Amanda J. Daley’s research while affiliated with Loughborough University and other places

Background Schools do not typically implement food labelling in their canteens, therefore young people may not be given nutrition information on which to make their food choices. One way of expressing the energy/calorie content of foods is to provide this information in the form of physical activity calorie equivalent (PACE) food labelling, which may help to contextualise the energy content of food/drinks to young people in a simple and understandable way. The study aimed to assess the usefulness of implementing PACE labelling in school canteens and to conduct a process evaluation of using this type of food labelling with young people. Methods A parallel two-armed cluster RCT to evaluate a PACE labelling intervention in secondary schools (typically, adolescents aged 11 and above) in England was conducted. Schools were randomised on a 2:1 basis to display PACE labelling by cakes/sweet biscuits in canteens or to continue with usual practice (comparator) for up to six weeks. There was a baseline period of no PACE labelling for a minimum of four weeks in all schools. Anonymised purchase data were provided by schools and analysed both descriptively and using analysis of covariance. Results Eighteen schools in England were randomised and 11 participated (6 intervention and 5 comparators). Analyses are based on ~ 99,000 purchase transactions of cakes and biscuits from participating schools. There was a reduction in cake/biscuit purchases in intervention schools versus comparators of ~ 11 items per week per 100 students at follow-up (adjusted mean difference = -0.112, 95% CI [-0.179 to -0.045], p = 0.005). Intervention schools did not report major difficulties with the implementation of PACE labelling. Conclusions PACE labelling appeared to reduce cakes/biscuit purchases by a small amount and may be a useful approach to reducing the purchase of discretionary foods in young people in the school environment. The implementation of PACE labelling appeared feasible for some schools, but other schools had reservations about the adverse effects this type of labelling may have on the well-being of students. Trial registration Registered on ClinicalTrials.gov on 18th November 2022. NCT05623618, https://clinicaltrials.gov/study/NCT05623618.

Background A novel ‘whole day’ approach that could motivate the public to be more physically active is Snacktivity™. The Snacktivity™ approach encourages individuals to accumulate 150 min of physical activity in short 2–5-min ‘snacks’ of moderate-vigorous intensity physical activity (MVPA) throughout the day/week. Method A randomised controlled trial to assess the feasibility/acceptability of a Snacktivity™ intervention and trial processes was conducted. The trial aimed to recruit 80 physically inactive adults from healthcare services and via social media. Participants were randomised to the Snacktivity™ intervention or usual care and followed up at 12 weeks. The intervention was predominately delivered by health professionals within consultations. Assessment of whether the Snacktivity™ intervention and trial methods were acceptable to participants, adherence to Snacktivity™ (assessed by Fitbit) and physical activity (assessed by accelerometer), and retention were considered according to traffic light stop-go progression criteria (green-amber-red). Results Seventy-two participants ( n = 37 Snacktivity™ intervention; n = 35 usual care) were recruited across 14 months (72/80, 90%, (green) 95% CI: 83% to 97%). Snacktivity™ adherence was achieved in 12/37 participants (32%, (red) 95% CI: 17% to 48%). Physical activity adherence was achieved in 17/37 participants (46%, (amber) 95% CI: 30% to 62%). Seven participants (10%, (green) 95% CI: 3% to 17%) withdrew from follow-up and 25/72 (35%, (amber) 95% CI: 24% to 46%) had no accelerometer data at follow-up (retention). Conclusion The Snacktivity™ intervention may be feasible and acceptable to implement. Findings can inform subsequent research that seeks to investigate whether Snacktivity™ based approaches are effective in promoting physical activity in the population. Trial Registration ISRCTN: 64851242. Registration date: 31/01/21.

Background Many adults do not meet physical activity recommendations for optimal health, and this is often because people find it difficult to maintain physical activity in the long term. This study focuses on identifying and synthesising factors that may influence the maintenance of physical activity in adults with and without known health conditions. Method A systematic review and qualitative synthesis using thematic analysis was conducted. Four databases (MEDLINE, SPORT Discus, APA, and Web of Science) were systematically searched for studies published from inception to February 2023 that included qualitative data about people’s experiences of maintaining physical activity. Results A total of 9337 abstracts were screened and 68 studies from 14 countries were included. Six main themes were identified: (1) influence of others (e.g. four forms of social support, accountability); (2) contextual and environmental influences (e.g. cost and access of physical activity, weather); (3) health-related influences (e.g. reflexivity about how physical activity improves health conditions, weight control); (4) making it work (e.g. flexibility, prioritising exercise); (5) habits; and (6) psychological processes (e.g. enjoyment, identifying as a physically active person). Conclusion People who maintained their participation in physical activity found it enjoyable, prioritised it, and integrated it into their daily routine. Participants were motivated to continue being physically active when they realised the benefits for their health. Social support, in particular companion support, was a key component facilitating continued engagement. Findings specific to maintenance of physical activity included reflexivity of how physical activity benefited health, flexibility, and identifying as a physically active person.

