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Toby Hunt,1,2 Sarah Madigan,2 Marie T Williams,3 Tim S Olds1 1Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, School of Health Sciences, University of South Australia, City East Campus, Adelaide, SA, Australia; 2Respiratory Clinical Research Unit, Repatriation General Hospital, Daw Park, SA, Australia; 3School of Population Health, University of South Australia, City East Campus, Adelaide, SA, Australia Abstract: “Physical inactivity” and “sedentary lifestyles” are phrases often used when describing lifestyles of people with chronic obstructive pulmonary disease (COPD). Evidence suggests activity types, independent of energy expenditure, influence health outcomes, so understanding patterns of time use is important, particularly in chronic disease. We aimed to identify reports of time use in people with COPD. Predefined search strategies were used with six electronic databases to identify individual activity reports (including frequencies and/or durations) in which community-dwelling people with COPD engaged. Eligible studies were assessed independently against predefined criteria and data were extracted by two reviewers. Data synthesis was achieved by aggregating activity reports into activity domains (sports/exercise, screen time, transport, quiet time, self-care, sociocultural, work/study, chores, and sleep). Twenty-six publications reported 37 specific daily activities. People with COPD were found to spend extended periods in sedentary behaviors (eg, standing [194 min/day]; sitting [359 min/day]; lying [88 min/day]), have limited engagement in physical activity (eg, walking [51 min/day]; exercising [1.2 episodes per week {ep/w}, 13 min/day]), have high health care needs (medical appointments [1.0 ep/w]), and experience difficulties associated with activities of daily living (eg, showering [2.5 ep/w, 60 minutes per episode]; preparing meals [4.7 ep/w]). Little data could be found describing how people with COPD use their time, and data synthesis was problematic because of variations in methodologies, population differences, and research emphases. Identified data largely referred to posture and were skewed according to country, assessment methods, and disease severity. Comparisons with age-matched population data showed people with COPD spent less time engaged in personal-care activities (self-care and sleeping) and chores than people in similar age groups. The incorporation of time-use outcomes in future research designs should be encouraged. Ideally, these tools should use consistent frameworks and comparable outcome measures in order to provide clearer descriptions of time use in chronic disease. Keywords: activities of daily living, human activities, leisure activities, sedentary lifestyles

Objectives: While there is consistent evidence that rural adults in Australia are less active than their urban counterparts, studies relating geographical remoteness to activity patterns in Australian adolescents have yielded inconsistent results. The aim of this study was to describe objectively and subjectively measured patterns of physical activity and sedentary behaviours across remoteness categories in a representative sample of 9-16 year old Australians.Design: Cross-sectional observational study.Methods: 2071 Australian adolescents provided self-report use of time data on four days and wore a pedometer for at least 6 days within the 2007 Australian National Children's Nutrition and Physical Activity Survey. Comparisons of activity patterns were made across four objectively-determined remoteness categories (Major City, Inner Regional, Outer Regional and Remote), adjusting for household income, parental education and age.Results: Adolescents living in major cities self-reported 11-29 min less moderate to vigorous physical activity each day than their counterparts living in geographically more remote areas, and took 150-850 fewer steps each day. While there were no differences in time spent in sport or active transport, differences in free play participation were significant. Males in major cities also reported higher levels of screen time. Differences were somewhat more marked among males than among females.Conclusions: Activity levels among Australian adolescents show contrasting patterns of geographical differences to those found in Australian adults. Higher levels of free play among rural Australian adolescents may be due to more available space and less fear of traffic and stranger risks. [ABSTRACT FROM AUTHOR]

PURPOSE:: Compendia of energy costs are often used to assign energy expenditures (EE) to self-reported and observed activity. As there is a lack of data on the energy cost of children's everyday activities, adult values are often used as surrogates. However, the best way to adjust adult values for use with children remains unclear. Various strategies have been used to estimate rates of EE in children. METHODS:: To evaluate these existing methods for assigning EE to children, a literature search reviewed all English-language studies that measured energy costs in healthy 6.0-17.9 yr olds using criterion EE measures. Data were combined using the Monte Carlo simulation procedure, with walking and running forming separate data sets. RESULTS:: The resultant data set (excluding walking and running) contained 5592 data points encompassing 51 activities. Analyses revealed using adults METs, combined with child resting metabolic rates, as the best existing technique to assign EE to children when measured values are not available. Prediction equations for the energy cost of walking and running were calculated using multiple regression. CONCLUSION:: This study has provided a literature base and analytical support for a compendium of energy costs for use with children with energy costs expressed as METs. [ABSTRACT FROM AUTHOR]

It is widely believed that the performance of children and adolescents on aerobic fitness tests is declining. To test this hypothesis, this meta-analysis compared the results of 55 reports of the performance of children and adolescents aged 6-19 years who have used the 20m shuttle run test (20mSRT). All data were collected in the period 1981-2000. Following corrections for methodological variation, the results of all studies were expressed using the common metric of running speed (km/h) at the last completed stage. Raw data were combined with pseudodata generated from reported means and standard deviations using Monte Carlo simulation. Where data were available on children and adolescents from the same country of the same age and sex, but tested at different times, linear regression was used to calculate rates of change. This was possible for 11 (mainly developed) countries, representing a total of 129,882 children and adolescents in 151 age x sex x country slices. There has been a significant decline in performance in the 11 countries where data were available, and in most age x sex groups, with a sample-weighted mean decline of 0.43% of mean values per year. The decline was most marked in older age groups and the rate of decline was similar for boys and girls. There has been a very rapid secular decline in the 20mSRT performance of children and adolescents over the last 20 years, at least in developed countries. The rate of decline is not related to the change in the country's relative wealth, as quantified by per capita gross domestic product (GDP). [ABSTRACT FROM AUTHOR]

