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Background: The role of nutrient timing in energy intake amongst people with dysglycaemia is understudied but could be a simple method to help regulate appetite. This study analysed within-person associations of sugar intake at breakfast and subsequent energy intake. Methods: We used 4-day diet diary data from 147 participants (47 % men) encompassing 547 days of diet recording in the Sedentary Time and Metabolic Health in People with Type 2 diabetes project (STAMP-2). Linear two-level models were used to investigate within- (day-level) and between-person (participant-level) variation in total and post-breakfast energy intake according to skipping breakfast, low- (> 0-14.2 g) or high- (> 14.2 g) sugar intake at breakfast, adjusting for potential confounding or mediation. Results: Post-breakfast energy intakes were observed to be lower after eating low- and high-sugar breakfasts (compared to skipping), but higher total energy intake was associated with eating a high-sugar breakfast. Compared to breakfast skipping, both low- and high-sugar breakfasts were strongly associated with lower post-breakfast energy intake (-178, 95 % confidence interval [CI] -261, -94 kcal/d; ‑151, 95 % CI -235, -67 kcal/d, respectively). However, compared to skipping breakfast, low-sugar breakfasts were weakly associated with higher total daily energy intake (64, 95 % CI -18, 146 kcal/d), whereas high-sugar breakfasts had a strong association (135, 95 % CI 52, 217 kcal/d). Post-breakfast energy intakes were similar between low- and high-sugar breakfast days (27, 95 % CI -53, 106 kcal/d), whilst total daily energy intake tended to be higher with high- (compared to low-) sugar breakfasts (70, -8, 149 kcal/d). We also observed evidence of energy compensation whereby 86 % of the extra energy consumed in a low-sugar breakfast was compensated for by reductions in post-breakfast energy intakes, compared to only 53 % after a high-sugar breakfast. Conclusion: Overall, high-, but not low-, sugar breakfasts were associated with higher total daily energy intake when compared to breakfast skipping, despite a similar reduction in post-breakfast energy intake. We found evidence of poorer post-breakfast energy intake compensation with high-sugar breakfasts than low-sugar breakfasts. These findings suggest portion size may be important to consider in future breakfast research, with sugar being a proxy of portion size.

Background Previous research has reported associations between features of the residential built environment and physical activity but these studies have mainly been cross-sectional, limiting inference. This paper examines whether changes in a range of residential built environment features are associated with changes in measures of physical activity in adults. It also explores whether observed effects are moderated by socio-economic status. Methods Data from the Examining Neighbourhood Activity in Built Living Environments in London (ENABLE London) study were used. A cohort of 1278 adults seeking to move into social, intermediate, and market-rent East Village accommodation was recruited in 2013–2015, and followed up after 2 years. Accelerometer-derived steps (primary outcome), and GIS-derived measures of residential walkability, park proximity and public transport accessibility were obtained both at baseline and follow-up. Daily steps at follow-up were regressed on daily steps at baseline, change in built environment exposures and confounding variables using multilevel linear regression to assess if changes in neighbourhood walkability, park proximity and public transport accessibility were associated with changes in daily steps. We also explored whether observed effects were moderated by housing tenure as a marker of socio-economic status. Results Between baseline and follow-up, participants experienced a 1.4 unit (95%CI 1.2,1.6) increase in neighbourhood walkability; a 270 m (95%CI 232,307) decrease in distance to their nearest park; and a 0.7 point (95% CI 0.6,0.9) increase in accessibility to public transport. A 1 s.d. increase in neighbourhood walkability was associated with an increase of 302 (95%CI 110,494) daily steps. A 1 s.d. increase in accessibility to public transport was not associated with any change in steps overall, but was associated with a decrease in daily steps amongst social housing seekers (− 295 steps (95%CI − 595, 3), and an increase in daily steps for market-rent housing seekers (410 95%CI -191, 1010) (P-value for effect modification = 0.03). Conclusion Targeted changes in the residential built environment may result in increases in physical activity levels. However, the effect of improved accessibility to public transport may not be equitable, showing greater benefit to the more advantaged.

BackgroundNeighbourhood characteristics may affect mental health and well-being, but longitudinal evidence is limited. We examined the effect of relocating to East Village (the former London 2012 Olympic Athletes’ Village), repurposed to encourage healthy active living, on mental health and well-being.Methods1278 adults seeking different housing tenures in East village were recruited and examined during 2013–2015. 877 (69%) were followed-up after 2 years; 50% had moved to East Village. Analysis examined change in objective measures of the built environment, neighbourhood perceptions (scored from low to high; quality −12 to 12, safety −10 to 10 units), self-reported mental health (depression and anxiety) and well-being (life satisfaction, life being worthwhile and happiness) among East Village participants compared with controls who did not move to East Village. Follow-up measures were regressed on baseline for each outcome with group status as a binary variable, adjusted for age, sex, ethnicity, housing tenure and household clustering (random effect).ResultsParticipants who moved to East Village lived closer to their nearest park (528 m, 95% CI 482 to 575 m), in more walkable areas, and had better access to public transport, compared with controls. Living in East Village was associated with marked improvements in neighbourhood perceptions (quality 5.0, 95% CI 4.5 to 5.4 units; safety 3.4, 95% CI 2.9 to 3.9 units), but there was no overall effect on mental health and well-being outcomes.ConclusionDespite large improvements in the built environment, there was no evidence that moving to East Village improved mental health and well-being. Changes in the built environment alone are insufficient to improve mental health and well-being.

Background Interventions to encourage active modes of travel (walking, cycling) may improve physical activity levels, but longitudinal evidence is limited and major change in the built environment / travel infrastructure may be needed. East Village (the former London 2012 Olympic Games Athletes Village) has been repurposed on active design principles with improved walkability, open space and public transport and restrictions on residential car parking. We examined the effect of moving to East Village on adult travel patterns. Methods One thousand two hundred seventy-eight adults (16+ years) seeking to move into social, intermediate, and market-rent East Village accommodation were recruited in 2013–2015, and followed up after 2 years. Individual objective measures of physical activity using accelerometry (ActiGraph GT3X+) and geographic location using GPS travel recorders (QStarz) were time-matched and a validated algorithm assigned four travel modes (walking, cycling, motorised vehicle, train). We examined change in time spent in different travel modes, using multilevel linear regresssion models adjusting for sex, age group, ethnicity, housing group (fixed effects) and household (random effect), comparing those who had moved to East Village at follow-up with those who did not. Results Of 877 adults (69%) followed-up, 578 (66%) provided valid accelerometry and GPS data for at least 1 day (≥540 min) at both time points; half had moved to East Village. Despite no overall effects on physical activity levels, sizeable improvements in walkability and access to public transport in East Village resulted in decreased daily vehicle travel (8.3 mins, 95%CI 2.5,14.0), particularly in the intermediate housing group (9.6 mins, 95%CI 2.2,16.9), and increased underground travel (3.9 mins, 95%CI 1.2,6.5), more so in the market-rent group (11.5 mins, 95%CI 4.4,18.6). However, there were no effects on time spent walking or cycling. Conclusion Designing walkable neighbourhoods near high quality public transport and restrictions on car usage, may offer a community-wide strategy shift to sustainable transport modes by increasing public transport use, and reducing motor vehicle travel.

Background:The aim of this randomized, 3-period, 3-treatment crossover trial was to examine the acute effects of regularly breaking up seated office work with short bouts of standing or light-intensity walking on postprandial interstitial glucose concentration.Methods:Seventeen middle-aged office workers performed 3 5-hour trial conditions at their workplace in a random order: 1) uninterrupted sitting, 2) sitting interrupted by 2 minutes of standing every 20 minutes, and 3) sitting interrupted by 2 minutes of light-intensity walking every 20 minutes. Participants consumed 2 standardized test drinks at the start of each trial condition and an iPro2 continuous glucose monitoring system (CGMS) recorded average interstitial glucose concentration every 5 minutes for the duration of the study.Results:The 5-hour interstitial glucose incremental area under the curve (iAUC) was 55.5% lower after sitting interrupted by light-intensity walking compared with after uninterrupted sitting (95% CI, –104.2% to –6.8%). There was also a suggestion of a beneficial effect of regular standing breaks, particularly in overweight men, although they were not as effective as the walking breaks (mean difference [95% CI], –29.6% [–73.9% to 14.7%]).Conclusions:Regularly breaking up prolonged sitting lowers postprandial glycemia in middle-aged adults without metabolic impairment.

