are leading modifiable causes of death and disease. Advances in artificial intelligence technology present tantalizing opportunities for creating virtual health coaches capable of providing personalized support at scale., Objective: This proof of concept study aimed to test the feasibility (recruitment and retention) and preliminary efficacy of physical activity and Mediterranean-style dietary intervention (MedLiPal) delivered via artificially intelligent virtual health coach., Methods: This 12-week single-arm pre-post study took place in Adelaide, Australia, from March to August 2019. Participants were inactive community-dwelling adults aged 45 to 75 years, recruited through news stories, social media posts, and flyers. The program included access to an artificially intelligent chatbot, Paola, who guided participants through a computer-based individualized introductory session, weekly check-ins, and goal setting, and was available 24/7 to answer questions. Participants used a Garmin Vivofit4 tracker to monitor daily steps, a website with educational materials and recipes, and a printed diet and activity log sheet. Primary outcomes included feasibility (based on recruitment and retention) and preliminary efficacy for changing physical activity and diet. Secondary outcomes were body composition (based on height, weight, and waist circumference) and blood pressure., Results: Over 4 weeks, 99 potential participants registered expressions of interest, with 81 of those screened meeting eligibility criteria. Participants completed a mean of 109.8 (95% CI 1.9-217.7) more minutes of physical activity at week 12 compared with baseline. Mediterranean diet scores increased from a mean of 3.8 out of 14 at baseline, to 9.6 at 12 weeks (mean improvement 5.7 points, 95% CI 4.2-7.3). After 12 weeks, participants lost an average 1.3 kg (95% CI -0.1 to -2.5 kg) and 2.1 cm from their waist circumference (95% CI -3.5 to -0.7 cm). There were no significant changes in blood pressure. Feasibility was excellent in terms of recruitment, retention (90% at 12 weeks), and safety (no adverse events)., Conclusions: An artificially intelligent virtual assistant-led lifestyle-modification intervention was feasible and achieved measurable improvements in physical activity, diet, and body composition at 12 weeks. Future research examining artificially intelligent interventions at scale, and for other health purposes, is warranted., (©Carol Ann Maher, Courtney Rose Davis, Rachel Grace Curtis, Camille Elizabeth Short, Karen Joy Murphy. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 10.07.2020.)

Purpose: Fatigue is a common and potentially disabling symptom in patients with cancer. It can often be effectively reduced by exercise. Yet, effects of exercise interventions might differ across subgroups. We conducted a meta-analysis using individual patient data of randomized controlled trials (RCT) to investigate moderators of exercise intervention effects on cancer-related fatigue., Methods: We used individual patient data from 31 exercise RCT worldwide, representing 4366 patients, of whom 3846 had complete fatigue data. We performed a one-step individual patient data meta-analysis, using linear mixed-effect models to analyze the effects of exercise interventions on fatigue (z score) and to identify demographic, clinical, intervention- and exercise-related moderators. Models were adjusted for baseline fatigue and included a random intercept on study level to account for clustering of patients within studies. We identified potential moderators by testing their interaction with group allocation, using a likelihood ratio test., Results: Exercise interventions had statistically significant beneficial effects on fatigue (β = -0.17; 95% confidence interval [CI], -0.22 to -0.12). There was no evidence of moderation by demographic or clinical characteristics. Supervised exercise interventions had significantly larger effects on fatigue than unsupervised exercise interventions (βdifference = -0.18; 95% CI -0.28 to -0.08). Supervised interventions with a duration ≤12 wk showed larger effects on fatigue (β = -0.29; 95% CI, -0.39 to -0.20) than supervised interventions with a longer duration., Conclusions: In this individual patient data meta-analysis, we found statistically significant beneficial effects of exercise interventions on fatigue, irrespective of demographic and clinical characteristics. These findings support a role for exercise, preferably supervised exercise interventions, in clinical practice. Reasons for differential effects in duration require further exploration.

Objective: Understanding the unmet supportive care needs of men on active surveillance for prostate cancer may enable researchers and health professionals to better support men and prevent discontinuation when there is no evidence of disease progression. This review aimed to identify the specific unmet supportive care needs of men on active surveillance., Methods: A systematic review following PRISMA guidelines was conducted. Databases (Pubmed, Embase, PsycINFO, and CINAHL) were searched to identify qualitative and/or quantitative studies that reported unmet needs specific to men on active surveillance. Quality appraisals were conducted before results were narratively synthesised., Results: Of the 3613 unique records identified, only eight articles were eligible (five qualitative and three cross-sectional studies). Unmet Informational, Emotional/Psychological, Social, and "Other" needs were identified. Only three studies had a primary aim of investigating unmet supportive care needs. Small active surveillance samples, use of nonvalidated measures, and minimal reporting of author reflexivity in qualitative studies were the main quality issues identified., Conclusions: The unmet needs of men on active surveillance is an underresearched area. Preliminary evidence suggests the information available and provided to men during active surveillance is perceived as inadequate and inconsistent. Men may also be experiencing unmet psychological/emotional, social, and other needs; however, further representative, high-quality research is required to understand the magnitude of this issue. Reporting results specific to treatment type and utilising relevant theories/models (such as the social ecological model [SEM]) is recommended to ensure factors that may facilitate unmet needs are appropriately considered and reported., (© 2019 John Wiley & Sons, Ltd.)