Background: Sleep, sedentary behaviour, physical activity, and the composition of these movement behaviours across the 24-h day are associated with cognitive function in early years children. This study used a Goldilocks day compositional data analysis approach to identify the optimal duration of sleep, sedentary behaviour, light physical activity, and moderate-to-vigorous physical activity associated with desired cognitive function outcomes in early years children., Methods: This cross-sectional study included 858 children aged 2.8-5.5 years from the Sleep and Activity Database for the Early Years. 24-h movement behaviours (sleep, sedentary behaviour, light physical activity, moderate-to-vigorous physical activity) were measured using ActiGraph accelerometers. Cognitive function was measured using three tasks from the Early Years Toolbox: visual-spatial working memory, response inhibition, and expressive vocabulary. A Goldilocks day compositional data analysis approach was used in R software to identify the optimal time-use compositions associated with the best 10% of the cognitive function scores., Results: The movement behaviour composition and the relative time spent in sleep and sedentary behaviour but not different intensities of physical activity were significantly associated with working memory (P ≤ 0.01). The movement behaviour composition and relative time spent in sleep, sedentary behaviour, and different intensities of physical activity were not significantly associated with response inhibition or expressive vocabulary (P > 0.2). Therefore, optimal time use was only determined for working memory. Optimal daily durations for working memory were observed with 11:00 (hr:min) of sleep, 5:42 of sedentary behaviour, 5:06 of light physical activity, and 2:12 of moderate-to-vigorous physical activity., Conclusion: Working memory was the only cognitive function outcome related to the 24-h movement behaviour composition. Optimal sleep for working memory was consistent with current recommended durations, while optimal moderate-to-vigorous physical activity greatly exceeded minimal recommended levels. Optimal sedentary behaviour was longer and light physical activity was shorter than the sample average., Competing Interests: Declarations Ethics approval and consent to participate The SADEY project was approved by the University of Wollongong Health and Medical Human Research Ethics Committee (2021/249) [28]. The studies included in this study were also ethically approved as follows: ACTNOW—Institutional Ethics Committee and the Norwegian Centre for Research Data—#248220; Jump Start—University of Wollongong Human Research Ethics Committee (HE14/137); PATH ABC—University of Wollongong Health and Medical Human Research Ethics Committee—#HE14/310); PROXDEV—University of Alberta Human Research Ethics Board (00081175). Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Across the life course, socioeconomic disadvantage disproportionately afflicts those with genetic predispositions to inflammatory diseases. We describe how socioeconomic disadvantage and polygenic risk for high BMI magnify the risk of obesity across childhood, and using causal analyses, explore the hypothetical impact of intervening on socioeconomic disadvantage to reduce adolescent obesity., Methods: Data were drawn from a nationally representative Australian birth cohort, with biennial data collection between 2004 and 2018 (research and ethics committee approved). We generated a polygenic risk score for BMI using published genome-wide association studies. We measured early-childhood disadvantage (age 2-3 years) with a neighbourhood census-based measure and a family-level composite of parent income, occupation, and education. We used generalised linear regression (Poisson-log link) to estimate the risk of overweight or obesity (BMI ≥85th percentile) at age 14-15 years for children with early-childhood disadvantage (quintiles 4-5) versus average (quintile 3) and least disadvantage (quintiles 1-2), for those with high and low polygenic risk separately., Findings: For 1607 children (n=796 female, n=811 male; 31% of the original cohort [N=5107]), polygenic risk and disadvantage were both associated with overweight or obesity; effects of disadvantage were more marked as polygenic risk increased. Of children with polygenic risk higher than the median (n=805), 37% of children living in disadvantage at age 2-3 years had an overweight or obese BMI by adolescence, compared with 26% of those with least disadvantage. For genetically vulnerable children, causal analyses indicated that early neighbourhood intervention to lessen disadvantage (to quintile 1-2) would reduce risk of adolescent overweight or obesity by 23% (risk ratio 0·77; 95% CI 0·57-1·04); estimates for improving family environments were similar (0·59; 0·43-0·80)., Interpretation: Actions addressing socioeconomic disadvantage could mitigate polygenic risk for developing obesity. This study benefits from population-representative longitudinal data but is limited by sample size., Funding: Australian National Health and Medical Research Council., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Physical activity, sedentary behaviour and sleep are associated with cognitive function in older adults. However, these behaviours are not independent, but instead make up exclusive and exhaustive components of the 24-h day. Few studies have investigated associations between 24-h time-use composition and cognitive function in older adults. Of these, none have considered how the quality of sleep, or the context of physical activity and sedentary behaviour may impact these relationships. This study aims to understand how 24-h time-use composition is associated with cognitive function across a range of domains in healthy older adults, and whether the level of recreational physical activity, amount of television (TV) watching, or the quality of sleep impact these potential associations., Methods: 384 healthy older adults (age 65.5 ± 3.0 years, 68% female, 63% non-smokers, mean education = 16.5 ± 3.2 years) participated in this study across two Australian sites (Adelaide, n = 207; Newcastle, n = 177). Twenty-four-hour time-use composition was captured using triaxial accelerometry, measured continuously across 7 days. Total time spent watching TV per day was used to capture the context of sedentary behaviours, whilst total time spent in recreational physical activity was used to capture the context of physical activity (i.e., recreational accumulation of physical activity vs. other contexts). Sleep quality was measured using a single item extracted from the Pittsburgh Sleep Quality Index. Cognitive function was measured using a global cognition index (Addenbrooke's Cognitive Examination III) and four cognitive domain composite scores (derived from five tests of the Cambridge Neuropsychological Test Automated Battery: Paired Associates Learning; One Touch Stockings of Cambridge; Multitasking; Reaction Time; Verbal Recognition Memory). Pairwise correlations were used to describe independent relationships between time use variables and cognitive outcomes. Then, compositional data analysis regression methods were used to quantify associations between cognition and 24-h time-use composition., Results: After adjusting for covariates and false discovery rate there were no significant associations between time-use composition and global cognition, long-term memory, short-term memory, executive function, or processing speed outcomes, and no significant interactions between TV watching time, recreational physical activity engagement or sleep quality and time-use composition for any cognitive outcomes., Discussion: The findings highlight the importance of considering all activities across the 24-h day against cognitive function in older adults. Future studies should consider investigating these relationships longitudinally to uncover temporal effects., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Mellow, Dumuid, Wade, Stanford, Olds, Karayanidis, Hunter, Keage, Dorrian, Goldsworthy and Smith.)

