Kenneth R Fox

• PhD
• Professor Emeritus at University of Bristol

The case for exercise and health has primarily been made on its impact on diseases such coronary heart disease, obesity and diabetes. However, there is a very high cost attributed to mental disorders and illness and in the last 15 years there has been increasing research into the role of exercise a) in the treatment of mental health, and b) in impr...

Background Challenges of recruitment to randomised controlled trials (RCTs) and successful strategies to overcome them should be clearly reported to improve recruitment into future trials. REtirement in ACTion (REACT) is a UK-based multi-centre RCT recruiting older adults at high risk of mobility disability to a 12-month group-based exercise and be...

Background: ACE (Active, Connected, Engaged) is a theory-informed, pragmatic intervention using peer volunteering support to promote active ageing in socially disengaged, inactive older adults. This study aimed to establish ACE's feasibility and acceptability. Methods: Fifty-four older adults were recruited as either peer volunteers (activators;...

Purpose Mobility limitation in older age reduces quality of life, generates substantial health and social care costs, and increases mortality. The REtirement in ACTion (REACT) trial established that a community-based, active ageing intervention can prevent decline in physical functioning in older adults already at increased risk of mobility limitat...

Background The prevention of mobility-related disability amongst adults is a global healthcare priority. Cost-effective community-based strategies to improve physical function and independence in older adults with mobility limitations are needed. This study investigated the effectiveness of the REtirement in ACTion (REACT) exercise intervention on...

Background Mobility limitation in older age reduces quality of life, generates substantial health- and social-care costs, and increases mortality. Objective The REtirement in ACTion (REACT) trial aimed to establish whether or not a community-based active ageing intervention could prevent decline in physical functioning in older adults already at i...

Background Citizens who contribute as volunteers and peer mentors within a community are important assets that can be mobilised to improve health and wellbeing. In order to optimise the contribution of peer-volunteers to active ageing initiatives, we need to understand their experiences and identify ways to support them in preparing for the role an...

Background Mobility limitations in older populations have a substantial impact on health outcomes, quality of life, and social care costs. The Retirement in Action (REACT) randomised controlled trial assessed a 12-month community-based group physical activity and behaviour maintenance intervention to help prevent decline in physical functioning in...

Background Mobility limitations in old age can greatly reduce quality of life, generate substantial health and social care costs, and increase mortality. Through the Retirement in Action (REACT) trial, we aimed to establish whether a community-based active ageing intervention could prevent decline in lower limb physical functioning in older adults...

Background Successful peer volunteering is central to many community-based, active ageing initiatives. This study synthesises the perspectives of a range of stakeholders involved in peer volunteering initiatives and provides recommendations as to how peer volunteers can be effectively mobilised as community assets. Methods An evidence synthesis of...

Background: The REtirement in ACTion (REACT) study is a multi-centre, pragmatic, two-arm, parallel-group randomised controlled trial (RCT) with an internal pilot phase. It aims to test the effectiveness and cost-effectiveness of a community, group-based physical activity intervention for reducing, or reversing, the progression of functional limita...

Background: Exposure to higher magnitude vertical impacts is thought to benefit bone health. The correlates of this high-impact physical activity (PA) in later life are unknown. Methods: Participants were from the Cohort for Skeletal Health in Bristol and Avon, Hertfordshire Cohort Study and MRC National Survey of Health and Development. Associa...

High impact physical activity (PA) is thought to benefit bone. We examined associations of lifetime walking and weight bearing exercise with accelerometer-measured high impact and overall PA in later life. Data were from 848 participants (66.2% female, mean age = 72.4 years) from the Cohort for Skeletal Health in Bristol and Avon, Hertfordshire Coh...

Spearman rank correlation coefficients for lifetime daily miles walked and weight bearing exercise.

Lifetime self-reported walking and weight-bearing exercise in relation to accelerometer-measured overall and high impact physical activity (PA) in later life.

Prospectively reported walking and weight bearing exercise at ages 36 and 60–64 in relation to accelerometer-measured overall and high impact physical activity (PA) at age 69 in the MRC NSHD.

This study aimed to examine the prospective associations between total physical activity, leisure-time physical activity (LTPA), and domestic and work-related physical activity (DWPA) involving heavy physical labor, with all-cause mortality in patients with cardiovascular disease (CVD). A 7-year follow-up cohort design was used based on the data fr...

Background: Of all age groups, older adults spend most of the time sitting and are least physically active. This sequential, mixed-methods feasibility study used a randomised controlled trial design to assess methods for trialling a habit-based intervention to displace older adults' sedentary behaviour with light activity and explore impact on beha...

Purpose: This 2-year follow-up study aimed to examine the associations between total volume, frequency, duration, and speed of walking with subsequent sleep difficulty in older adults. Methods: A total of 800 older adults aged 65 years and over participated in the first survey in 2012 and 511 of them were followed 2 years later. The 5-item Athens I...

