Showing papers by "Wendy J. Brown published in 2020"
TL;DR: The Pooled Intervention groups did not differ on body weight but improved resistance training, and reduced energy intake and insomnia symptom severity, and no additional weight loss was apparent when targeting improvements in physical activity, diet and sleep in combination compared with physical activity and diet.
Abstract: Background: This study compared the efficacy of two multi-component m-health interventions with a wait-list control group on body weight (primary outcome), and secondary outcomes of cardiovascular risk factors, lifestyle behaviours, and mental health. Methods: Three-arm randomised controlled trial (Enhanced: physical activity, diet, sleep, Traditional: physical activity, diet, Control) with assessments conducted at baseline, 6 and 12 months. Participants (n = 116) were overweight or obese adults aged 19–65 (M = 44.5 [SD = 10.5]). The 6-month intervention was delivered via a smartphone app providing educational materials, goal-setting, self-monitoring and feedback, and also included one face-to-face dietary consultation, a Fitbit and scales. The trial was prospectively registered and conducted between May 2017 and September 2018. Group differences on primary and secondary outcomes were examined between the Pooled Intervention groups (Pooled Intervention = Enhanced and Traditional) and Control groups, and then between Enhanced and Traditional groups. Results: Nineteen participants (16.4%) formally withdrew from the trial. Compared with the Control group, average body weight of the Pooled Intervention group did not differ at 6 (between-group difference = −0.92, (95% CI −3.33, 1.48)) or 12 months (0.00, (95% CI −2.62, 2.62)). Compared with the Control group, the Pooled Intervention group significantly increased resistance training (OR = 7.83, (95% CI 1.08, 56.63)) and reduced energy intake at 6 months (−1037.03, (−2028.84, −45.22)), and improved insomnia symptoms at 12 months (−2.59, (−4.79, −0.39)). Compared with the Traditional group, the Enhanced group had increased waist circumferences (2.69, (0.20, 5.18)) and sedentary time at 6 months (105.66, (30.83, 180.48)), and improved bed time variability at 12 months (−1.08, (−1.86, −0.29)). No other significant differences were observed between groups. Conclusions: Relative to Controls, the Pooled Intervention groups did not differ on body weight but improved resistance training, and reduced energy intake and insomnia symptom severity. No additional weight loss was apparent when targeting improvements in physical activity, diet and sleep in combination compared with physical activity and diet.
31 citations
TL;DR: Future data obtained from large populations, including spatial examination of the actual parks used and their characteristics, are essential to facilitate planning for park provision, optimising the use of these spaces for recreation and physical activity by mid-to older-aged adults, and creating healthy communities.
25 citations
TL;DR: The study provides estimates of problems with fertility in a cohort of young adult Australian women, and the results indicate that these are inversely associated with physical activity levels and positively associated with BMI.
Abstract: Study question Do physical activity (PA), sitting time (ST) and body mass index (BMI) affect fertility over a 15-year period in Australian women? Summary answer Moderate and high levels of PA confer advantages for fertility in women with normal BMI, but increased risk of infertility was observed in obese women. What is known already Higher BMI is positively associated with higher rates of problems with fertility, but the effects of physical activity and sitting time on fertility are less well understood. Study design, size, duration Participants in The Australian Longitudinal Study of Women's Health (ALSWH) completed mailed surveys in 2000, with follow-ups in 2003, 2006, 2009, 2012 and 2015 (N = 6130). Participants/materials, setting, methods Participants were aged 22 to 27 in 2000. They were asked to report their physical activity levels, sitting time and fertility problems in each survey from 2000 to 2015. BMI was calculated from self-reported weight and height. Cumulative incidence of fertility problems was calculated from 2000 to 2015 and hazard ratios (HR) and 95% CIs were calculated using survival analysis. Main results and the role of chance From 2000 to 2015, the cumulative incidence of fertility problems was 15.4% (95% CI: 14.5-16.4). High levels of PA were associated with reduced risk of problems with fertility [HR 0.82 (95% CI: 0.69-0.98)], and higher BMI was positively associated with fertility problems [overweight: HR 1.18, (95% CI 0.99-1.39); obese: HR 1.36, (95% CI 1.14-1.63)]. In survival analyses, incidence rates were highest in every survey interval in women who reported low PA levels and in women who were obese. Overall, ST was not associated with fertility problems. In stratified models, high levels of PA attenuated the risk of problems with fertility in women who were in the normal BMI category [HR 0.64, (95% CI 0.49-0.82)]. Limitations, reasons for caution The ALSWH relies on self-reported data, which may be subject to recall bias. Wider