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Snuggs S, Clot S, Lamport D, Sah A, Forrest J, Helme Guizon A, Kaur A, Iqbal Z, Caldara C, Wilhelm MC, Anin C, Vogt J. A mixed-methods approach to understanding barriers and facilitators to healthy eating and exercise from five European countries: highlighting the roles of enjoyment, emotion and social engagement. Psychol Health 2023:1-28. [PMID: 37933459 DOI: 10.1080/08870446.2023.2274045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/17/2023] [Indexed: 11/08/2023]
Abstract
Healthy adults are consistently falling below national and international recommendations for physical activity and dietary intake across Europe. This study took a co-creative approach with adult samples from five European countries to qualitatively and quantitatively establish motivators, barriers and sustaining factors for positive health behaviour change. Stage 1 delivered a newly-designed online programme, creating a community who identified challenges, motivators and solutions to sustaining positive healthy eating and physical activity behaviours. Stage 2 administered an online survey (developed from Stage 1 findings) to a larger sample to quantify the relative importance of these motivators and barriers. Results from both stages indicated enjoyment, positive emotions, and reward as key motivators for both behaviours across all five countries. Barriers included habit-breaking difficulties, temptation and negative affective states. Those with a high BMI placed more importance on social pressure than those with healthy BMI. Participants' reports of motivators and barriers reflected relevant approaches from consumer science, behavioural economics, and psychology. Interventions supporting adults who are not chronically ill but would benefit from improved diet and/or physical activity should not focus exclusively on health as a motivating factor. Emphasis on enjoyable behaviours, social engagement and reward will likely improve engagement and sustained behaviour change.
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Affiliation(s)
- Sarah Snuggs
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Sophie Clot
- Department of Economics, University of Reading, Reading, UK
| | - Daniel Lamport
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Anumeha Sah
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Joseph Forrest
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | | | - Amanpreet Kaur
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Zara Iqbal
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Cindy Caldara
- Univ. Grenoble Alpes, Grenoble INP, CERAG, Grenoble, France
| | | | - Camille Anin
- Univ. Grenoble Alpes, Grenoble INP, CERAG, Grenoble, France
| | - Julia Vogt
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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2
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Paulsen L, Benz L, Bojkowska I, Domokos B, Müller C, Wallmann-Sperlich B, Bucksch J. Forschungsprojekt EUBeKo. PRA¨VENTION UND GESUNDHEITSFO¨RDERUNG 2023. [PMCID: PMC10148008 DOI: 10.1007/s11553-023-01036-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/20/2023] [Indexed: 09/07/2023]
Abstract
Hintergrund Bewegung ist über eine Reihe sozialökologischer Bedingungsfaktoren zu verstehen, an welchen eine erfolgreiche Bewegungsförderung ansetzen muss. Kommunen nehmen dabei eine bedeutende Rolle ein, da sie gesundheitsförderliche Verhältnisse ermöglichen können. Häufig wird die Konzipierung, Umsetzung und Evaluierung sozialökologischer Ansätze jedoch nicht systematisch und theoriegeleitet abgeleitet. Veränderungen in den Verhältnissen werden durch das Verhalten und die Entscheidungen sog. „change agents“ bzw. kommunaler Entscheidungstragender, wie z. B. Bürgermeister:innen, beeinflusst. Daher ist es wichtig, Einflussfaktoren auf Entscheidungsprozesse zu kennen, um Überzeugungsarbeit für Bewegungsförderung in der Kommune zu leisten. Zudem braucht es Multiplikator:innen (z. B. Mitarbeitende in Gesundheitsämtern), die Kompetenzen besitzen, verhältnisorientierte Interventionen in Kommunen systematisch umzusetzen. Zielstellung und Projektverlauf Das Forschungsprojekt „Entscheidungs- und Umsetzungsprozesse verhältnisorientierter Bewegungsförderung in der Kommune für mehr Chancengerechtigkeit systematisch planen und implementieren“ (EUBeKo) wurde im Rahmen des Förderschwerpunkts „Bewegung und Bewegungsförderung“ des Bundesministeriums für Gesundheit gefördert. In diesem Beitrag werden das Projekt EUBeKo mit seinen zwei Forschungsfragen zum einen nach der Rolle und den Kompetenzen von Multiplikator:innen und zum anderen nach den Einflussfaktoren auf kommunale Entscheidungsprozesse sowie die Planung und Umsetzung verhältnisorientierter Bewegungsförderung in zwei Modellkommunen als auch die Strategien der Dissemination (z. B. Projekt-Webseite) beschrieben. Diskussion und Schlussfolgerungen Zu den Stärken des Projekts zählt die systematische und theoriegeleitete Aufbereitung und Durchführung eines Prozesses verhältnisorientierter Bewegungsförderung in der Kommune mit besonderem Fokus auf Planungs- und Entscheidungsprozesse sowie auf die Zielgruppen der kommunalen Multiplikator:innen und Entscheidungstragenden. Herausforderungen finden sich im Theorie-Praxis-Transfer und in den Auswirkungen der COVID-19-Pandemie („coronavirus disease 2019“) auf die Projektumsetzung.