Green tea or green tea extract (GT/GTE) has been demonstrated to reduce insulin resistance and improve glycemic control. However, evidence for this health beneficial effect is inconsistent. This systematic review evaluated the effect of GT/GTE on insulin resistance and glycemic control in people with pre-diabetes/type 2 diabetes mellitus (T2DM). Ovid MEDLINE, Embase, AMED, Web of Science, and the Cochrane Library were searched up to April 2017 for randomised controlled trials of participants with pre-diabetes or T2DM, where the intervention was GT/GTE. Meta-analysis was performed to assess the standardised mean difference (SMD) in biomarkers of insulin resistance and glycemic control between GT/GTE and placebo groups. Six studies (n=382) were pooled into random-effects meta-analysis. Overall, no differences were found between GT/GTE and the placebo for glycosylated hemoglobin (HbA1c: SMD, -0.32; 95% confidence interval [CI], -0.86 to 0.23), homeostatic model assessment for insulin resistance (HOMA-IR: SMD, 0.10; 95% CI, -0.17 to 0.38), fasting insulin (SMD, -0.25; 95% CI, -0.64 to 0.15), and fasting glucose (SMD, -0.10; 95% CI, -0.50 to 0.30). No evidence support the consumption of GT/GTE could reduce the levels of HbA1c, HOMA-IR, fasting insulin, or fasting glucose in people with pre-diabetes/T2DM. However, the studies included were small and of varying quality.

Summary Background The built environment can affect health behaviours, but longitudinal evidence is limited. We aimed to examine the effect of moving into East Village, the former London 2012 Olympic and Paralympic Games Athletes' Village that was repurposed on active design principles, on adult physical activity and adiposity. Methods In this cohort study, we recruited adults seeking new accommodation in East Village and compared physical activity and built environment measures with these data in control participants who had not moved to East Village. At baseline and after 2 years, we objectively measured physical activity with accelerometry and adiposity with body-mass index and bioimpedance, and we assessed objective measures of and participants' perceptions of change in their built environment. We examined the change in physical activity and adiposity between the East Village and control groups, after adjusting for sex, age group, ethnicity, housing tenure, and household (as a random effect). Findings We recruited participants for baseline assessment between Jan 24, 2013, and Jan 7, 2016, and we followed up the cohort after 2 years, between Feb 24, 2015, and Oct 24, 2017. At baseline, 1819 households (one adult per household) consented to initial contact by the study team. 1278 adults (16 years and older) from 1006 (55%) households participated at baseline; of these participants, 877 (69%) adults from 710 (71%) households were assessed after 2 years, of whom 441 (50%) participants from 343 (48%) households had moved to East Village. We found no effect associated with moving to East Village on daily steps, the time spent doing moderate-to-vigorous physical activity (either in total or in 10-min bouts or more), daily sedentary time, body-mass index, or fat mass percentage between participants who had moved to East Village and those in the control group, despite sizeable improvements in walkability and neighbourhood perceptions of crime and quality among the East Village group relative to their original neighbourhood at baseline. Interpretation Despite large improvements in neighbourhood perceptions and walkability, we found no clear evidence that moving to East Village was associated with increased physical activity. Improving the built environment on its own might be insufficient to increase physical activity. Funding National Institute for Health Research and National Prevention Research Initiative.

Background There may be opportunities for working adults to accumulate recommended physical activity levels (≥ 150 minutes of moderate-intensity physical activity in bouts of ≥ 10 minutes throughout the week) during the commute to work. Systematic reviews of interventions to increase active transport indicate that studies are predominantly of poor quality, rely on self-report and lack robust statistical analyses. Objectives To assess the effectiveness, cost and consequences of a behavioural intervention to increase walking during the commute to work. Design A multicentre, parallel-arm, cluster randomised controlled trial incorporating economic and process evaluations. Physical activity outcomes were measured using accelerometers and GPS (Global Positioning System) receivers at baseline and the 12-month follow-up. Setting Workplaces in seven urban areas in south-west England and south Wales. Participants Employees (n = 654) in 87 workplaces. Interventions Workplace-based Walk to Work promoters were trained to implement a 10-week intervention incorporating key behaviour change techniques. Main outcome measures The primary outcome was the daily number of minutes of moderate to vigorous physical activity (MVPA). Secondary outcomes included MVPA during the commute, overall levels of physical activity and modal shift (from private car to walking). Cost–consequences analysis included employer, employee and health service costs and consequences. Process outcomes included barriers to, and facilitators of, walking during the daily commute. Results There was no evidence of an intervention effect on MVPA at the 12-month follow-up [adjusted difference in means 0.3 minutes, 95% confidence interval (CI) –5.3 to 5.9 minutes]. The intervention cost was on average, £181.97 per workplace and £24.19 per participating employee. In comparison with car users [mean 7.3 minutes, standard deviation (SD) 7.6 minutes], walkers (mean 34.3 minutes, SD 18.6 minutes) and public transport users (mean 25.7 minutes, SD 14.0 minutes) accrued substantially higher levels of daily MVPA during the commute. Participants who walked for ≥ 10 minutes during their commute were more likely to have a shorter commute distance (p p p Conclusions Although this research showed that walking to work and using public transport are important contributors to physical activity levels in a working population, the behavioural intervention was insufficient to change travel behaviour. Broader contextual factors, such as length of journey, commuting options and availability of car parking, may influence the effectiveness of behavioural interventions to change travel behaviour. Further analyses of statistical and qualitative data could focus on physical activity and travel mode and the wider determinants of workplace travel behaviour. Trial registration Current Controlled Trials ISRCTN15009100. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 11. See the NIHR Journals Library website for further project information. Living Streets, a UK charity promoting everyday walking, provided funding for the intervention booklets and free pedometers for distribution to participants in the intervention group.

Background: Opportunities for working adults to accumulate recommended physical activity levels (at least 150min of moderate intensity physical activity in bouts of at least 10 min throughout the week) may include the commute to work. Systematic reviews of interventions to increase active transport suggest studies have tended to be of poor quality, relying on self-report and lacking robust statistical analyses. Methods: We conducted a multi-centre parallel-arm cluster randomised controlled trial, in workplaces in south-west England and south Wales, to assess the effectiveness of a behavioural intervention to increase walking during the commute. Workplace-based Walk to Work promoters were trained to implement a 10-week intervention incorporating key behavioural change techniques: providing information; encouraging intention formation; identifying barriers and solutions; goal setting; self-monitoring; providing general encouragement; identifying social support; reviewing goals, and; relapse prevention. Physical activity outcomes were objectively measured using accelerometers and GPS receivers at baseline and 12-month follow-up. The primary outcome was daily minutes of moderate to vigorous physical activity (MVPA). Secondary outcomes included overall levels of physical activity and modal shift (from private car to walking). Cost-consequences analysis included employer, employee and health service costs and outcomes. Results: Six hundred fifty-four participants were recruited across 87 workplaces: 10 micro (5–9 employees); 35 small(10–49); 22 medium (50–250); 20 large (250+). The majority of participants lived more than two kilometres from their place of work (89%) and travelled to work by car (65%). At 12-month follow-up, 84 workplaces (41 intervention,43 control) and 477 employees (73% of those originally recruited) took part in data collection activities. There was no evidence of an intervention effect on MVPA or overall physical activity at 12-month follow-up. The intervention cost on average £181.97 per workplace and £24.19 per participating employee. Conclusions: The intervention, focusing primarily on individual behaviour change, was insufficient to change travel behaviour. Our findings contribute to the argument that attention should be directed towards a whole systems approach, focusing on interactions between the correlates of travel behaviour. Trial registration: ISRCTN15009100. Prospectively registered. (Date assigned: 10/12/2014). Keywords: Walking, Active travel, Workplace, Behavioural intervention, Randomised controlled trial, Physical activity

