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Current evidence offers little guidance as to how interprofessional collaboration can be fostered within the context of integrated care and older people. This research describes the co-design of core competencies for interprofessional collaboration within integrated care teams for older people and the development of practical guidance to support teams in building proficiency. Using a co-design approach, we conducted three studies (co-design workshops, qualitative interviews, and an online validation forum), the combined output of which is a Core Competency Framework, that includes three domains describing six competencies for proficiency in interprofessional collaboration within integrated care of older people. Domain one

IntroductionPain is prevalent in people living with overweight and obesity. Obesity is associated with increased self-reported pain intensity and pain-related disability, reductions in physical functioning and poorer psychological well-being. People living with obesity tend to respond less well to pain treatments or management compared with people living without obesity. Mechanisms linking obesity and pain are complex and may include contributions from and interactions between physiological, behavioural, psychological, sociocultural, biomechanical and genetic factors. Our aim is to study the multidimensional pain profiles of people living with obesity, over time, in an attempt to better understand the relationship between obesity and pain.Methods and analysisThis longitudinal observational cohort study will recruit (n=216) people living with obesity and who are newly attending three weight management services in Ireland. Participants will complete questionnaires that assess their multidimensional biopsychosocial pain experience at baseline and at 3, 6, 12 and 18 months post-recruitment. Quantitative analyses will characterise the multidimensional pain experiences and trajectories of the cohort as a whole and in defined subgroups.Ethics and disseminationThe study protocol has been approved by the Ethics and Medical Research Committee of St Vincent’s Healthcare Group, Dublin, Ireland (reference no: RS21-059), the Galway Clinical Research Ethics Committee for Galway University Hospitals (refrence no: C.A. 2865), and the University College Dublin Human Research Ethics Committee (reference no: LS-E-22-41-Hinwood-Smart). Findings will be disseminated through peer-reviewed journals, conference presentations, public and patient advocacy groups, and social media.Study registrationOpen Science Framework Registration DOI:https://doi.org/10.17605/OSF.IO/QCWUE.

Objective To explore entry-level physiotherapy students’ attitudes and beliefs relating to weight bias and stigmatisation in healthcare. Design Cross sectional survey of physiotherapy students. Methods All final year physiotherapy students (n = 215) enrolled in entry-level physiotherapy programmes in the Republic of Ireland were invited to participate. Each received a questionnaire, consisting of 72 questions, within four key sections. Descriptive statistics and frequencies were used to analyse the data. Results A response rate of 83% (179/215) was achieved. Whilst physiotherapy students, overall, had a positive attitude towards people with obesity, 29% had a negative attitude towards people with obesity, 24% had a negative attitude towards managing this population and most (74%) believed obesity was caused by behavioural and individual factors. Over one third of students (35%) reported that they would not be confident in managing patients with obesity and more than half (54%) felt treating patients with obesity was not worthwhile. Conclusion This study provides preliminary findings to suggest that weight stigma-reduction efforts are warranted for physiotherapy students. Helping students to understand that obesity is a complex, chronic condition with multiple aspects requiring a multi-faceted approach to its management might be the first step towards dispelling these negative attitudes towards patients living with obesity. Inclusion of a formal obesity curriculum should perhaps now be part of the contemporary physiotherapy students’ education.

Background: The consumption of legumes is promoted as part of a healthy diet in many countries but associations of total and types of legume consumption with type 2 diabetes (T2D) are not well established. Analyses across diverse populations are lacking despite the availability of unpublished legume consumption data in prospective cohort studies. Objective: To examine the prospective associations of total and types of legume intake with the risk of incident T2D. Methods: Meta-analyses of associations between total legume, pulse, and soy consumption and T2D were conducted using a federated approach without physical data-pooling. Prospective cohorts were included if legume exposure and T2D outcome data were available and the cohort investigators agreed to participate. We estimated incidence rate ratios (IRRs) and CIs of associations using individual participant data including ≤42,473 incident cases among 807,785 adults without diabetes in 27 cohorts across the Americas, Eastern Mediterranean, Europe, and Western Pacific. Random-effects meta-analysis was used to combine effect estimates and estimate heterogeneity. Results: Median total legume intake ranged from 0-140 g/d across cohorts. We observed a weak positive association between total legume consumption and T2D (IRR = 1.02, 95% CI: 1.01 to 1.04) per 20 g/d higher intake, with moderately high heterogeneity (I2 = 74%). Analysis by region showed no evidence of associations in the Americas, Eastern Mediterranean, and Western Pacific. The positive association in Europe (IRR = 1.05, 95% CI: 1.01 to 1.10, I2 = 82%) was mainly driven by studies from Germany, UK, and Sweden. No evidence of associations was observed for the consumption of pulses or soy. Conclusions: These findings suggest no evidence of an association of legume intakes with T2D in several world regions. The positive association observed in some European studies warrants further investigation relating to overall dietary contexts in which legumes are consumed, including accompanying foods which may be positively associated with T2D. Funding for the InterConnect project was provided by the European Union Seventh Framework Programme (FP7/2007-2013) under grant agreement no. 602068. Additionally, investigators acknowledge funding from the following agencies: NJW, NGF, FI, and MP acknowledge funding from the Medical Research Council Epidemiology Unit (MC_UU_12015/1 and MC_UU_12015/5); NJW and NGF acknowledge support from National Institute of Health Research (NIHR) Biomedical Research Centre Cambridge: Nutrition, Diet, and Lifestyle Research Theme (IS-BRC-1215-20014). TB acknowledges funding from EUCAN-Connect under the European Union's Horizon 2020 research and innovation programme (grant agreement no. 824989). MBR and MAMG acknowledge funding from the Spanish Government Instituto de Salud Carlos III and the European Regional Development Fund (FEDER) (PI17/01795). JK acknowledges funding from the Korea Centers for Disease Control and Prevention, Ministry for Health and Welfare, Republic of Korea (4845-301 and 4851-302), and the Collaborative Genome Program for Fostering New Post-Genome Industry of the National Research Foundation (NRF) funded by the Ministry of Science and ICT (NRF-2017M3C9A6047623). RM acknowledges funding from the Tehran University of Medical Sciences (grant number: 81/15), Cancer Research UK (grant number: C20/A5860), the Intramural Research Program of the U.S. National Cancer Institute, NIH, and the International Agency for Research on Cancer. LB acknowledges that the Cohort of Swedish Men (COSM) and the Swedish Mammography Cohort (SMC) are part of the Swedish Infrastructure for Medical Population-Based Life-Course and Environmental Research (SIMPLER), which receives funding from the Swedish Research Council (2017-00644). BD is an investigator of the Brazilian National Health Technology Assessment Institute and SC received a fellowship from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), the Brazilian National Council for Scientific and Technological Development Fund (FEDER) (PI17/01795). The Zutphen Elderly Study was funded by The Netherlands Prevention Foundation, The Hague, The Netherlands and the National Institute of Aging, Bethesda, MD, USA. The funding sources did not participate in the design or conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript.