Purpose: This study aims to investigate the attitudes and preferences men on active surveillance for prostate cancer have regarding exercise and exercise-based support. Exercise outcomes align with traditionally masculine values, can improve mental and physical health, and may even slow early stage prostate cancer progression. However, attitudes and preferences towards exercise and exercise support are unexplored in men on active surveillance., Methods: Semi-structured qualitative interviews were conducted with participants (13 males with a history of active surveillance for prostate cancer; 5 female partners). Interviews were conducted either by telephone or in person and audiotaped, transcribed verbatim, and thematically analysed., Results: Several key themes were identified relating to the two research aims: 'Attitudes and Preferences towards Exercise, and 'Attitudes and Preferences towards Exercise Support'. Despite all men engaging in exercise, the majority did not meet the recommended guidelines for cancer survivors. The majority of men either were interested in receiving exercise support or had previously received it, often recommending this for all men on active surveillance. There were varied preferences regarding delivery modality (i.e., online or face to face), the inclusion of partners, and group versus individual formats., Conclusions: This study provides a novel insight into the attitudes and preferences of men on active surveillance regarding exercise and support. This research will help the development of acceptable and accessible person-centred support for men on active surveillance. However, further research is needed to evaluate the efficacy of different delivery modalities in this population., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: High population levels of sitting is contributing to high rates of chronic health problems. Therefore, the aim of this study was to identify the sitting time messages with the greatest potential to reduce sitting behaviour, as well as identify how this may differ according to demographic, behavioural and psychosocial characteristics., Methods: Australian adults (N = 1460) were asked to report the likelihood that they would adhere to seven messages promoting reduced sitting time and two messages promoting increased physical activity (from 'not at all likely' to 'very likely'). Ordinal regression models were used to compare messages on the likelihood of adherence and whether likelihood of adherence differed as a function of demographic, psychosocial and behavioural characteristics., Results: Likelihood of adherence was highest for the messages, 'Stand and take a break from sitting as frequently as you can' (83% respectively) and 'Avoid sitting for more than 10 hours during the entire day' (82%) and was significantly lower for the message, 'Sit as little as possible on all days of the week' (46%) compared to all other messages., Conclusions: To increase likelihood of adherence messages should be specific, achievable and promote healthy alternatives to sitting (e.g. standing). Messages promoting standing as a healthy alternative to sitting may be more likely to engage people with high sitting behaviour and messages promoting physical activity may be more likely to engage males and retired adults.

Background: To date, many online health behavior programs developed by researchers have not been translated at scale. To inform translational efforts, health researchers must work with marketing experts to design cost-effective marketing campaigns. It is important to understand the characteristics of end users of a given health promotion program and identify key market segments., Objective: This study aimed to describe the characteristics of the adopters of Active Team, a gamified online social networking physical activity app, and identify potential market segments to inform future research translation efforts., Methods: Participants (N=545) were Australian adults aged 18 to 65 years who responded to general advertisements to join a randomized controlled trial (RCT) evaluating the Active Team app. At baseline they provided demographic (age, sex, education, marital status, body mass index, location of residence, and country of birth), behavioral (sleep, assessed by the Pittsburgh Quality Sleep Index) and physical activity (assessed by the Active Australia Survey), psychographic information (health and well-being, assessed by the PERMA [Positive Emotion, Engagement, Relationships, Meaning, Achievement] Profile; depression, anxiety and stress, assessed by the Depression, Anxiety, and Stress Scale [DASS-21]; and quality of life, assessed by the 12-Item Short Form Health Survey [SF-12]). Descriptive analyses and a k-medoids cluster analysis were performed using the software R 3.3.0 (The R Foundation) to identify key characteristics of the sample., Results: Cluster analyses revealed four clusters: (1) younger inactive women with poor well-being (218/545), characterized by a higher score on the DASS-21, low mental component summary score on the SF-12, and relatively young age; (2) older, active women (153/545), characterized by a lower score on DASS-21, a higher overall score on the SF-12, and relatively older age; (3) young, active but stressed men (58/545) with a higher score on DASS-21 and higher activity levels; and (4) older, low active and obese men (30/545), characterized by a high body mass index and lower activity levels., Conclusions: Understanding the characteristics of population segments attracted to a health promotion program will guide the development of cost-effective research translation campaigns., Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12617000113358; https://www.anzctr.org .au/Trial/Registration/TrialReview.aspx?id=371463., International Registered Report Identifier (irrid): RR2-10.1186/s12889-017-4882-7., (©Ilea Sanders, Camille E Short, Svetlana Bogomolova, Tyman Stanford, Ronald Plotnikoff, Corneel Vandelanotte, Tim Olds, Sarah Edney, Jillian Ryan, Rachel G Curtis, Carol Maher. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 03.06.2019.)