implications of the findings The study provides estimates of problems with fertility in a cohort of young adult Australian women, and the results indicate that these are inversely associated with physical activity levels and positively associated with BMI. However, the high infertility risk in obese women was not attenuated by high levels of PA. The protective effects of PA were only observed in women with normal BMI. As rates of developing problems with fertility were highest in every survey interval among women who reported low levels of physical activity and in women who were obese, these findings suggest that improving physical activity levels could be an affordable strategy to reduce problems with fertility in women who are trying to conceive. These findings should be considered by clinical and public health practitioners. Study funding/competing interest(s) The ALSWH is funded by the Australian Government. Funding for these analyses was provided by a University of Queensland (UQ) International Postgraduate Research Scholarship and a UQ International Development Fellowship. The authors declare no conflicts of interest.
23 citations
TL;DR: This study examines the physical activity (PA) levels and sedentary behaviours of women with and without PCOS, and their alignment with the PCOS PA guideline.
Abstract: Objective Lifestyle is the first-line treatment for women with polycystic ovary syndrome (PCOS). This study examines the physical activity (PA) levels and sedentary behaviours of women with and without PCOS, and their alignment with the PCOS PA guideline. Methods This cross-sectional study on women (aged 22-27 years) in the Australian Longitudinal Study on Women's Health was conducted in 2019 using data collected in 2017. Self-reported PA levels and total daily sitting time (ST) of women with (n = 7051) and without (n = 796) self-reported PCOS were presented, stratified by body mass index (BMI) and a combined overweight/obese group. Results 71.0% and 56.7% of the entire study cohort achieved PA levels recommended for weight maintenance and weight loss, respectively. Overall, PA levels were lower and ST was higher in women with than without PCOS. In each BMI category, similar proportions of women with and without PCOS met the PA guidelines but became lower as BMI category increased. Fewer overweight/obese group women with than without PCOS aligned with recommendations for weight maintenance (58.7% vs 65.7%, P = .003) or weight loss (45.1% vs 50.3%, P = .032). ST ≥8 h/d was observed in two-thirds of women with and without self-reported PCOS similarly before and after stratifying by BMI. Conclusion High sedentary behaviour was extremely prevalent. Although the majority of women met PA recommendations for weight maintenance, only one in two overweight/obese women met PA recommendation for weight loss. Overweight/obese women with PCOS were more likely to participate in insufficient PA and require increased support to achieve sustainable healthy lifestyle.
21 citations
TL;DR: PIs had statistically significantly improved sleep quality among middle-aged adults with poor sleep quality without a diagnosed sleep disorder.
Abstract: BACKGROUND: Poor sleep health is highly prevalent. Physical activity is known to improve sleep quality but not specifically targeted in sleep interventions. PURPOSE: To compare the efficacy of a combined physical activity and sleep intervention with a sleep-only intervention and a wait-list control, for improving sleep quality in middle-aged adults without a diagnosed sleep disorder. METHODS: Three-arm randomized controlled trial (Physical Activity and Sleep Health (PAS), Sleep Health Only (SO), Wait-list Control (CON) groups; 3-month primary time-point, 6-month follow-up) of 275 (PAS = 110, SO = 110, CON = 55) inactive adults (40-65 years) reporting poor sleep quality. The main intervention component was a smartphone/tablet "app" to aid goal setting and self-monitoring physical activity and/or sleep hygiene behaviors (including stress management), and a pedometer for PAS group. Primary outcome was Pittsburgh Sleep Quality Index (PSQI) global score. Secondary outcomes included several self-reported physical activity measures and PSQI subcomponents. Group differences were examined stepwise, first between pooled intervention (PI = PAS + SO) and CON groups, then between PAS and SO groups. RESULTS: Compared with CON, PI groups significantly improved PSQI global and subcomponents scores at 3 and 6 months. There were no differences in sleep quality between PAS and SO groups. The PAS group reported significantly less daily sitting time at 3 months and was significantly more likely to report ≥2 days/week resistance training and meeting physical activity guidelines at 6 months than the SO group. CONCLUSIONS: PIs had statistically significantly improved sleep quality among middle-aged adults with poor sleep quality without a diagnosed sleep disorder. The adjunctive physical activity intervention did not additionally improve sleep quality. CLINICAL TRIAL INFORMATION: Australian New Zealand Clinical Trial Registry: ACTRN12617000680369; Universal Trial number: U1111-1194-2680; Human Research Ethics Committee, Blinded by request of journal: H-2016-0267.