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Affiliation(s)
- Lisa Paulsen
- Abteilung Prävention und Gesundheitsförderung, Fakultät für Natur- und Gesellschaftswissenschaften, Pädagogische Hochschule Heidelberg, Heidelberg, Deutschland
| | - Lea Benz
- Abteilung Prävention und Gesundheitsförderung, Fakultät für Natur- und Gesellschaftswissenschaften, Pädagogische Hochschule Heidelberg, Heidelberg, Deutschland
| | - Izabela Bojkowska
- Abteilung Prävention und Gesundheitsförderung, Fakultät für Natur- und Gesellschaftswissenschaften, Pädagogische Hochschule Heidelberg, Heidelberg, Deutschland
| | - Bruno Domokos
- Institut für Sportwissenschaft, Julius-Maximilians-Universität Würzburg, Würzburg, Deutschland
| | - Christina Müller
- Institut für Sportwissenschaft, Julius-Maximilians-Universität Würzburg, Würzburg, Deutschland
| | | | - Jens Bucksch
- Abteilung Prävention und Gesundheitsförderung, Fakultät für Natur- und Gesellschaftswissenschaften, Pädagogische Hochschule Heidelberg, Heidelberg, Deutschland
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Mathews E, Sauzet O, Thankappan KR. Effectiveness of a physical activity intervention program using peer support among sedentary women in Thiruvananthapuram City, India: results of a non-randomized quasi experimental study. Wellcome Open Res 2021; 6:87. [PMID: 34095510 PMCID: PMC8145223 DOI: 10.12688/wellcomeopenres.16618.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Interventions to promote physical activity are very limited in India. The objective of this study was to assess the effectiveness and sustainability of a peer support based physical activity (PA) intervention targeting sedentary women in Thiruvananthapuram City, India
. Methods: We used a non-randomized quasi-experimental study design with a comparison group. Using the Global Physical Activity Questionnaire (GPAQ) classifications, 401 sedentary women aged 18-64 years were selected by multistage cluster sampling and enrolled into the intervention (n=200) and control (n=201) arms. For the intervention arm, a culturally relevant intervention was delivered to the community stakeholders, participants and peer leaders at three subsequent intensities: intense (three months), less intense (three months) and no intervention (six months). The intervention consisted of a non-communicable disease (NCD) risk assessment, educational workshop, group counselling sessions, goal setting, handbook and peer support. The control participants received printed information on NCDs and their risk factors. PA assessments and anthropometric measurements were made at baseline, 4
th, 7
th and 13
th months. Mixed model analysis was done to assess the difference in PA levels between groups at various time points. Results: The proportion of women who were physically active (≥600 MET minutes per week) was significantly higher in the intervention arm compared to the control arm at 4
th (58.5 % vs 10%, p= 0.001), 7
th (48.5% vs 6%, p= 0.001)) and 13
th month (29.6 % vs 0.6%, p =0.001), respectively. Improvements from baseline PA expended by the intervention arm compared to the control arm in MET-min / week were 990, 575, and 466 at 4
th, 7
th and 13
th months, respectively. Conclusions: A PA intervention using peer support was found to be effective among women in India. Improvements in PA in the intervention arm decreased over time particularly after the no-intervention phase indicating the need for integrating it with community organizations.