Background The prevention of type 2 diabetes (T2DM) is recognised as a health care priority in the UK. In people living with T2DM, lifestyle changes (e.g. increasing physical activity) have been shown to slow disease progression and protect from the development of associated comorbidities. The use of digital health technologies provides a strategy to increase physical activity in patients with chronic disease. Furthermore, behaviour economics suggests that financial incentives may be a useful strategy for increasing the maintenance and effectiveness of behaviour change intervention, including physical activity intervention using digital health technologies. The Milton Keynes Activity Rewards Programme (MKARP) is a 24-month intervention which combines the use of a mobile health app, smartwatch (Fitbit or Apple watch) and financial incentives to encourage people living with T2DM to increase physical activity to improve health. Therefore, this randomised controlled trial aims to examine the long-term acceptability, health effects and cost-effectiveness of the MKARP on HbA1c in patients living with T2DM versus a waitlist usual care comparator. Methods A two-arm, single-centre, randomised controlled trial aiming to recruit 1018 participants with follow-up at 12 and 24 months. The primary outcome is the change in HbA1c at 12 months. Secondary outcomes included changes in markers of metabolic, cardiovascular, anthropometric, and psychological health along with cost-effectiveness. Recruitment will be via annual diabetes review in general practices, retinal screening services and social media. Participants aged 18 or over, with a diagnosis of type 2 diabetes and a valid HbA1c measurement in the last 2 months are invited to take part in the trial. Participants will be individually randomised (1:1 ratio) to receive either the Milton Keynes Activity Rewards Programme or usual care. The intervention will last for 24 months with assessment for outcomes at baseline, 12 and 24 months. Discussion This study will provide new evidence of the long-term effectiveness of an activity rewards scheme focused on increasing physical activity conducted within routine care in patients living with type 2 diabetes in Milton Keynes, UK. It will also investigate the cost-effectiveness of the intervention. Trial registration ISRCTN 14925701. Registered on 30 October 2023.

This narrative review describes the impetus for health screening for non-communicable diseases in dental settings and highlights important considerations for evaluating such interventions. Real world cases are presented that showcase health screening interventions implemented in the UK. Non-communicable diseases including diabetes and cardiovascular disease are a global public health challenge. They are largely preventable by implementing lifestyle changes such as healthy eating and participation in physical activity, regular health screening for disease prevention, and/or early initiation of treatment. Hypertension case finding and control is one of the key five areas of focus for adult health, and oral health and diabetes are two of five key clinical areas for children and young people where efforts should be focused to intervene, improve outcomes and reduce inequalities. Links between oral and chronic diseases have been discussed in recent years. Therefore, screening for diabetes and cardiovascular disease has become of greater relevance to the dental profession. There is emerging evidence indicating that screening for the risk factors of cardiovascular diseases and diabetes in dental settings shows promise for improving health outcomes and may offer a cost-effective preventive approach for the detection of diabetes. Real-world services implementing health screening in dental settings have highlighted possibilities for the future and highlight the potential for the role of the dental team in detecting chronic diseases.

Objective The objective of this study was to explore the acceptability to the public of receiving weight screening and the offer of support to lose weight from dental teams. Methods A cross‐sectional survey was conducted with recruitment of adults from dental practices and community and hospital settings in England and the National Institute for Health and Care Research (NIHR) Be Part of Research initiative. Results A total of 3580 participants were recruited across 22 dental sites and the NIHR Be Part of Research initiative. Sixty percent ( n = 2055/3430) of participants reported that they would be comfortable with their height and weight being measured at a dental appointment. Male participants and those of non‐White race and ethnicity had significantly increased odds of accepting weight screening (odds ratio [OR]: 1.98, 95% CI: 1.66–2.36; OR: 2.07, 95% CI: 1.42–3.03). Fifty‐seven percent ( n = 1915/3375) of participants reported that it would be acceptable for their dental team to offer support to help with weight management. Male participants and those of non‐White race and ethnicity had significantly increased odds of accepting support (OR: 1.79, 95% CI: 1.49–2.13; OR: 1.62, 95% CI: 1.11–2.37). The most accepted form of support was provision of information on local weight‐management programs ( n = 1989/2379, 83.6%). Conclusions The public is largely receptive to receiving weight screening and the offer of weight interventions from dental teams. Feasibility studies to test the implementation of lifestyle weight interventions in dental settings are required.