People's perceptions of the mental effort required for everyday activities may drive variation in the relationships between lifestyles and cognitive ability. We asked n = 259 healthy older adults aged 60 to 70 years (90 males, 169 females) to provide a rating of the Perceived Mental Effort (PME) for each activity instance they recalled over a 48-h period as part of a time-use recall. PME was rated on a 9-point scale from "very, very low" (score of 1) to "very, very high" (score of 9). Across the entire sample, participants rated a total of 196 different activities and 17,433 activity instances. The mean PME for individual activities was 3.50 ± 1.58. PMEs varied significantly by activity domain, with highest ratings being for Work (5.48 ± 1.72) and the lowest for Self-Care (2.89 ± 0.98). In multivariate analyses, PME ratings were higher in males than females (+0.30), PMEs were higher later in the day, increased with task duration, and decreased with age (all p < 0.0001). Time-weighted average individual PMEs across the two days of recall ranged from 1.86 to 6.50, and were 0.3 units higher for males, but unrelated to age. Repeated intra-individual PME ratings for the same activity were very reliable (ICC = 0.995, mean absolute difference = 0.03 ± 0.17). PMEs show promise as a reliable measure of mental effort., Competing Interests: Declaration of competing interest None., (Copyright © 2022. Published by Elsevier Inc.)

Background: In 2018, the Australian Government updated the Australian Physical Activity and Sedentary Behaviour Guidelines for Children and Young People. A requirement of this update was the incorporation of a 24-hour approach to movement, recognising the importance of adequate sleep. The purpose of this paper was to describe how the updated Australian 24-Hour Movement Guidelines for Children and Young People (5 to 17 years): an integration of physical activity, sedentary behaviour and sleep were developed and the outcomes from this process., Methods: The GRADE-ADOLOPMENT approach was used to develop the guidelines. A Leadership Group was formed, who identified existing credible guidelines. The Canadian 24-Hour Movement Guidelines for Children and Youth best met the criteria established by the Leadership Group. These guidelines were evaluated based on the evidence in the GRADE tables, summaries of findings tables and recommendations from the Canadian Guidelines. We conducted updates to each of the Canadian systematic reviews. A Guideline Development Group reviewed, separately and in combination, the evidence for each behaviour. A choice was then made to adopt or adapt the Canadian recommendations for each behaviour or create de novo recommendations. We then conducted an online survey (n=237) along with three focus groups (n=11 in total) and 13 key informant interviews. Stakeholders used these to provide feedback on the draft guidelines., Results: Based on the evidence from the Canadian systematic reviews and the updated systematic reviews in Australia, the Guideline Development Group agreed to adopt the Canadian recommendations and, apart from some minor changes to the wording of good practice statements, maintain the wording of the guidelines, preamble, and title of the Canadian Guidelines. The Australian Guidelines provide evidence-informed recommendations for a healthy day (24-hours), integrating physical activity, sedentary behaviour (including limits to screen time), and sleep for children (5-12 years) and young people (13-17 years)., Conclusions: To our knowledge, this is only the second time the GRADE-ADOLOPMENT approach has been used to develop movement behaviour guidelines. The judgments of the Australian Guideline Development Group did not differ sufficiently to change the directions and strength of the recommendations and as such, the Canadian Guidelines were adopted with only very minor alterations. This allowed the Australian Guidelines to be developed in a shorter time frame and at a lower cost. We recommend the GRADE-ADOLOPMENT approach, especially if a credible set of guidelines that was developed using the GRADE approach is available with all supporting materials. Other countries may consider this approach when developing and/or revising national movement guidelines., (© 2022. The Author(s).)

Background/objectives: Body mass index (BMI, body mass/height 2 ) is biased toward height in children. Here we investigate how change in population height affected change in BMI-based estimates of the prevalence of overweight and obesity in Australian children., Subjects/methods: Height, weight, and percent body fat (%BF) were measured at ages 8, 10, and 12 years (1855 sets of measures). Age-specific relationships between BMI and height were derived, adjusting for %BF, to estimate the degree of height bias inherent in BMI. Then, from cross-sectional measurements recorded in 1985 (N = 2388) and 1995 (N = 2148) in 8, 10, and 12 year olds, changes in overweight/obesity prevalences were calculated before and after accounting for the BMI-height bias., Results: Estimates of the effect of height on BMI following adjustment for %BF were similar across age groups and all were significant at p < 0.001. Referring to 12 year olds, at the same %BF for a 1% increase in height there was 0.77% (95% CI 0.55, 0.99) increase in BMI in boys, and 0.74% (0.28, 1.02) increase in girls. Between 1985 and 1995, mean height of 12-year-old boys and girls increased 3.9 and 3.2 cm, respectively. In 1985 unadjusted prevalences of combined overweight/obesity in boys and girls were 13.5% and 13.0%, respectively, and in 1995 were 24% and 24.5%. The latter values were reduced to 21.6% and 22.6% after adjusting for increased height., Conclusions: Previously reported increases in childhood overweight/obesity in Australia between 1985 and 1995 were likely to be moderately overestimated as a result of increased population height; suggesting that population height be taken into account in any pediatric investigation of changes in overweight/obesity prevalence over time., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

