Kade Davison

Background: Healthy lifestyle behaviors, including a balanced diet, regular physical activity, adequate sleep, avoiding tobacco, moderating alcohol consumption, and stress management, are associated with reduced risk of chronic disease and improved well-being. In recent years, digital interventions have emerged as cost-effective platforms for promoting these behaviors, yet few have been integrated into services delivered by certified exercise practitioners (CEPs) or focused on multiple domains of health. Objective: This study aimed to examine changes in health behaviors during implementation of the Food, Exercise, Sleep, and Stress (FESS) web-based questionnaire as an adjunct to traditional face-to-face services provided by CEPs and compare these changes across 2 prompting frequencies. Methods: A 2-arm, randomized pre-post intervention design was conducted with 41 participants (23 women), with a median age of 65 (IQR 58‐70) years, who were recruited from CEP clinics. Participants were randomized to complete the FESS questionnaire either 3 times per week (3-day group, n=21) or daily (everyday group, n=20) for 12 weeks. The questionnaire tracked health behaviors across 4 domains and provided health tips. Outcomes were assessed using the assessment version of the FESS questionnaire at baseline and at 6 and 12 weeks. Changes in FESS questionnaire responses were examined over time using Friedman ANOVA with Wilcoxon signed-rank post hoc tests. Group differences between prompting frequencies were assessed by calculating changes in questionnaire responses from baseline to 6 and 12 weeks and analyzing them using the Mann-Whitney U test. Compliance was assessed by calculating the proportion of completed FESS questionnaires relative to the total number of questionnaires prescribed for each participant within each intervention arm. Validity of the exercise domain was evaluated by comparing self-reported physical activity and sedentary time from daily FESS responses with accelerometer-derived measures in a subsample of participants. Results: Positive or no changes were observed across most behaviors, with significant improvements in vegetable consumption, water intake, stress, and sleep. Group comparisons indicated larger changes in stress and sleep behaviors in the everyday group; however, compliance was higher in the 3-day group. Compliance declined over time in both groups. Accelerometer validation of the exercise domain showed low rates of overreporting exercise (3/59, 5.1%) and underreporting sedentary behavior (11/59, 18.6%). Conclusions: The FESS questionnaire demonstrated feasibility and was associated with observed changes in health behaviors, particularly in diet, stress, and sleep, when integrated into CEP services. While daily use was associated with larger observed changes, reduced compliance highlights the importance of flexible engagement strategies. These preliminary findings suggest that CEP services may benefit from embedding structured digital tools into traditional face-to-face interactions, as such tools may support education, promote reflection and accountability between sessions, and facilitate attention to a broader range of lifestyle factors within routine CEP care. Further controlled studies are required to confirm these findings.

Background: Underwater therapy uses the physical properties of water to facilitate exercise and rehabilitation for people living with disability, injury, and/or illness and has been used in the management of a range of musculoskeletal, neurological, and other health conditions. Immersion Therapy™ (IT) is a novel form of underwater therapy that uses scuba equipment to facilitate individually tailored exercise and rehabilitation in a fully submerged environment. This study aimed to explore the perceived physical, social, and psychological impacts of IT on clients who participated in the program, and to develop a comprehensive understanding of their views of the service. Methods: This was a two-stage study incorporating both quantitative and qualitative approaches. The first stage comprised a descriptive analysis of service-related survey data completed by 80 unique clients and healthcare providers, including a qualitative content analysis of free-text responses. The second stage involved a qualitative descriptive exploration (n = 10), using semi-structured interviews with clients and, in some cases, their care providers, to examine experiences of the service in greater depth. Results: The findings suggest that clients, healthcare providers, and caregivers perceived IT as contributing to a range of biopsychosocial benefits, with participants reporting feelings of inclusion, equality, and empowerment. While physical benefits were also reported, these were perceived as secondary to the social and emotional benefits of participation. Conclusions: IT was perceived as a valued and beneficial intervention, and further development and more rigorous evaluation of this mode of therapy are warranted.