Background Mental illness is a worldwide public health concern. In the UK, there is a high prevalence of mental illness and poor mental wellbeing among young people. The aim of this study was to investigate whether physical activity is associated with better mental wellbeing and reduced symptoms of mental health disorder in adolescents. Methods A cohort of 928 12–13 year olds (Year 8) from six secondary schools in England, who had participated in the AHEAD trial, ‘Activity and Healthy Eating in Adolescence’, were followed up three years later (when 15–16 years old, Year 11). At baseline, physical activity was measured using accelerometers. At follow-up, mental wellbeing was measured using the ‘Warwick Edinburgh Mental Wellbeing Scale’ (WEMWBS) and symptoms of mental health disorder using the ‘Strengths and Difficulties Questionnaire’ (SDQ). Multivariable linear regression analyses were used to investigate associations between physical activity and both mental wellbeing and symptoms of mental health disorder. Results 794 (86%) of the eligible 928 young people provided valid accelerometer data at baseline. 668 (72%) provided complete mental wellbeing data and 673 (73%) provided complete symptoms of mental health disorder data at follow-up. The multivariable analyses showed no evidence of an association between physical activity volume (counts per minute (cpm)) or intensity (Moderate to Vigorous Physical Activity (MVPA)) and mental wellbeing (WEMWBS overall score) or overall symptoms of mental health disorder (SDQ Total Difficulties Score). However, higher levels of physical activity volume at age 12–13 years were associated with lower scores on the emotional problems subscale of the SDQ at age 15–16 years. Conclusions This cohort study found no strong evidence that physical activity is associated with better mental wellbeing or reduced symptoms of mental health disorder in adolescents. However, a protective association between physical activity and the emotional problems subscale of the SDQ was found. This suggests that physical activity has the potential to reduce symptoms of depression and anxiety in adolescents. Future cohort study designs should allow for repeated measures to fully explore the temporal nature of any relationship.

Background: Studies have found associations between features of the residential built environment and physical activity but these have been mainly cross-sectional. In this paper we explore whether longitudinal changes in environmental exposures are associated with changes in physical activity in adults. Methods: Data from the Examining Neighbourhood Activity in Built Living Environments in London (ENABLE London) study were used. Daily steps at follow-up were regressed on daily steps at baseline, change in built environment exposures and confounding variables using multilevel linear regression to assess if neighbourhood walkability, park proximity and public transport accessibility were associated with changes in accelerometer-derived daily steps. We also explored whether observed effects were moderated by housing tenure as a marker of socio-economic status. Findings: Between baseline and follow-up, participants experienced a 1·4 unit (95%CI 1·2,1·6) increase in neighbourhood walkability; a 270m (95%CI 232,307) decrease in distance to their nearest park; and a 0·7 point (95%CI 0·6,0·9) increase in accessibility to public transport. A 1 s.d. increase in neighbourhood walkability was associated with an increase of 302 (95%CI 110,494) daily steps. A 1 s.d. increase in accessibility to public transport was not associated with any change in steps overall, but was associated with a decrease in daily steps amongst social housing seekers (-295 steps (95%CI -595, 3), and an increase in daily steps for market-rent housing seekers (410 95%CI -191, 1010) (P-value for effect modification=0·03). Interpretation: Targeted changes in the residential built environment may result in increases in physical activity levels. However, the effect of improved accessibility to public transport may not be equitable, showing greater benefit to the more advantaged. Funding Statement: This research is being supported by project grants from the UK National Prevention Research Initiative (MR/J000345/1) and the UK National Institute for Health Research (NIHR; 12/211/69). Diabetes and obesity prevention research at St George’s, University of London is supported by the NIHR Collaboration for Leadership in Applied Health Research and Care, South London. CMN is supported by the Wellcome Trust Institutional Strategic Support Fund (204809/Z/16/Z). BR was supported by a PhD studentship from St George’s, University of London. ARC and ASP are supported by the NIHR Biomedical Research Centre at University Hospitals Bristol National Health Service Foundation Trust and the University of Bristol. AE is funded by the Medical Research Council as part of the Neighbourhoods and Communities Programme (MC_UU_12017–10). BG-C is supported by a National Health and Medical Research Council Principal Research Fellowship (1107672). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Full ethical approval was obtained from the relevant Multi-Centre Research Ethics Committee (REC Reference 12/LO/1031). All participants provided written informed consent.

Objective: There is considerable interest in whether the built environment influences health behaviours, but longitudinal evidence is limited. We examined the effect of moving into East Village (the former London 2012 Olympic Games Athletes Village, repurposed on active design principles), on levels of physical activity (PA) and adiposity among adults. Design: A natural experiment. Participants: A cohort of 1278 adults seeking to move into social, intermediate, and market-rent East Village accommodation was recruited in 2013-2015, and followed up after two years. Intervention: Moving to East Village. Main outcome: Change in objectively measured daily steps (ActiGraph GT3X+). Methods: Change in environmental exposures associated with physical activity were assessed using Geographic Information System derived measures. Individual objective measures of PA using accelerometry, body mass index (BMI) and bioelectrical impedance (fat mass %) were obtained, as were perceptions of change in the built environment. We examined change in levels of PA and adiposity, using multilevel models adjusting for sex, age group, ethnic group, housing sector (fixed effects) and household (random effect), comparing those who moved to East Village (intervention group) with those who did not (control group). Effects of housing sector as an effect modifier were also examined. Results: 877 adults (69%) were followed-up, of whom 50% had moved to East Village. Moving to East Village was associated with only a small non-significant increase in mean daily steps (154, 95% CI -231, 539), despite sizeable improvements in walkability and neighbourhood perceptions of crime and quality. There were no appreciable effects on time spent in moderate-to-vigorous PA (MVPA) or sedentary time, BMI or percentage fat mass, overall or by housing sector. Conclusion: Despite strong evidence of large improvements in neighbourhood perceptions and walkability there was no clear evidence that moving to East Village was associated with increased physical activity. Improving the physical activity environment on its own may be insufficient to increase population physical activity. Funding: This research is being supported by project grants from the Medical Research Council National Prevention Research Initiative (MR/J000345/1) and National Institute for Health Research (12/211/69). Diabetes and obesity prevention research at St George’s, University of London is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London. BR is supported by a St George’s, University of London, PhD Studentship. AE is funded by the UK Medical Research Council as part of the Neighbourhoods and Communities Programme (MC_UU_12017-10). BG-C is supported by an NHMRC Principal Research Fellowship (#1107672). ARC and ASP are supported by NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol. Declaration of Interest: We declare that we have no competing interests. Ethical Approval: Full ethical approval was obtained from the relevant Multi-Centre Research Ethics Committee (REC Reference 12/LO/1031). All participants provided written informed consent.

Background Electrically assisted bicycles (e-bikes) have been highlighted as a method of active travel that could overcome some of the commonly reported barriers to cycle commuting. The objective of this systematic review was to assess the health benefits associated with e-cycling. Method A systematic literature review of studies examining physical activity, cardiorespiratory, metabolic and psychological outcomes associated with e-cycling. Where possible these outcomes were compared to those from conventional cycling and walking. Seven electronic databases, clinical trial registers, grey literature and reference lists were searched up to November 2017. Hand searching occurred until June 2018. Experimental or observational studies examining the impact of e-cycling on physical activity and/or health outcomes of interest were included. E-bikes used must have pedals and require pedalling for electric assistance to be provided. Results Seventeen studies (11 acute experiments, 6 longitudinal interventions) were identified involving a total of 300 participants. There was moderate evidence that e-cycling provided physical activity of at least moderate intensity, which was lower than the intensity elicited during conventional cycling, but higher than that during walking. There was also moderate evidence that e-cycling can improve cardiorespiratory fitness in physically inactive individuals. Evidence of the impact of e-cycling on metabolic and psychological health outcomes was inconclusive. Longitudinal evidence was compromised by weak study design and quality. Conclusion E-cycling can contribute to meeting physical activity recommendations and increasing physical fitness. As such, e-bikes offer a potential alternative to conventional cycling. Future research should examine the long-term health impacts of e-cycling using rigorous research designs. Electronic supplementary material The online version of this article (10.1186/s12966-018-0751-8) contains supplementary material, which is available to authorized users.