Aim: To examine associations between patterns of language use and early adolescent well-being., Methods: Participants were 1763 Australian 11- to 12-year-olds in the Child Health CheckPoint. Six patterns of language use were identified from a writing activity using Linguistic Inquiry and Word Count and factor analysis: Acting in the present and future, Positive emotion, Gender and relationships, Self-aware, Inquisitive and time focused, and Confident. Well-being measures represented a spectrum from negatively to positively framed psychosocial health. Associations between language use and well-being were estimated using linear regression adjusted for age, sex and social disadvantage., Results: Positive emotion (high emotional tone, positive emotion) was associated with better general well-being (standardised regression coefficient (SRC) 0.05; 95% confidence interval 0.00 to 0.11; p = 0.04), life satisfaction (0.06; 0.01 to 0.11; p = 0.03), psychosocial health (0.07; 0.02 to 0.12; p = 0.01) and quality of life (QoL) (0.06; 0.01 to 0.11; p = 0.02). Similarly, Self-aware (high first person singular pronouns, authentic, low clout) was associated with better general well-being, life satisfaction and psychosocial health (SRC 0.05, 0.09, 0.08), but Confident (high clout, first person plural pronouns, affiliation) was associated with worse life satisfaction, psychosocial health and QoL (SRC -0.06, -0.09, -0.06)., Conclusion: If replicated in 'real-world' settings (e.g., social media), language patterns could provide naturalistic insights into early adolescents' well-being., (©2021 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Background: Previous research suggests that children who experience asthma may be less physically active; however, results have been inconclusive. This study aimed to investigate whether the presence of asthma or wheeze is associated with lower physical activity levels in children, and whether sex, body mass index or earlier asthma or wheeze status modifies the association., Methods: This study was conducted in 391 HealthNuts participants in Melbourne, Australia. Asthma and wheeze data were collected via questionnaire at age 4 and 6, and physical activity was measured through accelerometry. Using adjusted linear regression models, the cross-sectional and longitudinal associations were investigated., Results: There was no evidence of a difference in time spent in moderate-to-vigorous physical activity (MVPA) at age 6 years between children with and without asthma at age 4; children with asthma spent 8.3 minutes more time physically active per day (95% CI: -5.6, 22.1, P = .24) than children without asthma. Similar results were seen for children with current wheeze (5.8 minutes per day more, 95% CI: -5.9, 17.5, P = .33) or ever wheeze or asthma (7.7 minutes per day more, 95% CI: -4.8, 20.2, P = .23) at age 4 years. Comparable null results were observed in the cross-sectional analyses. Interaction with BMI could not be assessed; however, previous asthma or wheeze status and sex were not found to modify these associations., Conclusion: This analysis found no evidence of asthma hindering physical activity in these young children. These results are encouraging, as they indicate that the Australian asthma and physical activity public health campaigns are being effectively communicated and adopted by the public., (© 2020 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Introduction: Appealing approaches to increasing physical activity levels are needed. This study evaluated whether a social and gamified smartphone app (Active Team) could be one such approach., Study Design: A 3-group cluster RCT compared the efficacy of Active Team with a basic self-monitoring app and waitlist control group., Setting/participants: Australian adults (N=444, mean age of 41 years, 74% female) were recruited in teams (n=121) and randomly assigned (1:1:1) to the Active Team (n=141, 39 teams), self-monitoring app (n=160, 42 teams), or waitlist group (n=143, 40 teams). Data were collected in 2016-2017, and analysis was conducted in 2018-2019., Intervention: Active Team is a 100-day app-based, gamified, online social networking physical activity intervention., Main Outcome Measures: The primary outcome was change in objective physical activity from baseline to 3-month follow-up. Secondary outcomes included objective physical activity at 9 months and self-reported physical activity, quality of life, depression, anxiety and stress, well-being, and engagement., Results: Mixed models indicated no significant differences in objective physical activity between groups at 3 (F=0.17, p=0.84; Cohen's d=0.03, 95% CI= -0.21, 0.26) or 9 months (F=0.23, p=0.92; d=0.06, 95% CI= -0.17, 0.29) and no significant differences for secondary outcomes of quality of life, depression, anxiety and stress, or well-being. Self-reported moderate-to-vigorous physical activity was significantly higher in the Active Team group at the 9-month follow-up (F=3.05, p=0.02; d=0.50, 95% CI=0.26, 0.73). Engagement was high; the Active Team group logged steps on an average of 72 (SD=35) days and used the social and gamified features an average of 89 (SD=118) times., Conclusions: A gamified, online social networking physical activity intervention did not change objective moderate-to-vigorous physical activity, though it did increase self-reported moderate-to-vigorous physical activity and achieve high levels of engagement. Future work is needed to understand if gamification, online social networks, and app-based approaches can be leveraged to achieve positive behavior change., Trial Registration: This study is registered at Australian and New Zealand Clinical Trial Registry (protocol: ANZCTR12617000113358)., (Copyright © 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Long-chain omega-3 polyunsaturated fatty acids (LCn-3 PUFA) are essential nutrients and may be capable of delaying age-related cognitive decline. However, previous studies indicate that Australians are not meeting recommendations for LCn-3 PUFA intake. The current study therefore examined LCn-3 PUFA intake in an older Australia sample, as well as associations between LCn-3 PUFA intake and cognitive function., Methods: Cross-sectional data were collected from 90 adults aged 50 to 80 years. LCn-3 PUFA intake was assessed using a food frequency questionnaire and red blood cell fatty acid profiles were used to calculate the Omega-3 Index (RBC n-3 index). Cognitive function was measured using Addenbrooke's Cognitive Examination-III., Results: Positive associations were observed between age and RBC n-3 index (b=0.06, 95% CI: 0.01 - 0.10, P=0.01), and age and LCn-3 PUFA intake from fish oil capsules (b=17.5, 95% CI: 2.4 - 32.5 mg/day, P=0.02). When adjusting for LCn-3 PUFA from fish oil capsules, the association between age and RBC n-3 index was no longer significant. No associations were observed between LCn-3 PUFA intake and cognitive function., Conclusion: LCn-3 PUFA and fish oil consumption increased with age in this sample of older Australians, particularly due to supplement intake. However, LCn-3 PUFA intake was not associated with cognitive function., Competing Interests: The authors declare no conflict of interest.

Background: To date, time-use studies in palliative care have been limited to exploration of time commitments of caregivers. Understanding time-use in people with a life-limiting illness might provide insight into disease progression, symptom management and quality of life., Aim: To determine the feasibility of a repeated-measures, time-use study in people with a life-limiting illness, and their primary caregivers, and to explore associations between time-use and perceived quality of life., Design: An observational repeated-measures feasibility pilot study. A priori criteria were established for study uptake (70%), retention (80%) and study value/burden (⩾7 Numerical Rating Scale 0-10). Burden and value of the study, use of time (Multimedia Activity Recall for Children and Adults with adjunctive accelerometry) and quality of life data (EuroQol-5 Dimension-5-Level Health Questionnaire and Australia-modified Karnofsky Performance Status scale) were assessed at time-points across five consecutive months., Setting/participants: People living with a life-limiting illness and caregivers recruited from Southern Adelaide Palliative Services outpatient clinics., Results: A total of 10 participants (2 caregivers and 8 people with a life-limiting illness) enrolled in the study. All but one of the criteria thresholds was met: 66% of participants who consented to be screened were enrolled in the study, 80% of enrolled participants ( n  = 8) completed all assessments (two participants died during the study) and mean Numerical Rating Scale scores for acceptable burden and value of the study exceeded the criteria thresholds at every time-point., Conclusion: A repeated-measures time-use study design is feasible and was not unduly burdensome for caregivers and people living with a life-limiting illness.

