Objective To examine the effectiveness of physical activity interventions delivered or prompted by primary care health professionals for increasing moderate to vigorous intensity physical activity (MVPA) in adult patients. Design Systematic review and meta-analysis of randomised controlled trials. Data sources Databases (Medline and Medline in progress, Embase, PsycINFO, CINAHL, SPORTDiscus, Sports Medicine and Education Index, ASSIA, PEDro, Bibliomap, Science Citation Index, Conference Proceedings Citation Index), trial registries (Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, TRoPHI), and grey literature (OpenGrey) sources were searched (from inception to September 2020). Eligibility criteria for selecting studies Randomised controlled trials of aerobic based physical activity interventions delivered or prompted by health professionals in primary care with a usual care control group or another control group that did not involve physical activity. Study selection and analysis Two independent reviewers screened the search results, extracted data from eligible trials and assessed the risk of bias using the Cochrane risk of bias tool (version 2). Inverse variance meta-analyses using random effects models examined the primary outcome of difference between the groups in MVPA (min/week) from baseline to final follow-up. The odds of meeting the guidelines for MVPA at follow-up were also analysed. Results 14 566 unique reports were identified and 46 randomised controlled trials with a range of follow-ups (3-60 months) were included in the meta-analysis (n=16 198 participants). Physical activity interventions delivered or prompted by health professionals in primary care increased MVPA by 14 min/week (95% confidence interval 4.2 to 24.6, P=0.006). Heterogeneity was substantial (I 2 =91%, P<0.001). Limiting analyses to trials that used a device to measure physical activity showed no significant group difference in MVPA (mean difference 4.1 min/week, 95% confidence interval −1.7 to 9.9, P=0.17; I 2 =56%, P=0.008). Trials that used self-report measures showed that intervention participants achieved 24 min/week more MVPA than controls (95% confidence interval 6.3 to 41.8, P=0.008; I 2 =72%, P<0.001). Additionally, interventions increased the odds of patients meeting guidelines for MVPA by 33% (95% confidence interval 1.17 to 1.50, P<0.001; I 2 =25%, P=0.11) versus controls. 14 of 46 studies were at high risk of bias but sensitivity analyses excluding these studies did not alter the results. Conclusions Physical activity interventions delivered or prompted by health professionals in primary care appear effective at increasing participation in self-reported MVPA. Such interventions should be considered for routine implementation to increase levels of physical activity and improve health outcomes in the population. Systematic review registration PROSPERO CRD42021209484.

BackgroundThere is limited evidence that nutritional labelling on food/drinks is changing eating behaviours. Physical activity calorie equivalent (PACE) food labelling aims to provide the public with information about the amount of physical activity required to expend the number of kilocalories in food/drinks (eg, calories in this pizza requires 45 min of running to burn), to encourage healthier food choices and reduce disease.ObjectiveWe aimed to systematically search for randomised controlled trials and experimental studies of the effects of PACE food labelling on the selection, purchase or consumption of food/drinks.MethodsPACE food labelling was compared with any other type of food labelling or no labelling (comparator). Reports were identified by searching electronic databases, websites and social media platforms. Inverse variance meta-analysis was used to summarise evidence. Weighted mean differences (WMD) and 95% CIs were used to describe between-group differences using a random effects model.Results15 studies were eligible for inclusion. When PACE labelling was displayed on food/drinks and menus, significantly fewer calories were selected, relative to comparator labelling (WMD=−64.9 kcal, 95% CI −103.2 to −26.6, p=0.009, n=4606). Presenting participants with PACE food labelling results in the consumption of significantly fewer calories (WMD=−80.4 kcal, 95% CI−136.7 to −24.2, p=0.005, n=486) relative to comparator food labelling.ConclusionBased on current evidence PACE food labelling may reduce the number of kilocalories selected from menus and decrease the number of kilocalories/grams of food consumed by the public, compared with other types of food labelling/no labelling.Trial registration numberCRD42018088567.