To determine whether lifestyle intervention programs comprising dietary intervention and prescribed, unsupervised exercise improve outcomes for people with metabolic syndrome. A systematic review and meta-analysis of randomised controlled trials. Online databases CINAHL, MEDLINE, PubMed and Embase were searched from the earliest date available to October 2020. Post-intervention data were pooled to calculate mean differences (MD) or standardised mean differences (SMD) and 95% confidence intervals (CI) using inverse variance methods and random effects models. Trial methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale and overall quality of each meta-analysis was assessed using the Grading of Recommendation Assessment, Development and Evaluation approach. Eleven studies from 9 randomised controlled trials with 1,835 participants were included. There was high quality evidence that lifestyle intervention programs with unsupervised exercise reduced waist circumference (MD -2.82 cm, 95%CI -5.64 to 0.00, I2 91%) and blood pressure (systolic: MD -3.89 mmHg, 95%CI -5.19 to -2.58, I2 4%; diastolic: MD -3.16 mmHg, 95%CI -4.83 to -1.49, I2 50%) and increased physical activity levels (SMD 0.47, 95%CI 0.24 to 0.70, I2 45%) when compared to usual care. There was low quality evidence that they improved quality of life (SMD 0.59, 95%CI 0.05 to 1.13, I2 84%). Unsupervised programs had no significant effect on fasting blood glucose (unless > 3 months duration), metabolic syndrome prevalence or cholesterol. Lifestyle intervention programs with prescribed, unsupervised exercise are a practical alternative to supervised programs for people with metabolic syndrome when time, access or resources are limited or when social distancing is required. Supplementary Information The online version contains supplementary material available at 10.1007/s11154-021-09644-2.

To explore gym staff perspectives on the inclusion of people with disability in the gym setting. Semi-structured interviews were conducted with 16 staff at four urban gym facilities, exploring perspectives on disability inclusion. An interpretive descriptive approach was adopted with reflexive thematic analysis of interview data and subsequent mapping of themes to the socioecological model. Consistent with the socioecological model, the themes identified were ���people with disability benefit from participation in gym settings��� (personal); ���positive interactions with people with disability��� (interpersonal); ���managing expectations of other gym users��� (interpersonal); ���inclusion is supported by a positive ethos, staff training and accessible facilities��� (organisational); ���people with disability lack awareness of inclusive exercise opportunities��� (community); ���desire to increase collaboration with healthcare professionals��� (community); ���access to transport can facilitate gym attendance��� (community) and ���local gym policy��� (policy). Although an overall ethos of inclusion was apparent, areas identified for enhancement were: awareness of gym services in the community; inter-sectoral collaboration with healthcare and disability organisations; comprehensive disability inclusion training; transport systems and accessibility; engaging people with disability in gym service planning. Implications for rehabilitationGym staff value collaboration with healthcare and rehab professionals to support inclusion of people with disability in exercise.Standardised disability inclusion training for gym staff is recommended.Individuals with disability should be empowered to contribute to the development of inclusive gym facilities and services.Rehab professionals have a role to play in raising awareness and advocating for inclusive exercise opportunities. Gym staff value collaboration with healthcare and rehab professionals to support inclusion of people with disability in exercise. Standardised disability inclusion training for gym staff is recommended. Individuals with disability should be empowered to contribute to the development of inclusive gym facilities and services. Rehab professionals have a role to play in raising awareness and advocating for inclusive exercise opportunities.

Heterogeneity of descriptors and outcomes measured and reported in sedentary behaviour (SB) research hinder the meta-analysis of data and accumulation of evidence. The objective of the Core Research Outcomes for Sedentary Behaviour Interventions (CROSBI) consensus study was to identify and validate, a core outcome set (COS) to report (what, how, when to measure) in interventional sedentary behaviour studies. Outcomes, extracted from a systematic literature review, were categorized into domains and data items (COS v0.0). International experts (n = 5) provided feedback and identified additional items, which were incorporated into COS v0.1. A two round online Delphi survey was conducted to seek consensus from a wider stakeholder group and outcomes that achieved consensus in the second round COS (v0.2), were ratified by the expert panel. The final COS (v1.0) contains 53 data items across 12 domains, relating to demographics, device details, wear-time criteria, wear-time measures, posture-related measures, sedentary breaks, sedentary bouts and physical activity. Notably, results indicate that sedentary behaviour outcomes should be measured by devices that include an inclinometry or postural function. The proposed standardised COS is available openly to enhance the accumulation of pooled evidence in future sedentary behaviour intervention research and practice.