Objectives: Snacks contribute to overconsumption of energy-dense foods and thence obesity. Previous studies in this area are limited by self-reported data and small samples. In a large population-based cohort of parent-child dyads, we investigated how modification of pre-packaged snack food, i.e. (a) item quantity and variety, and (b) dishware (boxed container) size affected intake., Methods: Design: Randomized trial nested within the cross-sectional Child Health CheckPoint of the Longitudinal Study of Australian Children, clustered by day of visit., Sample: 1299 11-12 year olds, 1274 parents., Exposure: 2 × 2 manipulation of snack box container size and item quantity/variety: (1) small box, few items, (2) large box, few items, (3) small box, more items, (4) large box, more items., Procedure: Participants received a snack box during a 15 min break within their 3.5 h visit; any snacks remaining were weighed., Outcomes: Consumed quantity (grams) and energy intake (kilojoules)., Analyses: Unadjusted linear regression., Results: Children who were offered a greater quantity and variety of snack items consumed considerably more energy and a slightly higher food mass (main effect for energy intake: 349 kJ, 95% CI 282-416, standardized mean difference (effect size) 0.66; main effect for mass: 10 g, 95% CI 3-17, effect size 0.17). In contrast, manipulating box size had little effect on child consumption, and neither box size nor quantity/variety of items consistently affected adults' consumption., Conclusion: In children, reducing the number and variety of snack food items available may be a more fruitful intervention than focusing on container or dishware size. Effects observed among adults were small, although we could not exclude social desirability bias in adults aware of observation.

Objectives: Estimates of adults' moderate-to-vigorous physical activity (MVPA) based on self-report are generally higher than estimates derived from criterion measures. This study examines a possible explanation for part of this discrepancy: the cutpoint bias hypothesis. This hypothesis proposes that inter- and intra-individual variability in energy expenditure, combined with the fact that adults perform a high proportion of daily activities at or just above the traditional 3 MET cutpoint, result in systematic over-estimates of MVPA., Design: Cross-sectional., Methods: Time-use recalls (n = 6862) were collected using the Multimedia Activity Recall for Children and Adults from 2210 adults (1215 female, age 16-93 years) from 16 studies conducted in Australia and New Zealand between 2008-2017. Minutes spent in MVPA were estimated using models with varying levels of intra- and inter-individual (total variability) Unadjusted (0% total variability), Low (11.9%), Best Guess (20.7%), and High (30.0%)., Results: In the Unadjusted model, participants accumulated an average of 129 (standard deviation 127) min/day of MVPA. Estimated MVPA was 98 (110), 99 (107) and 108 (107) min/day in the Low, Best Guess and High variability models, respectively, with intra-class correlation coefficients with the Unadjusted model ranging from 0.78 to 0.83., Conclusions: These findings support the hypothesis of a cutpoint bias, which probably contributes to the large disparities seen between self-reported and criterion measures of MVPA. Future studies are needed to confirm these findings using other self-report instruments and in other populations., (Copyright © 2019 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Background: The last few years have seen renewed interest in use-of-time recalls in epidemiological studies, driven by a focus on the 24-h day [including sleep, sitting, and light physical activity (LPA)] rather than just moderate-vigorous physical activity (MVPA). This paper describes four different computerised use-of-time instruments (ACT24, PAR, MARCA and cpar24) and presents population time-use data from a collective sample of 8286 adults from different population studies conducted in Australia/New Zealand, Germany and the United States., Methods: The instruments were developed independently but showed a number of similarities: they were self-administered through the web or used computer-assisted telephone interviews; all captured energy expenditure using variants of the Ainsworth Compendium; each had been validated against criterion measures; and they used a domain structure whereby activities were aggregated under categories such as Personal Care and Work., Results: Estimates of physical activity level (average daily rate of energy expenditure in METs) ranged from 1.53 to 1.78 in the four studies, strikingly similar to population estimates derived from doubly labelled water. There was broad agreement in the amount of time spent in sleep (7.2-8.6 h), MVPA (1.6-3.1 h), personal care (1.6-2.4 h), and transportation (1.1-1.8 h). There were consistent sex differences, with women spending 28-81% more time on chores, 8-40% more time in LPA, and 3-39% less time in MVPA than men., Conclusions: Although there were many similarities between instruments, differences in operationalizing definitions of sedentary behaviour and LPA resulted in substantive differences in the amounts of time reported in sedentary and physically active behaviours. Future research should focus on deriving a core set of basic activities and associated energy expenditure estimates, an agreed classificatory hierarchy for the major behavioural and activity domains, and systems to capture relevant social and environmental contexts.

The ability to compare published group-level estimates of objectively measured moderate-to-vigorous physical activity (MVPA) across studies continues to increase in difficulty. The objective of this study was to develop conversion equations and demonstrate their utility to compare estimates of MVPA derived from the wrist and hip. Three studies of youth (N = 232, 9-12yrs, 50% boys) concurrently wore a hip-worn ActiGraph and a wrist-worn GENEActiv for 7-days. ActiGraph hip count data were reduced using four established cutpoints. Wrist accelerations were reduced using the Hildebrand MVPA 200 mg threshold. Conversion equations were developed on a randomly selected subsample of 132 youth. Equations were cross-validated and absolute error, absolute percent error, and modified Bland-Altman plots were evaluated for conversion accuracy. Across equations R 2 adj was 0.51-0.56 with individual-level absolute error in minutes ranging from 7 (wrist-to-hip Puyau) to 14.5 minutes (wrist-to-hip Freedson 3MET) and absolute percent differences ranging from 13.9%-24.5%. Group-level cross-validation to convert hip-to-wrist MVPA resulted in average absolute percent errors ranging from 3.1%-4.9%. Conversion of wrist-to-hip MVPA resulted in average absolute percent errors ranging from 3.0%-10.0%. We recommend the use of these equations to compare published estimates of MVPA between the wear-site cut-point combinations presented.