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Affiliation(s)
- Elezebeth Mathews
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, 671315, India
| | - Odile Sauzet
- Zentrum für Statistik, Universität Bielefeld, Bielefeld, Germany
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Duval S, Van't Hof JR, Oldenburg NC, Eder M, Finnegan JR, Luepker RV. A community-based group randomized trial to increase aspirin use for primary prevention of cardiovascular disease: Study protocol and baseline results for the "Ask About Aspirin" initiative. Contemp Clin Trials Commun 2021; 22:100772. [PMID: 34027223 DOI: 10.1016/j.conctc.2021.100772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 04/03/2021] [Accepted: 04/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background USPSTF evidence-based recommendations for the use of low-dose aspirin for primary prevention of cardiovascular disease were published in 2009. We describe a statewide campaign using innovative methods to educate the public and health communities about appropriate aspirin use. Methods/design The "Ask About Aspirin" initiative is designed to lower the number of first heart attacks and strokes in the State of Minnesota by promoting the appropriate use of low dose aspirin. A health system intervention combined with an aspirin awareness media campaign will be evaluated in a pragmatic group randomized controlled trial including 267 primary care clinics within 84 health systems over a four year period. Matched pairs of geographic territories will be randomized to intervention (12 territories) or control (12 territories). The primary outcome of appropriate aspirin use will be measured at the individual level, by community-based telephone surveys of 100 participants in each of the 24 geographically determined clusters. Discussion We briefly describe the rationale for the interventions being studied, as well as the major design choices. Rigorous research designs such as the one described here are necessary to determine whether evidence-based recommendations can be effectively disseminated in multiple health systems. Trial registration ClinicalTrials.gov: NCT02607917.
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Affiliation(s)
- Sue Duval
- Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jeremy R Van't Hof
- Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Niki C Oldenburg
- Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Milton Eder
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - John R Finnegan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Russell V Luepker
- Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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5
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Sweeney AM, Wilson DK, Pate R, Van Horn ML, McIver K, Dowda M. The role of parental support for youth physical activity transportation and community-level poverty in the healthy communities study. J Behav Med 2021; 44:563-570. [PMID: 33768390 DOI: 10.1007/s10865-021-00213-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 03/09/2021] [Indexed: 01/01/2023]
Abstract
This study evaluates whether parental provision of transportation for physical activity is associated with child/adolescent moderate-to-vigorous physical activity, while also evaluating community-level poverty. Self- and parental-reported surveys were administered with parents/caregivers and children in the Healthy Communities Study (N = 5138). Associations between individual-level demographics, community-level poverty, parental provision of transportation for physical activity, and moderate-to-vigorous physical activity were examined in multi-level models. Even when accounting for community-level poverty, which was significantly associated with lower moderate-to-vigorous physical activity, parental provision of transportation for physical activity was positively associated with greater moderate-to-vigorous physical activity. This study provides evidence for the importance of considering multiple systems of influence (e.g., community and individual factors) and considering how gaps in physical activity transportation for youth can be addressed in future health policies.
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Affiliation(s)
- Allison M Sweeney
- College of Nursing, University of South Carolina, Columbia, SC, 29201, USA.
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina, Columbia, SC, 29201, USA
| | - Russell Pate
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29201, USA
| | - M Lee Van Horn
- Department of Educational Psychology, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Kerry McIver
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29201, USA
| | - Marsha Dowda
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29201, USA
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6
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Freak-Poli RLA, Cumpston M, Albarqouni L, Clemes SA, Peeters A. Workplace pedometer interventions for increasing physical activity. Cochrane Database Syst Rev 2020; 7:CD009209. [PMID: 32700325 PMCID: PMC7389933 DOI: 10.1002/14651858.cd009209.pub3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The World Health Organization (WHO) recommends undertaking 150 minutes of moderate-intensity physical activity per week, but most people do not. Workplaces present opportunities to influence behaviour and encourage physical activity, as well as other aspects of a healthy lifestyle. A pedometer is an inexpensive device that encourages physical activity by providing feedback on daily steps, although pedometers are now being largely replaced by more sophisticated devices such as accelerometers and Smartphone apps. For this reason, this is the final update of this review. OBJECTIVES To assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving long-term health outcomes. