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Issue Population level changes in physical activity (PA) may benefit from policy intervention. In response to the UN Sustainable Development Goals, Wales introduced legislation (the Well-being of Future Generations (Wales) Act 2015) to holistically improve health and well-being, including the translation of national policy into practice. This audit provides a case study approach that could be replicated by researchers in other countries to appraise the role of PA actions in national and sub-national policies. Description An audit of policies published by national and sub-national public bodies between 2015 and 2020 was conducted. The list of identified policies was reviewed by an external panel to act as a ?critical friend? to verify its inclusiveness. Content of the policies were extracted and synthesised to determine: (i) how many policies included a PA action; (ii) what the drivers of those policies were; (iii) the content of the PA actions; and (iv) how the PA actions aligned with the Well-being of Future Generations (Wales) Act 2015. Results A final list of 73 policies was obtained. Only 16 national-level documents had a PA action, which had been published by 4/13 public bodies (who are bound by the Act). Of the 19 sub-national well-being policies, 15 included PA actions. Most policies were considered reactive and varied in terms of the clarity and specificity of the actions, the assignment roles/responsibilities, and the setting of targets; all overarching principles which can be used to strengthen national and sub-national policy in the future. The most common theme of action across the national-level documents was the broad action of PA promotion, which was identified in nine of the 16 documents. The actions within the national-level documents were reflected in the sub-national well-being plans. Lessons This research used a novel approach to assess alignment of policies related to PA and the Sustainable Development Goals (SDGs) in Wales. It provides an overview of the current status of policy related to PA in Wales, which can be used in manifestos and frameworks to shape the subsequent actions of public bodies. Main messages This case study provides a valuable example of how to utilise PA to address broader health and wellbeing agendas, and specifically the SDGs. It also demonstrates an approach to achieving stronger connections between national and sub-national policy to support the translation of policies into practice.

Background Youth have experienced unprecedented restrictions during the COVID-19 pandemic. It is important to ascertain youth's perceptions of how the lockdown restrictions have impacted their well-being. Given the varying restrictions imposed in different countries, exploring the impact relative to the specific restrictions is imperative. This study investigated youth's views on the impact of a third national lockdown on their well-being and physical activity. Methods Following informed parental consent, youth aged 8-18 years attending state schools in Wales, UK, were invited to complete an online questionnaire using an individualised link sent to the email addresses provided by parents (January 2021). A total of 4,259 survey links were issued. The questionnaire included questions on children's physical activity, mental well-being and experience of COVID-19. This study reports on free text responses from an optional two-part open-ended question on their experience during restrictions employed to manage the COVID-19 pandemic in Wales. The questions were (a) How does lockdown make you feel?, followed by (b) Why do you feel this way?. Flexible thematic analysis was employed to analyse the data and identify themes and sub-themes. Results Valid responses were received from 1,681 youth (11.8±2.3 years; 50% girls). Most participants expressed only a negative emotional response to their lockdown experience. Whilst there were no overall sex differences in the responses, age differences were observed. Specifically, the 12-13 year-old age group reported the lowest number of negative responses, compared to 8-9 year-olds who reported the highest. Six distinct negative emotional responses were identified: sadness, anger, worry, loneliness, boredom, laziness. Nevertheless, a small cohort of participants identified positive emotional responses that focused on being happy. Mixed emotions were also reported by participants which were most prevalent amongst 16-18 year-olds and least reported in 10-11 year-olds. Finally, the inability to participate in team sports was reported negatively, however, some youth reported the additional time facilitated greater participation in exercise. Conclusions The predominance of negative emotions highlights the significant and potentially long-lasting impact the lockdowns have had on youth's mental well-being. In addition, the findings evidence that youth associated sport participation with their mental health. Furthermore, the age differences identified highlight that youth's developmental stage, both emotionally and societally, should be considered in the recovery response to improve and reduce further deterioration in youth's mental health. This evidence should be considered when ministers evaluate the wider evidence to inform future restrictions required to manage the exit from COVID-19 and other future pandemics.

