Shelley Elizabeth Keating

Background: To characterize associations of age- and sex-normalized handgrip strength with physical activity, functional status, fatigue, metabolic parameters, and liver disease characteristics in children with metabolic dysfunction-associated steatotic liver disease (MASLD). Methods: This cross-sectional analysis included a prospectively recruited pediatric MASLD cohort. Maximum handgrip strength was measured using a Takei GRIP-A dynamometer following a protocol aligned with the Canadian Health Measures Survey and normalized using Canadian age- and sex-specific reference values. Low grip strength was defined as p = 0.024) and positively with HDL cholesterol (rho = 0.49, p < 0.001), weekly exercise (rho = 0.42, p = 0.003), and Lansky score (rho = 0.35, p = 0.012). Children with low grip strength had lower weekly exercise, Lansky scores, and HDL cholesterol. Median CAP was 318 dB/m in children with low grip strength and 296 dB/m in those without low grip strength (p = 0.085). Conclusions: Lower age- and sex-normalized handgrip strength was associated with lower physical activity, poorer functional status, lower HDL cholesterol, and higher CAP in children with MASLD. These findings support further study of handgrip strength as a simple functional measure in pediatric MASLD.

Aim: This prospective cohort study aimed to quantify dose–response associations between intensity-specific incidental physical activity (IPA) and the incidence of type 2 diabetes (T2D) in a large cohort of UK adults. A secondary aim was to estimate the T2D-specific equivalence of 1 minute of vigorous-intensity IPA relative to moderate- and light-intensity IPA. Methods: Participants were adults from the UK Biobank accelerometry sub-study who self-reported as nonexercisers. Individuals were excluded if they had T2D at baseline, were using insulin therapy, or received a T2D diagnosis within 12 months of follow-up. T2D status was primarily derived from primary care records. Device-measured IPA was categorized into light (LIPA; 1.5 to <3 METs), moderate (MIPA; 3 to <6 METs), and vigorous (VIPA; ≥6 METs) intensities. Additional analyses examined the T2D-specific equivalence of 1 minute of VIPA to MIPA and LIPA. The reference group comprised participants accumulating neither MIPA nor VIPA. Results: The primary analysis included 22 857 nonexercisers (mean age 62.1 ± 7.7 years, 42.8% male). Over a 7.8-year follow-up period, 721 (3.2%) participants developed T2D. MIPA and VIPA, but not LIPA, exhibited near-linear inverse associations with T2D risk. Median VIPA (4.75 minutes/day) was associated with a hazard ratio (HR) 0.62 [95% confidence interval (CI) 0.53-0.73], and median MIPA (23.70 minutes/day) showed a HR of 0.67 (95% CI: 0.52-0.86). One minute of VIPA/day was associated with an equivalent T2D risk reduction of 5.9 minutes MIPA/day and 46.6 minutes LIPA/day. Conclusion: MIPA and VIPA were associated with lower T2D risk in a dose-dependent manner. Although median LIPA was linked to reduced risk, it did not demonstrate a consistent dose–response relationship.

Objectives. To develop Australian guidelines on physical activity/exercise during pregnancy and the postpartum period. Design. Critical ‘umbrella’ reviews of the scientific evidence, combined with adaptation of recently published guidelines. Methods: A five stage approach included: identification of key source documents (including national physical activity/exercise guidelines and position statements from professional organizations, published since 2010); narrative review of evidence relating to 27 health outcomes; summarizing the evidence; development of draft guidelines and supporting information; and review and consultation to finalize the guidelines. Results. Our evidence review found that physical activity/exercise during pregnancy and the postpartum period is safe, has health benefits for the woman and her unborn child, and may reduce the risks of some pregnancy related complications. Four specific guidelines were developed. These encourage all women without pregnancy complications to: (1) meet the Australian Physical Activity and Sedentary Behavior Guidelines for Adults before, during and after pregnancy; (2) modify activities to accommodate the physical changes that occur as pregnancy progresses; (3) do pelvic floor exercises during and after pregnancy; and (4) take an active role in shared decision-making about their physical activity/exercise during and after pregnancy. The review also identified warning signs and contraindications for physical activity/exercise during pregnancy. Conclusions. All women who are pregnant or planning a pregnancy should be aware of the benefits of physical activity/exercise, and health professionals should encourage safe levels of activity and be familiar with the contraindications, signs and symptoms which suggest that physical activity/exercise should be modified or avoided.