Theories of behaviour change and health behaviour change interventions are most often evaluated in between-person designs. However, behaviour change theories apply to individuals not groups and behavioural interventions ultimately aim to achieve within-person rather than between-group change. Within-person methodology, such as N-of-1 (also known as single case design), can circumvent this issue, though has multiple design-specific challenges. This paper provides a conceptual review of the challenges and potential solutions for undertaking N-of-1 studies in health psychology. Key challenges identified include participant adherence to within-person protocols, carry-over and slow onset effects, suitability of behaviour change techniques for evaluation in N-of-1 experimental studies, optimal allocation sequencing and blinding, calculating power/sample size, and choosing the most suitable analysis approach. Key solutions include involving users in study design, employing recent technologies for unobtrusive data collection and problem solving by design. Within-person designs share common methodological requirements with conventional between-person designs but require specific methodological considerations. N-of-1 evaluation designs are appropriate for many though not all types of interventions. A greater understanding of patterns of behaviours and factors influencing behaviour change at the within-person level is required to progress health psychology into a precision science. Video abstract: Supplementary Material 1.

Purpose: To examine the feasibility, acceptability, and efficacy of online supportive care interventions targeting prostate cancer survivors (PCS)., Methods: Studies were identified through structured searches of PubMed, Embase and PsycINFO databases, and bibliographic review. Inclusion criteria were (1) examined feasibility, acceptability, or efficacy of an online intervention designed to improve supportive care outcomes for PCS; (2) presented outcome data collected from PCS separately (if mixed cancer); and (3) evaluated efficacy outcomes using randomized controlled trial (RCT) design., Results: Sixteen studies met inclusion criteria; ten were classified as RCTs. Overall, 2446 men (average age 64 years) were included. Studies reported on the following outcomes: feasibility and acceptability of an online intervention (e.g., patient support, online medical record/follow-ups, or decision aids); reducing decisional conflict/distress; improving cancer-related distress and health-related quality of life; and satisfaction with cancer care., Conclusion: We found good preliminary evidence for online supportive care among PCS, but little high level evidence. Generally, the samples were small and unrepresentative. Further, inadequate acceptability measures made it difficult to determine actual PCS acceptability and satisfaction, and lack of control groups precluded strong conclusions regarding efficacy. Translation also appears minimal; few interventions are still publicly available. Larger trials with appropriate control groups and greater emphasis on translation of effective interventions is recommended., Implications for Cancer Survivors: Prostate cancer survivors have a variety of unmet supportive care needs. Using online delivery to improve the reach of high-quality supportive care programs could have a positive impact on health-related quality of life among PCS.

The most common reported barrier to physical activity is a lack of sufficient time. Just like most resources in economics are finite, so too is time within a day. We utilized a time-utility model to better understand how people are allocating time for physical activity. Additionally, we tested whether the allocation of physical activity time impacts people's perception of "lack of time" as a barrier for physical activity or their likelihood of being sufficiently physical active. Australian adults (N = 725 participants, 54% men) reported their time use throughout their day, perceived lack of time as a barrier to activity, and physical activity. Cluster analysis and χ 2 -tests were used to test the study research questions. People tended to either be entirely inactive (29%) or active while doing either leisure (18%), occupation (18%), transport (14%), or household (22%) activities. Those who were active during their leisure or transport time were most likely to be sufficiently active. There were no significant differences among clusters in how much people perceived that lack of time was a physical activity barrier. The commonly reported barrier of not having enough time to be active might be a fallacy. Although a lack of time is a commonly reported barrier of physical activity, these findings bring to light that increasing physical activity behavior is not as simple as adding more time to the day.

Background: Web-based interventions that provide personalized physical activity advice have demonstrated good effectiveness but rely on self-reported measures of physical activity, which are prone to overreporting, potentially reducing the accuracy and effectiveness of the advice provided., Objective: This study aimed to examine whether the effectiveness of a Web-based computer-tailored intervention could be improved by integrating Fitbit activity trackers., Methods: Participants received the 3-month TaylorActive intervention, which included 8 modules of theory-based, personally tailored physical activity advice and action planning. Participants were randomized to receive the same intervention either with or without Fitbit tracker integration. All intervention materials were delivered on the Web, and there was no face-to-face contact at any time point. Changes in physical activity (Active Australia Survey), sitting time (Workforce Sitting Questionnaire), and body mass index (BMI) were assessed 1 and 3 months post baseline. Advice acceptability, website usability, and module completion were also assessed., Results: A total of 243 Australian adults participated. Linear mixed model analyses showed a significant increase in total weekly physical activity (adjusted mean increase=163.2; 95% CI 52.0-274.5; P=.004) and moderate-to-vigorous physical activity (adjusted mean increase=78.6; 95% CI 24.4-131.9; P=.004) in the Fitbit group compared with the non-Fitbit group at the 3-month follow-up. The sitting time and BMI decreased more in the Fitbit group, but no significant group × time interaction effects were found. The physical activity advice acceptability and the website usability were consistently rated higher by participants in the Fitbit group. Non-Fitbit group participants completed 2.9 (SD 2.5) modules, and Fitbit group participants completed 4.4 (SD 3.1) modules., Conclusions: Integrating physical activity trackers into a Web-based computer-tailored intervention significantly increased intervention effectiveness., Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616001555448; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371793 (Archived by WebCite at http://www.webcitation.org/73ioTxQX2)., (©Corneel Vandelanotte, Mitch J Duncan, Carol A Maher, Stephanie Schoeppe, Amanda L Rebar, Deborah A Power, Camille E Short, Christopher M Doran, Melanie J Hayman, Stephanie J Alley. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 18.12.2018.)