18 citations
TL;DR: Participation in SRAs was associated with lower incidence of hypertension, diabetes, and obesity in mid‐age adults over six years, and these findings support current efforts to promote wider and continuing participation inSRAs at this life stage.
Abstract: Evidence of prospective associations between participation in sports and recreational activities (SRAs) and health outcomes at the population level is scarce. We investigated the associations between participation in SRAs and 6-year incidence of hypertension, diabetes, and obesity in a cohort of mid-age Australian adults. We analyzed data from the HABITAT study (n = 8784), a cohort of adults aged 40+ years living in Brisbane, Australia. Mail surveys in 2007, 2009, 2011, and 2013 were used to collect data on participation in 11 SRAs in the past 12 months, as well as self-reported hypertension, diabetes, height, and weight. Obesity was defined as BMI ≥ 30.0 kg/m2. Logistic generalized estimating equation models with a 2-year lag were used. Participation in SRAs in 2007, 2009, and 2011 was matched with outcomes measured in 2009, 2011, and 2013. From 2007 to 2013, the cumulative incidence of hypertension, diabetes, and obesity was 14.9%, 3.2%, and 11%, respectively. Running, tennis, team sports, exercise classes, and resistance training were associated with reduced odds of hypertension. Running, cycling, resistance training, and yoga/tai chi were associated with reduced odds of diabetes. Cycling, tennis, home-based exercises, resistance training, and yoga/tai chi were associated with lower odds of obesity. Participation in SRAs was associated with lower incidence of hypertension, diabetes, and obesity in mid-age adults over six years. These findings support current efforts to promote wider and continuing participation in SRAs at this life stage.
15 citations
TL;DR: The 10,000 Steps program originated from a landmark whole-of-community multi-strategy intervention to increase physical activity (PA) in Rockhampton, Australia in 2001-2003 and is now delivered via website and smartphone apps and employs activity trackers (pedometers, Fitbit, Garmin).
Abstract: The 10,000 Steps program originated from a landmark whole-of-community multi-strategy intervention to increase physical activity (PA) in Rockhampton, Australia in 2001-2003. It used a social ecological framework to promote physical activity at the individual, population, environmental and policy level. Two of the fundamental aspects of the original program were goal setting (10,000 steps per day) and self-monitoring (use of a pedometer for daily step counts). A project website (www.10000steps.org.au) allowed registered participants to record their physical activity. Over time the program morphed into an e- & mHealth intervention without face-to-face elements. The program is now delivered via website and smartphone apps and employs activity trackers (pedometers, Fitbit, Garmin). To date the project has signed-up over 425,000 members who have logged 221 billion steps (∼43 million a day) on the website or app. More than 14,000 workplaces and community organisations have been involved with the program. A central element of the program, the 'Workplace Challenge' has been used by ∼65% of 10,000 Steps members, which on average increases physical activity by 159 min/week for those who participate in it. In 2011, the Queensland Government designated the 10,000 Steps program as their key physical activity workplace health promotion strategy. Multiple factors underpin the success of the program. The message is simple and clear: the project name, with its distinctive logo and tagline ('Every Step Counts') provides a clear and prescriptive target for the physical activity 'dose'. Using effective behaviour change techniques: goal setting (the 10,000 Steps concept), self-monitoring (steps are tracked), social support (participants organise as 'teams' to reach certain step goals) and gamification (teams competing against each other creating 'friendly competition'). Ongoing redevelopment: since inception, there have been three complete redesigns of the website (including a branding redesign), and new smartphone apps. More recently, the website was modified to allow syncing of steps using popular activity trackers. Resources to support implementation: the program provides resources (e.g. 'Active Workplace Guide') and has dedicated staff to respond to queries from workplaces and individuals to help overcome implementation barriers. Project staff continuously promote the program via media interviews, attendance at events, social media and marketing, advertising, and networking and collaboration. Ongoing evaluation has contributed to continuous funding: to ensure the program remains successful in a fast-changing technology environment, continuous evaluation has been necessary. These evaluation strategies, the success of the original project and the strong partnership with the program funder (Queensland Health) have all contributed to the long-term (19 years) support for the project.