Background: In Australia, chronic liver disease is now the third leading cause of premature death in people aged 50–59 years, and the fourth leading cause in all other 5-year age groups from 35 to 70 years in Australia. A consensus statement on the diagnosis and management of portal hypertension in patients with cirrhosis was developed by the Gastroenterological Society of Australia (GESA), the peak national organization for health care professionals and researchers working in gastroenterology and hepatology, to provide contemporary, evidence-based clinical guidelines. A summary of its recommendations is presented here. Methods: The consensus statement was developed in accordance with the Appraisal of Guidelines for Research and Evaluation II instrument and the 2016 National Health and Medical Research Council Standards for Guidelines. A panel of 46 health care professionals with expertise in managing portal hypertension participated in the development of the consensus statement. The consensus development conference method was used to determine consensus for each recommendation, with a hybrid face-to-face and online meeting held in Noosa, Australia, on 3 August 2024, followed by 2 online meetings. Results: A total of 52 recommendations were approved by the consensus development group without dissent across the following domains: (1) diagnosis, risk stratification, and prevention of decompensation; (2) portal hypertension–related bleeding; (3) ascites and renal impairment; (4) hepatic encephalopathy; (5) sarcopenia, nutrition, and frailty; (6) thrombosis in cirrhosis; (7) cardiopulmonary complications; (8) surgery and portal hypertension; and (9) pregnancy and portal hypertension. Discussion: This is the first Australian consensus statement on the diagnosis and management of portal hypertension in patients with cirrhosis. The recommendations in this summary document provide standardized clinical guidance with the goal of improving outcomes for patients with cirrhosis and portal hypertension in Australia.

Many veterans experience a decline in their physical activity following their separation from service. Contributory factors include changes in lifestyle, routines and occupational activities, or physical injury, disability, or mental ill health; whether service-related or otherwise. Low physical activity increases risk of serious health consequences, including cardiometabolic disease, which veterans experience at more than two-fold-higher rates than their general population counterparts. Psychological and social factors such as social identities, group norms and social support are important for physical activity uptake and maintenance, but are understudied in veteran populations and their families, especially alongside the incorporation of co-design principles and methods. This protocol paper presents a three-study research program aimed at improved management of cardiometabolic risk for veterans—with a focus on understanding barriers and enablers of physical activity, and culminating in the co-design of a physical activity toolkit. First, a cross-sectional survey will identify risk and protective factors associated with physical activity for veterans and their close family members, including psychosocial factors, such as norms about physical activity within veterans' families. Second, semi-structured interviews with at-risk veterans and family members will further examine perspectives and lived experience of barriers and enablers of physical activity uptake and maintenance. Third, focus group workshops will be undertaken to co-design a toolkit on physical activity that is evidence-based and acceptable for veterans with cardiometabolic risk and their families. Together, the research is expected to generate a new understanding of how best to support veterans and their families with uptake and maintenance of physical activity, particularly those with cardiometabolic risk indicators.

Objective: To examine dose-response associations of vigorous intermittent lifestyle physical activity micropatterns (VILPA; bouts ≤1 minute) and its moderate-to-vigorous equivalent (MV-ILPA; bouts ≤3 minutes) with incident type 2 diabetes. Research Design and Methods: Prospective data from UK Biobank accelerometry sub-study participants who reported no leisure-time exercise and had no type 2 diabetes at baseline were analysed. Daily duration and frequency of VILPA and MV-ILPA were derived from wrist-worn accelerometry. Incident type 2 diabetes was ascertained through linked primary care, hospital and death records. Dose-response associations were examined using multivariable-adjusted Fine-Gray subdistribution hazard models accounting for competing risks. Results: Among 22,706 participants (mean age 62.3 years; 56.4% female), 665 developed type 2 diabetes over an average follow-up of 7.9 years. Daily durations of VILPA and MV-ILPA showed inverse, non-linear L-shaped associations with incident type 2 diabetes. Median durations of 3.9 minutes/day of VILPA and 25.3 minutes/day of MV-ILPA were associated with 36% and 46% lower risk of type 2 diabetes, respectively, compared with those completing no VILPA or 3.9 minutes/day of MV-ILPA. Daily VILPA frequency showed a near-linear inverse association, with 10.4 bouts/day (median) corresponding to a hazard ratio (HR) of 0.64 (95% CI 0.51-0.81) compared with 0 bouts/day. Daily MV-ILPA frequency showed a U-shaped pattern, with risk reductions plateauing at approximately 56 bouts/day (HR 0.54, 95% CI 0.39−0.76). Conclusions: Among adults who do not do leisure-time exercise, accruing brief, intermittent bouts of moderate-to-vigorous intensity physical activity during day-to-day routines may be a promising strategy for prevention of type 2 diabetes.