Objective: Older adults' health has been linked with time in moderate-to-vigorous physical activity (MVPA), and recent studies suggest time in sedentary behaviour may also be important. Time-use behaviours (MVPA, light physical activity, sedentary time and sleep) are co-dependent, and therefore their associations with health should be examined in an integrated manner. This is the first study to investigate the relationship between older adults' reallocation of time among these time-use behaviours and markers of cardio-respiratory fitness, obesity and cardio-metabolic risk., Study Design: Cross-sectional study of 122 Australians (65 ± 3 y, 61% female)., Main Outcome Measures: Daily time use: average daily minutes spent in MVPA, light physical activity, sedentary time and sleep derived from 24-h, 7-day accelerometry, were conceptualised as a time-use composition. Cardio-respiratory fitness: graded submaximal cycle ergometer test. Obesity: objectively measured body mass index (BMI) and waist-to-hip ratio (WHR). Cardio-metabolic risk: sphygmomanometer-measured resting blood pressure and fingertip blood sampling for fasting total cholesterol and glucose., Results: Time-use composition was significantly associated with obesity markers (BMI, p = 0.001; WHR, p < 0.001). The reallocation of 15 min to MVPA from any of the other behaviours was associated with approximately +1.1 (95% confidence interval 0.2; 1.9) ml/kg -1  min -1 VO 2max , -0.7 (-1.0; -0.3) BMI units and -1.2 (-1.8; -0.7) WHR percentage points, while the opposite reallocation (15 min from MVPA to other behaviours) was associated with larger difference estimates of -1.8 (-3.2; -0.4) ml/kg -1  min -1 VO 2max , +1.2 (0.5; 1.9) BMI units and +2.1 (1.2; 3.1) WHR percentage points., Conclusion: These findings reinforce the importance of MVPA for health among older adults. Interventions to maintain MVPA, even without increasing it, may be valuable., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Descriptions of time use patterns in people with chronic obstructive pulmonary disease (COPD) are scarce and the relationship between use-of-time and COPD severity remains unclear. This study aimed to describe a typical day for people with COPD and to explore the differences in time-use patterns across the Body Mass-Index, Airflow Obstruction, Dyspnoea and Exercise Capacity (BODE) index using compositional analyses. Using a cross-sectional design, 141 adults with clinically stable COPD had their demographics, objective measures of function (pulmonary, exercise capacity and physical activity), and self-reported COPD-related impairment recorded. Daily time-use compositions were derived from 24-h accelerometry and 24-h use-of-time recall interviews. Compositional multiple linear regression models were used to explore the relationship between the BODE index and 24-h time-use compositions. These models were used to predict daily time (min/d) that is spent in time-use components across the BODE index. The BODE index score was clearly associated with 24-h accelerometry ( p < 0.0001) and 24-h use-of-time recall ( p < 0.0001) compositions. Relative to the remaining time-use components, higher BODE index scores were associated with greater sedentary behaviour ( p < 0.0001), Quiet time ( p < 0.0001), Screen time ( p = 0.001) and Self-care ( p = 0.022), and less daily Chores ( p < 0.0001) and Household administration ( p = 0.015) time. As the BODE index scores increased, time-use predictions were strongly associated with decreases in Chores (up to 206 min/d), and increases in Screen (up to 156 min/d) and Quiet time (up to 131 min/d). Time-use patterns may provide a basis for planning interventions relative to the severity of COPD., Competing Interests: T.H. reports receiving salary from employment with Boehringer Ingelheim Pty Limited independent of this submitted work. D.D. report no conflicts of interest. M.T.W. and T.S.O. report no direct conflicts but have received speaker fees, honoraria and travel costs, independent of this submitted work.

Acute exercise studies using transcranial magnetic stimulation (TMS) can provide important insights into the mechanisms underpinning the positive relationship between regular engagement in physical activity and cortical neuroplasticity. Emerging evidence indicates that a single session of aerobic exercise can promote the response to an experimentally induced suppressive neuroplasticity paradigm; however, little is known about the neuroplasticity response to facilitatory paradigms, including intermittent theta burst stimulation (iTBS). To more fully characterize the effects of exercise on brain plasticity we investigated if a single 30 min bout of high-intensity cycling (80% predicted heart rate reserve) modulated the response to an iTBS paradigm compared to rest. In 18 participants (9 females; 25.5 ± 5.0 years, range: 18-35 years) iTBS was applied using standard repetitive transcranial magnetic stimulation techniques immediately following exercise or 30 min of rest. Motor evoked potentials (MEPs) were recorded from the right first dorsal interosseous muscle at baseline, after the exercise/rest period but before iTBS, and at 5 time points following iTBS (0, 5, 10, 20 and 30 min). Contrary to our hypothesis, MEPs were suppressed following iTBS after a single 30 min bout of lower limb aerobic exercise compared to rest. These results indicate that acute aerobic exercise may not always enhance the response to an experimentally induced neuroplasticity paradigm. Further investigation of the factors that influence the relationship between exercise and neuroplasticity is warranted., (Copyright © 2018 IBRO. Published by Elsevier Ltd. All rights reserved.)

Background: In 2017, the Australian Government funded the update of the National Physical Activity Recommendations for Children 0-5 years, with the intention that they be an integration of movement behaviours across the 24-h period. The benefit for Australia was that it could leverage research in Canada in the development of their 24-h guidelines for the early years. Concurrently, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group published a model to produce guidelines based on adoption, adaption and/or de novo development using the GRADE evidence-to-decision framework. Referred to as the GRADE-ADOLOPMENT approach, it allows guideline developers to follow a structured and transparent process in a more efficient manner, potentially avoiding the need to unnecessarily repeat costly tasks such as conducting systematic reviews. The purpose of this paper is to outline the process and outcomes for adapting the Canadian 24-Hour Movement Guidelines for the Early Years to develop the Australian 24-Hour Movement Guidelines for the Early Years guided by the GRADE-ADOLOPMENT framework., Methods: The development process was guided by the GRADE-ADOLOPMENT approach. A Leadership Group and Consensus Panel were formed and existing credible guidelines identified. The draft Canadian 24-h integrated movement guidelines for the early years best met the criteria established by the Panel. These were evaluated based on the evidence in the GRADE tables, summaries of findings tables and draft recommendations from the Canadian Draft Guidelines. Updates to each of the Canadian systematic reviews were conducted and the Consensus Panel reviewed the evidence for each behaviour separately and made a decision to adopt or adapt the Canadian recommendations for each behaviour or create de novo recommendations. An online survey was then conducted (n = 302) along with five focus groups (n = 30) and five key informant interviews (n = 5) to obtain feedback from stakeholders on the draft guidelines., Results: Based on the evidence from the Canadian systematic reviews and the updated systematic reviews in Australia, the Consensus Panel agreed to adopt the Canadian recommendations and, apart from some minor changes to the wording of good practice statements, keep the wording of the guidelines, preamble and title of the Canadian Guidelines. The Australian Guidelines provide evidence-informed recommendations for a healthy day (24-h), integrating physical activity, sedentary behaviour (including limits to screen time), and sleep for infants (<1 year), toddlers (1-2 years) and preschoolers (3-5 years)., Conclusions: To our knowledge, this is only the second time the GRADE-ADOLOPMENT approach has been used. Following this approach, the judgments of the Australian Consensus Panel did not differ sufficiently to change the directions and strength of the recommendations and as such, the Canadian recommendations were adopted with very minor alterations. This allowed the Guidelines to be developed much faster and at lower cost. As such, we would recommend the GRADE-ADOLOPMENT approach, especially if a credible set of guidelines, with all supporting materials and developed using a transparent process, is available. Other countries may consider using this approach when developing and/or revising national movement guidelines.

