Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: The range of benefits associated with regular physical activity participation are irrefutable. Despite the well-known benefits, physical inactivity remains one of the major contributing factors to ill-health throughout industrialised countries. Traditional lifestyle interventions such as group education sessions or telephone counselling are effective at increasing physical activity participation, however physical activity levels tend to decline over time. Wearable activity trackers that allow users to objectively monitor activity levels are now widely available and may offer an alternative method for assisting individuals to remain physically active. Objective: This review aims to determine the effects of interventions utilising consumer-based wearable activity trackers on physical activity participation and sedentary behaviour when compared to interventions that do not utilise activity tracker feedback. Methods: A systematic review was performed searching the following databases for studies that included the use of an activity tracker to improve physical activity participation: CENTRAL, MEDLINE, PubMed, Scopus, Web of Science, CINHAL, SPORTDiscus and HTA. Controlled trials of adults comparing the use of an activity tracker to other non-activity tracker based interventions were included. The main outcome measures were physical activity participation and sedentary behaviour. All studies were assessed for risk of bias and the GRADE system was used to rank the quality of evidence. The guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement were followed. A random-effects meta-analyses was completed on the included outcome measures to estimate the treatment effect of interventions that included an activity tracker compared to a control group. Results: There was a significant increase in daily step count (SMD: 0.24; 95% CI 0.16 to 0.33; p=<0.0001), MVPA (SMD: 0.27; 95% CI 0.15 to 0.39; p=<0.0001) and energy expenditure (SMD 0.28; 95%CI 0.03 to 0.54; p=0.03) and a non-significant decrease in sedentary behaviour (SMD -0.20; 95% CI -0.43 to 0.03; p=0.08) following the intervention versus control comparator across all studies in the meta-analyses. Conclusions: Utilising an activity tracker as either the primary component of an intervention or as part of a broader physical activity intervention has the potential to increase physical activity participation. As the effects of physical activity interventions are often short-term, the inclusion of an activity tracker may provide an effective tool to assist health professionals to provide ongoing monitoring and support.

Acute hospital services account for the largest proportion of health care system budgets, and older adults are the most frequent users. As a result, older people who have been recently discharged from hospital may be at greater risk of readmission. This study aims to evaluate the comparative effectiveness of transitional care interventions on unplanned hospital readmissions within 28 days, 12 weeks and 24 weeks following hospital discharge. The present study was a randomised controlled trial (ACTRN12608000202369). The trial involved 222 participants who were recruited from medical wards in two metropolitan hospitals in Australia. Participants were eligible for inclusion if they were aged 65 years and over, admitted with a medical diagnosis and had at least one risk factor for readmission. Participants were randomised to one of four groups: standard care, exercise program only, Nurse Home visit and Telephone follow-up (N-HaT), or Exercise program and Nurse Home visit and Telephone follow-up (ExN-HaT). Socio-demographics, health and functional ability were assessed at baseline, 28 days, 12 weeks and 24 weeks. The primary outcome measure was unplanned hospital readmission which was defined as any hospital admission for an unforeseen or unplanned cause. Participants in the ExN-HaT or the N-HaT groups were 3.6 times and 2.6 times respectively significantly less likely to have an unplanned readmission 28 days following discharge (ExN-HaT group HR 0.28, 95% CI 0.09–0.87, p = 0.029; N-HaT group HR 0.38, 95% CI 0.13–1.07, p = 0.067). Participants in the ExN-HaT or the N-HaT groups were 2.13 and 2.63 times respectively less likely to have an unplanned readmission in the 12 weeks after discharge (ExN-HaT group HR 0.47, 95% CI 0.23–0.97, p = 0.014; N-HaT group HR 0.38, 95% CI 0.18–0.82, p = 0.040). At 24 weeks after discharge, there were no significant differences between groups. Multifaceted transitional care interventions across hospital and community settings are beneficial, with lower hospital readmission rates observed in those receiving more transitional intervention components, although only in first 12 weeks. Australian and New Zealand Clinical Trial Registry ( ACTRN12608000202369 ).