Computer-tailored interventions, which deliver health messages adjusted based on characteristics of the message recipient, can effectively improve a range of health behaviours. Typically, the content of the message is tailored to user demographics, health behaviours and social cognitive factors (e.g., intentions, attitudes, self-efficacy, perceived social support) to increase message relevance, and thus the extent to which the message is read, considered and translated into attitude and behaviour change. Some researchers have suggested that the efficacy of computer-tailored interventions may be further enhanced by adapting messages to suit recipients' need for cognition (NFC) - a personality trait describing how individuals tend to process information. However, the likely impact of doing so, especially when tailored in conjunction with other variables, requires further consideration. It is possible that intervention effects may be reduced in some circumstances due to interactions with other variables (e.g., perceived relevance) that also influence information processing. From a practical point of view, it is also necessary to consider how to optimally operationalise and measure NFC if it is to be a useful tailoring variable. This paper aims to facilitate further research in this area by critically examining these issues based on relevant theories and existing evidence.

Engagement in electronic health (eHealth) and mobile health (mHealth) behavior change interventions is thought to be important for intervention effectiveness, though what constitutes engagement and how it enhances efficacy has been somewhat unclear in the literature. Recently published detailed definitions and conceptual models of engagement have helped to build consensus around a definition of engagement and improve our understanding of how engagement may influence effectiveness. This work has helped to establish a clearer research agenda. However, to test the hypotheses generated by the conceptual modules, we need to know how to measure engagement in a valid and reliable way. The aim of this viewpoint is to provide an overview of engagement measurement options that can be employed in eHealth and mHealth behavior change intervention evaluations, discuss methodological considerations, and provide direction for future research. To identify measures, we used snowball sampling, starting from systematic reviews of engagement research as well as those utilized in studies known to the authors. A wide range of methods to measure engagement were identified, including qualitative measures, self-report questionnaires, ecological momentary assessments, system usage data, sensor data, social media data, and psychophysiological measures. Each measurement method is appraised and examples are provided to illustrate possible use in eHealth and mHealth behavior change research. Recommendations for future research are provided, based on the limitations of current methods and the heavy reliance on system usage data as the sole assessment of engagement. The validation and adoption of a wider range of engagement measurements and their thoughtful application to the study of engagement are encouraged., (©Camille E Short, Ann DeSmet, Catherine Woods, Susan L Williams, Carol Maher, Anouk Middelweerd, Andre Matthias Müller, Petra A Wark, Corneel Vandelanotte, Louise Poppe, Melanie D Hingle, Rik Crutzen. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 16.11.2018.)

Background: Exercise effects in cancer patients often appear modest, possibly because interventions rarely target patients most in need. This study investigated the moderator effects of baseline values on the exercise outcomes of fatigue, aerobic fitness, muscle strength, quality of life (QoL), and self-reported physical function (PF) in cancer patients during and post-treatment., Methods: Individual patient data from 34 randomized exercise trials (n = 4519) were pooled. Linear mixed-effect models were used to study moderator effects of baseline values on exercise intervention outcomes and to determine whether these moderator effects differed by intervention timing (during vs post-treatment). All statistical tests were two-sided., Results: Moderator effects of baseline fatigue and PF were consistent across intervention timing, with greater effects in patients with worse fatigue (Pinteraction = .05) and worse PF (Pinteraction = .003). Moderator effects of baseline aerobic fitness, muscle strength, and QoL differed by intervention timing. During treatment, effects on aerobic fitness were greater for patients with better baseline aerobic fitness (Pinteraction = .002). Post-treatment, effects on upper (Pinteraction < .001) and lower (Pinteraction = .01) body muscle strength and QoL (Pinteraction < .001) were greater in patients with worse baseline values., Conclusion: Although exercise should be encouraged for most cancer patients during and post-treatments, targeting specific subgroups may be especially beneficial and cost effective. For fatigue and PF, interventions during and post-treatment should target patients with high fatigue and low PF. During treatment, patients experience benefit for muscle strength and QoL regardless of baseline values; however, only patients with low baseline values benefit post-treatment. For aerobic fitness, patients with low baseline values do not appear to benefit from exercise during treatment.

