J. McKenna

Effect of a national programme of men's health delivered in English Premier League football clubs

OBJECTIVESnTo investigate the impact of a national programme of mens health delivered in/by English Premier League (EPL) football clubs on health profiles.nnnSTUDY DESIGNnHealth promotion interventions were delivered to male supporters with heightened health risks, and hard-to-engage men who were not using primary care and health information services. Interventions included educational activities on match days and weekly lifestyle classes at the football stadia/training venues. Activities were led by the health trainers in 16 EPL football clubs.nnnMETHODSnPre- and post-intervention, men completed validated self-report measures for demographics and health behaviours. Intention-to-treat (ITT) analysis was performed alongside a standard per-protocol (PP) analysis based on pre- vs post-intervention differences over 3 months. Descriptive statistics were used to show demographics pre-intervention and changes in the health profiles of participants.nnnRESULTSnPredominantly, recruits were White British men aged 18-44 years. Most men (78%, 909/1159) did not see themselves as having health problems. Around 35% (364/1044) never consulted a general practitioner (GP), while 57% (591/1040) reported that they never used health advice services. In men providing pre-intervention responses, the proportions who failed to meet the recommendations for healthy behaviours were as follows: physical activity, 85% (1106/1301); sitting time, 68% (623/907); consumption of fruit/vegetables, 88% (948/1072); smoking, 33% (422/1262); alcohol consumption, 30% (203/679); and body mass index (BMI), 63.8% (570/893). ITT and PP analyses demonstrated the significant increases in weekly physical activity (Pxa0<xa00.001) and daily consumption of fruit and vegetables (Pxa0<xa00.001), and significant decreases in daily sitting time (Pxa0<xa00.001), weekly alcohol consumption (Pxa0<xa00.001) and BMI (Pxa0<xa00.05).nnnCONCLUSIONnA national programme of mens health delivered in EPL football clubs reached men failing to meet health guidelines. Interventions engaged men who neither consulted a GP nor used health information services. Positive changes were found for an array of activity-related and other health behaviours on PP analysis and the more stringent evaluation condition of ITT analysis.

Health improvement for men and hard-to-engage-men delivered in English Premier League football clubs

Unhealthy behaviours represent modifiable causes of non-communicable disease. In men, concern focuses on those (i) demonstrating the poorest health, exacerbated by a lack of awareness of the risks that their lifestyles pose and (ii) who neither consult their doctor nor use health services. Classed as hard-to-engage, distinctive strategies are needed to reach these men. Impact and process evaluations assessed the effect of a programme of mens health-delivered in/by English Premier League football clubs. Men attended match-day events and/or weekly classes involving physical activity and health education. Validated self-report measures for demographics and lifestyle behaviours were completed pre- and post-intervention. Intention-to-treat analysis was performed on pre-versus-post-intervention differences in lifestyle profiles, whereas interviews (n = 57) provided mens accounts of programme experience. Participants were predominantly white British (70.4%/n = 2669), 18-44 (80.2%/n = 3032) and employed (60.7%/n = 1907). One-third (n = 860) never visited their doctor. Over 85% (n = 1428) presented with combinations of lifestyle risk factors. Intention-to-treat analysis showed improvements (P < 0.001) in lifestyle profiles. Interviews confirmed recruitment of men who were hard-to-engage and unhealthy. Men were attracted through football and/or the clubs, whereas specific design factors impacted on participation. Limitations include use of self-reports, narrow demographics, small effect sizes, lack of follow-up and the absence of non-completers in interviews.

The pre-adoption demographic and health profiles of men participating in a programme of men's health delivered in English Premier League football clubs.

OBJECTIVESnTo investigate the pre-adoption demographic and health profiles of men participating in a programme of mens health delivered in English Premier League (EPL) football clubs.nnnSTUDY DESIGNnA series of match day and programmed health promotion interventions held in EPL clubs (nxa0=xa016), including awareness-raising activity days for supporters, weekly healthy lifestyle classes, and outreach activities targeted in local communities. Interventions were delivered at football stadia, club training venues and community facilities. Interventions were run by health trainers who received specific training in mens health and behavioural change activities.nnnMETHODSnParticipants completed self-report measures for demographics and lifestyle behaviours, including physical activity, consumption of fruit and vegetables, smoking, height, weight, consumption of alcohol and perception of health. Measurement occurred before the interventions. Data were independently analysed and used to assess adoption of the interventions and pre-intervention health profiles of participants.nnnRESULTSnNine hundred and forty-six men adopted the interventions, but the mode of engagement led to variations in the sample size. Demographics showed that 89% (nxa0=xa0783/875) were aged 18-44 years and 78% (nxa0=xa0685/878) were White British. In a subsample, the percentages of men failing to meet health guidelines were as follows: physical activity, 79%xa0(nxa0=xa0351/440); consumption of fruit and vegetables, 82% (nxa0=xa0315/380); smoking, 28% (nxa0=xa0103/373); high body weight, 67% (nxa0=xa0245/358); and high alcohol consumption, 40% (nxa0=xa0112/279). Sixty-nine percent of men (nxa0=xa0242/348) considered that they had no health problems, but 67% (nxa0=xa0208/310) presented with three or more risk factors for coronary heart disease. Over 40% (nxa0=xa0125/307) reported never going to see their general practitioner.nnnCONCLUSIONnA national programme of mens health promotion interventions delivered in EPL football clubs was effective in reaching target audiences. Interventions were predominantly adopted by men not meeting health guidelines.