Physical activity (PA) promotion is a complex challenge, with the Global Action Plan on Physical Activity (GAPPA) endorsing a systems approach and recommending countries assess existing areas of progress which can be strengthened. This paper reports a process facilitating a systems approach for identifying current good practice and gaps for promoting PA in Ireland. Elements of participatory action research were enabled through 3 stages: (1) aligning examples of actions from Irish policy documents (n = 3) to the GAPPA, (2) workshop with stakeholders across multiple sectors, and (3) review of outputs. Data collected through the workshop were analyzed using a deductive thematic analysis guided by the GAPPA. The policy context in Ireland aligns closely to the GAPPA with the creation of Active Systems the most common strategic objective across policy documents. Forty participants (50% male) took part in the systems approach workshop, which after revision resulted in 80 examples of good practice and 121 actions for greater impact. A pragmatic and replicable process facilitating a systems approach was adopted and showed current Irish policy and practices align with the GAPPA “good practices.” The process provides existing areas of progress which can be strengthened, as well as the policy opportunities and practice gaps.

This mixed-methods study aimed to determine the feasibility of incorporating movement breaks into university classes in terms of acceptability (disruption, engagement, satisfaction), practicality (ease of scheduling and conducting breaks) and efficacy (sedentary time, concentration, alertness, enjoyment). Movement breaks of five to 10 min duration were scheduled after 20 min of sedentary time during 2-h classes. Classes without movement breaks were used as a comparison. Data were collected using surveys, objective physical activity monitoring and focus group interviews of students (n = 85) and tutors (n = 6). Descriptive statistics (quantitative data) and independent coding and thematic analysis (qualitative data) were completed. Students (mean age 23 ± 2 years, 69% female) actively engaged in movement breaks with no adverse events. Movement breaks were perceived to be beneficial for concentration, engagement and productivity. Timing of the break was perceived to be important to enhance the benefit and reduce disruption. Students preferred outdoor or competitive movement breaks. Students spent 13 min less time sitting (95%CI 10 to 17), took 834 more steps (95%CI 675 to 994) and had higher levels of concentration, alertness and enjoyment (p &lt, 0.001) in classes with movement breaks compared to classes without. Classroom movement breaks are feasible and may be considered for incorporation into university classes to reduce sedentary behaviour and increase physical activity, alertness, concentration and enjoyment.

Alongside glucose lowering therapy, clinical guidelines recommend lifestyle interventions as cornerstone in the care of people living with type 2 diabetes (T2DM). There is a specific need for an up-to-date review assessing the effectiveness of lifestyle interventions for people with T2DM living in low-and-middle income countries (MICs). Four electronic databases were searched for RCTs published between 1990 and 2020. T2DM, lifestyle interventions, LMICs and their synonyms were used as search terms. Data codebooks were developed and data were extracted. Narrative synthesis and meta-analysis were conducted using random effects models to calculate mean differences (MD) and standardized mean differences (SMD) and 95% confidence intervals (CI). Of 1284 articles identified, 30 RCTs (n = 16,670 participants) met the inclusion criteria. Pooled analysis revealed significant improvement in HBA1c (MD −0.63; CI: −0.86, −0.40), FBG (SMD −0.35; CI: −0.54, −0.16) and BMI (MD −0.5; CI: −0.8, −0.2). In terms of intervention characteristics, those that included promoted self-management using multiple education components (e.g., diet, physical activity, medication adherence, smoking cessation) and were delivered by healthcare professionals in a hospital/clinic setting were deemed most effective. However, when interpreting these results, it is important to consider that most included studies were evaluated as being of low quality and there was a significant amount of intervention characteristics heterogeneity. There is a need for further well-designed studies to inform the evidence base on which lifestyle interventions are most effective for glycemic control in adults with T2DM living in LMICs.

Background Current data indicates 70% of adults with obesity report experiencing bias and stigmatisation when engaging with healthcare. Most studies to date, have focused on weight bias from a healthcare professional’s perspective. Few have explored weight bias from the perspective of the individual living with obesity and no study has conducted this research in the Irish context. Aims This study explored, the lived-in experience of individuals afflicted with obesity, when interacting with the Irish healthcare system. It examined whether participants encountered weight bias and stigma, if so, how it may have impacted them and gathered their suggestions on how it could be best addressed. Methods Employing a phenomenological approach, purposive sampling and semi-structured interviews were conducted with 15 individuals living with class II (BMI 35.0–39.9) or III obesity (BMI ≥40kg/m2) who reported regular and consistent engagement with the Irish healthcare system. Predominant emergent themes were categorised using the interview domains; (1) experiences of obesity bias and stigma, (2) impact of this bias and stigma and (3) suggested avenues to reduce bias and stigma. Findings Participants reported experiencing high levels of weight bias and stigmatisation. Relating to experiences, three themes were identified; interpersonal communication, focus of care and physical environment. In terms of its impact, there were two emergent themes; negativity towards future healthcare and escalation of unhealthy behaviours. Suggested avenues to eliminate bias and stigma included the introduction of a timely and clear clinical pathway for obesity management and a focus on HCPs education in relation to obesity causes and complexity. Conclusions Outside of specialist obesity tertiary care, weight bias and stigmatisation is commonly reported in the Irish healthcare system. It is a significant issue for those living with obesity, detrimental to their physiological and psychological health. A concerted effort by HCPs across clinical, research and educational levels is required to alleviate its harmful effects.

