• Cardiovascular disease risk marker responses to breaking up prolonged sedentary time in individuals with paraplegia: the Spinal Cord Injury Move More (SCIMM) randomised crossover laboratory trial protocol

      Withers, Thomas M.; Croft, Louise; Goosey-Tolfrey, Victoria L.; Dunstan, David W.; Leicht, Christof A.; Bailey, Daniel Paul (BMJ, 2018-06-22)
      Introduction: Sedentary behaviour is a distinct risk factor for cardiovascular disease (CVD) and could partly explain the increased prevalence of CVD in people with spinal cord injury (SCI). Interrupting prolonged sitting periods with regular short bouts of walking acutely suppresses postprandial glucose and lipids in able-bodied individuals. However, the acute CVD risk marker response to breaking up prolonged sedentary time in people with SCI has not been investigated. Methods and analysis: A randomised two-condition laboratory crossover trial will compare: 1) breaking up prolonged sedentary time with 2 min moderate-intensity arm crank activity every 20 min, with 2) uninterrupted prolonged sedentary time (control) in people with SCI. Outcomes will include acute effects on postprandial glucose, insulin, lipids and blood pressure. Blood samples will be collected and blood pressure measured at regular intervals during each 5.5 h condition. Ethics and dissemination: This study was approved by the Cambridge South NHS Research Ethics Committee. This research will help determine if breaking up prolonged sedentary time could be effective in lowering CVD risk in people with SCI. The findings of the research will be published in a peer review journal and disseminated to relevant user groups. Trial registration: The study is registered as a clinical trial on the ISRCTN register (trial ID: ISRCTN51868437).  
    • Evidence in support of the call to ban the tackle and harmful contact in school rugby: a response to World Rugby

      Pollock, Allyson M.; White, Adam John; Kirkwood, Graham; Newcastle University; University of Winchester (BMJ, 2017-08-01)
      In a paper published in BJSM (June 2016), World Rugby employees Ross Tucker and Martin Raftery and a third coauthor Evert Verhagen took issue with the recent call to ban tackling in school rugby in the UK and Ireland. That call (to ban tackling) was supported by a systematic review published in BJSM. Tucker et al claim that: (1) the mechanisms and risk factors for injury along with the incidence and severity of injury in youth rugby union have not been thoroughly identified or understood; (2) rugby players are at no greater risk of injury than other sports people, (3) this is particularly the case for children under 15 years and (4) removing the opportunity to learn the tackle from school pupils might increase rates of injuries. They conclude that a ban ‘may be unnecessary and may also lead to unintended consequences such as an increase in the risk of injury later in participation.’ Here we aim to rebut the case by Tucker et al. We share new research that extends the findings of our original systematic review and meta-analysis. A cautionary approach requires the removal of the tackle from school rugby as the quickest and most effective method of reducing high injury rates in youth rugby, a public health priority.
    • How effective is community physical activity promotion in areas of deprivation for inactive adults with cardiovascular disease risk and/or mental health concerns? Study protocol for a pragmatic observational evaluation of the 'Active Herts' physical activity programme

      Howlett, Neil; Jones, Andy; Bain, Lucy; Chater, Angel M.; University of Hertfordshire; University of East Anglia; University of Bedfordshire; University College London (BMJ, 2017-11-25)
      Introduction There is a high prevalence of inactive adults in the UK, and many suffer from conditions such as cardiovascular disease (CVD) or poor mental health. These coexist more frequently in areas of higher socioeconomic deprivation. There is a need to test the effectiveness, acceptability and sustainability of physical activity programmes. Active Herts uses novel evidence-based behaviour change techniques to target physical inactivity. Methods and analysis Active Herts is a community physical activity programme for inactive adults aged 16+ with one or more risk factors for CVD and/or a mild to moderate mental health condition. This evaluation will follow a mixed-methods longitudinal (baseline, and 3-month, 6-month and 12-month follow-ups) design. Pragmatic considerations mean delivery of the programme differs by locality. In two areas programme users will receive a behaviour change technique booklet, regular consultations, a booster phone call, motivational text messages and signposting to 12 weeks of exercise classes. In another two areas programme users will also receive 12 weeks of free tailored exercise classes, with optional exercise ‘buddies’ available. An outcome evaluation will assess changes in physical activity as the primary outcome, and sporting participation, sitting, well-being, psychological capability and reflective motivation as secondary outcomes. A process evaluation will explore the views of stakeholders, delivery staff and programme leads. Economic evaluation will examine the programme costs against the benefits gained in terms of reduced risk of morbidity. Ethics and dissemination This study was been approved by the Faculty of Medicine and Health Sciences Research Ethics Committee at the University of East Anglia. Informed written consent will be obtained from programme users in the evaluation. Results will be published in peer-reviewed journals, presented at conferences, and shared through the study website and local community outlets.
    • Tackling in physical education rugby: an unnecessary risk?