Background: Increases in physical activity through active travel have the potential to have large beneficial effects on populations, through both better health outcomes and reduced motorized traffic. However accurately identifying travel mode in large datasets is problematic. Here we provide an open source tool to quantify time spent stationary and in four travel modes(walking, cycling, train, motorised vehicle) from accelerometer measured physical activity data, combined with GPS and GIS data. Methods: The Examining Neighbourhood Activities in Built Living Environments in London study evaluates the effect of the built environment on health behaviours, including physical activity. Participants wore accelerometers and GPS receivers on the hip for seven days. We time-matched accelerometer and GPS, and then extracted data from the commutes of 326 adult participants, using stated commute times and modes, which were manually checked to confirm stated travel mode. This yielded examples of five travel modes: walking, cycling, motorised vehicle, train and stationary. We used this example data to train a gradient boosted tree, a form of supervised machine learning algorithm, on each data point (131537 points), rather than on journeys. Accuracy during training was assessed using five-fold cross-validation. We also manually identified the travel behaviour of both 21 participants from ENABLE London (402749 points), and 10 participants from a separate study (STAMP-2, 210936 points), who were not included in the training data. We compared our predictions against this manual identification to further test accuracy and test generalisability. Results: Applying the algorithm, we correctly identified travel mode 97.3% of the time in cross-validation (mean sensitivity 96.3%, mean active travel sensitivity 94.6%). We showed 96.0% agreement between manual identification and prediction of 21 individuals’ travel modes (mean sensitivity 92.3%, mean active travel sensitivity 84.9%) and 96.5% agreement between the STAMP-2 study and predictions (mean sensitivity 85.5%, mean active travel sensitivity 78.9%). Conclusion: We present a generalizable tool that identifies time spent stationary and time spent walking with very high precision, time spent in trains or vehicles with good precision, and time spent cycling with moderate precisionIn studies where both accelerometer and GPS data are available this tool complements analyses of physical activity, showing whether differences in PA may be explained by differences in travel mode. All code necessary to replicate, fit and predict to other datasets is provided to facilitate use by other researchers.

Background There has been increasing interest in whether the built environmentinfluences health behaviours, but robust longitudinal evidence is limited. We assessed the effect of moving into East Village (the former London 2012 Olympic Games Athletes Village), a neighbourhood built on active design principles, on levels of physical activity (PA) and adiposity among adults. Methods A cohort of 1278 adults (16+) seeking to move into social, intermediate (a mixture of shared ownership, shared equity, affordable rent), and market-rent East Village accommodation were recruited in 2013–2015, and followed up after two years. Objective measures of PA using accelerometry (ActiGraph GT3X+), body mass index (BMI) and bioelectrical impedance (fat mass %) were made. We examined change in levels of PA and adiposity, using multilevel models adjusting for sex, age group, ethnicity, housing sector (fixed effects) and household (random effect), comparing those who moved to East Village (intervention group) with those who lived outside East Village (control group). Effects by housing sector and weekdays versus weekends for PA were also examined. Results 877 adults (69%) were followed-up, half had moved to East Village. Moving to East Village was associated with a small increase in daily steps (151, 95% CI −233, 534), more so in the intermediate sector (399, 95% CI −211, 1009) than in the social and market-rent sectors, but effects were not statistically significant. There were no differences in time spent in moderate-to-vigorous PA (MVPA) or any appreciable weekday versus weekend effects. There was no evidence of differences in time spent in light PA or sedentary time both overall and by housing sector with the exception of the market-rent group in whom moving to East Village was associated with a decrease in light PA (−13.0 mins, 95% CI −24.7,–1.2 mins). There were no effects of moving to East Village on BMI or fat mass% overall or by housing sector. Conclusion At two-year follow-up, moving to East Village, a neighbourhood designed for healthy active living, did not have beneficial, consistent effects on objectively measured physical activity or adiposity of public health importance.

ObjectivesThe neighbourhood environment is increasingly shown to be an important correlate of health. We assessed associations between housing tenure, neighbourhood perceptions, sociodemographic factors and levels of physical activity (PA) and adiposity among adults seeking housing in East Village (formerly London 2012 Olympic/Paralympic Games Athletes’ Village).SettingCross-sectional analysis of adults seeking social, intermediate and market-rent housing in East Village.Participants1278 participants took part in the study (58% female). Complete data on adiposity (body mass index (BMI) and fat mass %) were available for 1240 participants (97%); of these, a subset of 1107 participants (89%) met the inclusion criteria for analyses of accelerometer-based measurements of PA. We examined associations between housing sector sought, neighbourhood perceptions (covariates) and PA and adiposity (dependent variables) adjusted for household clustering, sex, age group, ethnic group and limiting long-standing illness.ResultsParticipants seeking social housing had the fewest daily steps (8304, 95% CI 7959 to 8648) and highest BMI (26.0 kg/m2, 95% CI 25.5kg/m2to 26.5 kg/m2) compared with those seeking intermediate (daily steps 9417, 95% CI 9106 to 9731; BMI 24.8 kg/m2, 95% CI 24.4 kg/m2to 25.2 kg/m2) or market-rent housing (daily steps 9313, 95% CI 8858 to 9768; BMI 24.6 kg/m2, 95% CI 24.0 kg/m2to 25.2 kg/m2). Those seeking social housing had lower levels of PA (by 19%–42%) at weekends versus weekdays, compared with other housing groups. Positive perceptions of neighbourhood quality were associated with higher steps and lower BMI, with differences between social and intermediate groups reduced by ~10% following adjustment, equivalent to a reduction of 111 for steps and 0.5 kg/m2for BMI.ConclusionsThe social housing group undertook less PA than other housing sectors, with weekend PA offering the greatest scope for increasing PA and tackling adiposity in this group. Perceptions of neighbourhood quality were associated with PA and adiposity and reduced differences in steps and BMI between housing sectors. Interventions to encourage PA at weekends and improve neighbourhood quality, especially among the most disadvantaged, may provide scope to reduce inequalities in health behaviour.

Background Since the early 2000s, a number of publications in the medical literature have highlighted inadequacies in the design, conduct and reporting of pilot trials. This work led to two notable publications in 2016: a conceptual framework for defining feasibility studies and an extension to the CONSORT 2010 statement to include pilot trials. It was hoped that these publications would educate researchers, leading to better use of pilot trials and thus more rigorously planned and informed randomised controlled trials. The aim of the present work is to evaluate the impact of these publications in the field of physical activity by reviewing the literature pre- and post-2016. This first article presents the pre-2016 review of the reporting and the current editorial policy applied to pilot trials published in physical activity journals. Methods Fourteen physical activity journals were screened for pilot and feasibility studies published between 2012 and 2015. The CONSORT 2010 extension to pilot and feasibility studies was used as a framework to assess the reporting quality of the studies. Editors of the eligible physical activity journals were canvassed regarding their editorial policy for pilot and feasibility studies. Results Thirty-one articles across five journals met the eligibility criteria. These articles fell into three distinct categories: trials that were carried out in preparation for a future definitive trial (23%), trials that evaluated the feasibility of a novel intervention but did not explicitly address a future definitive trial (23%) and trials that did not have any clear objectives to address feasibility (55%). Editors from all five journals stated that they generally do not accept pilot trials, and none gave reference to the CONSORT 2010 extension as a guideline for submissions. Conclusion The result that over half of the studies did not have feasibility objectives is in line with previous research findings, demonstrating that these findings are not being disseminated effectively to researchers in the field of physical activity. The low standard of reporting across most reviewed articles and the neglect of the extended CONSORT 2010 statement by the journal editors highlight the need to actively disseminate these guidelines to ensure their impact. Electronic supplementary material The online version of this article (10.1186/s40814-018-0317-1) contains supplementary material, which is available to authorized users.

