ObjectivesWhile there is strong evidence that regular participation in physical activity (PA) brings numerous health benefits to older adults, and interventions to effectively promote PA are being developed and tested, the characteristics and components of the most effective interventions remain unclear. This systematically conducted review of systematic reviews evaluated the effects and characteristics of PA promotion interventions aimed at community dwelling people over 50 years old.MethodsMajor databases were searched for reviews from January 1990 to May 2015. TIDieR guidelines aided data extraction and the ROBIS tool was used to assess the risk of bias. Primary outcomes were objective and self-reported levels of PA. Indicators of psychological wellbeing and participation rates were secondary outcomes.ResultsOf 1284 records identified, 19 reviews met inclusion criteria and eight included meta-analyses. Interventions typically incorporated behaviour change techniques (BCTs) and were delivered as face-to-face, remote, group, individual or as combined interventions. Despite their heterogeneity, interventions often resulted in sustained improvements in PA over the study period, typically at 12 months, and led to improvements in general wellbeing. However, ways to ensure effective maintenance beyond one year are unclear. Certain intervention components were more clearly associated with positive effects (e.g. tailoring promotion strategy with combination of cognitive and behavioural elements, low to moderate intensity activity recommended). We found no evidence that certain other intervention characteristics were superior in achieving positive outcomes (e.g. mode of delivery, setting, professional background of the intervention provider, type of PA recommended).ConclusionThe evidence suggests that interventions to promote PA among older adults are generally effective but there is uncertainty around the most beneficial intervention components. There are indications that purely cognitive strategies and BCTs might be less suitable for older adults than motivators more meaningful to them, including social and environmental support, and enjoyment coming from being physically active. A whole system-oriented approach is required that is tailored to meet the needs of older adults and aligned with social, individual and environmental factors.

Undertaking a RCT of art participation within stroke rehabilitation was feasible. Art participation may enhance self-efficacy and positively influence emotional wellbeing. These should be outcomes in a future definitive trial. A cluster RCT would ensure art groups could be reliably convened. Fewer measures, and better retention strategies are required. Implications for Rehabilitation This feasibility randomised controlled trial (RCT) showed that recruiting and retaining stroke survivors in an RCT of a visual arts participation intervention within stroke rehabilitation was feasible. Preference to participate in art activities may influence recruitment and drop-out rates, and should be addressed and evaluated fully. Art participation as part of rehabilitation may improve some aspects of post-stroke wellbeing, including positive affect and self-efficacy for art. A future definitive cluster RCT would facilitate full evaluation of the value art participation can add to rehabilitation.

1Social context, art making processes and creative output: A qualitative study exploring how psychosocial benefits of art participation occur during stroke rehabilitation ABSTRACT PurposeTo explore stroke survivors' and artists' beliefs about participatory visual arts programme participation during in-patient rehabilitation to identify benefits and potential mechanisms of action. MethodQualitative design using semi-structured in-depth interviews with stroke survivors (n=11) and artists (n=3).Analysis: Data was audio-recorded and transcribed. Framework approach was used to identify themes and develop conceptual schemes. ResultsThe non-medical, social context of art facilitated social interaction, provided enjoyment and distraction from stroke and re-established social identity thereby improving mood. The processes of art-making generated confidence and self-efficacy, setting and achievement of creative, communication and physical recovery goals that provided control over survivors' situation and hope for recovery. Creative output involved completion of artwork and display for viewing. This enhanced self-esteem and improved mood, providing survivors with new identities through positive appraisal of the work by others. Self-efficacy, hope and control appeared to mediate benefits. ConclusionThis study provides a model of intervention components, mechanisms of action and outcome mediators to explain how art participation may work. Findings suggest that art may influence important psychosocial outcomes that other rehabilitation approaches do not typically address. The study paves the way for a future effectiveness trial. BACKGROUND

Improvement measurement is usually focused on measuring intended , with minimal use of balancing measures which when used, typically monitor expected before implementation. This paper proposes that improvers and leaders should seek a balanced accounting of all consequences of improvement across the life of an improvement programme, including deliberately pausing after implementation to identify and quantitatively or qualitatively evaluate any or