Summary Current international guidelines recommend people living with obesity should be prescribed a minimum of 300 min of moderately intense activity per week for weight loss. However, the most efficacious exercise prescription to improve anthropometry, cardiorespiratory fitness (CRF) and metabolic health in this population remains unknown. Thus, this network meta‐analysis was conducted to assess and rank comparative efficacy of different exercise interventions on anthropometry, CRF and other metabolic risk factors. Five electronic databases were searched for randomized controlled trials (RCTs) that compared different exercise modalities to improve anthropometry, CRF and/or metabolic health in adults living with obesity. RCTs were evaluated using the Cochrane risk of bias tool. A random effects network meta‐analysis was performed within a frequentist framework. Of the 6663 articles retrieved, 45 studies with a total 3566 participants were included. Results reveal that while any type of exercise intervention is more effective than control, weight loss induced is modest. Interventions that combine high‐intensity aerobic and high‐load resistance training exert beneficial effects that are superior to any other exercise modality at decreasing abdominal adiposity, improving lean body mass and increasing CRF. Clinicians should consider this evidence when prescribing exercise for adults living with obesity, to ensure optimal effectiveness.

Background: The National Integrated Care Programme for Older People (NICPOP), formerly NCPOP aims to support older people to live well in their homes by developing primary and secondary care services for older people, especially those with complex needs. The programme develops integrated intermediate care which traverses both hospital and community settings through multidisciplinary and interagency teams. This team-based approach to the integration of health services is a novel innovation in Irish health service delivery and will require, over time, a shift in cultures of care to allow for the development of competencies for inter-professional collaboration across the care continuum. The ECLECTIC project will develop an implementation framework for achieving, maintaining and monitoring competencies for interprofessional collaboration among multi-disciplinary teams charged with delivering care for older people across the continuum from acute to community settings. Design: The ECLECTIC research design has been developed in collaboration with the NICPOP. In phase one of the project, a co-design team will collaborate to define and shape competencies for interprofessional collaboration. Phase two will involve the delivery of a collective leadership intervention over a 10-month period with multidisciplinary professionals working with older people across two geographical regions (Mullingar/Midlands and Beaumont/Dublin North). Each group will comprise of members of two multidisciplinary teams charged with coordinating and delivering care to older people across the continuum of acute to community care. Observations of collaborative inter-professional working will take place before, during, and after intervention. In phase three of the study, analysis of the interview and observation data will be presented to the co-design team in order to develop an implementation framework for future teams. Discussion: The co-design process will develop core competencies and performance indicators for collaborative interprofessional working. The resulting implementation framework will be implemented nationally as part of the NICPOP.

Background Sedentary behaviour (SB) research has grown exponentially but efficacy for interventions to reduce sedentary behaviour is often contaminated by interventions primarily or co-targeting other behaviours and outcomes. The primary aim of this research therefore, was to systematically review the efficacy of interventions specifically targeting sedentary behaviour reduction, as a sole primary outcome, from randomised control trials in healthy ambulatory adults. This research also sought to identify the successful interventions characteristics, behaviour change techniques (BCT’s) and underlying theories, and their relation to intervention effectiveness. Methods We followed PRISMA reporting guidelines for this systematic review. Six electronic databases were searched and a grey literature review conducted. Only randomised or cluster randomised controlled trials, from 2000 to 2020, in adult populations with a sole primary outcome of change in sedentary behaviour were included. Data codebooks were developed, data were extracted, and a narrative synthesis and meta-analysis was conducted using mixed methods random effects models. Results Of 5589 studies identified, 7 studies met the inclusion criteria. Six studies reported activPAL3 measures of mean daily sitting time, and four reported mean daily standing time, stepping time and number of sedentary breaks. Pooled analysis of weighted mean differences revealed a reduction in mean daily sitting time of -32.4mins CI (-50.3, -14.4), an increase in mean daily standing time of 31.75mins CI (13.7, 49.8), and mean daily stepping time of 9.5mins CI (2.8, 16.3), and an increase in rate of sedentary breaks per day of 3.6 (CI 1.6, 5.6). BCTs used exclusively in two of the three most effective interventions are ‘feedback on behaviour’ and ‘goal setting behaviour’ whilst all three most effective interventions included ‘instruction on how to perform the behaviour’ and ‘adding objects to the environment’, BCTs which were also used in less effective interventions. Conclusions Although limited by small sample sizes and short follow up periods, this review suggests that interventions specifically designed to change sedentary behaviour, reduce overall daily sitting time by half an hour, with an equivalent increase in standing time, in the short to medium term. Effective characteristics and behaviour change strategies are identified for future development of high quality interventions targeting change in sedentary behaviour. Prospero registration PROSPERO 2020 CRD42020172457 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172457.

The association between fish consumption and new-onset type 2 diabetes is inconsistent and differs according to geographical location. We examined the association between the total and types of fish consumption and type 2 diabetes using individual participant data from 28 prospective cohort studies from the Americas (6), Europe (15), the Western Pacific (6), and the Eastern Mediterranean (1) comprising 956,122 participants and 48,084 cases of incident type 2 diabetes. Incidence rate ratios (IRRs) for associations of total fish, shellfish, fatty, lean, fried, freshwater, and saltwater fish intake and type 2 diabetes were derived for each study, adjusting for a consistent set of confounders and combined across studies using random-effects meta-analysis. We stratified all analyses by sex due to observed interaction (p = 0.002) on the association between fish and type 2 diabetes. In women, for each 100 g/week higher intake the IRRs (95% CIs) of type 2 diabetes were 1.02 (1.01-1.03, I2 = 61%) for total fish, 1.04 (1.01-1.07, I2 = 46%) for fatty fish, and 1.02 (1.00-1.04, I2 = 33%) for lean fish. In men, all associations were null. In women, we observed variation by geographical location: IRRs for total fish were 1.03 (1.02-1.04, I2 = 0%) in the Americas and null in other regions. In conclusion, we found evidence of a neutral association between total fish intake and type 2 diabetes in men, but there was a modest positive association among women with heterogeneity across studies, which was partly explained by geographical location and types of fish intake. Future research should investigate the role of cooking methods, accompanying foods and environmental pollutants, but meanwhile, existing dietary regional, national, or international guidelines should continue to guide fish consumption within overall healthy dietary patterns.