Introduction Encouraging walking during the daily commute is a potential strategy for increasing physical activity levels. This study aimed: (i) to examine, and compare by travel mode, the objectively measured physical activity of a working adult population, and, (ii) to identify associations between mode of travel to work and a range of individual, interpersonal, organisational and environmental characteristics. Methods Employees (n=654) recruited from 87 workplaces in geographically distinct areas provided data through accelerometers, Global Positioning System (GPS) receivers, travel diaries and questionnaires. Separate multivariable logistic regression models were developed to examine factors associated with physical activity during the commute and mode of travel to work. Results In comparison to car users (7.3 minutes±Standard Deviation 7.6), walkers (34.3±18.6) and public transport users (25.7±14.0) accrued substantially higher levels of daily moderate to vigorous physical activity during the commute. Combined accelerometer and GPS data showed that participants who walked at least ten minutes during their commute were more likely to have a shorter commute distance (p, Highlights • Objective measures were used to characterise physical activity during the commute. • Walkers and public transport users are more physically active than car users. • Commute mode is influenced by individual characteristics and wider determinants. • Reducing availability of free parking could help discourage car use.

Aim To explore in a feasibility study whether ‘e‐cycling’ was acceptable to, and could potentially improve the health of, people with Type 2 diabetes. Methods Twenty people with Type 2 diabetes were recruited and provided with an electric bicycle for 20 weeks. Participants completed a submaximal fitness test at baseline and follow‐up to measure predicted maximal aerobic power, and semi‐structured interviews were conducted to assess the acceptability of using an electric bicycle. Participants wore a heart rate monitor and a Global Positioning System (GPS) receiver in the first week of electric bicycle use to measure their heart‐rate during e‐cycling. Results Eighteen participants completed the study, cycling a median (interquartile range) of 21.4 (5.5–37.7) km per week. Predicted maximal aerobic power increased by 10.9%. Heart rate during electric bicycle journeys was 74.7% of maximum, compared with 64.3% of maximum when walking. Participants used the electric bicycles for commuting, shopping and recreation, and expressed how the electric bicycle helped them to overcome barriers to active travel/cycling, such as hills. Fourteen participants purchased an electric bicycle on study completion. Conclusions There was evidence that e‐cycling was acceptable, could increase fitness and elicited a heart rate that may lead to improvements in cardiometabolic risk factors in this population. Electric bicycles have potential as a health‐improving intervention in people with Type 2 diabetes., What's new? No studies to date have explored the utility of electric bicycle (e‐bike) use in people with Type 2 diabetes.‘E‐cycling’ elicits a higher heart rate than walking in people with Type 2 diabetes.Preliminary evidence suggests that e‐cycling may be effective in increasing fitness in people with Type 2 diabetes.E‐cycling was popular, with two‐thirds of participants purchasing an e‐bike at the end of the study.As people with Type 2 diabetes are a population in which advice to increase physical activity is often ineffective, e‐cycling has good potential as a health‐improving intervention.

Background: Diagnosis with Type 2 Diabetes is an opportunity for individuals to change their physical activity and dietary behaviours. Diabetes treatment guidelines recommend theory based, patient-centred care and advocate the provision of support for patient motivation but the motivational experiences of people newly diagnosed with diabetes have not been well studied. Framed in self-determination theory, this study aimed to qualitatively explore how this patient group articulate and experience different types of motivation when attempting lifestyle change.Methods: A secondary analysis of semi-structured interview data collected with 30 (n female = 18, n male = 12) adults who had been newly diagnosed with type two diabetes and were participants in the Early ACTID trial was undertaken. Deductive directed content analysis was performed using NVivo V10 and researcher triangulation to identify and describe patient experiences and narratives that reflected the motivation types outlined in self-determination theory and if/how these changed over time.Results: The findings revealed the diversity in motivation quality both between and within individuals over time and that patients with newly-diagnosed diabetes have multifaceted often competing motivations for lifestyle behaviour change. Applying self-determination theory, we identified that many participants reported relatively dominant controlled motivation to comply with lifestyle recommendations, avoid their non-compliance being “found out” or supress guilt following lapses in behaviour change attempts. Such narratives were accompanied by experiences of frustrating slow behaviour change progress. More autonomous motivation was expressed as something often achieved over time and reflected goals to improve health, quality of life or family time. Motivational internalisation was evident and some participants had integrated their behaviour change to a new way of life which they found resilient to common barriers.Conclusions: Motivation for lifestyle change following diagnosis with type two diabetes is complex and can be relatively low in self-determination. To achieve the patient empowerment aspirations of current national health care plans, intervention developers, and clinicians would do well to consider the quality not just quantity of their patients’ motivation.Trial registration: ISRCTN ISRCTN92162869. Retrospectively registered

Background A fundamental issue limiting the understanding of children's independent mobility (IM) is the absence of a standardised measurement method. This pilot study explored the use of three different measures of IM to assess intergenerational change and investigated social perceptions in children's unsupervised roaming. Methods Data were collected for 45 participants from three directly-related generations. IM was assessed and analysed in all participants using three measures; IM Licence (permission to travel unsupervised), IM Index (the summed score from multiple items on a questionnaire) and IM Maximum (maximum roaming distance from participants' residential addresses located on Google Maps). Qualitative data were collected from all participants regarding perceptions of IM. Results Significant correlations between IM Index and IM Maximum were observed for child participants ( R 2 =0.334) but not for parents ( R 2 =0.024) or grandparents ( R 2 =0.284). IM Licence was not comparable with either IM Index or IM Maximum. Decreases in IM from grandparent to child were observed for all three measures of IM, with some children experiencing extremely low levels of IM. Conclusion The results highlight the need for a standard measurement protocol for IM that facilitates comparability among studies. Maximum IM distance estimated via web-based interactive mapping may be a promising choice in this respect.

Background To examine the tracking of active travel through adolescence, and its association with body mass index (BMI) and fat mass at age 17 in a UK cohort. Methods We analysed data collected from the Avon Longitudinal Study of Parents and Children (ALSPAC). The analyses include all participants with self-reported travel mode to school at ages 12, 14 and 16 years, and measured height, weight and body composition at age 17 (n=2,026). Tracking coefficients were calculated for individual travel behaviours (including walking and cycling) through adolescence using Generalised Estimating Equations. Linear regression analyses examined associations between travel pattern (consistently passive, consistently active, active at two time points or active at one time point), BMI, and DXA-measured fat mass (expressed as internally derived standard deviation scores) at 17 years. Analyses were adjusted for height (where appropriate), sex, age, parental social class, and maternal education with interaction terms to assess sex differences. Results There was substantial tracking in active travel through adolescence, with 38.5% of males and 32.3% of females consistently walking or cycling to school. In males, a consistently or predominantly active travel pattern was associated with a lower BMI SD score at age 17 (consistently active: adjusted β=−0.23; 95% CI −0.40, −0.06; active at two time points: adjusted β−0.30; 95% CI −0.50, −0.10) compared to those with a consistently passive pattern. No associations were seen in females. Conclusions Maintenance of active travel behaviours throughout adolescence may help to protect against the development of excess BMI in males. In addition to encouraging the adoption of active travel to school, public health messages should aim to prevent drop out from active travel to promote good health in youth., Highlights • Active travel tracks through adolescence. • Walking tracks more strongly than cycling. • Active travel is associated with body composition in males.

Objectives: To examine direct and indirect associations of sleep duration and quality with insulin resistance, considering body mass index (BMI) as a potential mediator in newly diagnosed type 2 diabetes mellitus patients. Methods: Cross-sectional data from patients enrolled in the Early Activity in Diabetes study. We studied 522 newly diagnosed type 2 diabetes mellitus patients, 65.9% male, mean age 63.5 ± 10.1 years. Of the total sample 53% had a BMI of ⩾30 kg/m2. Participants completed a 7-day sleep diary and sleep questionnaire. Average sleep duration (minutes), average nap duration (minutes) and average number of night awakenings were derived. Objective measures of height and body weight were obtained for the BMI calculation (kg/m2). Insulin resistance was obtained using the homeostatic model assessment – insulin resistance (HOMA2-IR) standardized technique. Results: Average number of night awakenings was positively correlated with BMI ( r= 0.22, p < 0.001) and negatively associated with logged HOMA2-IR ( r= -0.16, p = 0.04). Path analysis demonstrated night awakenings were directly associated with BMI and indirectly associated with insulin resistance, whilst considering BMI as a potential mediator ( p < 0.05). Sleep duration was not associated with BMI or insulin resistance ( p > 0.05). Conclusions: Sleep quality, not sleep duration, plays an important role in insulin resistance in newly diagnosed type 2 diabetes mellitus patients. BMI may mediate the relationship between indicators of sleep quality and insulin resistance. There is a need to examine the impact of improving sleep quality on obesity and insulin resistance in patients with type 2 diabetes mellitus.