‘It is fun, fitness and football really’: a process evaluation of a football-based health intervention for men

Concerns about gender inequalities in longevity, particularly premature male mortality, have prompted a range of innovative approaches to health promotion work dating back to the 1980s. In developing such work, sport, and football in particular, has emerged as a gendered cultural field that has utility for engaging men in community health initiatives. Evaluations of such work have shown that health initiatives using football settings, football interventions or even club branding can have positive impact on various health measures in the short and longer term. However, little work to date has looked at the underlying mechanisms that generate success in such projects. This paper presents secondary analysis of data collected during the evaluation of the Premier League Health (PLH) programme specifically focusing on these underlying mechanisms and how/where gender (masculinities) appears in these processes. We draw on interview data with 16 staff who had been involved in the delivery of the PLH initiative and 58 men who took part. Thematic analysis highlighted two overarching (and underpinning) themes: ‘Trust’, what processes it was key to and how it was developed and sustained; and ‘Change’, including what it was facilitated by and what impact it had. The paper adds to our understanding of how active listening, flexibility and sustained engagement are key to community-based sports projects’ success. Furthermore, it demonstrates how the physicality and sociability of involvement, rather than any direct focus on ‘health’, are important in acting as a springboard for facilitating reflection and aiding lifestyle changes for men.

Delivering men's health interventions in English Premier League football clubs: key design characteristics

OBJECTIVESnTo investigate the key design characteristics of Premier League Health (PLH), a national programme of mens health improvement delivered in/by 16 English Premier League (EPL) football clubs.nnnSTUDY DESIGNnHealth Trainers (HTs) were hired by EPL clubs to deliver PLH. HTs were the focus of investigations aimed at identifying the active design characteristics of male-specific health promotion interventions.nnnMETHODSnSemi-structured interviews led by researchers were performed with 13/16 HTs and identified the key design characteristics influential in (I) reaching and (II) helping participants adopt health improvement interventions delivered in professional football club settings.nnnRESULTSnHTs believed that combining the appeal of football alongside EPL clubs, offered a unique opportunity to reach adult males, including hard-to-engage-men (HTEM). Awareness raising events held on match days aimed to connect with men, but outreach activities were especially important for engaging participants. Following initial reach, familiar settings, such as the club stadia and community venues were also important for ensuring regular involvement in health improvement sessions. Interventions shaped around mens health needs and delivered at times when participants could more easily attend, were factors which helped to engage men. Supportive social environments and a range of exercise modes and delivery options were also seen by HTs as being similarly important. Both the informality and familiarity of EPL clubs were viewed by HTs as having substantial advantages over conventional NHS settings for reaching and engaging men. Importantly, HTs contributed substantial skills to the delivery of PLH.nnnCONCLUSIONnAlthough, top flight professional football clubs can recruit men, including those regarded as hard-to-engage into health improvement programmes, considerable attention to delivery refinement is needed to support male participants adopting interventions aimed at promoting healthy lifestyles.

Physical Activity and Sedentary Behavior Clustering: Segmentation to Optimize Active Lifestyles

BACKGROUNDnIncreasingly the health impacts of physical inactivity are being distinguished from those of sedentary behavior. Nevertheless, deleterious health prognoses occur when these behaviors combine, making it a Public Health priority to establish the numbers and salient identifying factors of people who live with this injurious combination.nnnMETHODSnUsing an observational between-subjects design, a nonprobability sample of 22,836 participants provided data on total daily activity. A 2-step hierarchical cluster analysis identified the optimal number of clusters and the subset of distinguishing variables. Univariate analyses assessed significant cluster differences.nnnRESULTSnHigh levels of sitting clustered with low physical activity. The Ambulatory & Active cluster (n = 6254) sat for 2.5 to 5 h·d(-1) and were highly active. They were significantly younger, included a greater proportion of males and reported low Indices of Multiple Deprivation compared with other clusters. Conversely, the Sedentary & Low Active cluster (n = 6286) achieved ≤60 MET·min·wk(-1) of physical activity and sat for ≥8 h·d(-1). They were the oldest cluster, housed the largest proportion of females and reported moderate Indices of Multiple Deprivation.nnnCONCLUSIONSnPublic Health systems may benefit from developing policy and interventions that do more to limit sedentary behavior and encourage light intensity activity in its place.