Background: Behaviour-change outcomes are often incompletely reported in multidomain trials. We evaluated behaviour change during a 12-month Mediterranean diet (MedDiet) and physical activity (PA) intervention.Participants and Setting: Adults aged 60 to 90 years without cognitive impairment, independently living in two Australian cities.Methods: n=83 participants (MedWalk group) were supported over 12 months to consume a MedDiet and engage in at least 150 minutes of moderate to vigorous PA (MVPA) per week. Control group participants (n=73) maintained habitual diet and PA. Four validated measures (MedWalk MedDiet Adherence Screener (MW-MEDAS), MedDiet Score, accelerometry-derived MVPA and MET minutes by International Physical Activity Questionnaire-elderly) were analysed separately and combined into a total adherence score to determine change in behaviour from baseline. Differences within and between groups were analysed at baseline, 6-months and 12-months using linear mixed effect modelling, controlling for predictors of attrition and baseline group differences.Results: Participants were 74% female, with a mean±SD age of 74.9 ± 5.9 years. After 12 months, MW-MEDAS had increased by an average of 3.3/14 points, and total adherence score by 1.4/8 points in the MedWalk group (p<.001), with no significant change in the control group. There were no significant changes in dietary behaviours in the control group, and MVPA declined in both groups at 6 months.Conclusions: The MedWalk intervention improved overall adherence among older adults over 12 months, driven by an increase in MedDiet adherence. PA did not increase, potentially due to high baseline PA or challenges in changing PA behaviours.

Professional standards are used to inform and measure educational programs and individual credentialling of many professions, including those in allied health. The objective of this project was to develop consensus on international professional standards for clinical exercise physiologists. The project employed an e-Delphi approach to build a consensus, being guided by a steering committee and an expert working group. The expert working group reviewed the elements and the steering committee overviewed the results of each round. The expert working group were invited to consider whether elements should be included or excluded and, if to be included, whether these should be core or non-core. The wording of the elements was also checked for accuracy. To be included in the end professional standards and as core, each element required 80% consensus from the expert working group. The e-Delphi process found consensus on four overarching professional standard domains for clinical exercise physiology: professional practice; foundational knowledge; assessment and client management; and case formulation and design and delivery of evidence-based interventions. Consensus was also achieved on individual elements. All bar two of the elements were accepted as core, with these two both being included in the professional standards since they were close to meeting the 80% consensus threshold and because they are reflected in the clinical exercise physiology professional standards where this profession is established. The international professional standards consensus has been achieved with the aim of supporting the development of a standardised approach to international education and practice in clinical exercise physiology.

BACKGROUND Healthy lifestyle behaviors, including a balanced diet, regular physical activity, adequate sleep, avoiding tobacco, moderating alcohol consumption, and stress management, are associated with reduced risk of chronic disease and improved well-being. In recent years, digital interventions have emerged as cost-effective platforms for promoting these behaviors, yet few have been integrated into service delivered by certified exercise practitioners (CEPs) or focused on multiple domains of health. OBJECTIVE This study evaluated the effectiveness, compliance, and validity of the Food, Exercise, Sleep and Stress (FESS) web-based questionnaire as an adjunct to traditional face-to-face services provided by CEPs. METHODS A two-arm, pre-post intervention design was conducted with 41 participants (23 female) with a median age of 65 years (interquartile range 58-70) were recruited from CEP clinics in South Australia. Participants were randomized to complete the FESS questionnaire either three times per week (3-day group, n=21) or daily (Everyday group, n=20) for 12 weeks. The questionnaire tracked health behaviors across four domains and provided health tips and advice. Outcomes were assessed using the assessment version of the FESS questionnaire at baseline, and at 6 and 12 weeks. Effectiveness of the FESS questionnaire was evaluated using Friedman’s ANOVA with Wilcoxon signed-rank post-hoc tests. Group differences were assessed by calculating changes in questionnaire responses from baseline to 6 and 12 weeks, analyzed with the Mann-Whitney U test. Compliance was assessed by calculating the proportion of completed FESS questionnaires relative to the total number of questionnaires prescribed for each participant by intervention arm. Validity of the exercise domain was evaluated by comparing self-reported physical activity and sedentary time from daily FESS responses with concurrent accelerometer-derived measures in a subsample of participants. RESULTS Positive or no changes were observed across most behaviors, with significant improvements in vegetable consumption, water intake, stress, and sleep. Group comparisons indicated greater improvements in stress and sleep behaviors in the Everyday group; however, compliance was higher in the 3-day group. Compliance declined over time in both groups. Accelerometer validation showed low rates of overreporting exercise (5.1%) and underreporting sedentary behavior (18.6%). CONCLUSIONS The FESS questionnaire demonstrated feasibility and effectiveness in supporting positive lifestyle changes, particularly in diet, stress, and sleep, when integrated into CEP services. While daily use may enhance outcomes, reduced compliance highlights the importance of flexible engagement strategies. These findings suggest that CEP services may benefit from embedding structured digital tools into traditional face-to-face interactions, as such tools can provide education, promote reflection and accountability between sessions, and address a broader range of lifestyle factors to enhance the care that CEPs deliver.