AB Purpose: Sedentary time, in particular, prolonged unbroken sedentary time, is detrimental to health and displaces time spent in either light or moderate intensity physical activity. This cross-sectional study aimed to identify the potential impact of reallocating time from sedentary behaviors to more active behaviors on measures of body composition and metabolic health in people with type 2 diabetes. Methods: Participants were 519 adults with newly diagnosed type 2 diabetes who had been recruited to the Early Activity in Diabetes (Early ACTID) randomized controlled trial. Waist-worn accelerometers were used to obtain objective measurement of sedentary time, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) at baseline alongside clinical measurements and fasting blood samples to determine cholesterol, triglycerides, HOMA-IR, and glucose. Isotemporal substitution modeling was performed to determine the potential impact of reallocating 30 min of sedentary time accumulated in a single bout (long bout) with 30 min of interrupted sedentary time, LPA, or MVPA. Results: Sedentary time accounted for 65% of the waking day, of which 45% was accumulated in prolonged (>=30 min) bouts. Reallocation of 30 min of long-bout sedentary time with 30 min of short-bout sedentary time was associated with lower body mass index (BMI) (adjusted [beta], -0.60; 95% confidence interval [CI], -1.00, -0.21) and waist circumference (WC) (adjusted [beta], -1.16; 95% CI, -2.08, -0.25). Stronger effects were seen for LPA and MVPA. Reallocation of 30 min of long-bout sedentary time with LPA was associated with higher HDL-cholesterol (adjusted [beta], 0.02; 95% CI, 0.00-0.03 mmol[middle dot]L-1). Conclusions: Encouraging adults with newly diagnosed type 2 diabetes to break up prolonged periods of sedentary time may be an effective strategy for improving body composition and metabolic health.

Objective We conducted a systematic review to investigate the cross-sectional and prospective associations of accelerometer-measured total sedentary time and breaks in sedentary time with individual cardiometabolic biomarkers in adults ≥ 18 years of age. Methods Ovid Medline, Embase, Web of Science and the Cochrane Library were searched for studies meeting the inclusion criteria. Due to inconsistencies in the measurement and analysis of sedentary time, data was synthesised and presented narratively rather than as a meta-analysis. Results Twenty-nine studies were included in the review; twenty-eight reported on total sedentary time and six on breaks in sedentary time. There was consistent evidence from cross-sectional data of an unfavourable association between total sedentary time and insulin sensitivity. There was also some evidence that total sedentary time was unfavourably associated with fasting insulin, insulin resistance and triglycerides. Furthermore, there was some evidence from cross-sectional data of a favourable association between breaks in sedentary time and triglycerides. Conclusion Total sedentary time was consistently shown to be associated with poorer insulin sensitivity, even after adjusting for time spent in physical activity. This finding supports the proposed association between sedentary time and the development of Type 2 diabetes and reinforces the need to identify interventions to reduce time spent sedentary.

Background: Environmental characteristics of home neighbourhoods are hypothesised to be associated with residents' physical activity levels, yet many studies report only weak or equivocal associations. We theorise that this may be because neighbourhood characteristics influence the location of activity more than the volume. Using a sample of UK adolescents, we examine the role of home neighbourhood supportiveness for physical activity, both in terms of volume of activity undertaken and a measure of proximity to home at which activity takes place. Methods: Data were analysed from 967 adolescents living in and around the city of Bristol, UK. Each participant wore an accelerometer and a GPS device for 7 days during school term time. These data were integrated into a Geographical Information System containing information on the participants' home neighbourhoods and measures of environmental supportiveness. We then identified the amount of out-of-school activity of different intensities that adolescents undertook inside their home neighbourhood and examined how this related to home neighbourhood supportiveness. Results: We found that living in a less supportive neighbourhood did not negatively impact the volume of physical activity that adolescents undertook. Indeed these participants recorded similar amounts of activity (e.g. 20.5 mins per day of moderate activity at weekends) as those in more supportive neighbourhoods (18.6 mins per day). However, the amount of activity adolescents undertook inside their home neighbourhood did differ according to supportiveness; those living in less supportive locations had lower odds of recording activity inside their home neighbourhood. This was observed across all intensities of activity including sedentary, light, moderate, and vigorous. Conclusions: Our findings suggest that the supportiveness of the neighbourhood around home may have a greater influence on the location of physical activity than the volume undertaken. This finding is at odds with the premise of the socio-ecological models of physical activity that have driven this research field for the last two decades, and has implications for future research, as by simply measuring volumes of activity we may be underestimating the impact of the environment on physical activity behaviours.

AimResidual β-cell function is present at the time of diagnosis with Type 1 diabetes. Preserving this β-cell function reduces complications. We hypothesized that exercise preserves β-cell function in Type 1 diabetes and undertook a pilot trial to address the key uncertainties in designing a definitive trial to test this hypothesis.MethodsA randomized controlled pilot trial in adults aged 16–60 years diagnosed with Type 1 diabetes within the previous 3 months was undertaken. Participants were assigned to control (usual care) or intervention (exercise consultation every month), in a 1 : 1 ratio for 12 months. The primary outcomes were recruitment rate, drop out, exercise adherence [weeks with ≥ 150 min of self-reported moderate to vigorous physical activity (MVPA)], and exercise uptake in the control group. The secondary outcomes were differences in insulin sensitivity and rate of loss of β-cell function between intervention and control at 6 and 12 months.ResultsOf 507 individuals who were approached, 58 (28 control, 30 intervention) entered the study and 41 completed it. Participants were largely white European males, BMI 24.8 ± 3.8 kg/m2, HbA1c 75 ± 25 mmol/mol (9 ± 2%). Mean level of objectively measured MVPA increased in the intervention group (mean 243 to 273 min/week) and 61% of intervention participants reached the target of ≥ 150 min/week of self-reported MVPA on at least 42 weeks of the year. Physical activity levels fell slightly in the control group (mean 277 to 235 min of MVPA/week). There was exploratory evidence that intervention group became more insulin sensitive and required less insulin. However, the rate of loss of β-cell function appeared similar between the groups, although the change in insulin sensitivity may have affected this.ConclusionWe show that it is possible to recruit and randomize people with newly diagnosed Type 1 diabetes to a trial of an exercise intervention, and increase and maintain their exercise levels for 12 months. Future trials need to incorporate measures of greater adherence to exercise training targets, and include more appropriate measures of β-cell function. (Clinical Trials Registry No; ISRCTN91388505)

The Examining Neighbourhood Activities in Built Living Environments in London (ENABLE London) study provides a unique opportunity to examine differences in mental health and well-being amongst adults seeking social, intermediate (affordable rent), and market-rent housing in a purpose built neighbourhood (East Village, the former London 2012 Olympic Athletes’ Village), specifically designed to encourage positive health behaviours. Multi-level logistic regression models examined baseline differences in levels of depression, anxiety and well-being across the housing groups. Compared with the intermediate group, those seeking social housing were more likely to be depressed, anxious and had poorer well-being after adjustment for demographic and health status variables. Further adjustments for neighbourhood perceptions suggest that compared with the intermediate group, perceived neighbourhood characteristics may be an important determinant of depression amongst those seeking social housing, and lower levels of happiness the previous day amongst those seeking market-rent housing. These findings add to the extensive literature on inequalities in health, and provide a strong basis for future longitudinal work that will examine change in depression, anxiety and well-being after moving into East Village, where those seeking social housing potentially have the most to gain., Highlights • A natural experiment examining baseline mental health and well-being in adults seeking three housing tenures in East Village. • Those seeking social housing are more likely to report depressive symptoms and low life satisfaction at baseline. • Differences in well-being outcomes across the housing groups can be partially explained by neighbourhood perceptions. • Those seeking social housing appear to have the most to gain by moving to East Village.