OBJECTIVE To examine whether the effect of a 3-year lifestyle intervention on body weight and cardiometabolic risk factors differs by prediabetes metabolic phenotype. RESEARCH DESIGN AND METHODS This post-hoc analysis of the multi-center, randomized trial, PREVention of diabetes through lifestyle interventions and population studies In Europe and around the World (PREVIEW), included 1510 participants with prediabetes (BMI≥25 kg·m-2; defined using oral glucose tolerance tests). Of these, 58% had isolated impaired fasting glucose (iIFG), 6% had isolated impaired glucose tolerance (iIGT), and 36% had IFG+IGT; 73% had normal HbA1c ( RESULTS In the available-case and complete-case analyses, participants with IFG+IGT had greater sustained weight loss after lifestyle intervention (adjusted mean at 156 weeks -3.5% [95%CI, -4.7%, -2.3%]) than those with iIFG (mean -2.5% [-3.6%, -1.3%]) relative to baseline (P=0.011). Participants with IFG+IGT and iIFG had similar cardiometabolic benefits from the lifestyle intervention. The differences in cardiometabolic benefits between those with iIGT and IFG+IGT were minor or inconsistent in different analyses. Participants with normal vs intermediate HbA1c had similar WL over 3 years and minor differences in cardiometabolic benefits during weight loss, whereas those with normal HbA1c had greater improvements in fasting glucose, 2-hour glucose (adjusted between-group difference at 156 weeks -0.54 mmol·L-1 [-0.70, -0.39]; PP CONCLUSIONS Individuals with iIFG and IFG+IGT had similar improvements in cardiometabolic health from a lifestyle intervention. Those with normal HbA1c had greater improvements than those with intermediate HbA1c.

BackgroundPhysical activity levels are known to decline following hospitalisation for people with cystic fibrosis (pwCF). However, optimal physical activity promotion strategies are unclear. This study investigated the effect of a web-based application (ActivOnline) in promoting physical activity in young pwCF.MethodsMulticentre randomised controlled trial with assessor blinding and qualitative evaluation. People with CF (12–35 years) admitted to hospital for a respiratory cause were eligible and randomised to the 12-week ActivOnline intervention (AO) or usual care (UC). The primary outcome was change in device-based time spent in moderate-to-vigorous physical activity (MVPA) from baseline to post-intervention. Follow-up was at 6 months from hospital discharge when qualitative evaluation was undertaken.Results107 participants were randomised to AO (n=52) or UC (n=55). Sixty-three participants (59%) contributed to the intention-to-treat analysis. Mean (SD) age was 21 (6) years (n=46, ConclusionA web-based application, including individualised goal setting, real-time feedback and motivation for behavioural change, was no better than usual care at promoting physical activity in young pwCF following hospital discharge. High levels of baseline physical activity levels in both groups, and limited engagement with the intervention, suggest alternative strategies may be necessary to identify and support young pwCF who would benefit from enhanced physical activity.Trial registration numberACTRN12617001009303, 13 July 13 2017.

Novel coronavirus disease 2019 (COVID-19) pandemic restrictions have negatively impacted physical activity (PA) and sedentary time/behaviour. This integrative review systematically explored the socioecological factors that impacted and influenced these movement behaviours in children and adolescents during the pandemic. Five electronic databases were systematically searched in January 2021, with data extracted from 16 articles (n = 18,352; 5–17 years; 12 countries). Risk-of-bias was assessed using the Mixed Methods Assessment Tool (MMAT), with correlates identified, coded, and themed via thematic analysis. A socioecological model of during-pandemic PA and sedentary time/behaviour was conceptualised and mapped to the Capability, Opportunity, Motivation, and Behaviour (COM-B) model of behaviour-change mechanisms, illustrating influences over five levels: Individual (biological)—age and sex; Individual (psychological)—mental health, and cognition, motivation, and behaviour; Social—family factors, and structured support; Environmental—area of residence and resources; and Policy—COVID-19-related rules. For sedentary time/behaviour, individual-(age and sex), social-(family factors) and policy-(COVID-19-related rules) level factors may be important correlates. There were no age or sex associations with PA levels, though there was some indication that sedentary time/behaviour increased with age. Interventions seeking to enhance young people’s movement behaviours during periods of enforced restrictions should focus on enhancing opportunities on a social and environmental level.

