Nicola W. Burton

Obstructive sleep apnea (OSA) is a prevalent sleep disorder with multi-level adverse impacts. Although positive airway pressure (PAP) therapy is the gold standard treatment, sustained patient use remains a challenge. The aim of this study was to synthesize evidence on direct associations between demographic and socioeconomic indicators with PAP therapy in adults with OSA. A scoping review following PRISMA-ScR protocol was conducted. PubMed, PsycINFO, CINAHL, and Cochrane databases were searched for publications between 1990 and February 2026 with key words associated with OSA, PAP use, and demographic (age, gender), and socioeconomic (education, employment status, occupational prestige, income and neighborhood advantage) indicators. Data were extracted on study design, follow-up, sample characteristics, PAP use definitions and measurement, and direct association results. Findings were summarized graphically and synthesized narratively. The majority of evidence suggested no direct association of PAP therapy use with age, gender, or education. There was limited evidence available for other SES indicators. Findings suggest that demographic characteristics alone may not be key determinants of PAP use. Future studies could further explore SES associations with PAP therapy use or move beyond examining direct associations to consider other types of associations e.g. moderating or interactive effects. Open Science Framework (DOI 10.17605/OSF.IO/B9RT5).

Background: In‐person walking assessments are time consuming, limiting their clinical use. This study aimed to identify simple questions that best reflected the walking ability of patients with peripheral artery disease. Methods: This was a post‐hoc analysis of responses for self‐reported mobility and fatigue‐based questions, and walking distance from the BIP (Behavioral Intervention by Allied Health Professionals to Promote Physical Activity) trial. Responses to questions that predicted minimum clinically important differences in walking distance (20 m) were identified using generalized linear models. Random forest was used to train the identified questions using baseline data, which were tested for their ability to estimate 6‐minute walking distances measured at 4, 12 and 24 months. Longitudinal associations between responses to questions and walking distance over 24 months were analyzed using linear mixed effects. Results: In 188 eligible participants, statistical models suggested that different responses to the questions, “Does your health now limit you in climbing 1 flight of stairs?,” “Does your health now limit you in walking 100 m?,” and “During the past 4 weeks, did you feel worn out?” were predictive of significant differences in walking distance at all follow‐up time points (all P P <0.001) between baseline and all follow up time points, as compared with those who reported being “limited a lot”. Conclusions: Simple self‐report questions reflected walking ability of patients with peripheral artery disease and may be useful for remote assessment.

Background : Exercise is essential for chronic disease management, but intervention implementation in rural populations remains unclear. This review aimed to synthesize the characteristics and impact of exercise interventions delivered to adults living with chronic conditions in rural areas. Methods : Six databases (MEDLINE, Embase, Emcare, Scopus, CINAHL, and SPORTDiscus) were searched from inception to September 2025 for interventional studies evaluating exercise training interventions of ≥2 weeks among adults with chronic conditions living in rural areas across all countries. Data were extracted on study characteristics, exercise prescription, delivery methods, engagement strategies, and effectiveness outcomes related to physical activity and physical function. Results : Twenty-seven studies (n = 2846 participants; 13 randomized controlled trials [RCT], 14 non-RCT) were included. The most common condition groups were musculoskeletal, cancer (acute or survivorship), respiratory, and metabolic/endocrine. Interventions were predominantly supervised and delivered in person (37%) or via telehealth (33%), most often by exercise professionals (37%). Combined aerobic and resistance (48%), aerobic only (22%), and resistance only (15%) training were commonly prescribed. Most studies prescribed 2 to 3 weekly sessions (57%), lasting 30 to 60 minutes (67%). Rural adaptations included telehealth delivery, upskilling nonexercise professionals, minimal or no equipment use, and delivery in existing healthcare settings. Evidence for intervention effectiveness was mixed; positive effects were observed for physical function outcomes (2 RCT and 5 non-RCT), while evidence for improvements in physical activity behavior (4 RCT and 1 non-RCT) and aerobic fitness (2 RCT and 6 non-RCT) were inconsistent. Conclusions : Interventions were generally supervised and incorporated rural adaptations. While physical function outcomes showed promising improvements, evidence for increasing physical activity and aerobic fitness remains inconclusive.

Background : Our aim was to determine adult’s trajectories of meeting 150 minutes per week of physical activity (PA) and assess associations between environmental features (and changes in these) with trajectory membership. Methods : We used data from the How Areas in Brisbane Influence HealTh and AcTivity (HABITAT) cohort study, Australia. Data on PA were assessed in 2007, 2009, 2011, 2013, and 2016 among individuals aged 45–60 years. At each survey, data on length of bike paths, area of parks, residential density, street connectivity, land use mix, and number of street lights were measured. PA trajectories were determined using group-based trajectory modeling. Group differences were analyzed based on median and interquartile range (IQR) of environmental features and associations were assessed through multinomial logistic regression. Results : We identified 4 trajectories of meeting PA guidelines: low (14.4%), decreasing (13.7%), increasing (30.4%), and high (41.5%). Median (IQR) values of environmental features were very similar among trajectory groups ( P > .05) with relatively little change between initial (2007) and final (2016) timepoints. Associations with trajectory membership were observed for bike path length among participants in the mid-tertile of the low trajectory group compared with the high trajectory (odds ratio [OR] = 0.55; 95% confidence interval [CI], 0.36–0.84); and for street connectivity in the low (OR = 0.67; 95% CI, 0.51–0.87), and increasing trajectory groups (OR = 0.76; 95% CI, 0.61–0.94). Conclusion : In the context of this “livable city,” environmental features did not thoroughly predict patterns of PA among mid-age adults. Environmental predictors of PA deserve further attention, especially in low-income and middle-income countries, as active friendly environments have important connotations for various types of PA.