ObjectivesTo describe the active commuting (AC) patterns of adults with type 2 diabetes and how these relate to physical activity and sedentary behaviour in UK Biobank. Social and environmental correlates of AC will also be explored.DesignCross-sectional analysis of a cohort study.SettingsThis is a population cohort of over 500 000 people recruited from 22 centres across the UK. Participants aged between 37 and 73 years were recruited between 2006 and 2010.Participants6896 participants with a self-reported type 2 diabetes diagnosis who reported commuting to work and had complete covariate data were included in the analysis.Exposure measuresExposure measures were AC to work, measured as usual mode of transport.Outcome measuresOutcome measures were weekly minutes of moderate to vigorous physical activity (MVPA), hours/day of sedentary time and participation in active travel.ResultsAC (reporting walking or cycling to work only) was reported by 5.5% of participants, with the great majority using the car to commute (80%). AC was associated with an additional 73 (95% CI 10.8 to 134.9) and 105 (95% CI 41.7 to 167.2) weekly minutes of MVPA for men and women, respectively. AC was associated with reduced sedentary time (β −1.1, 95% CI −1.6 to –0.7 hours/day for men; and β −0.8, 95% CI −1.2 to –0.3 hours/day for women). Deprivation and distance from home to work were identified as correlates of AC behaviour.ConclusionsRates of AC are very low in adults with type 2 diabetes. However, AC offers a potentially sustainable solution to increasing physical activity and reducing sedentary behaviour. Therefore, strategies to improve the environment and encourage AC may help to increase population levels of physical activity and reduce the disease burden associated with type 2 diabetes.

ObjectiveDietary advice is fundamental in the prevention and management of type 2 diabetes (T2DM). Advice is improved by individual assessment but existing methods are time-consuming and require expertise. We developed a twenty-five-item questionnaire, the UK Diabetes and Diet Questionnaire (UKDDQ), for quick assessment of an individual’s diet. The present study examined the UKDDQ’s repeatability and relative validity compared with 4 d food diaries.DesignThe UKDDQ was completed twice with a median 3 d gap (interquartile range=1–7 d) between tests. A 4 d food diary was completed after the second UKDDQ. Diaries were analysed and food groups were mapped on to the UKDDQ. Absolute agreement between total scores was examined using intra-class correlation (ICC). Agreement for individual items was tested with Cohen’s weighted kappa (κw).SettingSouth West of England.SubjectsAdults (n 177, 50·3 % women) with, or at high risk for, T2DM; mean age 55·8 (sd 8·6) years, mean BMI 34·4 (sd 7·3) kg/m2; participants were 91 % White British.ResultsThe UKDDQ showed excellent repeatability (ICC=0·90 (0·82, 0·94)). For individual items, κw ranged from 0·43 (‘savoury pastries’) to 0·87 (‘vegetables’). Total scores from the UKDDQ and food diaries compared well (ICC=0·54 (0·27, 0·70)). Agreement for individual items varied and was good for ‘alcohol’ (κw=0·71) and ‘breakfast cereals’ (κw=0·70), with no agreement for ‘vegetables’ (κw=0·08) or ‘savoury pastries’ (κw=0·09).ConclusionsThe UKDDQ is a new British dietary questionnaire with excellent repeatability. Comparisons with food diaries found agreements similar to those for international dietary questionnaires currently in use. It targets foods and habits important in diabetes prevention and management.

We present a new framework for vision-based estimation of calorific expenditure from RGB-D data - the first that is validated on physical gas exchange measurements and applied to daily living scenarios. Deriving a person’s energy expenditure from sensors is an important tool in tracking physical activity levels for health and lifestyle monitoring. Most existing methods use metabolic lookup tables (METs) for a manual estimate or systems with inertial sensors which ultimately require users to wear devices. In contrast, the proposed pose-invariant and individual-independent vision framework allows for a remote estimation of calorific expenditure. We introduce, and evaluate our approach on, a new dataset called SPHERE-calorie, for which visual estimates can be compared against simultaneously obtained, indirect calorimetry measures based on gas exchange. We conclude from our experiments that the proposed vision pipeline is suitable for home monitoring in a controlled environment, with calorific expenditure estimates above accuracy levels of commonly used manual estimations via METs. With the dataset released, our work establishes a baseline for future research for this little-explored area of computer vision.

Deriving a person's energy expenditure accurately forms the foundation for tracking physical activity levels across many health and lifestyle monitoring tasks. In this study, the authors present a method for estimating calorific expenditure from combined visual and accelerometer sensors by way of an RGB-Depth camera and a wearable inertial sensor. The proposed individual-independent framework fuses information from both modalities which leads to improved estimates beyond the accuracy of single modality and manual metabolic equivalents of task (MET) lookup table based methods. For evaluation, the authors introduce a new dataset called SPHERE_RGBD + Inertial_calorie, for which visual and inertial data are simultaneously obtained with indirect calorimetry ground truth measurements based on gas exchange. Experiments show that the fusion of visual and inertial data reduces the estimation error by 8 and 18% compared with the use of visual only and inertial sensor only, respectively, and by 33% compared with a MET-based approach. The authors conclude from their results that the proposed approach is suitable for home monitoring in a controlled environment.

Using a sample of English schoolchildren, we evaluate whether a change in school local area environmental supportiveness between primary and secondary school is associated with changes in active travel behaviours and physical activity levels. Participant׳s activity levels and travel behaviours were recorded for a week during their primary school final year and secondary school first year. Environmental supportiveness was evaluated using a Geographical Information System. Children attending both a primary and secondary school with a more supportive local environment were more likely to maintain active travel behaviours than those with less supportive environments. However, no trends were apparent with change in school supportiveness and change in physical activity. Policies that focus on the maintenance and uptake of active travel behaviours may help maintain children׳s physical activity levels into adolescence.

The aim of the study was to investigate the associations between bicycling and carotid arterial stiffness, independent of objectively measured moderate-and-vigorous physical activity. This cross-sectional study included 375 adolescents (age 15.7 ± 0.4 years) from the Danish site of the European Youth Heart Study. Total frequency of bicycle usage was assessed by self-report, and carotid arterial stiffness was assessed using B-mode ultrasound. After adjusting for pubertal status, body height, and objectively measured physical activity and other personal lifestyle and demographic factors, boys using their bicycle every day of the week displayed a higher carotid arterial compliance {standard beta 0.47 [95% confidence interval (CI) 0.07-0.87]} and distension [standard beta 0.38 (95% CI -0.04 to 0.81)]. Boys using their bicycle every day of the week furthermore displayed a lower Young's elastic modulus [standard beta -0.48 (95% CI -0.91 to -0.06)]. Similar trends were observed when investigating the association between commuter bicycling and carotid arterial stiffness. These associations were not observed in girls. Our observations suggest that increasing bicycling in adolescence may be beneficial to carotid arterial health among boys.

Granulomatosis with polyangiitis (GPA; previously Wegener granulomatosis) is a rare, multisystem, necrotizing granulomatous vasculitis that classically affects the upper and lower respiratory tracts and kidneys but can have diverse clinical features. The clinical course is often rapidly progressive, and without appropriate treatment is almost universally fatal. Early symptoms are often nonspecific and a high index of suspicion is needed to recognize this serious disease, particularly in the absence of overt pulmonary or renal manifestations. Because initial symptoms can mimic those of infection, patients often present first to the general pediatrician. We present a case of pediatric GPA in a 14-year-old boy who initially presented with constitutional symptoms, sore throat, and hematuria, and then developed grossly necrotic-appearing tonsils before rapid deterioration requiring intensive life-saving measures. We review the common manifestations of GPA, including those that may be unique to the pediatric population, and emphasize the importance of early diagnosis and intervention in preventing devastating outcomes from this disease.