This study aimed to identify and compare the demographic, health behavior, health status, and social media use correlates of online health-seeking behaviors among men and women. Cross-sectional self-report data were collected from 1,289 Australian adults participating in the Queensland Social Survey. Logistic regression analyses were used to identify the correlates of online health information seeking for men and women. Differences in the strength of the relation of these correlates were tested using equality of regression coefficient tests. For both genders, the two strongest correlates were social media use (men: odds ratio [ OR] = 2.57, 95% confidence interval [CI: 1.78, 3.71]; women: OR = 2.93, 95% CI [1.92, 4.45]) and having a university education (men: OR = 3.63, 95% CI [2.37, 5.56]; women: OR = 2.74, 95% CI [1.66, 4.51]). Not being a smoker and being of younger age were also associated with online health information seeking for both men and women. Reporting poor health and the presence of two chronic diseases were positively associated with online health seeking for women only. Correlates of help seeking online among men and women were generally similar, with exception of health status. Results suggest that similar groups of men and women are likely to access health information online for primary prevention purposes, and additionally that women experiencing poor health are more likely to seek health information online than women who are relatively well. These findings are useful for analyzing the potential reach of online health initiatives targeting both men and women.

The relationship between plasma glucose concentration and intracellular glucose (liver, heart, brain, gill, gonad, intestine, kidney, spleen, white muscle) was determined in fish species with a range in plasma glucose (Atlantic cod, 5.06 mM; cunner, 3.8 mM; rainbow trout, 3.7 mM; lumpfish, 0.9 mM; short-horned sculpin, 0.6 mM; and winter flounder, 0.6 mM). The ratio of intracellular glucose/plasma glucose was always higher than one in liver for all species consistent with a diffusion gradient from the tissue to the plasma. In all other tissues in Atlantic cod, cunner, and rainbow trout the diffusion gradient was from the plasma to the intracellular space. In short-horned sculpin, the mean ratio in heart and white muscle exceeded one and in winter flounder the ratio was significantly greater than one at 5.97 and 2.92 for heart and muscle, respectively. The presence of an active glucose 6-phosphatase in white muscle could account for elevated amounts of free glucose. The white muscle of all species displayed phosphoenolpyruvate carboxykinase and in winter flounder the activity was as high in white muscle as in liver suggesting that gluconeogenesis may be associated with a relatively high-muscle glucose content. The glycogen content was highest in liver followed by heart with lower amounts in all other tissues. There was an inverse correlation between heart glycogen content and plasma glucose concentration when all species were included. It is contended that in species with low plasma glucose, heart glycogen is accumulated at a slow rate under normoxia, to be called upon under hypoxic conditions when the gradient for inward diffusion is unfavourable for high rates of glucose metabolism.

Purpose: Men who are survivors of prostate cancer report a variety of psychological and physical factors contributing to a lower quality of life, and physical activity can assist to mitigate these issues. This review aims to provide a summary of physical activity behaviour change trials targeting prostate cancer survivors, assess the feasibility of these interventions and, if possible, identify intervention and study characteristics associated with significant intervention effects., Method: Four databases (PubMed, CINAHL, PsycINFO and EMBASE) were systematically searched for randomised controlled trials containing at least one behavioural outcome relating to physical activity published up until July 2016. Forward and backwards, hand, key author citation searching and known research were also considered., Results: From a total of 13, 828 titles, the search resulted in 12 studies (6 prostate cancer only and 6 mixed cancer interventions), eight of which found positive results most often related immediately to post-intervention aerobic activity. Factors relating to efficacy were not conclusive due to the heterogeneity of studies and lack of cancer-specific data in mixed cancer trials. Future research focusing on intervention reach, maintenance of intervention effects and resistance training outcomes is needed., Conclusion: There is preliminary evidence to suggest that a variety of physical activity behaviour change interventions targeting men with a history of prostate cancer can be efficacious, at least in the short term. Experimental studies are required to identify key intervention features., Implications for Cancer Survivors: Physical activity interventions can assist prostate cancer survivors in relation to short-term lifestyle change, though more evidence is required to improve the clarity of factors related to efficacy.

Background: Electronic health (eHealth) and mobile health (mHealth) approaches to address low physical activity levels, sedentary behavior, and unhealthy diets have received significant research attention. However, attempts to systematically map the entirety of the research field are lacking. This gap can be filled with a bibliometric study, where publication-specific data such as citations, journals, authors, and keywords are used to provide a systematic overview of a specific field. Such analyses will help researchers better position their work., Objective: The objective of this review was to use bibliometric data to provide an overview of the eHealth and mHealth research field related to physical activity, sedentary behavior, and diet., Methods: The Web of Science (WoS) Core Collection was searched to retrieve all existing and highly cited (as defined by WoS) physical activity, sedentary behavior, and diet related eHealth and mHealth research papers published in English between January 1, 2000 and December 31, 2016. Retrieved titles were screened for eligibility, using the abstract and full-text where needed. We described publication trends over time, which included journals, authors, and countries of eligible papers, as well as their keywords and subject categories. Citations of eligible papers were compared with those expected based on published data. Additionally, we described highly-cited papers of the field (ie, top ranked 1%)., Results: The search identified 4805 hits, of which 1712 (including 42 highly-cited papers) were included in the analyses. Publication output increased on an average of 26% per year since 2000, with 49.00% (839/1712) of papers being published between 2014 and 2016. Overall and throughout the years, eHealth and mHealth papers related to physical activity, sedentary behavior, and diet received more citations than expected compared with papers in the same WoS subject categories. The Journal of Medical Internet Research published most papers in the field (9.58%, 164/1712). Most papers originated from high-income countries (96.90%, 1659/1717), in particular the United States (48.83%, 836/1712). Most papers were trials and studied physical activity. Beginning in 2013, research on Generation 2 technologies (eg, smartphones, wearables) sharply increased, while research on Generation 1 (eg, text messages) technologies increased at a reduced pace. Reviews accounted for 20 of the 42 highly-cited papers (n=19 systematic reviews). Social media, smartphone apps, and wearable activity trackers used to encourage physical activity, less sedentary behavior, and/or healthy eating were the focus of 14 highly-cited papers., Conclusions: This study highlighted the rapid growth of the eHealth and mHealth physical activity, sedentary behavior, and diet research field, emphasized the sizeable contribution of research from high-income countries, and pointed to the increased research interest in Generation 2 technologies. It is expected that the field will grow and diversify further and that reviews and research on most recent technologies will continue to strongly impact the field., (©Andre Matthias Müller, Carol A Maher, Corneel Vandelanotte, Melanie Hingle, Anouk Middelweerd, Michael L Lopez, Ann DeSmet, Camille E Short, Nicole Nathan, Melinda J Hutchesson, Louise Poppe, Catherine B Woods, Susan L Williams, Petra A Wark. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 18.04.2018.)