14 citations
TL;DR: Maintaining ‘active’ PA status was associated with 40% lower MBS and 30% lower PBS costs over three years in Australian women, suggesting helping women to remain active in mid-life could result in considerable savings for both women and the Australian government.
Abstract: Few studies have examined relationships between physical activity (PA) during mid-age and health costs in women. The aim of this study was to investigate associations between PA levels and trajectories over 12 years with medical and pharmaceutical costs in mid-age Australian women. Data from 6953 participants in the Australian Longitudinal Study on Women’s Health (born in 1946–1951) were analysed in 2019. PA was self-reported in 2001 (50-55y), 2007 (56-61y) and 2013 (62-67y). PA data were linked with 2013–2015 data from the Medicare (MBS) and Pharmaceutical (PBS) Benefits Schemes. Quantile regression was used to examine associations between PA patterns [always active, increasers, decreasers, fluctuaters or always inactive (reference)] with these medical and pharmaceutical costs. Among women who were consistently inactive (< 500 MET.minutes/week) in 2001, 2007 and 2013, median MBS and PBS costs (2013 to 2015) were AUD4261 and AUD1850, respectively. Those costs were AUD1728 (95%CI: 443–3013) and AUD578 (95%CI: 426–729) lower among women who were consistently active in 2001, 2007 and 2013 than among those who were always inactive. PBS costs were also lower in women who were active at only one survey (AUD205; 95%CI: 49–360), and in those whose PA increased between 2001 and 2013 (AUD388; 95%CI: 232–545). Maintaining ‘active’ PA status was associated with 40% lower MBS and 30% lower PBS costs over three years in Australian women. Helping women to remain active in mid-life could result in considerable savings for both women and the Australian government.
9 citations
TL;DR: It is important that future studies report standardised and detailed descriptions of key elements that form the basis of supervised and unsupervised exercise training groups, given that exercise is a critical component for maintenance of glycaemic control in patients with T2D.
Abstract: Exercise training is vital for glycaemic control in patients with type 2 diabetes mellitus (T2D). While the positive effects of supervised exercise training are well established, unsupervised training may offer an alternative and more sustainable means of realising the benefits of exercise away from a resource-heavy supervised setting. To evaluate the available literature and compare the efficacy of supervised and unsupervised exercise training programs on glycaemic control in patients with T2D. CINAHL, MEDLINE, PubMed, and EMBASE, searched from inception to 20 July 2018. Only studies that included both supervised and unsupervised training were included. Four studies, involving 115 participants, were included. One compared supervised with unsupervised exercise training and three investigated the efficacy of unsupervised training following supervised training. While supervised training is effective for improving glycaemic control in patients with T2D, unsupervised training may not maintain these changes. Included studies lacked detail relating to the supervised and unsupervised training programs. Given that exercise is a critical component for maintenance of glycaemic control in patients with T2D, and because unsupervised training has been shown to be effective in improving clinical outcomes in other disease populations, further research is warranted to compare supervised and unsupervised exercise training in patients with T2D. It is important that future studies report standardised and detailed descriptions of key elements that form the basis of supervised and unsupervised exercise training groups.