Background: Evidence for the health benefits of a physically active lifestyle among older adults is strong, yet only a small proportion of older people meet physical activity recommendations. A synthesis of evidence identified "best bet" approaches, and this study sought guidance from end-user representatives and stakeholders to refine one of thes...

Purpose: This study aimed to examine the longitudinal independent associations of objectively-assessed physical activity at different intensities, including moderate-to-vigorous physical activity, light physical activity, and sedentary behaviors, with dimensions of subjective well-being in older adults. Methods: A total of 307 community-dwelling...

The implementation, fidelity and receipt of a self-determination theory-based after-school physical activity intervention (Action 3:30) delivered by Teaching Assistants (TAs) was examined using a mixed-methods process evaluation. Physical activity motivation and need satisfaction were reported by 539 participants at baseline, the end of interventio...

The short clinical version of the Physical Self-Perception Profile - (CPSPP) was constructed to measure self-perceptions in the physical domain in older people and patients in clinical and rehabilitation settings. It is made up of subscales to assess perceptions of physical function, physical health, strength, sports competence, body attractiveness...

Background Many children do not meet physical activity guidelines. Parents and friends are likely to influence children's physical activity but there is a shortage of measures that are able to capture these influences. Methods A new questionnaire with the following three scales was developed: 1) Parental influence on physical activity; 2) Motives f...

This qualitative study explored the acceptability of high-impact physical activity for increasing bone strength in later life. Thematic analysis established the barriers and facilitators to this physical activity. They prioritised joint over skeletal health, of which they had little concept. Interventions need to clearly communicate the rationale a...

Background Many studies have shown that low levels of exercise in later life are associated with the progression of difficulties with activities of daily living. However, few have assessed the independent effect of exercise components on difficulty in performing activities of daily living and explored whether the relationship between exercise and a...

Successful public health initiatives require multi-sector collaboration. AVONet was a UK collaborative developed to provide evidence-based strategies for active ageing. This study explored the success of AVONet in the achievement of its objectives as perceived by all partners. A convergent parallel mixed-methods design was employed, utilizing a qua...

Background: This update describes changes to procedures for our randomised controlled trial of 'On Your Feet to Earn Your Seat', a habit-based intervention to reduce sedentary behaviour in older adults. Some of the amendments have arisen from the addition of new sites, each offering different possibilities and constraints for study procedures. Oth...

Understanding the risk factors of metabolic syndrome (MetS) is important to public health, since individuals with MetS have an increased risk of health problems. This study examined the associations of exercise, sedentary time and insomnia with incident MetS among older adults 1 year later. A total of 1,359 older adults receiving hospital health ex...

Adults aged 60 years and over spend most time sedentary and are the least physically active of all age groups. This early-phase study explored acceptability of a theory-based intervention to reduce sitting time and increase activity in older adults, as part of the intervention development process. An 8-week uncontrolled trial was run among two inde...

This study aimed to assess the independent and prospective associations of aspects of self-reported leisure-time physical activity (LTPA) and leisure-time sedentary behaviors (LTSB) with subjective well-being (SWB). Data from the 1999, 2003, and 2007 phases of the Survey of Health and Living Status of the Elderly conducted by the Taiwan Ministry of...

Exercise has been found to be associated with improved sleep quality. However, most of the evidence is based on resistance exercise, walking, or gym-based aerobic activity. This study aimed to examine the effects of an 8-week aquatic exercise program on objectively measured sleep parameters among older adults with mild sleep impairment. A total of...

The preventive effect of late-life physical exercise on cognitive deterioration has been reported in many cohort studies. However, the effect of exercise, independent of other cognitively demanding and social activities, is equivocal and little is known about the relative contributions of frequency, intensity, and duration of exercise. This study a...

Many children do not engage in recommended levels of physical activity (PA), highlighting the need to find ways to increase children's PA. Process evaluations play an important role in improving the science of randomised controlled trials. We recently reported the results of the Action 3:30 cluster randomised feasibility trial illustrating higher l...

Physical activity may regulate affective experiences at work, but controlled studies are needed and there has been a reliance on retrospective accounts of experience. The purpose of the present study was to examine the effect of lunchtime walks on momentary work affect at the individual and group levels. Physically inactive employees (N = 56; M age...

Background Active travel to school can be an important contributor to the total physical activity of children but levels have declined and more novel approaches are required to stimulate this as an habitual behaviour. The aim of this mixed methods study was to investigate the feasibility of an international walk to school competition supported by n...

The frequency of trips outdoors is a strong indicator of older adults' physical activity levels. This qualitative study compared and contrasted determinants of trips outdoors between rural-(n=13) and urban-living (n=15) people aged 65 and older living in England. Interview transcripts were analysed through directed and summative content analysis em...