Background\ud To date, the scientific literature on socioeconomic correlates and determinants of physical activity behaviours has been dispersed throughout a number of systematic reviews, often focusing on one factor (e.g. education or parental income) in one specific age group (e.g. pre-school children or adults). The aim of this umbrella review is to provide a comprehensive and systematic overview of the scientific literature from previously conducted research by summarising and synthesising the importance and strength of the evidence related to socioeconomic correlates and determinants of PA behaviours across the life course.\ud \ud Methods\ud Medline, Embase, ISI Web of Science, Scopus and SPORTDiscus were searched for systematic literature reviews and meta-analyses of observational studies investigating the association between socioeconomic determinants of PA and PA itself (from January 2004 to September 2017). Data extraction evaluated the importance of determinants, strength of evidence, and methodological quality of the selected papers. The full protocol is available from PROSPERO (PROSPERO2014:CRD42015010616).\ud \ud Results\ud Nineteen reviews were included. Moderate methodological quality emerged. For adults, convincing evidence supports a relationship between PA and socioeconomic status (SES), especially in relation to leisure time (positive relationship) and occupational PA (negative relationship). Conversely, no association between PA and SES or parental SES was found for pre-school, school-aged children and adolescents.\ud \ud Conclusions\ud Available evidence on the socioeconomic determinants of PA behaviour across the life course is probable (shows fairly consistent associations) at best. While some evidence is available for adults, less was available for youth. This is mainly due to a limited quantity of primary studies, weak research designs and lack of accuracy in the PA and SES assessment methods employed. Further PA domain specific studies using longitudinal design and clear measures of SES and PA assessment are required.

Societal and technological changes have resulted in sitting being the dominant posture\ud during most activities of daily living, such as learning, working, travelling and leisure time. Too much\ud time spent in seated activities, referred to as sedentary behaviour, is a novel concern for public health\ud as it is one of the key lifestyle causes of poor health. The European DEDIPAC (Determinants of Diet\ud and Physical Activity) Knowledge Hub coordinated the work of 35 institutions across 12 European member states to investigate the determinants of sedentary behaviour. DEDIPAC reviewed current\ud evidence, set a theoretical framework and harmonised the available epidemiological data. The main\ud results are summarised. The conclusion is that there is a dire lack of data that is exploitable across\ud Europe to inform policy and intervention. There is an urgent need to develop international data\ud collection compliant with FAIR (Findable, Accessible, Interoperable, Re-usable) and standardised\ud surveillance systems for sedentary behaviour.

International audience; Low levels of physical activity (PA) are reported to contribute to the occurrence of non-communicable diseases over the life course. Although psychological factors have been identified as an important category concerning PA behavior, knowledge on psychological determinants of PA is still inconclusive. Therefore, the aim of this umbrella systematic literature review (SLR) was to summarize and synthesize the scientific evidence on psychological determinants of PA behavior across the life course. A systematic online search was conducted on MEDLINE, ISI Web of Science, Scopus, and SPORTDiscus databases. The search was limited to studies published in English from January 2004 to April 2016. SLRs and meta-analyses (MAs) of observational studies investigating the association of psychological variables and PA were considered eligible. Extracted data were evaluated based on importance of determinants, strength of evidence, and methodological quality. The full protocol is available from PROSPERO (Record ID: CRD42015010616). Twenty reviews (14 SLRs and 6 MAs), mostly of moderate methodological quality, were found eligible. Convincing evidence was found for self-efficacy (positive association with PA) in children and adolescents, and stress (negative association with PA) regardless of age. Most of the evidence revealing an association between psychological determinants and PA is probable and limited, mainly due to differences in the definition of PA and of psychological determinants across reviews. Thus, scholars are urged to reach a consensus on clear definitions of relevant psychological determinants of PA, subsuming cultural biases and allowing the possibility to obtain clear interpretations and generalizability of findings. Finally, most psychological determinants should be considered within a larger framework of other multi-level determinants that may interact or mediate some of the effects.

Introduction et but de l’etude Des travaux recents montrent que le comportement sedentaire a des effets nefastes sur la sante, meme parmi les individus physiquement actifs. Le developpement d’interventions efficaces ciblant la reduction des comportements sedentaires necessite une connaissance precise des facteurs qui influencent la sedentarite. L’objectif de cette revue est d’analyser, par une approche socioecologique, les facteurs individuels, sociaux, environnementaux et lies aux politiques publiques des comportements sedentaires chez l’adulte. Materiel et methodes Des recherches ont ete effectuees dans les bases de donnees suivantes : Pubmed, Embase, CINAHL, PscyINFO et Web of Science pour identifier les articles en anglais pertinents publies entre janvier 2000 et mai 2014. La strategie de recherche s’est basee sur 4 elements et leurs synonymes : « comportement sedentaire », « determinants/facteurs », « types de comportement sedentaire » et « types de determinants/facteurs ». Les etudes realisees chez des adultes de 18 a 65 ans et non selectionnes sur la base d’une pathologie ont ete inclues. Les analyses ont ete menees selon le modele socioecologique. Le protocole complet est disponible sur la base Prospero (Prospero 2014 :CRD42014009823). Resultats et analyse statistique Parmi les 4508 etudes initialement identifiees par mots-cles, 56 etudes originales (53 observationnelles, 2 qualitatives, 1 experimentale) ont ete analysees. Le comportement sedentaire est majoritairement auto-rapporte comme le temps passe devant un ecran ou le temps total passe assis. Dans 14 etudes, le temps total sedentaire est mesure objectivement par accelerometrie (n = 13) ou par mesure de la frequence cardiaque (n = 1). Parmi les facteurs individuels, l’âge, le niveau d’activite physique, l’indice de masse corporelle, le statut socioeconomique, l’humeur et l’attitude sont significativement associes aux comportements sedentaires. Pour les facteurs sociaux, une tendance a passer plus de temps assis ou devant un ecran pour les loisirs est identifiee chez les personnes mariees/en concubinage, alors qu’avoir des enfants n’apparait pas comme un facteur significatif. Plusieurs facteurs environnementaux sont associes aux comportements sedentaires : la proximite des espaces verts, la marchabilite du voisinage et la securite liee a la circulation. Le nombre d’etudes ciblant simultanement plusieurs niveaux du modele socioecologique reste faible. Conclusion Ces resultats confirment le role determinant de plusieurs facteurs individuels, mais aussi sociaux et environnementaux a considerer lors de l’elaboration des interventions ciblant une reduction de la sedentarite. En outre, cette revue met en evidence plusieurs limites de la litterature actuelle et donc des pistes de recherche pour approfondir l’analyse des determinants du comportement sedentaire : le besoin d’etudes longitudinales, l’exploration des facteurs lies aux politiques publiques, l’analyse des interactions entre les determinants et une meilleure classification des types et contexte de comportement sedentaire.

