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To quantify physical activity (PA) levels in people with multiple sclerosis (pwMS) using objective measurement and to establish using a meta-analytical approach if pwMS are less active than the general population. A systematic search of eight databases was conducted. Cohort and intervention studies which included an objective measure of PA were included. Objective PA outputs of steps per day and minutes of moderate-vigorous activity (MVPA) per day were extracted from the MS studies and the published NHANES dataset. Meta-analysis was used to compare the differences between the groups for these parametric outcomes. A general population sample from the National Health and Nutritional Examination Survey (NHANES) in the United States of America was used as a comparative group. The systematic search resulted in 32 papers (n = 2 randomized control trials, n = 30 cohort studies). A total of 3 762 pwMS were included. The sample was largely female (n = 3 118, 82.8%) and ambulatory with/without use of an aid (n = 31 studies). There were significant differences between the MS and the published NHANES comparative group with respect to 1) steps per day [mean difference: -3845 (-4120.17, -3569.83), P < .0001, n = 10 studies] and 2) minutes of MVPA per day [mean difference: 9.00 (-12.5, -5.4), P < .0001, n = 3 studies], indicating pwMS are less physically active than the NHANES sample. Results suggest that pwMS are less physically active than a general population across PA outputs of steps per day and minutes of MVPA per day. There is a need to increase PA levels among pwMS.

Behaviour is central to the management of diabetes, both for people living with diabetes and for healthcare professionals delivering evidence‐based care. This review outlines the evolution of behavioural science and the application of theoretical models in diabetes care over the past 25 years. There has been a particular advancement in the development of tools and techniques to support researchers, healthcare professionals and policymakers in taking a theory‐based approach, and to enhance the development, reporting and replication of successful interventions. Systematic guidance, theoretical frameworks and lists of behavioural techniques provide the tools to specify target behaviours, identify why ideal behaviours are not implemented, systematically develop theory‐based interventions, describe intervention content using shared terminology, and evaluate their effects. Several examples from a range of diabetes‐related behaviours (clinic attendance, self‐monitoring of blood glucose, retinal screening, setting collaborative goals in diabetes) and populations (people with type 1 and type 2 diabetes, healthcare professionals) illustrate the potential for these approaches to be widely translated into diabetes care. The behavioural science approaches outlined in this review give healthcare professionals, researchers and policymakers the tools to deliver care and design interventions with an evidence‐based understanding of behaviour. The challenge for the next 25 years is to refine the tools to increase their use and advocate for the role of theoretical models and behavioural science in the commissioning, funding and delivery of diabetes care.

Current evidence supports the efficacy of PA intervention on subjective but not objective outcomes. However, conclusions from this review should be interpreted with caution because of the small number of studies included and small sample size. Further, while using theory in intervention design, interventions in this review have not reported the refining of theory. Exploration of the use of additional BCTs to change PA behavior is also required within future interventions.

Highlights Policies that support physical activity (PA) in the school-setting have promise but their impact is poorly understood. Nine policy action areas for which there was evidence of impact were identified. These were whole-school PA policy, physical education, sport/extracurricular PA, classroom-based PA, active breaks, physical environment, shared use agreements, active school transport and surveillance. Evidence supports the effectiveness of PA policy actions within the school-setting but cautions a “one-size fits all” approach. Further evaluation of policy implementation to maximize translation into practice is required. Greater clarity regarding terminology, measurement, and methods for evaluation of policy interventions is needed, and suggestions provided.