Stephen Zwolinsky

Optimizing lifestyles for men regarded as ‘hard-to-reach’ through top-flight football/soccer clubs

This study assessed the effect of a 12-week behavioural intervention delivered in and by English Premier League football/soccer clubs, and its influence on lifestyle behaviours, in men typically regarded as hard-to-reach. One hundred and thirty men aged 18 years or older engaging in the programme self-reported data on optimal lifestyle behaviours (OLBs) (physical activity, diet, smoking and alcohol consumption) at pre- and post-intervention. Logistic regression models were used to predict the likelihood of OLBs post-intervention. Healthy behaviours were uncommon at baseline, yet at 12 weeks, 19% (n = 24) of men displayed positive change in one behaviour and 67% (n = 87) had changed ≥2. A combination of improving diet (odds ratio [OR] = 2.76; 95% confidence interval [CI] = 1.65-4.63) and being employed (OR = 4.90, CI = 1.46-16.5) significantly increased the likelihood of reporting ≥150 min of physical activity per week. Increased physical activity significantly increased the likelihood of self-reporting a healthy diet (OR = 2.32, CI = 1.36-3.95). This study shows that a 12-week behavioural intervention can reach and engage a proportion of at risk men. Further, among such men, the intervention helped to stabilize and improve several of the most important lifestyle behaviours that impact mortality and morbidity.

Reaching older people with PA delivered in football clubs: the reach, adoption and implementation characteristics of the Extra Time Programme

BackgroundOlder adults (OA) represent a core priority group for physical activity and Public Health policy. As a result, significant interest is placed on how to optimise adherence to interventions promoting these approaches. Extra Time (ET) is an example of a national programme of physical activity interventions delivered in professional football clubs for OA aged 55+ years. This paper aims to examine the outcomes from ET, and unpick the processes by which these outcomes were achieved.MethodsThis paper represents a secondary analysis of data collected during the evaluation of ET. From the 985 OA reached by ET, n=486 adopted the programme and completed post-intervention surveys (typically 12 weeks). We also draw on interview data with 18 ET participants, and 7 staff who delivered the programme. Data were subject to thematic analysis to generate overarching and sub themes.ResultsOf the 486 participants, the majority 95%, (n= 462) were White British and 59.7% (n=290) were female. Most adopters (65.4%/n=318) had not participated in previous interventions in the host clubs. Social interaction was the most frequently reported benefit of participation (77.2%, n=375). While the reach of the club badge was important in letting people know about the programme, further work enhanced adoption and satisfaction. These factors included (i) listening to participants, (ii) delivering a flexible age-appropriate programme of diverse physical and social activities, (iii) offering activities which satisfy energy drives and needs for learning and (iv) extensive opportunities for social engagement.ConclusionsFindings emerging from this study indicate that physical activity and health interventions delivered through professional football clubs can be effective for engaging OA.

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

OBJECTIVES To 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. STUDY DESIGN Health 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. METHODS Semi-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. RESULTS HTs 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. CONCLUSION Although, 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.

Health improvement and professional football: players on the same side?

Although health policies typically express an interest in facilitating healthful changes in people’s lifestyles, population-wide lifestyle interventions (Department of Health [DH], 2010; Hillsdon, Cavill, Nanchahal, Diamond, & White, 2001) have had limited success on improving physical activity (PA) levels in the UK (The Information Centre for Health and Social Care, 2013). One of the central problems here is that few drivers of behaviour are universal. In this understanding, the next best option is to find the shared features of sufficiently large segments of any society that can justifiably be called ‘communities’. One such community is that of football fans. Here, recent evidence indicates that football-based health improvement schemes can successfully recruit and/or improve participants’ health and PA profiles (Brady, Perry, Murdoch, & McKay, 2010; Pringle et al., 2013). Using two examples, we explore the role of professional football clubs in delivering health improvement services to adults identified as a priority in government health policy (DH, 2011a). In doing so, we highlight some of the debates surrounding the commissioning, implementation and the evaluation of PA and lifestyle interventions. The public health ‘case’ for more people, more active, more often is increasingly clear and further supported with evidence from the Chief Medical Officer’s Report on PA (Start Active Stay Active; DH, 2011b). Regular PA prevents and/or manages a range of costly, inactivity-related conditions including coronary heart disease, type 2 diabetes, stroke, obesity, some cancers and mental illness (DH, 2011b). With a supporter profile spanning diverse social strata, it is helpful to consider national figures for inactivity to grasp what might be realised by harnessing the potential of intervening through professional football in the UK. First, as few as 39% of men and 29% of women meet recommended PA guidelines and participate in moderate PA for at least 30 minutes five times a week (The Information Centre for Health and Social Care, 2013). When adults 65 years and older are considered, these participation rates become much worse (DH, 2011b). Since similar profiles are reflected worldwide (Lee et al., 2012), it is unsurprising that physical inactivity is a major public health problem of the twenty-first century (Weiler & Stamatakis, 2010). Linking this perspective to the notion of football as the ‘world game’ (Premier League, 2012a) hints at its even greater relevance to global health.