Background: In perioperative settings exercise testing can be used to assess a patient's physical fitness, with VO ₂ max used as a marker to indicate fitness and subsequent risk of adverse surgical outcomes. However, the commonly used reporting methods of VO ₂ max may be problematic in populations with excessive FM such as those awaiting MBS for obesity. Hence, alternative ways of expressing VO ₂ max will be explored. Methods: Historical data from individuals presenting for MBS were analyzed. Predicted VO ₂ max values were adjusted relative to the participants measured and “normative” body mass, where each prediction was assigned a classification score. Predicted VO ₂ max adjusted to the participants measured FFM was also considered. Data were compared to individuals that are lean and sedentary as well as those with obesity from a previous study. Results: Data from 20 participants awaiting MBS (43.15 ± 11.82 years, 68.50 ± 8.39 cm, 115.29 ± 16.82 kg and 59.93 ± 8.69 kg FFM) were examined. Predicted VO ₂ max relative: to total mass was 20.15 ± 5.00 mL/kg/min; normative body mass was 30.04 ± 6.58 mL/kg/min; and FFM was 38.55 ± 9.08 mL/kg FFM/min. Median fitness classifications increased from very poor to poor when predicted VO ₂ max was expressed relative to normative body mass. Conclusions: Reporting predicted VO ₂ max results relative to body mass may be underestimating fitness and overestimating surgical risk in people who are very obese.

Background: Obesity affects over one billion people globally and is a leading contributor to chronic disease. For those with clinically severe obesity, metabolic and bariatric surgery (MBS) is the most effective intervention for long-term weight loss. However, surgery is often delayed due to systemic barriers, during which time patients may experience further health decline. Low cardiorespiratory fitness is a known risk factor for perioperative complications, prompting recommendations for prehabilitation to target readiness for surgery. Despite this, few patients meet physical activity guidelines, and supervised preoperative exercise programs are rarely offered in routine care. Telehealth-delivered exercise programs offer a promising solution, but evidence of their feasibility, acceptability, and impact in the MBS setting remains limited. Objective: This study (BARI-Prehab) aims to assess the efficacy and acceptability of a telehealth-delivered prehabilitation exercise program in improving cardiometabolic health among patients awaiting MBS. Methods: In this multicenter, open-label, randomized controlled trial, we will randomize 48 adult participants (1:1) to either usual care (control group) or a 4-week telehealth exercise intervention. The primary outcome is aerobic capacity (VO2 in mL/kg/min at the anaerobic threshold), measured using cardiopulmonary exercise testing. Secondary outcomes include resting heart rate, heart rate variability, resting metabolic rate, body composition, grip strength, and 7-day physical activity. Intervention acceptability will also be evaluated. Results: Data collection and analysis are ongoing. This trial, funded in September 2020, will evaluate the capacity of a telehealth exercise program to improve cardiometabolic health and determine its suitability for implementation in the MBS preoperative pathway. Following initial protocol development, ethics approval, and trial setup, the clinical phase formally commenced with registration on June 16, 2023. Enrollment is ongoing, with a projected end date of March 2026. As of May 2025, a total of 220 patients have been screened for participation, of whom 30 have enrolled in the trial. The first results are expected to be submitted for publication by mid-2026. Conclusions: The BARI-Prehab trial will provide evidence on the acceptability and impact of a remotely delivered exercise intervention in the context of MBS. These findings will have implications for the design of accessible, scalable preoperative care models. The significance of this research lies in its potential to guide clinical practice, inform policy, and improve health outcomes for patients undergoing MBS. Trial Registration: ClinicalTrials.gov NCT05235945; https://clinicaltrials.gov/study/NCT05235945 International Registered Report Identifier (IRRID): DERR1-10.2196/77538