Background With the global shift in health care from secondary to primary care, employment opportunities for newly qualified physiotherapists are likely to be in the primary care setting. However, to date, undergraduate physiotherapy clinical education has been centred around secondary care, focusing on acute services in large teaching hospitals. For contemporary physiotherapists to become effective first-contact primary care providers, they need to be exposed to the primary care environment during their undergraduate education. Objectives To explore the concept and identify perceived barriers and facilitators to providing physiotherapy undergraduate clinical placements in the primary healthcare setting Design A three-round Delphi survey was used. Participants were asked to answer open-ended questions with regard to: (i) student preparation for and (ii) provision of primary care placements (Round 1). Content analysis was employed to identify key themes. These themes generated statements for Round 2. In Round 2, participants were asked to rate their level of agreement/disagreement with the generated statements. In Round 3, a final rating process was conducted. Level of consensus was established as ≥70% agreement, with an interquartile range of ≤1. Participants One hundred and ninety-eight primary care physiotherapy staff. Results Barriers identified included shortage of resources (e.g. staff) and a lack of tradition; in other words, students are not traditionally educated in the primary care setting. Response rates were 60% (120/198), 70% (84/120) and 76% (64/84) for Rounds 1, 2 and 3, respectively. All seven key facilitators identified reached consensus. They included additional support for staff taking students and motivated students. Conclusions This study revealed that there is support for the provision of physiotherapy clinical education in the primary care setting. Through careful consideration with clear planning and collaboration with all stakeholders, it may be possible to convert the main barriers identified into facilitators to ensure that there will be an adequately prepared physiotherapy work force in the future.

The overall objective of this study was to evaluate current Irish undergraduate physiotherapy education in relation to the promotion and prescription of physical activity and exercise for healthy and clinical populations and to devise rec- ommendations for future education in this field to ensure professional entry-level physiotherapists are optimally prepared for contemporary practice. The evaluation consisted of a content analysis of current Irish BSc Physiotherapy programmes (n = 4) and four additional studies involving key stakeholders; final year students (n = 62) clinical educators (n = 30), academic educa- tors (n = 27) and experienced physiotherapy clinicians (n = 72). Four key areas were identified as requiring attention in order to optimise physical activity and exercise education. These key areas are (i) curriculum content, (ii) curriculum context (relating to where the curriculum is delivered), (iii) teaching and learning strategies (and levels of learning) and (iv) curriculum design and development. The evaluation in its entirety is explored in this paper under these four main headings. Results are summarised and followed by a discussion of the implications of findings for professional entry-level physiotherapy education. Both the findings and their implications are drawn together in this way to provide a coherent picture of the new knowledge generated by this work and its potential impact on physiotherapy education. Based on this newly generated knowledge, recommendations for future physiotherapy education in terms of physical activity and exercise promotion and prescription are provided. These recommendations are accompanied by an illustrated sample curriculum for contemporary education. Methodological limitations are addressed and discussed and avenues for future research are highlighted.

BACKGROUND: With the on-going reform of the Irish health service it is likely that future employment opportunities for physiotherapy graduates will be in primary care. In order to adequately prepare a future workforce, pre-registration physiotherapy programmes must respond to the change in focus of healthcare delivery. To date there has been no study that examines current entry-level physiotherapy practice placement allocations in the Republic of Ireland. AIM: To examine the profile of practice placement settings of pre-registration physiotherapy students in the Republic of Ireland, in order to ascertain what the trend of practice placement settings has been over a three year period and whether this trend reflects the Irish health service change in focus from acute to primary care. METHOD: The four schools of physiotherapy categorised practice placement allocations under the following six headings (1) acute hospitals (2) district hospital/specialised rehabilitation (3) Primary Community & Continuing Care services (4) private hospitals/clinics (5) overseas and (6) other. This data was combined and descriptive statistics were used to analyse it. RESULTS: A total of 3142 placements were available across the four schools in the three years from 2009–2012. Of these, 74% (n= 2310) were in acute hospitals, 17% (n= 542) were in district hospitals/specialised rehabilitation services, 5% (n= 171) were in primary care services, 1% (n= 41) in private hospitals/clinics and 2 % (n= 72) were overseas placements. Primary care placements increased slightly in number over the three years, from 4% (n= 42/1041) in 2009/10 to 7% (n= 75/1067) by 2011/12. CONCLUSION: Although the allocation of practice placements to primary care services increased slightly over the three years, acute hospitals are the predominant settings for practice education in the Republic of Ireland. This does not reflect the Irish health service reform and students may not feel adequately prepared to work in the primary care sector on qualification.