Background A variety of public health interventions have been undertaken in low- and middle-income countries (LMICs) to prevent morbidity and mortality associated with household air pollution (HAP) due to cooking, heating and lighting with solid biomass fuels. Pregnant women and children under five are particularly vulnerable to the effects of HAP, due to biological susceptibility and typically higher exposure levels. However, the relative health benefits of interventions to reduce HAP exposure among these groups remain unclear. This systematic review aims to assess, among pregnant women, infants and children (under 5 years) in LMIC settings, the effectiveness of interventions which aim to reduce household air pollutant emissions due to household solid biomass fuel combustion, compared to usual cooking practices, in terms of health outcomes associated with HAP exposure. Methods This protocol follows standard systematic review processes and abides by the PRISMA-P reporting guidelines. Searches will be undertaken in MEDLINE, EMBASE, CENTRAL, WHO International Clinical Trials Registry Platform (ICTRP), The Global Index Medicus (GIM), ClinicalTrials.gov and Greenfile, combining terms for pregnant women and children with interventions or policy approaches to reduce HAP from biomass fuels or HAP terms and LMIC countries. Included studies will be those reporting (i) pregnant women and children under 5 years; (ii) fuel transition, structural, educational or policy interventions; and (iii) health events associated with HAP exposure which occur among pregnant women or among children within the perinatal period, infancy and up to 5 years of age. A narrative synthesis will be undertaken for each population-intervention-outcome triad stratified by study design. Clinical and methodological homogeneity within each triad will be used to determine the feasibility for undertaking meta-analyses to give a summary estimate of the effect for each outcome. Discussion This systematic review will identify the effectiveness of existing HAP intervention measures in LMIC contexts, with discussion on the context of implementation and adoption, and summarise current literature of relevance to maternal and child health. This assessment reflects the need for HAP interventions which achieve measurable health benefits, which would need to be supported by policies that are socially and economically acceptable in LMIC settings worldwide. Systematic review registration PROSPERO CRD42020164998

BACKGROUND Cardiovascular disease accounts for 17.9 million deaths globally each year. Many research study datasets have been collected to answer questions about the relationship between cardiometabolic health and accelerometer-measured physical activity. A further benefit of these datasets is that they can be used to answer additional health research questions beyond the original purpose of the data collected. This scoping review aimed to map the available datasets which have collected accelerometer measured physical activity and markers of cardiometabolic health. This data was then used to inform the development of a publicly available resource, named the Global Physical Activity Dataset catalogue (GPAD). This resource provides an online catalogue of datasets that have assessed cardiometabolic health markers and accelerometer-measured physical activity. The ambition of such a catalogue is to enable easier identification of potentially harmonisable datasets, to answer important questions in this area with greater statistical power and generalisability. OBJECTIVE This review aims to systematically identify datasets that have measured physical activity using accelerometers and cardiometabolic health markers using either an observational or interventional study design. METHODS Databases, trial registries and grey literature (inception until 02/2021-updated search from 02/2021 through 09/2022) were systematically searched to identify studies that have analysed datasets of physical activity and cardiometabolic health outcomes. To be eligible for inclusion, datasets must have measured physical activity using an accelerometric device in adults aged ≥18 years, a sample size greater than 400 participants (unless recruited participants in a lower middle income country where a sample size threshold was reduced to 100), utilised an observational, longitudinal or trial based study design and collected at least one cardiometabolic health marker (unless only body mass was measured). Two reviewers screened the search results to identify eligible studies and from these, the unique names of each dataset were recorded and characteristics about each dataset were extracted from several sources. RESULTS A total of 16,720 study reports were identified and after screening, 319 were eligible, with 122 unique datasets in these study reports meeting the review inclusion criteria. Datasets were found in 49 countries across five continents, with most developed in Europe (n=53) and the least in Africa and Oceania (n=4 and n=3 respectively). The most common accelerometric brand and device wear location was Actigraph and the waist respectively. Height and body mass were the most frequently measured cardiometabolic health markers in datasets (119/122 datasets), followed by blood pressure (82/122 datasets). The number of participants in the included datasets ranged from 103,712 to 120. Once the review processes had been completed the GPAD catalogue was developed to house all the identified datasets. CONCLUSIONS This review identified, and mapped the contents of, datasets from around the world that have collected potentially harmonisable accelerometer-measured physical activity and cardiometabolic health markers. The GPAD catalogue is an online open-source resource developed from the results of this review which aims to facilitate the harmonisation of datasets to produce evidence that will reduce the burden of disease from physical inactivity.

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