Background: objective measures of physical activity and function with a diverse cohort of UK adults in their 70s and 80s were used to investigate relative risk of all-cause mortality and diagnoses of new diseases over a 4-year period. Participants: two hundred and forty older adults were randomly recruited from 12 general practices in urban and sub...

The relationship of objectively measured sedentary time (ST), frequency of breaks in ST, and lower extremity function (LEF) was investigated in a diverse sample aged >= 70 years (n = 217). Physical activity (PA) was assessed by accelerometry deriving moderate-vigorous PA (MVPA) minutes per registered hour (MVPA min . hr(-1)), registered ST (ST min...

Background Many older adults are both highly sedentary (that is, spend considerable amounts of time sitting) and physically inactive (that is, do little physical activity). This protocol describes an exploratory trial of a theory-based behaviour change intervention in the form of a booklet outlining simple activities ('tips') designed both to reduc...

Extracurricular programmes could provide a mechanism to increase the physical activity (PA) of primary-school-aged children. The aim of this feasibility study was to examine whether the Action 3:30 intervention, which is delivered by teaching assistants, holds promise as a means of increasing the PA of Year 5 and 6 children. A cluster randomised fe...

Of all age groups, older adults spend the most time watching TV, which is one of the most common sedentary behaviours. Such sedentary activity in older adulthood is thought to risk deterioration of physical and mental functioning, health and wellbeing. Identifying the characteristics of older adults whose TV viewing increases over time may help to...

Background There is some evidence that physical activity (PA), sedentary time and screen time (ST) are associated with childhood obesity, but research is inconclusive and studies are mainly based on self-reported data. The literature is dominated by data from North American countries and there is a shortage of objective data from Malta which has on...

Objective To examine well-being and work performance changes accompanying participation in a16-week uncontrolled feasibility lunchtime walking trial. Method Participants were 75 (92% female; M age = 47.68) previously physically inactive non-academic employees from a large British university. Multilevel modelling analyses examined well-being and wo...

This 10-year follow-up study examined the associations between different categories of physical activity and insomnia among Taiwanese older adults aged 65 years and older. Data were collected in 1999 (n=1810) and 2009 (n=1128) by faceto- face interviews. Physical activity was evaluated with the Physical Activity Scale for the Elderly. Totals for ea...

The aim of the study was the development of a valid and reliable short form of the physical self-perception profile. Data were collected from three samples of Greek adults, spanning 17–67 years. (Sample 1: n = 595; Sample 2: n = 602; Sample 3: n = 609). The physical self-perception profile—short form (PSPP-SF) comprised 15 items with three items pe...

Objectives: To examine the associations between volume and intensity of older peoples' physical activity, with their subsequent health service usage over the following four to five years. Study design: A prospective cohort design using baseline participant characteristics, objectively assessed physical activity and lower limb function provided b...

School travel mode and parenting practices have been associated with children's physical activity (PA). The current study sought to examine whether PA parenting practices differ by school travel mode and whether school travel mode and PA parenting practices are associated with PA. 469 children (aged 9-11) wore accelerometers from which mean weekday...

Abstract The objectives of the study were to identify levels of physical activity and sedentary time and assess how they differ by weight status in Maltese boys and girls. Participants were 234 Maltese children aged 11-12 years, of which 187 (80%) provided complete data. Physical activity was assessed using accelerometry and weight status determine...

This study explored the associations of the volume and intensity of physical activity and the volume of sedentary time with subjective well-being in a diverse group of 228 older adults in the UK (111 female, mean age 78.2 years (SD 5.8)). Physical activity (PA) and sedentary behaviour were assessed by accelerometry deriving mean steps per day, mean...

In 20 years’ time, nearly a quarter of the population in the UK will be aged 65 and over. Older age brings greater threats of coronary heart disease, stroke, diabetes, cancer, arthritis and obesity. Gradual loss of physical and cognitive function and onset of debilitating mental conditions such as dementia pose serious threats to independence and w...

This study used cross-sectional and longitudinal analyses to examine physical activity, sedentary behaviors and eating habits and their associations with occurrence of obesity among Taiwanese adolescents. A cross-sectional survey was conducted in September 2008 with a total number of 3,221 seventh graders from 11 junior high schools in Taiwan. Amon...

A 16-week lunchtime walking intervention was designed to increase physical activity in physically inactive University employees. The programme was delivered and monitored twice over seven months to examine feasibility across different seasons. Seventy-five participants (n= 69 females, n= 6 males; M age = 47.68) were randomly allocated into a Winter...