Physical inactivity and non-adherence to physiotherapy are common problems. Physiotherapists as promoters, preventers and rehabilitators are ideally placed to influence physical activity behaviours. Possessing the knowledge and skills to facilitate this behaviour change and to promote adherence to physiotherapy must be viewed as clinical competency. This paper reviews four psychological strategies; self-determination theory, social cognitive theory, cognitive behavioural therapy and motivational interviewing that have been shown to have a positive influence on exercise behaviour. The origins and theoretical model of all four are discussed and an example of an intervention based on each model from the literature is provided. A review of how physiotherapists can use each to inform their practice follows. To conclude the similarities between all four that can be implemented into practice are discussed.

Purpose: To explore final-year physiotherapy students' perceptions of primary health care practice to determine (1) aspects of their curriculum that support their learning, (2) deficiencies in their curriculum, and (3) areas that they believe should be changed to adequately equip them to make the transition from student to primary health care professional. Methods: Framework analysis methodology was used to analyze group opinion obtained using structured group feedback sessions. Sixty-eight final-year physiotherapy students from the four higher education institutions in Ireland participated. Results: The students identified several key areas that (1) supported their learning (exposure to evidence-based practice, opportunities to practise with problem-based learning, and interdisciplinary learning experiences); (2) were deficient (primary health care placements, additional active learning sessions, and further education and practice opportunities for communication and health promotion), and (3) required change (practice placements in primary health care, better curriculum organization to accommodate primary health care throughout the programme with the suggestion of a specific primary health care module). Conclusion: This study provides important insights into physiotherapy students' perceptions of primary health care. It also provides important indicators of the curriculum changes needed to increase graduates' confidence in their ability to take up employment in primary health care.

The scope of contemporary physiotherapy practice is a critical factor in determining the appropriate educational preparation for physiotherapists now and into the future. The world-wide shift from secondary to primary healthcare has, and is, continuing to result in new and different ways of working. It is crucial that curricular changes reflect these developments. In this study a qualitative approach using Biggs 3P's - Pressage, Process and Product model to discuss curriculum design.The aim of the study was to explore the perspectives of both national and international physiotherapy educators/practitioners in primary healthcare, on the key elements required in physiotherapy education programmes to prepare future primary healthcare practitioners.Snowball sampling was used to identify experts in education and/or primary healthcare practice. Semi-structured interviews were conducted using an interview guide based on the Biggs 3P's model.Twelve participants were recruited from Ireland (n = 2), the UK (n = 4), Canada (n = 3), New Zealand (n = 2) and Australia (n = 1) using snowball sampling.Interviews were analysed using thematic analysis. Themes identified included; understanding the philosophy of physiotherapy practice, cultural competence, inter-disciplinary team working and communication skills. Contextual factors and teaching and learning strategies were discussed.There is an urgent need for physiotherapy education programmes to adopt the concept of primary healthcare as the basis for the physiotherapy curriculum and illuminate key components for consideration.

Objectives Practice tutors' evaluation to (i) establish current physical activity and exercise promotion and prescription curriculum content and (ii) their knowledge, attitudes and beliefs concerning physical activity and exercise prescription in clinical education, in terms of contemporary and emerging health trends and priorities. Design A cross sectional survey employing a questionnaire and focus groups. Participants All practice tutors delivering physiotherapy undergraduate education in four physiotherapy schools in Ireland ( n =38) were invited to participate. Thirty participated giving a response rate of 79%. Methods Two methods of data collection were employed. Clinical content questionnaires were administered, the results of which informed follow-up focus groups. Focus group transcriptions were analysed using the ‘Framework Analysis' method. Results 66% of practice tutors were unhappy with their own knowledge and felt they required further training in the following areas: strategies for changing physical activity behaviour; exercise promotion and prescription for public health; exercise prescription for lifestyle related disease. Main themes emerging from the focus groups were (i) perceptions of the physiotherapist's role, (ii) perceptions of the practice tutor's role and (iii) facilitators and barriers to change. Conclusion In terms of physical activity and exercise prescription education, practice tutors identified a need for further education to improve their knowledge base. However, their attitudes and beliefs relating to physiotherapists' and educators' role in terms of teaching contemporary and emerging health trends and priorities were mixed. Results of this study provide useful data to inform future physiotherapy curricula development in terms of physical activity and exercise content.

Background: Global epidemiological trends indicate that lifestyle related conditions will dominate illness care for the foreseeable future. With physical inactivity an established risk factor for these conditions, physical activity and exercise prescription have increasing relevance to physiotherapy practice. Purpose: In terms of physical activity and exercise prescription for healthy and clinical populations, the purpose of this study was firstly, to determine senior physiotherapists' knowledge and establish whether a postgraduate qualification enhanced this knowledge and secondly, to investigate their attitudes and beliefs relating to the role of physiotherapy in contemporary practice. Methods: One hundred senior physiotherapists from 27 health care settings throughout Ireland were invited to participate. Each therapist was sent a questionnaire (specifically developed for use in this study). It included seven key sections (73 questions) relating to physical activity and exercise prescription. Three open-ended questions invited comment on priorities for the profession in terms of future practice. Quantitative data was analysed using the Statistical Package for Social Science (SPSS version 18) and a 'Framework analysis' methodology was utilised for qualitative analysis. Results: A 71% (n = 71) response rate was achieved. All respondents reported having a specific interest in physical activity and exercise prescription. However, just over half (55%) were aware of international guidelines for physical activity. The following were identified as areas in which the physiotherapists felt they required greater proficiency: exercise prescription for healthy sedentary populations; interventions to promote physical activity and strategies to improve physical activity adherence and exercise prescription for lifestyle-related conditions. Those with a postgraduate qualification reported were significantly more knowledgeable in this field than those without. The main themes that emerged from the open-ended questions were (i) barriers preventing physiotherapists from being experts in physical activity promotion and exercise prescription and (ii) perceptions of the role of the contemporary physiotherapist. Conclusion: Senior physiotherapists identified a need for further education in the areas of health promotion and strategies to improve physical activity adherence. Furthermore, they advocated that contemporary physiotherapists adopt a more prominent role in wellness and prevention, both in the clinical setting and the community. Results of this study provide useful data to inform future developments in physiotherapy undergraduate and postgraduate education. Physical activity and exercise have increasing relevance to contemporary practice in particular in securing a central role for physiotherapists in the prevention and management of lifestyle related conditions.