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

BACKGROUND Increasingly 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. METHODS Using 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. RESULTS High 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. CONCLUSIONS Public Health systems may benefit from developing policy and interventions that do more to limit sedentary behavior and encourage light intensity activity in its place.

Can ‘English Premier League’ funding for PE and school sport achieve its aims?

There are a number of assertions being made for a £10 m investment by the English Premier League for primary school sport. For example, it is claimed that Physical Education plus school sport can improve cognitive functioning, concentration, behaviour, educational attainment and overall physical health. However, far from being sufficient in helping to achieve these benefits and sustain long-term activity participation, for some children, Physical Education and competitive sport may actually be counterproductive. In some instances, it may switch them off from activity altogether. Therefore, we need to understand more about which elements of this scheme work, who they work for and which circumstances they work in. Fundamentally, this will only be achieved through hard evidence and robust evaluation.

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

OBJECTIVES The 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. STUDY DESIGN This 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. METHODS Agreement 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. RESULTS The 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%. CONCLUSIONS The 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.

Comments on Bruun, D.M. et al. Community-based recreational football: a novel approach to promote physical activity and quality of life in prostate cancer survivors. Int. J. Environ. Res. Public health 2014, 11, 5557-5585-time to raise our game.

Bruun and colleagues [1] provide a timely and thorough insight into the potential health opportunities on offer via the structural organisation of football associations, football clubs and the global grip of the beautiful game. Their extensive evaluation framework represents an important clarion call for those concerned with football-led health improvement. At the same time, it is wise to consider how this can be made realistic and relevant to those who may regard the football-led ‘concept’ as too alternative or even inappropriate, in the contemporary socio-political and economic context. To meet current concerns, football-led health improvement interventions must be both effective and efficient, not least because budgetary restraints inevitably stimulate comparisons between different programmes and approaches. Importantly, advocates can now point to compelling research and evaluation evidence indicating that football-based interventions (a) reach and engage older men with complex health needs [2], (b) reduces participants’ alcohol consumption [3], (c) increases physical activity [3] and (d) produce significant reductions in weight [4]. Football clubs deliver these effects every day through established community outreach-programmes.

Systematic review of acute physically active learning and classroom movement breaks on children’s physical activity, cognition, academic performance and classroom behaviour: understanding critical design features

Objective To examine the impact of acute classroom movement break (CMB) and physically active learning (PAL) interventions on physical activity (PA), cognition, academic performance and classroom behaviour. Design Systematic review. Data sources PubMed, EBSCO, Academic Search Complete, Education Resources Information Center, PsycINFO, SPORTDiscus, SCOPUS and Web of Science. Eligibility criteria for selecting studies Studies investigating school-based acute bouts of CMB or PAL on (PA), cognition, academic performance and classroom behaviour. The Downs and Black checklist assessed risk of bias. Results Ten PAL and eight CMB studies were identified from 2929 potentially relevant articles. Risk of bias scores ranged from 33% to 64.3%. Variation in study designs drove specific, but differing, outcomes. Three studies assessed PA using objective measures. Interventions replaced sedentary time with either light PA or moderate-to-vigorous PA dependent on design characteristics (mode, duration and intensity). Only one study factored individual PA outcomes into analyses. Classroom behaviour improved after longer moderate-to-vigorous (>10 min), or shorter more intense (5 min), CMB/PAL bouts (9 out of 11 interventions). There was no support for enhanced cognition or academic performance due to limited repeated studies. Conclusion Low-to-medium quality designs predominate in investigations of the acute impacts of CMB and PAL on PA, cognition, academic performance and classroom behaviour. Variable quality in experimental designs, outcome measures and intervention characteristics impact outcomes making conclusions problematic. CMB and PAL increased PA and enhanced time on task. To improve confidence in study outcomes, future investigations should combine examples of good practice observed in current studies. PROSPERO registration number CRD42017070981.

Sustaining health improvement activities delivered in English professional football clubs using evaluation: a short communication

It has been suggested that football and communities are inextricably linked. Healthy lifestyles are an important component in maintaining the sustainability of local communities, not least, because a convincing evidence base supports the holistic benefits that can be derived from health-enhancing behaviours, such as regular physical activity. As such, efforts to promote health improvement through sport and physical activity include those interventions delivered in professional sporting settings. Johnman and colleagues (Johnman and Mackie, ‘The Beautiful Game’) have heralded sports clubs as important venues for the delivery of health improvement interventions for a range of groups across local communities. This includes health improvement activities delivered in professional football club community schemes. While exemplary practice shows how health improvement programmes can be implemented and evaluated, our experience and engagement with professional football club community schemes supports the notion that more needs to be undertaken to help clubs develop monitoring and evaluation strategies in order to assess the impact of their health improvement programmes. In our short communication, we share our plans for helping two professional football clubs develop their monitoring and evaluation strategies for their community health promotion programmes. Potential outcomes emerging from this process are twofold. (1) To help club community schemes in-build and sustain monitoring and evaluation practices within their future health improvement provision. (2) To use the impact and process outcomes emerging from programme evaluations, to successfully secure the necessary resources to sustain future health improvement activities for their local communities. Outcomes emerging from this study will be of interest to football clubs and evaluators alike, as they seek to develop evaluation strategies for their health improvement programmes.