Physical activity assessment for public health: efficacious use of the single-item measure

OBJECTIVESnThe accurate mass assessment of physical activity is essential for effective Public Health policy and practice. Combined with a desire to minimize participant burden, the self-reported single-item physical activity screening measure has become increasingly attractive and widespread. To help reduce any potential misclassification, refining this instrumentation in line with any changes in prescribed activity levels is essential to optimize accuracy.nnnSTUDY DESIGNnThis study compares the levels of agreement, sensitivity and specificity for the single-item measure versus International Physical Activity Questionnaire (IPAQ) using current physical activity recommendations.nnnMETHODSnAgreement was assessed in a non-probability sample of 7650 adults. The κ statistic, sensitivity and specificity were used to assess agreement between the tools for classifying participants as sufficiently active for health (≥150 min of physical activity per week) or not, and being classified as inactive (<30 of minutes of physical activity per week) or not.nnnRESULTSnThe single-item measure showed weak agreement with the IPAQ for identifying participants who met the current physical activity guidelines (κ = 0.13, 95% CI 0.12 to 0.14), sensitivity was 18.7% and specificity was 97.2%. For the classification of inactive participants it showed a moderate agreement with IPAQ (κ = 0.45, 95% CI 0.43 to 0.47), sensitivity was 74.2% and specificity was 79.7%.nnnCONCLUSIONSnThe single-item measure had a low diagnostic capacity compared to IPAQ. Further research is needed if it is to be used in large scale surveys and interventions where screening for sufficiently active or inactive individuals is the goal.

A case study objectively assessing female physical activity levels within the National Curriculum for Physical Education

The purpose of this study was to assess the impact of the National Curriculum for Physical Education (NCPE) lesson themes and contexts on the profile of moderate-to-vigorous physical activity (MVPA). Fifteen, Year 9 Physical Education (PE) lessons were assessed within the lesson themes of Outwitting Opponents (OO) (delivered through field hockey and netball) and Accurate Replication (AR) (delivered through gymnastics) using the System for Observing the Teaching of Games in Physical Education. Accelerometry identified MVPA within PE lessons (Actigraph-GTM1, 10-second epoch, MVPA ≥2296 counts/min). Among 112 females MVPA averaged 20.8% of available learning time. Significantly more MVPA was facilitated during OO than AR (22.7 vs. 15.9%, p < 0.001, d = 0.88). Within both lesson themes, warm-up was the most active lesson context while pre- and post-lesson general management were the least active. Contrary to expectations, neither small-sided nor modified games, versus full-sided games, increased MVPA within OO. During AR technical and applied-skill practice resulted in low MVPA. Objective evidence has justified concerns about female adolescent MVPA within PE. At current levels an additional 17.5 minutes of MVPA per 60 minute PE lesson would be needed to meet the minimum 50% guideline.

The Transition of Medical Students Through Residency: Effects on Physical Activity and Other Lifestyle-Related Behaviors

BACKGROUNDnLittle is known about lifestyle choices and preventive healthcare-seeking behaviors during the transition from medical school graduation to residency training, a period characterized by increased rates of stress and lack of free time due to demanding working conditions. All of these issues are likely to affect physical activity (PA) level. This study explored the evolution of PA and other lifestyle behaviors during this transition.nnnMETHODSnA cross-sectional study and a cohort study were conducted with medical students (2010) and physicians before and after the first year of residency (2013 and 2014). A self-administered questionnaire assessed PA, health and lifestyle behaviors.nnnRESULTSnFrom a sample of 420 medical students and 478 residents, 74% comply with current PA guidelines. PA decreased by 16% during residency. Low levels of PA were found among (i) females and in respondents who reported (ii) poor self-perceived health and (iii) unhealthy body weight (P < .05). Low PA level was also significantly associated with poor mental health in first-year residents.nnnCONCLUSIONSnThe transition has a negative effect on physicians PA level that may affect physicians own health and patient care. Medical programs should encourage residents to engage in PA to assure physicians personal and mental health.

Initial effects of a free swimming pilot programme on the physical activity levels of young people

Concerns remain over the physical activity (PA) levels of young people.1,2 Consequently, identifying interventions that are effective at encouraging young people to adopt and improve PA levels over the life course3 – especially those not meeting PA guidelines – is central to non-communicable disease prevention in later life.1 Efforts to increase PA levels through the promotion of swimming and aquatic activities for children and young people are one such option.4,5 Swimming has been referred to as the UKs ‘major participation sport’ and a mode of exercise that inactive groups contemplate when seeking to increase their PA levels.4 The aspiration to find effective and sustainable models of PA intervention necessitates rigorous monitoring and evaluation within the context where implementation takes place. With those thoughts in mind, this research set out to investigate the effectiveness of a local authority (LA) led pilot programme of free swimming (FS), with this paper reporting the initial key findings emerging from this study.