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Occupational Safety and Health (OSH) UPDATE, Web of Science, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform from the earliest record to December 2016. We also consulted the reference lists of included studies and contacted study authors to identify additional records. We updated this search in May 2019, but these results have not yet been incorporated. One more study, previously identified as an ongoing study, was placed in 'Studies awaiting classification'. SELECTION CRITERIA We included randomised controlled trials (RCTs) of workplace interventions with a pedometer component for employed adults, compared to no or minimal interventions, or to alternative physical activity interventions. We excluded athletes and interventions using accelerometers. The primary outcome was physical activity. Studies were excluded if physical activity was not measured. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. When studies presented more than one physical activity measure, we used a pre-specified list of preferred measures to select one measure and up to three time points for analysis. When possible, follow-up measures were taken after completion of the intervention to identify lasting effects once the intervention had ceased. Given the diversity of measures found, we used ratios of means (RoMs) as standardised effect measures for physical activity. MAIN RESULTS We included 14 studies, recruiting a total of 4762 participants. These studies were conducted in various high-income countries and in diverse workplaces (from offices to physical workplaces). Participants included both healthy populations and those at risk of chronic disease (e.g. through inactivity or overweight), with a mean age of 41 years. All studies used multi-component health promotion interventions. Eleven studies used minimal intervention controls, and four used alternative physical activity interventions. Intervention duration ranged from one week to two years, and follow-up after completion of the intervention ranged from three to ten months. Most studies and outcomes were rated at overall unclear or high risk of bias, and only one study was rated at low risk of bias. The most frequent concerns were absence of blinding and high rates of attrition. When pedometer interventions are compared to minimal interventions at follow-up points at least one month after completion of the intervention, pedometers may have no effect on physical activity (6 studies; very low-certainty evidence; no meta-analysis due to very high heterogeneity), but the effect is very uncertain. Pedometers may have effects on sedentary behaviour and on quality of life (mental health component), but these effects were very uncertain (1 study; very low-certainty evidence). Pedometer interventions may slightly reduce anthropometry (body mass index (BMI) -0.64, 95% confidence interval (CI) -1.45 to 0.18; 3 studies; low-certainty evidence). Pedometer interventions probably had little to no effect on blood pressure (systolic: -0.08 mmHg, 95% CI -3.26 to 3.11; 2 studies; moderate-certainty evidence) and may have reduced adverse effects (such as injuries; from 24 to 10 per 100 people in populations experiencing relatively frequent events; odds ratio (OR) 0.50, 95% CI 0.30 to 0.84; low-certainty evidence). No studies compared biochemical measures or disease risk scores at follow-up after completion of the intervention versus a minimal intervention. Comparison of pedometer interventions to alternative physical activity interventions at follow-up points at least one month after completion of the intervention revealed that pedometers may have an effect on physical activity, but the effect is very uncertain (1 study; very low-certainty evidence). Sedentary behaviour, anthropometry (BMI or waist circumference), blood pressure (systolic or diastolic), biochemistry (low-density lipoprotein (LDL) cholesterol, total cholesterol, or triglycerides), disease risk scores, quality of life (mental or physical health components), and adverse effects at follow-up after completion of the intervention were not compared to an alternative physical activity intervention. Some positive effects were observed immediately at completion of the intervention periods, but these effects were not consistent, and overall certainty of evidence was insufficient to assess the effectiveness of workplace pedometer interventions. AUTHORS' CONCLUSIONS Exercise interventions can have positive effects on employee physical activity and health, although current evidence is insufficient to suggest that a pedometer-based intervention would be more effective than other options. It is important to note that over the past decade, technological advancement in accelerometers as commercial products, often freely available in Smartphones, has in many ways rendered the use of pedometers outdated. Future studies aiming to test the impact of either pedometers or accelerometers would likely find any control arm highly contaminated. Decision-makers considering allocating resources to large-scale programmes of this kind should be cautious about the expected benefits of incorporating a pedometer and should note that these effects may not be sustained over the longer term. Future studies should be designed to identify the effective components of multi-component interventions, although pedometers may not be given the highest priority (especially considering the increased availability of accelerometers). Approaches to increase the sustainability of intervention effects and behaviours over a longer term should be considered, as should more consistent measures of physical activity and health outcomes.