Parenting programs could provide effective routes to increasing children's physical activity and reducing screen-viewing. Many studies have reported difficulties in recruiting and retaining families in group parenting interventions. This paper uses qualitative data from the Teamplay feasibility trial to examine parents' views on recruitment, attend...

Sex differences in the ratio of fat mass (FM):fat-free mass (FFM) during weight change should differentially affect the extent of weight change during energy imbalance in men and women. In the present study, we determined FM and FFM contents by dual-energy X-ray absorptiometry and calculated the P-ratios (protein energy/total energy) of excess weig...

The relationship of objectively measured sedentary time (ST), frequency of breaks in ST, with lower extremity function (LEF) was investigated in a diverse sample aged ≥ 70 years (n=217). Physical activity (PA) was assessed by accelerometry deriving moderate-vigorous PA minutes per registered hour (MVPA min·h-1), registered ST (ST min·h-1), and brea...

Understanding children's physical activity motivation, its antecedents and associations with behavior is important and can be advanced by using self-determination theory. However, research among youth is largely restricted to adolescents and studies of motivation within certain contexts (e.g., physical education). There are no measures of self-dete...

A qualitative study was conducted within a randomised trial of facilitated physical activity for depression based on Self-Determination Theory and motivational interviewing. Interviews were held with 19 participants at 4 months, and 12 participants were re-interviewed 8 months later. The interviews were analysed in accordance with Grounded Theory u...

This study examined the association between fitness change and subsequent academic performance in Taiwanese schoolchildren from 7th grade to 9th grade. The 7th graders from 1 junior high school district participated in this study (N = 669). Academic performance was extracted from school records at the end of each grade. Cardiovascular (CV) fitness,...

Obesity rates in children are particularly high in European countries. Based on self-report data in the Health Behaviour in School-age Children study, obesity in 11-year-old Maltese children is second only to children in the United States. This is the first study on obesity in 10-11-year-old Maltese children using objective measures with a national...

Physical activity takes place in different social contexts such as leisure, home, and work. However, the differential associations of these distinct categories of activity with aspects of well-being have rarely been investigated. This study was designed to estimate independent associations of (a) leisure-time, (b) domestic and (c) work-related phys...

Background: Many children do not meet physical activity (PA) guidelines. Extracurricular programmes could provide a mechanism to increase the PA levels of primary-school-aged children. Teaching assistants (TAs) are a valuable resource in all UK primary schools and could be trained to delivery after-school PA programmes. The aim of this feasibility...

To examine whether parental screen-viewing, parental attitudes or access to media equipment were associated with the screen-viewing of 6-year-old to 8-year-old children. Cross-sectional survey. Online survey. Parental report of the number of hours per weekday that they and, separately, their 6-year-old to 8-year-old child spent watching TV, using a...

Many children spend too much time screen-viewing (watching TV, surfing the internet and playing video games) and do not meet physical activity (PA) guidelines. Parents are important influences on children's PA and screen-viewing (SV). There is a shortage of parent-focused interventions to change children's PA and SV. Teamplay was a two arm individu...

Intended learning outcomes and detailed content for week 2. Table SB. Percentage of randomized parents and children per trial arm who provided accelerometer data at Time 0, 1 and 2. Table SC. Number of valid days of accelerometer data provided by parents and study children*. Figure SA. Flowchart of participants through the study. Figure SB. Percent...

Associations of objectively measured physical activity (PA) with objectively measured lower limb function in adults aged 70 and older were studied. Lower limb function was assessed using the Short Physical Performance Battery (SPPB) and PA by an accelerometer providing mean daily counts per minute (CPM), mean daily steps and minutes of moderate or...

Background Establishing healthy physical activity (PA) behaviours in early childhood is important for future PA behaviours. Parents play a central role in young children’s PA. However, there is currently little research on parenting interventions to increase child PA. This study was formative work to inform the content of a pilot randomised-control...

Background: The beneficial effect of physical activity for the prevention of a range of chronic diseases is widely acknowledged. These conditions are most prevalent in low-income groups where physical activity levels are consistently lower. Social marketing is the government's recommended approach to promoting physical activity but evidence of its...

This study examined the association among childhood obesity, weight status change, and subsequent academic performance at 6-year follow-up. First-grade students from one elementary school district in Taichung City, Taiwan were followed for 6 years (N = 409). Academic performance was extracted from the school records at the end of each grade. Weight...

Study question Does facilitated physical activity provide an effective treatment for adults with depression presenting in primary care? Summary answer Although trial participants receiving the physical activity intervention in addition to usual care reported increased physical activity compared with those receiving usual care alone, there was no e...

Many children do not engage in sufficient levels of physical activity (PA) and spend too much time screen-viewing (SV). High levels of SV (e.g. watching TV, playing video games and surfing the internet) and low levels of PA have been associated with adverse health outcomes. Parenting courses may hold promise as an intervention medium to change chil...