BackgroundPhysical activity (PA) is important in the management of type 2 diabetes (T2DM), however many people find it difficult to implement and/or sustain in the self-management of the condition. Electrically assisted cycling (e-cycling) may be viewed as a means of self-management in which effort is invested to balance the interplay of lifestyle factors and disease progression.AimTo explore engagement with an e-cycling intervention conducted with adults with T2DM.Design & settingProspective qualitative interview study with adults in central Bristol (UK) and surrounding suburbs, in the context of the self-management of T2DM in primary care.MethodInterviews were conducted with 20 individuals with T2DM (42–70 years, 11 male, 9 female) prior to their participation in a 20-week e-cycling intervention. Post-intervention interviews were conducted with 18 participants (11 male, 7 female). Interviews were transcribed verbatim and inductive thematic analysis was undertaken.ResultsParticipants were aware that PA contributed to the management of their diabetes. Engagement with e-cycling was viewed as both an acceptable and a social lifestyle intervention. Furthermore, participants were unhappy with the volume of medication used to manage their diabetes and e-cycling fostered autonomy in the management of T2DM. GPs and practice nurses were regarded as an important source of reliable information, and were considered to be best placed to talk about interventions to increase PA.ConclusionE-cycling is viewed as an acceptable form of PA to aid the self-management of T2DM. E-cycling may support people with T2DM to reduce their medication intake and in turn foster greater autonomy in managing the condition. The findings have implications for the role of primary care health professionals in supporting both patients and significant others in adoption of e-cycling.

Many school-based physical activity (PA) interventions have been developed, but only a few have assessed their long-term effects. A PA intervention taking place in the first four years of some Slovenian primary schools entails an enhanced physical education (PE) curriculum, including two extra lessons of PE per week, a wider selection of PE content, and additional outdoor education delivered by both a specialist PE teacher and a general teacher. The effects of the intervention on children's physical fitness (motor tasks and anthropometry) were evaluated within a quasi-experimental study. In total, 324 children from nine Slovenian primary schools either received the enhanced curriculum (intervention (n=160)) or standard PE (control (n=164)), and were followed for a four-year intervention period and seven years post intervention. Data from the SLOFIT database were used to compare differences in the physical fitness of children each year. Linear Mixed Models were used to test the influence of the PA intervention. Over an 11-year period, the PA intervention group significantly differed in all motor tasks, but not in anthropometric measures or body mass index, after controlling for year of measurement and sex. Differences between the control and intervention groups decreased with time. This study highlights the importance of tracking the long term effects of PA interventions. PA intervention in the first four years of Slovenian primary school offers the possibility of improving physical performance in children; initiatives aiming to increase their performance (physical fitness, physical activity) and health outcomes are warranted.

Background In the evaluation of childhood obesity interventions, few researchers undertake a rigorous feasibility stage in which the design and procedures of the evaluation process are examined. Consequently, phase III studies often demonstrate methodological weaknesses. Purpose Our aim was to conduct a feasibility trial of the evaluation of WATCH IT, a community obesity intervention for children and adolescents. We sought to determine an achievable recruitment rate; acceptability of randomisation, assessment procedures, and dropout rate; optimal outcome measures for the definitive trial; and a robust sample size calculation. Method Our goal was to recruit 70 participants over 6 months, randomise them to intervention or control group, and retain participation for 12 months. Assessments were taken prior to randomisation and after 6 and 12 months. Procedures mirrored those intended for a full-scale trial, but multiple measures of similar outcomes were included as a means to determine those most appropriate for future research. Acceptability of the research and impact of the research on the programme were ascertained through interviewing participants and staff. Results We recruited 70 participants and found that randomisation and data collection procedures were acceptable. Self-referral ( via media promotion) was more effective than professional referral. Blinding of assessors was sustained to a reasonable degree, and optimal outcome measures for a full-scale trial were identified. Estimated sample size was significantly greater than sample sized reported in published trials. There was some negative impact on the existing programme as a result of the research, a lesson for designers of future trials. Limitations We successfully recruited socially disadvantaged families, but the majority of families were of White British nationality. The composition of the participants was an added valuable lesson, suggesting that recruitment strategies to obtain a more heterogeneous ethnic sample warrant consideration in future research. Conclusions This study provided us with confidence that we can run a phase III multi-centre trial to test the effectiveness of WATCH IT. Importantly, it was invaluable in informing the design not only of that trial but also of future evaluations of childhood obesity treatment interventions.

BackgroundMany children do not meet UK physical activity (PA) guidelines. Girls are less active than boys, and the age-related decline in activity is steeper for girls. Dance is the favourite form of PA among adolescent girls in the UK. Participation in after-school dance classes could significantly contribute to girls’ PA. Therefore, after-school dance may be effective for increasing PA levels.ObjectivesTo determine the effectiveness and cost-effectiveness of a dance-based intervention to increase the objectively assessed mean weekday minutes of moderate- to vigorous-intensity physical activity (MVPA) of Year 7 girls (11- and 12-year olds) 1 year after baseline measurement.DesignTwo-arm cluster randomised controlled trial and economic evaluation. Year 7 girls in participant schools received a ‘taster’ session and were invited to participate. Up to 33 girls per school were able to participate. Schools were randomly assigned (equal numbers) to intervention or control arms.SettingA total of 18 mainstream secondary schools across greater Bristol.ParticipantsYear 7 girls in participating schools who could participate in physical education.InterventionNine intervention schools received an after-school dance intervention (40 × 75-minute sessions) underpinned by self-determination theory, which attempts to improve intrinsic motivation for being active, and delivered by external dance instructors. Control schools continued as normal.Main outcome measuresThe main outcome was accelerometer-assessed mean minutes of MVPA at T2. Measures were assessed at baseline (T0), the end of the intervention (T1) and at T0 + 52 weeks (T2).ResultsBaseline MVPA levels were high. A total of 508 girls were included in the primary analysis, which found no difference in weekday MVPA between trial arms. There was no effect on secondary accelerometer outcomes. Data were subjected to a per-protocol analysis and no effect was found. However, at T1, girls who attended dance classes had 4.61 minutes more of MVPA and 14.27 minutes more of light-intensity activity between 15.00 and 17.00 on the days on which they attended intervention sessions. The intervention was inexpensive at £73 per participant (£63 when excluding dance instructor travel) but was not cost-effective owing to the ineffectiveness of the intervention. The European Quality of Life-5 Dimensions Youth survey data were unresponsive to changes in the sample. The process evaluation reported that girls in attendance enjoyed the sessions, that exertion levels were low during sessions and that attendance was low and declined. Fidelity to the session-plan manual was low but theoretical fidelity (to self-determination theory) was good. Qualitative information provides information for improving future interventions.ConclusionsThe intervention was enjoyed by participants. However, there was no difference in the MVPA levels (which were high at baseline) of girls allocated to receive dance compared with girls receiving the control. High baseline MVPA levels indicate that the study appealed to an already active cohort and, therefore, may not have targeted those most in need of an intervention. Dance is an enjoyable activity for adolescent girls and could be further trialled as a means by which to increase PA. Research might consider the impact of dividing the intervention period into smaller blocks.Trial RegistrationCurrent Controlled Trials ISRCTN52882523.FundingThe National Institute for Health Research Public Health Research programme. The work was also undertaken with the support of the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UK Clinical Research Collaboration (UKCRC) PHR Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UKCRC, is gratefully acknowledged. This study was designed and delivered in collaboration with the Bristol Randomised Trials Collaboration, a UKCRC Registered Clinical Trials Unit in receipt of NIHR Clinical Trials Unit support funding. All intervention costs were funded by the respective councils to which the participant schools were affiliated, namely North Somerset Council, Bristol City Council, and Bath and North East Somerset Council.

Background Investigating socioeconomic variation in physical activity (PA) and sedentary time is important as it may represent a pathway by which socioeconomic position (SEP) leads to ill health. Findings on the association between children's SEP and objectively assessed PA and/or sedentary time are mixed, and few studies have included international samples. Objective Examine the associations between maternal education and adolescent's objectively assessed PA and sedentary time. Methods This is an observational study of 12 770 adolescents (10–18 years) pooled from 10 studies from Europe, Australia, Brazil and the USA. Original PA data were collected between 1997 and 2009. The associations between maternal education and accelerometer variables were examined using robust multivariable regression, adjusted for a priori confounders (ie, body mass index, monitor wear time, season, age and sex) and regression coefficients combined across studies using random effects meta-analyses. Analyses were conducted in March 2014. Results Adolescents of university educated mothers spent more time sedentary (9.5 min/day, p=0.005) and less time in light activity (10 min/day, p Conclusions Across a number of international samples, adolescents of mothers with lower education may not be at a disadvantage in terms of overall objectively measured PA.