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Affiliation(s)
- Rosanne LA Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Miranda Cumpston
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Loai Albarqouni
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Stacy A Clemes
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Anna Peeters
- Institute for Health Transformation, Deakin University, Geelong, Australia
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7
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Physical Activity Interventions After Hip or Knee Joint Replacement: a Systematic Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00275-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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8
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Murray JM, Brennan SF, French DP, Patterson CC, Kee F, Hunter RF. Mediators of Behavior Change Maintenance in Physical Activity Interventions for Young and Middle-Aged Adults: A Systematic Review. Ann Behav Med 2019; 52:513-529. [PMID: 29672666 DOI: 10.1093/abm/kay012] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Regular physical activity is important for maintaining physical and mental health. Benefits are optimized when physical activity is maintained. Understanding causal mechanisms is important to inform future interventions. Purpose To investigate mediators of physical activity maintenance. Methods Six databases were searched (Medline, EMBASE, PsycINFO, CINAHL, Cochrane Database of Systematic Reviews, and Web of Science). Eligibility criteria included adult nonclinical populations, validated measure of physical activity behavior at baseline and at least 6 months postbaseline, control/comparison group(s), and reported mediators of physical activity behavior change. Mediators were examined according to (i) formal mediation tests, (ii) mediator association with physical activity outcome, and (iii) intervention effects on mediators. Results There were few formal mediation tests conducted (n = 12/39 included studies), and various other methodological limitations were identified. There was some evidence that effective mediators in formal mediation tests at 6 months and later included the "behavioral processes of change" (n = 5/6). Many of the included interventions were not effective for changing targeted mediators (only 34% of 413 tests of mediator changes were significant). Conclusions There were a number of methodological and statistical limitations in the evidence base. In future, prespecified formal mediation tests should be carried out and could be aided by a formal framework. Social and environmental variables should be considered in addition to intrapersonal variables. Improving knowledge of how to change hypothesized mediators, based on theory and evidence, will reveal how physical activity behavior change maintenance can be achieved. Maintenance research would be enhanced by establishing a formal definition of behavior change "maintenance." PROSPERO registration: PROSPERO 2015:CRD- 42015025462.
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Affiliation(s)
- Jennifer M Murray
- Centre for Public Health Research/UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, UK
| | - Sarah F Brennan
- Centre for Public Health Research/UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, UK
| | - David P French
- Department for Health Psychology, Manchester Centre of Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK
| | - Christopher C Patterson
- Centre for Public Health Research/UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, UK
| | - Frank Kee
- Centre for Public Health Research/UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, UK
| | - Ruth F Hunter
- Centre for Public Health Research/UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, UK
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9
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Tully MA, Cunningham C, Wright A, McMullan I, Doherty J, Collins D, Tudor-Locke C, Morgan J, Phair G, Laventure B, Simpson EEA, McDonough SM, Gardner E, Kee F, Murphy MH, Agus A, Hunter RF, Hardeman W, Cupples ME. Peer-led walking programme to increase physical activity in inactive 60- to 70-year-olds: Walk with Me pilot RCT. PUBLIC HEALTH RESEARCH 2019. [DOI: 10.3310/phr07100] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background
Levels of physical activity decline with age. Some of the most disadvantaged individuals in society, such as those with a lower rather than a higher socioeconomic position, are also the most inactive. Peer-led physical activity interventions may offer a model to increase physical activity in these older adults and thus help reduce associated health inequalities. This study aims to develop and test the feasibility of a peer-led, multicomponent physical activity intervention in socioeconomically disadvantaged community-dwelling older adults.
Objectives
The study aimed to develop a peer-led intervention through a rapid review of previous peer-led interventions and interviews with members of the target population. A proposed protocol to evaluate its effectiveness was tested in a pilot randomised controlled trial (RCT).
Design
A rapid review of the literature and the pilot study informed the intervention design; a pilot RCT included a process evaluation of intervention delivery.
Setting
Socioeconomically disadvantaged communities in the South Eastern Health and Social Care Trust and the Northern Health and Social Care Trust in Northern Ireland.
Participants
Fifty adults aged 60–70 years, with low levels of physical activity, living in socioeconomically disadvantaged communities, recruited though community organisations and general practices.
Interventions
‘Walk with Me’ is a 12-week peer-led walking intervention based on social cognitive theory. Participants met weekly with peer mentors. During the initial period (weeks 1–4), each intervention group participant wore a pedometer and set weekly step goals with their mentor’s support. During weeks 5–8 participants and mentors met regularly to walk and discuss step goals and barriers to increasing physical activity. In the final phase (weeks 9–12), participants and mentors continued to set step goals and planned activities to maintain their activity levels beyond the intervention period. The control group received only an information booklet on active ageing.