Background: While the internet is considered a promising avenue for providing physical activity support to prostate cancer survivors, little is known about the accessibility of quality websites in the real world., Purpose: This work aimed to explore what websites prostate cancer survivors are likely to find when seeking physical activity support online and to evaluate their quality using evidenced-based criteria., Method: A search strategy was developed in consultation with prostate cancer survivors (n = 44) to reflect the most common ways they are likely to search the internet. The search was then conducted by a single reviewer, and identified websites were assessed for quality by two reviewers using an evidence-based quality assessment tool developed for this study. Discrepancies were resolved by a third reviewer., Results: Of the 45 identified websites, 13 (29%) received a high quality rating, 22 (49%) received a moderate rating and 10 (22%) received a low quality rating. Higher-quality websites tended to have a .org or .gov domain and tended to be located using searches specific to prostate cancer or prostate cancer and exercise. Very few websites contained complete information regarding the physical activity guidelines for cancer survivors, and no websites provided comprehensive behaviour change support., Conclusion: There are some good-quality physical activity websites accessible to men with prostate cancer. However, they may be difficult to find and/or require updating to include complete recommendations and more behaviour change support., Implications for Cancer Survivors: Efforts to improve physical activity information online and strategies to direct prostate cancer survivors to higher-quality websites and support services are needed to ensure safety and efficacy.

Background: Participation in regular physical activity holds key benefits for cancer survivors, yet few cancer survivors meet physical activity recommendations. This study aimed to develop and pilot test a mHealth app referral service aimed at assisting cancer survivors to increase their physical activity. In particular, the study sought to examine feasibility and acceptability of the service and determine preliminary efficacy for physical activity behaviour change., Methods: A systematic search identified potentially appropriate Apple (iOS) and Android mHealth apps. The apps were audited regarding the type of physical activity encouraged, evidence-based behavioural strategies and other characteristics, to help match apps to users' preferences and characteristics. A structured service was devised to deliver the apps and counselling, comprising two face-to-face appointments with a mid-week phone or email check-up. The mHealth app referral service was piloted using a pre-post design among 12 cancer survivors. Participants' feedback regarding the service's feasibility and acceptability was sought via purpose-designed questionnaire, and analysed using inductive thematic analysis and descriptive statistics. Change in physical activity was assessed using a valid and reliable self-report tool and analysed using paired t-tests. In line with recommendations for pilot studies, confidence intervals and effect sizes were reported to aid interpretation of clinical significance, with an alpha of 0.2 used to denote statistical significance., Results: Of 374 mHealth apps identified during the systematic search, 54 progressed to the audit (iOS = 27, Android = 27). The apps consistently scored well for aesthetics, engagement and functionality, and inconsistently for gamification, social and behaviour change features. Ten participants completed the pilot evaluation and provided positive feedback regarding the service's acceptability and feasibility. On average, participants increased their moderate-vigorous physical activity by 236 min per week (d = 0.73; 95% CI = -49 to 522; p = 0.09)., Conclusion: This study offered initial evidence that a mHealth app referral service for cancer survivors is feasible and acceptable and may increase physical activity levels. The large increase in physical activity is promising, but should be interpreted with caution given the small sample size and lack of control group. Further research is warranted on a larger scale to investigate generalisability, long-term compliance and application in clinical settings.