Context: Feasibility and pilot study designs are common in palliative care research. Finding standard guidelines on the structure and reporting of these study types is difficult., Objectives: In feasibility and pilot studies in palliative care research, to determine 1) how commonly a priori feasibility are criteria reported and whether results are subsequently reported against these criteria? and 2) how commonly are participants' views on acceptability of burden of the study protocol assessed?, Methods: Four databases (OVID Medline, EMBASE, CINAHL, and PubMed via caresearch.com.au.) were searched. Search terms included palliative care, terminal care, advance care planning, hospice, pilot, feasibility, with a publication date between January 1, 2012 and December 31, 2013. Articles were selected and appraised by two independent reviewers., Results: Fifty-six feasibility and/or pilot studies were included in this review. Only three studies had clear a priori criteria to measure success. Sixteen studies reported participant acceptability or burden with measures. Forty-eight studies concluded feasibility., Conclusion: The terms "feasibility" and "pilot" are used synonymously in palliative care research when describing studies that test for feasibility. Few studies in palliative care research outline clear criteria for success. The assessment of participant acceptability and burden is uncommon. A gold standard for feasibility study design in palliative care research that includes both clear criteria for success and testing of the study protocol for participant acceptability and burden is needed. Such a standard would assist with consistency in the design, conduct and reporting of feasibility and pilot studies., (Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: Choice of accelerometer wear-site may facilitate greater compliance in research studies. We aimed to test whether a simple method could automatically discriminate whether an accelerometer was worn on the hip or wrist from free-living data., Design: Cross-sectional., Methods: Twenty-two 10-12y old children wore a GENEActiv at the wrist and at the hip for 7-days. The angle between the forearm and the total acceleration vector for the wrist-worn monitor and between the pelvis and the total acceleration vector for the hip-worn monitor (i.e. the angle between the Y-axis component of the acceleration and the total acceleration vector) was calculated for each 5s epoch. The standard deviation of this angle (SDangle) was calculated over time for the wrist-worn and hip-worn monitor for windows of varying lengths. We hypothesised that the wrist angle would be more variable than the hip angle., Results: Wear site could be discriminated based on SDangle; the shorter the time window the lower the optimal threshold and Area under the Receiver-Operating-Characteristic curve (AUROC) for discrimination of wear-site (AUROC=0.833 (1min) - 0.952 (12h)). Classification accuracy was good for windows of 8min (sensitivity=90%, specificity=87%, AUROC=0.92) and plateaued for windows of ≥60min (sensitivity and specificity >90%, AUROC=0.95-0.96)., Conclusions: We have presented a robust, computationally simple method that detects whether an accelerometer is being worn on the hip or wrist from 8 to 60min of data. This facilitates the use of wear-site specific algorithms to analyse accelerometer data., (Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Background: the aim of this study was to explore the associations between use of time and momentary hedonic affect ('enjoyment') in adults in the peri-retirement period., Methods: a total of 124 adults [61 males, 63 females; age 62 (4) years] completed a computerised use-of-time recall on 4 days at each of four time points (3-6 months pre-, 3, 6 and 12 months post-retirement), as well as surveys regarding self-reported health, well-being, sleep quality and loneliness. They reported how much they enjoyed each activity on a 0-10 scale. An individual Enjoyment Index was calculated as the time-weighted average of each participant's enjoyment ratings. Time-weighted enjoyment ratings were also calculated for nine mutually exclusive and exhaustive activity domains (Sleep, Chores, Work, Social, Screen Time, Self-care, Quiet Time, Transport, Physical Activity) and sub-domains., Results: the mean (±SD) Enjoyment Index was 7.43 ± 0.61, and was significantly and positively associated with well-being (P = 0.003 to P < 0.0001) and sleep quality (P = 0.03 to P < 0.0001), and negatively associated with loneliness (P = 0.003 to P < 0.0001). Mean Enjoyment Index values increased significantly (P < 0.0001) from pre-retirement (7.19 ± 0.82) to post-retirement (7.46 ± 0.89, 7.42 ± 0.91 and 7.49 ± 0.89 at 3, 6 and 12 months post-retirement). There were significant differences in enjoyment across domains, with Physical Activity (7.86 ± 1.11) and Social (7.66 ± 0.85) being the most enjoyable, and Work (7.10 ± 0.89) and Chores (7.09 ± 0.85) the least enjoyable., Conclusion: enjoyment of everyday activities increased after retirement and remained elevated for at least 12 months. Work appears to constitute a relative hedonic deficit., (© The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Purpose: This study aimed to provide a means for calibrating raw acceleration data from wrist-worn accelerometers in relation to past estimates of children's moderate-to-vigorous physical activity (MVPA) from a range of cut points applied to hip-worn ActiGraph data., Methods: This is a secondary analysis of three studies with concurrent 7-d accelerometer wear at the wrist (GENEActiv) and hip (ActiGraph) in 238 children age 9-12 yr. The time spent above acceleration (ENMO) thresholds of 100, 150, 200, 250, 300, 350, and 400 mg from wrist acceleration data (≤5-s epoch) was calculated for comparison with MVPA estimated from widely used children's hip-worn ActiGraph MVPA cut points (Freedson/Trost, 1100 counts per minute; Pate, 1680 counts per minute; Evenson, 2296 counts per minute; Puyau, 3200 counts per minute) with epochs of ≤5, 15, and 60 s., Results: The optimal ENMO thresholds for alignment with MVPA estimates from ActiGraph cut points determined from 70% of the sample and cross validated with the remaining 30% were as follows: Freedson/Trost = ENMO 150+ mg, irrespective of ActiGraph epoch (intraclass correlation [ICC] ≥ 0.65); Pate = ENMO 200+ mg, irrespective of ActiGraph epoch (ICC ≥ 0.67); Evenson = ENMO 250+ mg for ≤5- and 15-s epochs (ICC ≥ 0.69) and ENMO 300+ mg for 60-s epochs (ICC = 0.73); Puyau = ENMO 300+ mg for ≤5-s epochs (ICC = 0.73), ENMO 350+ mg for 15-s epochs (ICC = 0.73), and ENMO 400+ mg for 60-s epochs (ICC = 0.65). Agreement was robust with cross-validation ICC = 0.62-0.71 and means within ∣7.8∣% ± 4.9% of MVPA estimates from ActiGraph cut points, except Puyau 60-s epochs (ICC = 0.42)., Conclusion: Incremental ENMO thresholds enable children's acceleration data measured at the wrist to be simply and directly compared, at a group level, with past estimates of MVPA from hip-worn ActiGraphs across a range of cut points.