Main outcome measures
Rates of recruitment, retention of participants and completeness of the primary outcome [moderate- and vigorous-intensity physical activity measured using an ActiGraph GT3X+ accelerometer (ActiGraph, LLC, Pensacola, FL, USA) at baseline, 12 weeks (post intervention) and 6 months]; acceptability assessed through interviews with participants and mentors.
Results
The study planned to recruit 60 participants. In fact, 50 eligible individuals participated, of whom 66% (33/50) were female and 80% (40/50) were recruited from general practices. At 6 months, 86% (43/50) attended for review, 93% (40/43) of whom returned valid accelerometer data. Intervention fidelity was assessed by using weekly step diaries, which were completed by both mentors and participants for all 12 weeks, and checklists for the level of delivery of intervention components, which was high for the first 3 weeks (range 49–83%). However, the rate of return of checklists by both mentors and participants diminished thereafter. Outcome data indicate that a sample size of 214 is required for a definitive trial.
Limitations
The sample was predominantly female and somewhat active.
Conclusions
The ‘Walk with Me’ intervention is acceptable to a socioeconomically disadvantaged community of older adults and a definitive RCT to evaluate its effectiveness is feasible. Some modifications are required to ensure fidelity of intervention delivery is optimised. Future research needs to identify methods to recruit males and less active older adults into physical activity interventions.
Trial registration
Current Controlled Trials ISRCTN23051918.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 10. See the NIHR Journals Library website for further project information. Funding for the intervention was gratefully received from the Health Improvement Division of the Public Health Agency.
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Affiliation(s)
- Mark A Tully
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
- UK Clinical Research Collaboration, Centre of Excellence for Public Health Northern Ireland, Belfast, UK
- Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey, UK
- Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health, School of Health Sciences, Ulster University, Newtownabbey, UK
| | - Conor Cunningham
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
- UK Clinical Research Collaboration, Centre of Excellence for Public Health Northern Ireland, Belfast, UK
| | - Ashlene Wright
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
- UK Clinical Research Collaboration, Centre of Excellence for Public Health Northern Ireland, Belfast, UK
| | - Ilona McMullan
- UK Clinical Research Collaboration, Centre of Excellence for Public Health Northern Ireland, Belfast, UK
- Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health, School of Health Sciences, Ulster University, Newtownabbey, UK
| | - Julie Doherty
- Psychology Research Institute, Ulster University, Coleraine, UK
| | - Debbie Collins
- Department of General Practice, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Catrine Tudor-Locke
- Department of Kinesiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Joanne Morgan
- UK Clinical Research Collaboration, Centre of Excellence for Public Health Northern Ireland, Belfast, UK
- Community Development and Health Network, Newry, UK
| | - Glenn Phair
- Northern Ireland Clinical Trials Unit, The Royal Hospitals, Belfast, UK
| | | | | | - Suzanne M McDonough
- UK Clinical Research Collaboration, Centre of Excellence for Public Health Northern Ireland, Belfast, UK
- Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health, School of Health Sciences, Ulster University, Newtownabbey, UK
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Evie Gardner
- Northern Ireland Clinical Trials Unit, The Royal Hospitals, Belfast, UK
| | - Frank Kee
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
- UK Clinical Research Collaboration, Centre of Excellence for Public Health Northern Ireland, Belfast, UK
| | - Marie H Murphy
- Centre for Physical Activity and Health Research, Ulster University, Newtownabbey, UK
| | - Ashley Agus
- Northern Ireland Clinical Trials Unit, The Royal Hospitals, Belfast, UK
| | - Ruth F Hunter
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
- UK Clinical Research Collaboration, Centre of Excellence for Public Health Northern Ireland, Belfast, UK
| | - Wendy Hardeman
- Health Promotion Research Group, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Margaret E Cupples
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
- UK Clinical Research Collaboration, Centre of Excellence for Public Health Northern Ireland, Belfast, UK
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10
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Kamada M, Kitayuguchi J, Abe T, Taguri M, Inoue S, Ishikawa Y, Bauman A, Lee IM, Miyachi M, Kawachi I. Community-wide intervention and population-level physical activity: a 5-year cluster randomized trial. Int J Epidemiol 2019; 47:642-653. [PMID: 29228255 PMCID: PMC5913653 DOI: 10.1093/ije/dyx248] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2017] [Indexed: 11/15/2022] Open
Abstract