Aims: Supervised exercise provides numerous health benefits for people with type 2 diabetes mellitus (T2D); however, long-term adherence is poor. We aimed to identify (1) factors associated with total physical activity (PA) participation 10 months following supervised exercise and (2) barriers to and enablers of self-directed exercise. Methods: Fifty-seven adults with type 2 diabetes mellitus (age: 60.4 [8.6] y, 23% women, glycated hemoglobin [HbA_1c]: 8.7% [1.9%], PA: 68.1 [142.3] min·wk⁻¹) were allocated to low-volume combined aerobic and resistance high-intensity interval training (78 min·wk⁻¹) or combined moderate intensity continuous training (210 min·wk⁻¹). Participants completed 8 weeks of supervised training, then 10 months of self-directed exercise (12 mo total). Sociodemographic, medical, psychological, and health determinants of total PA at 12 months were identified using correlation and multiple regression analyses. Barriers and enablers were derived from individual participant interviews. Results: At 12 months, average weighted total PA was 209.4 (174.3) minutes per week. Only allocation to combined aerobic and resistance high-intensity interval training was an independent predictor of total PA at 12 months (β = 0.477, P = .027). Enablers of self-directed exercise included flexible exercise schedule and social support. Barriers were limited access to specialized equipment and competing time demands. Conclusions: This study highlights factors to consider when designing long-term exercise support for people with type 2 diabetes mellitus.

Aim: Patients’ trust and confidence in telehealth are core components of its adoption, effectiveness and sustained use. This study aimed to develop and validate scales to measure trust and confidence in using telephone and video consultations in people with chronic kidney disease (CKD). Methods: After developing potential items, two-phases were conducted to investigate construct validity. Phase 1 examined face and content validity via: think-aloud patients focus group ( n = 5), specialists email feedback ( n = 3) and telehealth investigators group discussion ( n = 4). Phase 2 used factor analytical methods to evaluate structural validity and internal consistency reliability after surveying a sample of people with CKD at an Australian metropolitan hospital. Four exploratory factor analyses (EFA) with oblique rotation Promax were conducted. Parallel analysis was used for factor retention and items with factor loadings ≥0.60 on the primary factor and without substantive cross-loadings were maintained. Cronbach's alpha ( α ) measured the internal consistency reliability. Results: Phase 1 resulted in 17 items to measure trust in telephone consultations, 17 items to measure trust in video consultations, 8 items to measure confidence in using telephone consultations and 8 items to measure confidence in using video consultations (total 50 items). Phase 2: EFA results ( N = 156) for the trust scales were both unidimensional: (1) 12-item trust in telephone consultations ( α = 0.92); (2) 12-item trust in video consultations ( α = 0.93). EFA resulted in two factors for each of the confidence scales: (3) Confidence in using telephone consultations ( α = 0.82), comprising 4-item ‘competence & capability’ factor ( α = 0.84) and 3-item ‘social & technical support’ factor ( α = 0.82); (4) Confidence in using video consultations ( α = 0.84) comprising 4-item experience ‘competence & capability’ factor ( α = 0.84) and 3-item ‘social & technical support’ factor ( α = 0.82). Internal consistency reliability of all scales and subscales were adequate ( α > 0.80). Conclusion: Our study demonstrated excellent psychometric properties of the TCTVC scales, which can be reliably used across broader cohorts.

Student-led digital health clinics allow for the practical application of knowledge and learned skills with real world clients. Understanding client perspectives of these programs may provide insights to improve clinics and maximise outcomes for clients and students. This study aimed to evaluate the perceptions and experiences of people with a metabolic condition (n=9) who participated in a student-led digital health exercise physiology clinic. Eligible participants were adults with overweight or obesity and/or a metabolic condition who completed a six-week clinic comprising weekly individual video consultations for exercise prescription and support (including a wearable activity monitor and asynchronous individual program via mobile app). Focus groups were conducted with participants within two weeks of clinic completion. Participant feedback was aligned against the constructs of the Theoretical Framework of Acceptability. Three key themes were identified: i) digital health clinics improve accessibility to exercise physiology services, but introduce an ongoing technical burden, ii) student exercise physiologists are valued, irrespective of their experience level, iii) technology issues are common and challenging for digital health service, but technology features are important to participants. Participants had positive feelings towards the clinic, appreciated the accessibility of the sessions and praised the empathetic and helpful nature of the student exercise physiologists. Challenges to acceptability included technological issues and inefficiencies with clinic structure (such as lack of technical orientation). This student-led digital health exercise physiology clinic had positive participant experiences and high client acceptability from this sample.