To consolidate and evaluate meta-analyses reporting the effects of blood flow restricted exercise (BFRE) on measures of health and physical fitness across all populations. This preregistered umbrella review followed PRISMA guidelines. A comprehensive search of five databases identified meta-analyses evaluating the effects of BFRE interventions (aerobic, resistance, combined) compared to exercising and non-exercising control conditions on measures of health and performance. A multilevel meta-analysis of standardised mean differences (SMDs) was conducted to examine the effects of BFRE. Subgroup analyses were conducted for the participant and intervention characteristics. Risk of bias was assessed using the AMSTAR-2. 47 meta-analyses comprised of 265 unique studies were included. All reviews were rated as low-moderate quality. BFRE had a small effect on hypertrophy (SMD ​= ​0.39, p ​< ​0.001) and a moderate effect on strength (SMD ​= ​0.61, p ​< ​0.001) when compared to low load, but not high load resistance training (hypertrophy, SMD = −0.13, p ​= ​0.142; strength, SMD = -0.28, p ​< ​0.001). BFRE had small-to-moderate effects on aerobic fitness (SMD = 0.50, p ​< ​0.001), vascular health (SMD = 0.45, p ​< ​0.001), blood pressure (SMD = 0.46, p ​< ​0.001), and muscular power (SMD = 0.56, p ​< ​0.001). BFRE had no effect on physical function (SMD = 0.16, p ​= ​0.096), pain (SMD = 0.00, p ​= ​0.996), and speed (SMD = 0.22, p ​= ​0.213). BFRE is a viable option to improve hypertrophy, strength, aerobic fitness, and vascular health across various populations, though its effects on hypertrophy and strength are smaller when compared to traditional high load resistance training. It doesn't appear to offer any additional benefits than other training methods for physical function, pain, or speed, although sub-analyses suggest further research is warranted in select areas of application.

Objectives: People living with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) may face unique barriers to physical activity. Active video games may overcome these barriers and increase physical activity. The primary aim of this pilot study was to determine the feasibility and acceptability of active video games to increase physical activity levels of people with ME/CFS. Methods: A mixed method design was employed. Adults living with ME/CFS were randomised to a six-month intervention of (1) pacing, (2) pacing and conventional physical activity, or (3) pacing and active video gaming. Feasibility and acceptability were determined through semi-structured interviews. Health-related outcomes (e.g., physical activity, blood samples, quality of life, and functioning) were also collected. Results: Fifteen people were assigned an intervention group with 12 completing. Three themes were identified from post-intervention interviews (1) positivity led to overall acceptability, (2) flexibility enabled participant autonomy, and (3) knowledge was gained about the self. No changes were seen in physical activity levels. An active video gaming intervention is acceptable but not feasible for people living with ME/CFS. Conclusions: Taken together, results suggest that physical activity can be managed safely by some people living with ME/CFS. Trial registration ACTRN12616000285459.