Background Evidence from a limited number of short-term trials indicates the difficulty in achieving population-level improvements in physical activity (PA) through community-wide interventions (CWIs). We sought to evaluate the effectiveness of a 5-year CWI for promoting PA in middle-aged and older adults using a cluster randomized design. Methods We randomized 12 communities in Unnan, Japan, to either intervention (9) or control (3). Additionally, intervention communities were randomly allocated to three subgroups by different PA types promoted. Randomly sampled residents aged 40–79 years responded to the baseline survey (n = 4414; 74%) and were followed at 1, 3 and 5 years (78–83% response rate). The intervention was a 5-year CWI using social marketing to promote PA. The primary outcome was a change in recommended levels of PA. Results Compared with control communities, adults achieving recommended levels of PA increased in intervention communities [adjusted change difference = 4.6 percentage points (95% confidence interval: 0.4, 8.8)]. The intervention was effective for promoting all types of recommended PAs, i.e. aerobic (walking, 6.4%), flexibility (6.1%) and muscle-strengthening activities (5.7%). However, a bundled approach, which attempted to promote all forms of PAs above simultaneously, was not effective (1.3–3.4%, P ≥ 0.138). Linear dose–response relationships between the CWI awareness and changes in PA were observed (P ≤ 0.02). Pain intensity decreased in shoulder (intervention and control) and lower back (intervention only) but there was little change difference in all musculoskeletal pain outcomes between the groups. Conclusions The 5-year CWI using the focused social marketing strategy increased the population-level of PA.
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Affiliation(s)
- Masamitsu Kamada
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Shinjuku-ku, Tokyo, Japan.,Physical Education and Medicine Research Center UNNAN, Unnan, Shiman, Japan
| | - Jun Kitayuguchi
- Physical Education and Medicine Research Center UNNAN, Unnan, Shiman, Japan
| | - Takafumi Abe
- Physical Education and Medicine Research Center UNNAN, Unnan, Shiman, Japan.,Center for Community-Based Healthcare Research and Education (CoHRE), Shimane University, Izumo, Shimane, Japan
| | - Masataka Taguri
- Department of Biostatistics and Epidemiology, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Shigeru Inoue
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yoshiki Ishikawa
- Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Adrian Bauman
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - I-Min Lee
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Motohiko Miyachi
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Shinjuku-ku, Tokyo, Japan
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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11
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Obling KH, Overgaard K, Juul L, Maindal HT. Effects of a motivational, individual and locally anchored exercise intervention (MILE) on cardiorespiratory fitness: a community-based randomised controlled trial. BMC Public Health 2019; 19:239. [PMID: 30819145 PMCID: PMC6393962 DOI: 10.1186/s12889-019-6556-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 02/15/2019] [Indexed: 11/23/2022] Open
Abstract
Background Risk factors for chronic disease, including low cardiorespiratory fitness levels (VO2max), are often present in middle-aged populations. We aimed to evaluate the efficacy of a motivational, individual, and locally anchored physical activity intervention on increasing VO2max in 30–49 year-olds with low VO2max. Methods 232 adult volunteers with low VO2max were randomised to intervention (n = 115) or routine care (n = 117). The intervention included four motivational interviews; six months’ free membership to a local sports club; and a GPS-watch/activity monitor for uploading training data to an online platform/community. Routine care was one or two motivational interviews. Inclusion criteria were low VO2max based on the cut off levels: ≤ 39 and ≤ 35 ml O2/kg/min. For 30–39 and 40–49 year-old men respectively and ≤ 33 and ≤ 31 ml O2/kg/min for 30–39 and 40–49 year-old women, respectively. The primary outcome was change in VO2max from baseline to twelve months estimated with a maximal ergometer bicycle test. Secondary outcomes included physical activity, biochemical and anthropometric measures, and health-related quality of life. The primary analyses were based on all available data and sensitivity- and predefined sex analyses were performed. The between-group differences were estimated using independent t-tests and presented with 95% confidence intervals. Results No significant between-group differences in primary or secondary outcomes were found at twelve months’ follow-up. The mean VO2max change from baseline in the intervention- and routine care (ml/kg/min) was 3.8 (95% CI: 2.6; 5.0) and 3.4 (95% CI: 1.7; 5.2), respectively. No changes in physical activity were observed. The mean VO2max (ml/kg/min) changes from baseline in the intervention- and routine care group in men were: 5.0 (95% CI: 3.5; 6.4) and 3.5 (95% CI: 1.5; 5.4); and in women: 1.5 (95% CI: -0.1; 3.1) and 3.4 (95% CI: -0.1; 7.8), respectively. Significant differences in VO2max between non-completers (44.2%) and completers were observed, 26.3 (95% CI: 25.1; 27.5) vs 28.2 ml/kg/min (95% CI: 27.1; 29.0; p = 0.02). Sensitivity analyses did not change the main result. Conclusion Offering a multi-component physical activity intervention to 30–49 year-olds with low levels of VO2max had no effect on the change in VO2max from baseline to twelve months compared with routine care. Trial registration ClinicalTrials.gov (no. NCT01801956). Registered 1 March 2013.