8 citations
TL;DR: In this paper, a combination therapy of diet and exercise is the first-line treatment of GDM, with positive effects on maternal weight gain and the prevalence of infants born large-for-gestational age.
Abstract: Obesity during pregnancy is associated with the development of adverse outcomes, including gestational diabetes mellitus (GDM). GDM is highly associated with obesity and independently increases the risk of both complications during pregnancy and future impaired glycemic control and risk factors for cardiovascular disease for both the mother and child. Despite extensive research evaluating the effectiveness of lifestyle interventions incorporating diet and/or exercise, there remains a lack of definitive consensus on their overall efficacy alone or in combination for both the prevention and treatment of GDM. Combination of diet and physical activity/exercise interventions for GDM prevention demonstrates limited success, whereas exercise-only interventions report of risk reductions ranging from 3 to 49%. Similarly, combination therapy of diet and exercise is the first-line treatment of GDM, with positive effects on maternal weight gain and the prevalence of infants born large-for-gestational age. Yet, there is inconclusive evidence on the effects of diet or exercise as standalone therapies for GDM treatment. In clinical care, women with GDM should be treated with a multidisciplinary approach, starting with lifestyle modification and escalating to pharmacotherapy if needed. Several key knowledge gaps remain, including how lifestyle interventions can be optimized during pregnancy, and whether intervention during preconception is effective for preventing the rising prevalence of GDM.
7 citations
TL;DR: Concerns about the intervention designs and effectiveness as well as challenges for the adherence of the nursing staff to the protocol are revealed.
Abstract: Medical device-related pressure injuries are the most common cause of pressure injuries within the intensive care unit, in particular those caused by nasogastric tubes and endotracheal tubes There are several known methods, which can alleviate the pressure of these devices on the skin surface to reduce the rate of these injuries To determine the feasibility of conducting a larger, adequately powered trial testing, several clinically effective interventions to reduce the incidence of medical device-related pressure injuries caused by these devices Patients were recruited into both study arms and received one of three different methods of skin protection for both arms Outcome measures included fidelity to the processes of care protocol, recruitment potential, and the number of medical device-related pressure injuries Recruitment (n = 87) was slower than expected with less than 10% of screened potential patients available for enrolment Fidelity to the process of care for each subgroup was variable with better adherence in the nasogastric tube arm compared to the endotracheal tube arm This feasibility study has revealed concerns about the intervention designs and effectiveness as well as challenges for the adherence of the nursing staff to the protocol
TL;DR: The aim was to describe the characteristics of young adult women who report urinary incontinence, the types of UI they experience, the strategies they use or consider important for managing UI, and help‐seeking behavior.
Abstract: Aim: The aim was to describe the characteristics of young adult women who report urinary incontinence (UI), the types of UI they experience, the strategies they use or consider important for managing UI, and help-seeking behavior. Methods: Data were from the 1989-1995 Australian Longitudinal Study on Women's Health cohort (n = 8457) at age 22 to 27 (in 2017). Descriptive statistics were used to summarize: characteristics of young women who experience UI; the types of UI they experience; which strategies women use to manage UI; perceptions of bladder control; and the proportion of women who seek help (and reasons why not). Prevalence ratios for UI according to sample characteristics were calculated using Poisson regression models. Results: At age 22 to 27, 11% (n = 986) of young women reported UI in the past month. Compared with women who did not have UI, those reporting UI were 7 kg heavier on average and were more likely to be in the obese body mass index category, report high psychological distress, and have at least one child. Most women with UI reported mixed symptoms of UI (stress and urge), and used a combination of strategies to self-manage UI symptoms. Only one in five women had sought help or advice from a healthcare professional. Conclusions: Obesity, parity, and high psychological distress are strong correlates of UI in young women. As the majority of women with UI do not seek help, the antenatal period may be a critical time for healthcare providers to identify those at risk, and encourage early prevention or effective management strategies. As physical activity is positively associated with better outcomes for obesity and psychological distress, there may also be concurrent improvements in UI if these issues are addressed.
TL;DR: Several psychosocial factors mediated changes in physical activity but not in sleep outcomes, and mediation effects of sleep hygiene on sleep quality highlight the importance of providing evidence-based strategies to improve sleep quality.