Images portraying exercise are commonly used to promote exercise behavior and to measure automatic associations of exercise (e.g., via implicit association tests). The effectiveness of these promotion efforts and the validity of measurement techniques partially rely on the untested assumption that the images being used are perceived by the general public as portrayals of exercise that is pleasant and motivating. The aim of this study was to investigate how content of images impacted people's automatic and reflective evaluations of exercise images. Participants ( N = 90) completed a response time categorization task (similar to the implicit association test) to capture how automatically people perceived each image as relevant to Exercise or Not exercise . Participants also self-reported their evaluations of the images using visual analog scales with the anchors: Exercise / Not exercise, Does not motivate me to exercise / Motivates me to exercise, Pleasant / Unpleasant , and Energizing/Deactivating . People tended to more strongly automatically associate images with exercise if the images were of an outdoor setting, presented sport (as opposed to active labor or gym-based) activities, and included young (as opposed to middle-aged) adults. People tended to reflectively find images of young adults more motivating and relevant to exercise than images of older adults. The content of exercise images is an often overlooked source of systematic variability that may impact measurement validity and intervention effectiveness.

Background: Participating in regular physical activity is a recommended cancer recovery strategy for breast cancer survivors. However, tailored support services are not widely available and most survivors are insufficiently active to obtain health benefits. Delivering tailored programs via the Internet offers one promising approach. However, recent evaluations of such programs suggest that major improvements are needed to ensure programs meet the needs of users and are delivered in an engaging way. Understanding participants' experiences with current programs can help to inform the next generation of systems., Purpose: The purposes of this study are to explore breast cancer survivor's perspectives of and experiences using a novel computer-tailored intervention and to describe recommendations for future iterations., Methods: Qualitative data from a sub-sample of iMove More for Life study participants were analysed thematically to identify key themes. Participants long-term goals for participating in the program were explored by analysing open-ended data extracted from action plans completed during the intervention (n = 370). Participants negative and positive perceptions of the website and recommendations for improvement were explored using data extracted from open-ended survey items collected at the immediate intervention follow-up (n = 156)., Results: The majority of participants reported multi-faceted goals, consisting of two or more outcomes they hoped to achieve within a year. While clear themes were identified (e.g. 'being satisfied with body weight'), there was considerable variability in the scope of the goal (e.g. desired weight loss ranged from 2 to 30 kg). Participants' perceptions of the website were mixed, but clear indications were provided of how intervention content and structure could be improved., Conclusions: This study provides insight into how to better accommodate breast cancer survivors in the future and ultimately design more engaging computer-tailored interventions.

Purpose: This study evaluated the American Speech-Language-Hearing Association's recommendation that audiometric testing for patients with tinnitus should use pulsed or warble tones. Using listeners with varied audiometric configurations and tinnitus statuses, we asked whether steady, pulsed, and warble tones yielded similar audiometric thresholds, and which tone type was preferred., Method: Audiometric thresholds (octave frequencies from 0.25-16 kHz) were measured using steady, pulsed, and warble tones in 61 listeners, who were divided into 4 groups on the basis of hearing and tinnitus status. Participants rated the appeal and difficulty of each tone type on a 1-5 scale and selected a preferred type., Results: For all groups, thresholds were lower for warble than for pulsed and steady tones, with the largest effects above 4 kHz. Appeal ratings did not differ across tone type, but the steady tone was rated as more difficult than the warble and pulsed tones. Participants generally preferred pulsed and warble tones., Conclusions: Pulsed tones provide advantages over steady and warble tones for patients regardless of hearing or tinnitus status. Although listeners preferred pulsed and warble tones to steady tones, pulsed tones are not susceptible to the effects of off-frequency listening, a consideration when testing listeners with sloping audiograms.

There is a wide interspecific range in plasma glucose levels in teleosts from less than 0.5 to greater than 10 mmol l -1 Here we assessed how glucose availability influences glucose metabolism in hearts of Atlantic cod ( Gadus morhua ), rainbow trout ( Oncorhynchus mykiss ), lumpfish ( Cyclopterus lumpus ) and short-horned sculpin ( Myoxocephalus scorpius ) under normoxic and hypoxic conditions. These species had plasma glucose levels of 5.1, 4.8, 0.9 and 0.5 mmol l -1 , respectively. Rates of glucose metabolism and lactate production were determined in isolated hearts perfused with medium containing physiological levels of glucose. Under normoxic conditions there was no significant difference in rates of either glucose metabolism (average 15 nmol g -1  min -1 ) or lactate production (average 30 nmol g -1  min -1 ) across species. Under hypoxia (12% of air saturation) there were significant increases in rates of glucose metabolism and lactate production in hearts from Atlantic cod (glucose-130; lactate-663 nmol g -1  min -1 ) and rainbow trout (glucose-103; lactate-774 nmol g -1  min -1 ); however, there was no change in rate of glucose metabolism in hearts from either lumpfish or short-horned sculpin and only increases in lactate production to rates much lower than the other species. Furthermore, Atlantic cod hearts perfused with medium containing low non-physiological levels of glucose (0.5 mmol l -1 ) had the same rates of glucose metabolism under normoxic and hypoxic treatments. Anaerobic metabolism supported by extracellular glucose is compromised in fish with low levels of plasma glucose, which in turn may decrease performance under oxygen-limiting conditions at the whole-animal level., Competing Interests: Competing interestsThe authors declare no competing or financial interests., (© 2017. Published by The Company of Biologists Ltd.)