Background : The cross-sectional association between movement behaviors and body composition in children is well established, but evidence of directionality is lacking. This study examined bidirectional associations between wake-time movement behavior and body composition and whether associations differed between children with typical motor development and motor coordination difficulties. Methods : Waist-worn accelerometers assessed sedentary time, light-intensity physical activity, and moderate- to vigorous-intensity physical activity at baseline (aged 4–5 y) and annually for 3 years among 475 children from the Coordination and Activity Tracking in CHildren cohort study (n = 175 with motor coordination difficulty, n = 283 boys). Annual assessments included height, weight, waist circumference, percentage body fat via bioelectric impedance analysis, and motor coordination using the Movement Assessment Battery for Children–Second Edition. Wake-time movement behaviors were expressed as isometric log-ratio coordinates, and associations with body composition were examined using cross-lagged panel models of compositional data, including compositional isotemporal substitution analysis. Results : Children with higher body mass index z  scores, larger waist circumference, and higher body fat percentage prospectively engaged in less healthy movement behavior compositions characterized by more sedentary time and less moderate- to vigorous-intensity physical activity. Overall movement behavior compositions were not significantly prospectively related to body composition, although several specific isotemporal substitution associations were observed. Estimated associations did not significantly differ between children with typical motor development and those with motor coordination difficulties. Conclusion : These findings suggest that children’s body composition may influence future movement behaviors, demonstrating the importance of behavior change interventions targeting children with overweight or obesity to promote healthy movement behavior combinations and overcome widening disparities over time.

Regular exercise is fundamental for people with metabolic dysfunction-associated steatotic liver disease (MASLD), yet exercise maintenance is generally poor. This generative co-design process aimed to embed the voices and opinions of people with lived experience of MASLD and their care stakeholders to (i) frame barriers and enablers to exercise maintenance and (ii) highlight priorities for exercise-focused research agendas in MASLD.

Introduction: Behavioural changes targeting diet and physical activity to achieve weight loss are considered the cornerstones of metabolic dysfunction-associated steatotic liver disease (MASLD) management. Digital health interventions effectively address barriers in accessing such lifestyle interventions particularly for persons in remote and regional communities that have high rates of MASLD and limited access to healthcare. This research uses co-design methodology to inform the development of a multimodal, digital lifestyle intervention for individuals with MASLD. Methods: Over 20 months (May 2023-January 2025), an iterative co-design process guided by the Double Diamond framework- discover, define, develop, deliver- was implemented. Twenty-seven adults (≥18 years) from Alfred Health, Australia participated in one-on-one interviews to explore insights and perspectives during the discover phase. This included people with MASLD ( n = 10; 50% female; mean age: 63.6 years), and healthcare professionals ( n = 17; 59% female; mean age: 37.1 years) [dietitians ( n = 5), exercise professionals ( n = 6) and hepatologists/clinicians ( n = 6)], representing a range of ethnic backgrounds. Key themes were synthesised using a reflexive thematic analysis employing a data-driven, inductive approach during the define phase. The develop phase led to actionable suggestions, and final feedback was sought from participants in the deliver phase. Results: Interviews identified barriers and facilitators that influenced participant engagement and adherence to the digital intervention, highlighting the need for an evidence-based, personalised and holistic approach during the discover and define phases. Five key themes emerged: i) content relevance and adaptability, ii) personalisation, iii) social and community, iv) barriers and facilitators, and v) website interface design. The develop phase focused on refining the intervention based on participant feedback and deliver phase encompassed finalising the digital intervention. Conclusions: This iterative co-design process identified the needs and preferences of individuals with MASLD for a multimodal, digital lifestyle intervention. This research will guide a holistic, tailored approach with culturally appropriate resources and community engagement, piloted to assess feasibility.