Background Limited evidence from the United States suggests that county/state rates of people with obesity are positively associated with voting for the Republican Party presidential candidate, although this question has not yet been studied at the individual level, and/or outside of the United States, where the health and political systems are very different in other countries. Objectives Using individual level data, assess differences in rates of people with obesity according to political voting in the United Kingdom 2019 general election, and examine whether people living in constituencies won by Members of Parliament (MPs) from the Conservative Party were more likely to be living with obesity than those living in constituencies won by MPs from other parties. Methods Data was obtained by the Ipsos KnowledgePanel where panellists are recruited via a random probability unclustered address-based sampling method. 4000/14,016 panellists were randomly invited to provide data on socio-demographics, health outcomes, voting behaviour and height/weight. Results 2668/4000 (67%) of invitees provided data, 95/2668 (3.5%) were not eligible to vote, with the remaining 2573 (96.5%) included. Conservative Party voters were more likely to be living with obesity than those who voted Labour (OR:1.42 95% CI (1.01–1.99)) or Liberal Democrats (1.54 95% CI (1.00–2.37)). Conservative Party voters on average had significantly higher BMI scores than those voting Labour and Liberal Democrats; BMI mean difference 0.88 points (95% CI: 0.16–1.61) between Conservative and Labour voters, and 1.04 points (95% CI: 0.07–2.02) between Conservatives and Liberal Democrats voters. There was no evidence participants living in constituencies won by Conservative MPs were more likely to be living with obesity than constituencies won by other party MPs. Conclusion Governments and public health agencies may need to focus on the political affiliation of the public when developing strategies to reduce the number of people with obesity.

Objectives The primary aim of this study was to investigate the feasibility and acceptability of general practitioners (GPs) using sit–stand desks to facilitate standing during consultations. A further aim was to examine the views of patients about GPs standing for their consultations. Design A pre–post single-group experimental trial design. Setting General practices in England, UK. Participants 42 GPs (working a minimum of five clinical sessions per week) and 301 patients (aged ≥18 years). Interventions The intervention consisted of each GP having a sit–stand desk (Opløft Sit-Stand Platform) installed in their consultation room for 4 working weeks. Sit–stand desks allow users to switch, in a few seconds, between a sitting and standing position and vice versa, by adjusting the height of the desk. Main outcome measures To test feasibility and acceptability, GPs reported their views about using sit–stand desks at work at baseline and follow-up. Sitting time and physical activity were also measured via accelerometer at baseline and follow-up. Patients who attended a consultation where their GP was standing were asked to complete an exit questionnaire about the perceived impact on the consultation. Results Most GPs reported using their sit–stand desk daily (n=28, 75.7%). 16 GPs (44.4%) used their sit–stand desk during face-to-face consultations every day. Most GPs and patients did not view that GPs standing during face-to-face consultations impacted the doctor–patient relationship (GPs; 73.5%, patients; 83.7%). GPs’ sitting time during work was 121 min per day lower (95% CI: −165 to −77.58) at follow-up compared with baseline. Conclusions Use of sit–stand desks is acceptable within general practice and may reduce sitting time in GPs. This may benefit GPs and help reduce sitting time in patients. Trial registration number ISRCTN76982860 .

Background Physical inactivity is associated with feelings of burnout and fatigue, which in turn are associated with reduced performance among healthcare practitioners. This study explored movement behaviours of general practitioners (GPs) and the association between these behaviours with burnout and fatigue. Methods GPs in Northern Ireland were asked to wear a thigh-worn accelerometer for seven days and complete validated questionnaires to assess the association between daily number of steps, time spent sitting and standing with feelings of burnout and fatigue. Results Valid accelerometer data were obtained from 47 (77.0%) participants. Average workday sitting time, standing time and number of steps were 10.6 h (SD 1.5), 3.8 h (SD 1.3), and 7796 steps (SD 3116) respectively. Participants were less sedentary (8.0 h (SD 1.6)) and more active (4.7 h (SD 1.4) standing time and 12,408 steps (SD 4496)) on non-workdays. Fourteen (30.4%) participants reported burnout and sixteen (34.8%) reported severe fatigue. There were no significant associations between sitting, standing and step counts with burnout or fatigue (p > 0.05). Conclusion GPs were less active on workdays compared to non-workdays and exhibited high levels of sitting. Feelings of burnout and fatigue were highly prevalent, however movement behaviours were not found to be associated with burnout and fatigue. Given the increased sedentariness among GPs on workdays compared to non-workdays, GPs should consider how they can improve their movement behaviours on workdays to help optimise their wellbeing.

Collaborative approaches across healthcare to address obesity are needed but intervention in dental settings is not widely implemented. Here we systematically synthesized the views of both the public and dental teams about delivering weight management interventions in dental settings and identified potential barriers to implementation. A systematic review of five databases from inception to April 3, 2023 was completed. Proportional meta‐analyses were performed with quantitative data and thematic analysis of qualitative data. A total of 7851 studies were screened and 33 included in the review. The prevalence of height and weight screening in dental settings varied (4%–87%) with an average of 29% undertaking screening ( p = <0.01; 95% CI: 14%–46%). A significant proportion of the public were supportive of weight screening in dental settings (83%; p = <0.01; 95% CI:76%–88%). Significant barriers to providing weight screening and/or intervention included fear of offending patients (57%; 95% CI: 45%–68%) and a lack of time (48%; 95% CI: 30%–66%). Qualitative data revealed further barriers including stigmatizing views of dental teams toward people living with overweight/obesity. Enablers of weight discussion included associating weight with oral health. Overall, whilst some barriers were identified, there is potential for weight management interventions to be used more routinely in dental settings.