OBJECTIVE To examine whether the effect of a 3-year lifestyle intervention on body weight and cardiometabolic risk factors differs by prediabetes metabolic phenotype. RESEARCH DESIGN AND METHODS This post hoc analysis of the multicenter, randomized trial, PREVention of diabetes through lifestyle interventions and population studies In Europe and around the World (PREVIEW), included 1,510 participants with prediabetes (BMI ≥25 kg ⋅ m−2; defined using oral glucose tolerance tests). Of these, 58% had isolated impaired fasting glucose (iIFG), 6% had isolated impaired glucose tolerance (iIGT), and 36% had IFG+IGT; 73% had normal hemoglobin A1c (HbA1c; RESULTS In the available-case and complete-case analyses, participants with IFG+IGT had greater sustained weight loss after lifestyle intervention (adjusted mean at 156 weeks −3.5% [95% CI, −4.7%, −2.3%]) than those with iIFG (mean −2.5% [−3.6%, −1.3%]) relative to baseline (P = 0.011). Participants with IFG+IGT and iIFG had similar cardiometabolic benefits from the lifestyle intervention. The differences in cardiometabolic benefits between those with iIGT and IFG+IGT were minor or inconsistent in different analyses. Participants with normal versus intermediate HbA1c had similar weight loss over 3 years and minor differences in cardiometabolic benefits during weight loss, whereas those with normal HbA1c had greater improvements in fasting glucose, 2-h glucose (adjusted between-group difference at 156 weeks −0.54 mmol ⋅ L−1 [95% CI −0.70, −0.39], P < 0.001), and triglycerides (difference −0.07 mmol ⋅ L−1 [−0.11, −0.03], P < 0.001) during the lifestyle intervention. CONCLUSIONS Individuals with iIFG and IFG+IGT had similar improvements in cardiometabolic health from a lifestyle intervention. Those with normal HbA1c had greater improvements than those with intermediate HbA1c.

Whilst participation in regular exercise and sport has generally increased over recent decades globally, fundamental questions remain regarding the influence of growth, maturation, and sex on the magnitude of training response throughout adolescence. Trained (108 participants, 43 girls; age: 14.3 ± 1.8 years) and untrained (108 participants, 43 girls; age: 14.7 ± 1.7 years) adolescents completed an incremental ramp test to exhaustion during which breath by gas exchange, beat-by-beat heart rate (HR), stroke volume (SV) and cardiac output (Q·) and muscle deoxygenation were assessed. Device-based physical activity was also assessed over seven consecutive days. Boys, irrespective of training status, had a significantly higher absolute (2.65 ± 0.70 L min−1 vs. 2.01 ± 0.45 L min−1, p < 0.01) and allometrically scaled (183.8 ± 31.4 mL·kg−b min−1 vs. 146.5 ± 28.5 mL·kg−b min−1, p < 0.01) peak oxygen uptake (V·O2) than girls. There were no sex differences in peak HR, SV or Q· but boys had a higher muscle deoxygenation plateau when expressed against absolute work rate and V·O2 (p < 0.05). Muscle deoxygenation appears to be more important in determining the sex differences in peak V·O2 in youth. Future research should examine the effects of sex on the response to different training methodologies in youth.

BACKGROUND Little is known about the opinions or perceived benefits of an inspiratory muscle training intervention in patients with cystic fibrosis and their multidisciplinary team. OBJECTIVE The aim of this qualitative study was to examine patients' and multidisciplinary teams' views on inspiratory muscle training to inform and tailor future interventions. METHODS Individual, semistructured interviews were conducted to evaluate participants’ perspectives of a 4-week inspiratory muscle training intervention. In this study, 8 of 13 individuals involved in the inspiratory muscle training program (5 children aged 11-14 years; 2 physiotherapists; and 1 respiratory physician) participated. Interviews were transcribed verbatim, analyzed using thematic analyses, and then coded into relevant themes. RESULTS Four key themes emerged: acceptability, facilitators, barriers, and recommendations. While fun, enjoyment, and improved perceived physical ability were reported by children and their multidisciplinary team following the inspiratory muscle training program, the multidisciplinary team identified factors such as time and cost as key barriers. CONCLUSIONS A short inspiratory muscle training program was perceived to have positive effects on the physical ability and psychosocial health of children with cystic fibrosis. These findings highlight the importance of obtaining participants’ and multidisciplinary teams' perceptions and recommendations to ensure the efficacy and optimal design of future inspiratory muscle training protocols.