Background: Activity behaviours (physical activity, sedentary time and screen time) have been linked to health outcomes in childhood. Furthermore, socioeconomic disparities have been observed in both children's activity behaviours and health outcomes. Children's physical home environments may play a role in these relationships. This study aimed to examine the associations and interactions between children's physical home environment, socioeconomic status and moderate-to-vigorous physical activity, sedentary time and screen time., Methods: Australian children (n = 528) aged 9-11 years from randomly selected schools participated in the cross-sectional International Study of Childhood Obesity, Lifestyle and the Environment. Children's physical home environment (access to equipment), socioeconomic status (household income and parental education) and demographic variables (gender and family structure) were determined by parental questionnaire. Moderate-to-vigorous physical activity and sedentary time were measured objectively by 7-day 24-h accelerometry. Screen time was obtained from child survey. The associations between the physical home environment, socioeconomic status and moderate-to-vigorous physical activity, sedentary time and screen time were examined for 427 children, using analysis of covariance, and linear and logistic regression, with adjustment for gender and family structure., Results: The presence of TVs (p < 0.01) and video game consoles (p < 0.01) in children's bedrooms, and child possession of handheld video games (p = 0.04), cell phones (p < 0.01) and music devices (p = 0.04) was significantly and positively associated with screen time. Ownership of these devices (with the exception of music devices) was inversely related to socioeconomic status (parental education). Children's moderate-to-vigorous intensity physical activity (p = 0.04) and possession of active play equipment (p = 0.04) were both positively associated with socioeconomic status (household income), but were not related to each other (with the exception of bicycle ownership)., Conclusions: Children with less electronic devices, particularly in their bedrooms, participated in less screen time, regardless of socioeconomic status. Socioeconomic disparities were identified in children's moderate-to-vigorous physical activity, however socioeconomic status was inconsistently related to possession of active play equipment. Home active play equipment was therefore not a clear contributor to the socioeconomic gradients in Australian children's moderate-to-vigorous physical activity.

Purpose: To describe sedentary behaviors (duration, bouts and context) in people with and without a chronic health condition., Methods: Design: Secondary analysis of two cross-sectional studies. Participants: People with stable chronic obstructive pulmonary disease (COPD) (n = 24, male:female 18:6) and their spousal carers (n = 24, 6:18); stroke survivors (n = 24, 16:8) and age- and sex-matched healthy adults (n = 19, 11:8). Level of physiological impairment was measured with post-bronchodilator spirometry (FEV 1 %predicted) for people with COPD, and walking speed for people with stroke. Outcomes: Participants were monitored over seven days (triaxial accelerometer, Sensewear armband) to obtain objective data on daily sedentary time, and prolonged sedentary bouts (≥ 30 min). During the monitoring period, a 24-hour use of time recall instrument was administered by telephone interview to explore the context of sedentary activities (e.g. television, computer or reading). Sedentary time was quantified using accelerometry and recall data, and group differences were explored. Linear regression examined associations between physiological impairment and sedentary time., Results: Participant groups were similar in terms of age (COPD 75 ± 8, carers 70 ± 11, stroke 69 ± 10, healthy 73 ± 7 years) and body mass index (COPD 28 ± 4, carers 27 ± 4, stroke 31 ± 4, healthy 26 ± 4 kg.m -2 ). The healthy group had the lowest sedentary time (45% of waking hours), followed by the carer (54%), stroke (60%) and COPD (62%) groups ( p < 0.0001). Level of physiological impairment was an independent predictor of waking sedentary time ( p = 0.001)., Conclusions: People with a chronic health condition spent more time sedentary than those without a chronic condition, and there were small but clear differences between groups in the types of activities undertaken during sedentary periods. The study findings may aid in the design of targeted interventions to decrease sedentary time in people with chronic health conditions., Competing Interests: Conflict of Interest: All authors declare no conflict of interest in this paper.

Fitness is an important component of health, and obese adolescents regularly have poor fitness. Unfortunately, few have assessed the impact of community-based lifestyle interventions on multiple components of fitness. The purpose of this study was to assess the impact of participation in a community-based intervention involving adolescents and parents on multiple components of fitness of obese adolescents. In a within-subject, waitlist controlled clinical trial with 12 months follow-up in Western Australia, participants (n = 56) completed multiple fitness measures at baseline, immediately prior to beginning an 8-week intervention and at 3, 6 and 12 months during a maintenance period. Performance on the shuttle walk was improved immediately post-intervention (increase of 42.8 m, 95% CI: 7.5, 78.2) and at 12 months post-intervention (increase of 44.6 m, 95% CI: 1.3, 87.8) compared with pre-intervention. Muscle performance of quadriceps and deltoids were improved post-intervention (increase of 1.1 (95% CI: 0.1, 2.1) kg · F and 1.0 (0.02, 2.1) kg · F, respectively) and all muscle performance measures were improved at 12 months following the intervention. There were no changes in waist circumference. A community-based lifestyle programme such as Curtin University's Activity, Food and Attitudes Program (CAFAP) may be a viable strategy for improving fitness in overweight adolescents.

Background: How people use their time has health implications, but use of time may be influenced by factors such as age, sex, education and health., Objective: This study aimed to provide detailed information on the daily activity patterns of older working people., Study Design: 139 older Australian adults (aged 50-79 years) undertook comprehensive interviews on their use of time. This paper presents a cross-sectional analysis of the baseline findings from a longitudinal study., Main Outcome Measures: Use of time was measured using the Multimedia Activity Recall for Children and Adults (MARCA), administered via computer-assisted phone interview. Activity patterns were described, and compared on the basis of sex, education and health status., Results: The main activities undertaken were sleep (mean 466min/day), work (mean 233min/day) and chores (mean 160min/day), with little time spent on physical activity (mean 13min/day). Women spent more time doing chores (p<0.001) while men spent more time on vigorous activities (p<0.001). Participants with "fair" health spent less time on inside chores (p=0.05) and grooming (p=0.02) than healthier participants., Conclusions: Healthy lifestyle interventions for older workers should aim to increase physical activity levels by targeting specific activities, depending on sex and health status., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)