The purpose of this study was to examine physiotherapy students’ perceptions of current education content of entry-level physiotherapy programmes in terms of physical activity (PA) and exercise promotion and prescription (EPP). Sixty-two physiotherapy students from three Irish Universities participated. Three Structured Group Feedback Sessions (SGFS) were conducted. Using open-ended questions, group opinions were sought in relation to their PA and EPP education. In accordance with SGFS methodology, comments that received majority support were recorded. Data were analysed using ‘Framework Analysis’ methodology. Emerging themes related to (i) course content, (ii) clinical education, and (iii) methods of teaching and learning. The SGFS approach was found to be a useful method, providing an opportunity for students to substantiate and expand on their views.

Background Overwhelming evidence shows that physical activity and exercise promotion and prescription are effective in preventing and managing numerous chronic conditions. With physiotherapists commonly referred to as 'exercise prescription experts', an in-depth knowledge of exercise promotion and prescription is assumed. However, to date, no information exists about what is or should be included in terms of undergraduate physiotherapy physical activity and exercise education, nor whether the content prepares graduates to be exercise experts for contemporary practice. Objectives To provide an accurate, contemporary picture of physical activity and exercise promotion and prescription content within Irish undergraduate physiotherapy curricula. Method Content analysis was used to explore physical activity and exercise inclusion within four of the five programmes in Ireland. Seven categories were generated. Frequency analysis for each category was used to provide a guide to the extensiveness of physical activity and exercise promotion and prescription content. Results All curricula included varying quantities of basic exercise science and exercise testing and prescription. Physical activity and exercise promotion and prescription for conditions routinely referred to physiotherapy, such as cardio respiratory disease, were well represented. Three key areas were identified as being absent or needing further emphasis: physical activity/exercise for public health, strategies for changing physical activity behaviour, and physical activity/exercise for lifestyle-related diseases. Conclusion Results indicate a strong need for re-evaluation of physical activity and exercise education in Irish physiotherapy curricula. There is a lack of explicit exercise content in relation to public health and lifestyle-related disease.

The First Physical Therapy Summit on Global Health was convened at the 2007 World Confederation for Physical Therapy (WCPT) Congress to vision practice in the 21st century and, in turn, entry-level education and research, as informed by epidemiological indicators, and consistent with evidence-based noninvasive interventions, the hallmark of physical therapy. The Summit and its findings were informed by WHO data and validated through national databases of the countries of the five WCPT regions. The health priorities based on mortality were examined in relation to proportions of physical therapists practicing in the areas of regional priorities and of the curricula in entry-level programs. As a validation check and to contextualize the findings, input from members of the 800 Summit participants was integrated and international consultants refined the recommendations. Lifestyle-related conditions (ischemic heart disease, smoking-related conditions, hypertension, stroke, cancer, and diabetes) were leading causes of premature death across regions. Contemporary definitions of physical therapy support that the profession has a leading role in preventing, reversing, as well as managing lifestyle-related conditions. The proportions of practitioners practicing primarily in these priority areas and of the entry-level curricula based on these priorities were low. The proportions of practitioners in priority areas and entry-level curricula devoted to lifestyle-related conditions warrant being better aligned with the prevalence of these conditions across regions in the 21st century. A focus on clinical competencies associated with effective health education and health behavior change formulates the basis for The Second Physical Therapy Summit on Global Health.

Two key factors will determine the demand on the physiotherapy profession in contemporary Ireland in the future. Firstly, the shift towards primary care, with a focus on prevention and health promotion and secondly, the chronic conditions that will dominate illness care for the foreseeable future are incontestable given lifestyle profiles and changing life expectancies. For physiotherapists to become effective first contact primary care providers, their role must change from one exclusively geared towards illness, disease and disability to one that provides greater emphasis on the health and wellness, and prevention of 21st century health concerns, specifically, lifestyle related diseases. Modifying lifestyle practices (risk factors) such as tobacco use, excessive alcohol consumption, poor nutrition, weight gain and physical inactivity is listed as a major priority by the Health Services Executive (HSE), given that an escalating number of children, as well as over half Irish adults have one or more manifestations of lifestyle related conditions. Research has shown that a successful assault on lifestyle conditions is more likely achieved by addressing lifestyle rather than primarily focusing on symptom reduction, indicating that health assessment and risk factor modification, undoubtedly, warrant being 21st century physiotherapy competencies. Based on historical precedent and evidence, this article highlights how physiotherapists, by exploiting interventions such as health education, physical activity and exercise, can play a major role in prevention and in some cases, reversing the tide of lifestyle related conditions. Furthermore, the current transition to primary care, with a focus on prevention and health promotion, will facilitate Irish physiotherapists to affect public health practice in every person and patient. Physiotherapy in Ireland could lead the way globally by serving as a model of change.