      White, Adam John; Batten, John; Robinson, Stefan; Anderson, Eric; Burns, Andrew; Batey, Jo; Ryan-Stewart, Helen; Discombe, Russell (BMJ, 2018-01-14)
      Since 2016, we have been strong advocates for the removal of tackling from rugby (League and Union) played in school physical education in the United Kingdom [1]. This is because (a) tackling is the leading cause of injury in rugby, (b) rugby has a level of risk that is higher than non-contact sports, (c) there is no requirement or need for tackling as part of the school physical education curriculum, and (d) many children are compelled to participate in contact rugby [2]. In response to this call, the Chief Medical Officers and the Physical Activity Expert Group commented: ‘The Committee reject the call to ban tackling, as they do not feel rugby participation poses an unacceptable risk of harm’ [3]. Yet, the notion of risk (un) acceptability is a construct that needs further discussion, which we will start here [4].
    • What are the most effective behaviour change techniques to promote physical activity and/or reduce sedentary behaviour in inactive adults? : a systematic review protocol

      Howlett, Neil; Trivedi, Daksha; Troop, Nicholas A.; Chater, Angel M.; University of Hertfordshire; University College London (BMJ, 2015-08-05)
      Introduction: A large proportion of the population are not meeting recommended levels of physical activity and have increasingly sedentary lifestyles. Low levels of physical activity are predictive of poor health outcomes and time spent sedentary is related to a host of risk factors independently of physical activity levels. Building an evidence base of the best approaches to intervene in the lifestyles of inactive individuals is crucial in preventing longterm disease, disability, and higher mortality rates. Methods and Analysis: Systematic searches will be conducted on all relevant databases (e.g. PubMed, Scopus, CINAHL, PsycINFO). Studies will be included if they assess interventions aimed at changing physical activity or sedentary behaviour levels in adults (over 18) who are inactive and do not suffer from chronic conditions. Studies must also be randomised controlled trials (RCT), have a primary outcome of physical activity or sedentary behaviour, and measure outcomes at least six months after intervention completion. Studies will be coded using the Behaviour Change Technique (BCT) taxonomy v1 and TIDieR guidelines. Two reviewers will independently screen full-text articles and extract data on study characteristics, participants, BCTs, intervention features, and outcome measures. Study quality will also be assessed independently by two reviewers using the Cochrane risk of bias tool. A meta-analysis will be considered if there is sufficient homogeneity across outcomes. GRADE criteria will be used to assess quality of evidence. Dissemination: This will be the first review to systematically appraise interventions aimed at changing the physical activity or sedentary behaviour of inactive individuals using RCT designs with a six-month follow-up post intervention. This review will better inform intervention designers targeting inactive populations and inform the design of a future complex intervention. Review registration: This protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 17th October 2014 (registration number: CRD42014014321).
    • What are the most effective behaviour change techniques to promote physical activity and/or reduce sedentary behaviour in sedentary adults? A systematic review protocol.

      Howlett, Neil; Trivedi, Daksha; Troop, Nicholas A.; Chater, Angel M.; University of Hertfordshire; University College London (BMJ, 2015-08-05)
    • What influences people’s responses to public health messages for managing risks and preventing infectious diseases? a rapid systematic review of the evidence and recommendations

      Ghio, Daniela; Lawes-Wickwar, Sadie; Tang, Mei Yee; Epton, Tracy; Howlett, Neil; Jenkinson, Elizabeth; Stanescu, Sabina; Westbrook, Juliette; Kassianos, Angelos P.; Watson, Daniella; et al. (BMJ, 2021-10-05)
      Background Individual behaviour changes, such as hand hygiene and physical distancing, are required on a population scale to reduce transmission of infectious diseases such as COVID-19. However, little is known about effective methods of communicating risk reducing information, and how populations might respond. Objective To synthesise evidence relating to what: a) characterises effective public health messages for managing risk and preventing infectious disease, b) influences people’s responses to messages. Design A rapid systematic review was conducted. Protocol is published on Prospero CRD42020188704. Data sources Electronic databases were searched: Ovid Medline, Ovid PsycINFO and Healthevidence.org, and grey literature (PsyarXiv, OSF Preprints) up to May 2020. Study selection All study designs were included that: (a) evaluated public health messaging interventions targeted at adults, (b) concerned a communicable disease spread via primary route of transmission of respiratory and/or touch. Outcomes included preventative behaviours, perceptions/awareness and intentions. Non-English language papers were excluded. Synthesis Due to high heterogeneity studies were synthesised narratively focusing on determinants of intentions in the absence of measured adherence/preventative behaviours. Themes were developed independently by two researchers and discussed within team to reach consensus. Recommendations were translated from narrative synthesis to provide evidence-based methods in providing effective messaging. Results Sixty-eight eligible papers were identified. Characteristics of effective messaging include delivery by credible sources, community engagement, increasing awareness/knowledge, mapping to stage of epidemic/pandemic. To influence intent effectively, public health messages need to be acceptable, increase understanding/perceptions of health threat and perceived susceptibility. Discussion There are four key recommendations: (1) engage communities in development of messaging, (2) address uncertainty immediately and with transparency, (3) focus on unifying messages from sources, and (4) frame messages aimed at increasing understanding, social responsibility and personal control. Embedding principles of behavioural science into public health messaging is an important step towards more effective health-risk communication during epidemics/pandemics.