Background: Several studies have examined how the implementation of behavior change techniques (BCTs) varies between different activity trackers. However, activity trackers frequently allow tracking of activity, sleep, and sedentary behaviors; yet, it is unknown how the implementation of BCTs differs between these behaviors., Objective: The aim of this study was to assess the number and type of BCTs that are implemented by wearable activity trackers (self-monitoring systems) in relation to activity, sleep, and sedentary behaviors and to determine whether the number and type of BCTs differ between behaviors., Methods: Three self-monitoring systems (Fitbit [Charge HR], Garmin [Vivosmart], and Jawbone [UP3]) were each used for a 1-week period in August 2015. Each self-monitoring system was used by two of the authors (MJD and BM) concurrently. The Coventry, Aberdeen, and London-Refined (CALO-RE) taxonomy was used to assess the implementation of 40 BCTs in relation to activity, sleep, and sedentary behaviors. Discrepancies in ratings were resolved by discussion, and interrater agreement in the number of BCTs implemented was assessed using kappa statistics., Results: Interrater agreement ranged from 0.64 to 1.00. From a possible range of 40 BCTs, the number of BCTs present for activity ranged from 19 (Garmin) to 33 (Jawbone), from 4 (Garmin) to 29 (Jawbone) for sleep, and 0 (Fitbit) to 10 (Garmin) for sedentary behavior. The average number of BCTs implemented was greatest for activity (n=26) and smaller for sleep (n=14) and sedentary behavior (n=6)., Conclusions: The number and type of BCTs implemented varied between each of the systems and between activity, sleep, and sedentary behaviors. This provides an indication of the potential of these systems to change these behaviors, but the long-term effectiveness of these systems to change activity, sleep, and sedentary behaviors remains unknown., (©Mitch Duncan, Beatrice Murawski, Camille E Short, Amanda L Rebar, Stephanie Schoeppe, Stephanie Alley, Corneel Vandelanotte, Morwenna Kirwan. Originally published in the Interactive Journal of Medical Research (http://www.i-jmr.org/), 14.08.2017.)

Issue addressed Sedentary behaviours, in particular sitting, increases the risk of cardiovascular disease, type 2 diabetes, obesity and poorer mental health status. In Australia, 70% of adults sit for more than 8h per day. The use of social media applications (e.g. Facebook, Twitter, and Instagram) is on the rise; however, no studies have explored the association of social media use with sitting time and body mass index (BMI). Methods Cross-sectional self-report data on demographics, BMI and sitting time were collected from 1140 participants in the 2013 Queensland Social Survey. Generalised linear models were used to estimate associations of a social media score calculated from social media use, perceived importance of social media, and number of social media contacts with sitting time and BMI. Results Participants with a high social media score had significantly greater sitting times while using a computer in leisure time and significantly greater total sitting time on non-workdays. However, no associations were found between social media score and sitting to view TV, use motorised transport, work or participate in other leisure activities; or total workday, total sitting time or BMI. Conclusions These results indicate that social media use is associated with increased sitting time while using a computer, and total sitting time on non-workdays. So what? The rise in social media use may have a negative impact on health by contributing to computer sitting and total sitting time on non-workdays. Future longitudinal research with a representative sample and objective sitting measures is needed to confirm findings.

Background: Physical activity (PA) during pregnancy is associated with a variety of health benefits including a reduced risk of pregnancy related conditions such as pre-eclampsia and pregnancy-induced hypertension and leads to greater control over gestational weight gain. Despite these associated health benefits, very few pregnant women are sufficiently active. In an attempt to increase health outcomes, it is important to explore innovative ways to increase PA among pregnant women. Therefore, the aim of this study was to assess the feasibility, acceptability and efficacy of a four week web-based computer-tailored PA intervention among pregnant women., Methods: Seventy-seven participants were randomised into either: (1) an intervention group that received tailored PA advice and access to a resource library of articles relating to PA during pregnancy; or (2) a standard information group that only received access to the resources library. Objective moderate-to-vigorous physical activity (MVPA) was assessed at baseline and immediately post-intervention. Recruitment, attrition, intervention adherence, and website engagement were assessed. Questions on usability and satisfaction were administered post-intervention., Results: Feasibility was demonstrated through acceptable recruitment (8.5 participants recruited and randomised/month), and attrition (25%). Acceptability among intervention group participants was positive with high intervention adherence (96% of 4 modules completed). High website engagement (participants logged in 1.6 times/week although only required to log in once per week), usability (75/100), and satisfaction outcomes were reported in both groups. However, participants in the intervention group viewed significantly more pages on the website (p < 0.05), reported that the website felt more personally relevant (p < 0.05), and significantly increased their MVPA from baseline to post-intervention (mean difference = 35.87 min), compared to the control group (mean difference = 9.83 min) (p < 0.05), suggesting efficacy., Conclusions: The delivery of a computer-tailored web-based intervention designed to increase PA in pregnant women is feasible, well accepted and associated with increases in short-term MVPA. Findings suggest the use of computer-tailored information leads to greater website engagement, satisfaction and greater PA levels among pregnant women compared to a generic information only website., Trial Registration: The trial was 'retrospectively registered' with the Australian New Zealand Clinical Trials Registry ( ACTRN12614001105639 ) on 17 th October, 2014.