Abstract: Objectives: Examining mediators of intervention efficacy in an m-health intervention targeting physical activity and sleep in 160 Australian adults.Design: Nationwide randomised controlled trial.Ma...
13 Apr 2020
TL;DR: A cluster-controlled trial of two prophylactic silicone sacral dressings to prevent sacral pressure injuries in critically ill patients and a rebuttal to one of these trials is presented.
Abstract: For referencing Stankiewicz M et al. In response to: Comparing strength of evidence: a rebuttal to A cluster-controlled trial of two prophylactic silicone sacral dressings to prevent sacral pressure injuries in critically ill patients. Wound Practice and Research 2020; 28(1):40-41. DOI https://doi.org/10.33235/wpr.28.1.40-41 Stankiewicz M, Gordon J, Dulhunty JM, Brown W, Pollock H and Barker-Gregory N
TL;DR: The relevance of current guidelines for working adults is questioned, as most of the research underpinning their development was drawn from studies of leisure time PA and did not take account of occupational PA.
Abstract: In recent years several governments and agencies have developed population-based physical activity (PA) guidelines to guide disease prevention and health promotion policies and strategies. Most guidelines for adults now recommend an overall volume of 150–300 min of at least moderate to vigorous activity per week (500–1000 MET.min/week), twice weekly muscle strengthening exercises and minimising time spent in prolonged sitting.1 2 As these guidelines do not distinguish between PA in different domains (eg, leisure, transport, occupational), it is assumed, for example, that walking for 60 min as part of paid work (as Morris’ postal workers did in the 1960s) is as beneficial for health as is walking for leisure or transport. The problem today is that few occupations involve continuous moderate intensity PA, even though many workers are ‘on their feet all day’ (eg, nurses, retailers, teachers, tradespersons and so on), although at a fairly low level of intensity.
In their editorial, Holtermann et al 3 appear to question the relevance of current guidelines for working adults, as most of the research underpinning their development was drawn from studies of leisure time PA and did not take account of occupational PA. This is true, and reflects the fact that, in the case …
TL;DR: Future research should continue to address whether the strength of preferences influence study outcome and participation and whether the study preferences change over time.
Abstract: Purpose:To explore whether there was a difference in objectively measured physical activity and study participation between people who received their preferred study group allocation (matched) and ...
TL;DR: Lumbar spine imaging was common in population-based Australian women, with rates increasing over 20 years, and raising awareness of this in clinicians is likely to result in significant cost savings if clinical guidelines are followed.
Abstract: ObjectiveThere are concerns that lumbar spine imaging represents low value care. Our aim was to examine the use of lumbar spine imaging [radiography, computed tomography (CT), magnetic resonance imaging (MRI)] over 20 years, and costs and person-level characteristics of imaging in a large cohort of Australian women.MethodsThe Australian Longitudinal Study on Women's Health (ALSWH) is a longitudinal population-based survey of women randomly selected from national health insurance scheme (Medicare) database. This study examined 13458 women born in 1973-1978 who consented to link their ALSWH and Medical Benefits Scheme records. Self-reported data on demographics, body mass index, depression, physical and mental health, and back pain were collected in each survey performed in 1996, 2000, 2003, 2006, 2009, 2012, and 2015. Data on lumbar spine imaging from 1996 to 2015 were obtained from the Medical Benefits Scheme database.Results38.9% of women underwent some form of lumbar spine imaging over 20 years. While radiography increased from 1996 to 2011 and decreased thereafter, CT and MRI continued to increase from 1996 to 2015. In women with self-reported back pain, depression and poorer physical health were associated with imaging, with no significant differences in types of imaging. Based on imaging rates in ALSWH, the estimated costs for Australian women aged 30-39 years were AU$51,735,649 over 2011-2015.ConclusionsLumbar spine imaging was common in population-based Australian women, with rates increasing over 20 years. Depression and poor physical health were associated with lumbar spine imaging. Raising awareness of this in clinicians is likely to result in significant cost savings if clinical guidelines are followed, with the potential of freeing resources for high value care and health outcomes.