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Affiliation(s)
- Kirstine Høj Obling
- Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
| | - Kristian Overgaard
- Department of Public Health, Section for Sport Science, Aarhus University, Dalgas Avenue 4, 8000, Aarhus C, Denmark
| | - Lise Juul
- Department of Clinical Medicine, Danish Center for Mindfulness, Aarhus University, Jens Chr. Skous Vej 4, 8000, Aarhus C, Denmark
| | - Helle Terkildsen Maindal
- Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
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12
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Changes in Sedentary and Active Lifestyle, Diet Quality and Body Composition Nine Months after an Education Program in Polish Students Aged 11⁻12 Years: Report from the ABC of Healthy Eating Study. Nutrients 2019; 11:nu11020331. [PMID: 30717465 PMCID: PMC6412996 DOI: 10.3390/nu11020331] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 12/18/2018] [Accepted: 01/22/2019] [Indexed: 11/25/2022] Open
Abstract
The sustainability of education focused on improving the dietary and lifestyle behaviours of teenagers has not been extensively studied. The aim of this study was to determine the sustainability of diet-related and lifestyle-related school-based education on sedentary and active lifestyle, diet quality and body composition of Polish pre-teenagers in a medium-term follow-up study. An education-based intervention study was carried out on 464 students aged 11–12 years (educated/control group: 319/145). Anthropometric measurements were taken and body mass index (BMI) and waist-to-height ratios (WHtR) were calculated, both at the baseline and after nine months. Dietary data from a short-form food frequency questionnaire (SF-FFQ4PolishChildren) were collected. Two measures of lifestyle (screen time, physical activity) and two diet quality scores (pro-healthy, pHDI, and non-healthy, nHDI) were established. After nine months, in the educated group (vs. control) a significantly higher increase was found in nutrition knowledge score (mean difference of the change: 1.8 points) with a significantly higher decrease in physical activity (mean difference of the change: −0.20 points), nHDI (−2.3% points), the z-WHtR (−0.18 SD), and the z-waist circumference (−0.13 SD). Logistic regression modelling with an adjustment for confounders revealed that after nine months in the educated group (referent: control), the chance of adherence to a nutrition knowledge score of at least the median was over 2 times higher, and that of the nHDI category of at least the median was significantly lower (by 35%). In conclusion, diet-related and lifestyle-related school-based education from an almost one-year perspective can reduce central adiposity in pre-teenagers, despite a decrease in physical activity and the tendency to increase screen time. Central adiposity reduction can be attributed to the improvement of nutrition knowledge in pre-teenagers subjected to the provided education and to stopping the increase in unhealthy dietary habits.
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13
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Lucertini F, Ferri Marini C, Sisti D, Stocchi V, Federici A, Gregorio F, Piangerelli D, Chiatti C, Cherubini A, Boemi M, Romagnoli F, Cucchi M, D'Angelo F, Luconi MP, Bonfigli AR. Discontinuously supervised aerobic training vs. physical activity promotion in the self-management of type 2 diabetes in older Italian patients: design and methods of the 'TRIPL-A' randomized controlled trial. BMC Geriatr 2019; 19:11. [PMID: 30634923 PMCID: PMC6330458 DOI: 10.1186/s12877-018-1022-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 12/20/2018] [Indexed: 12/03/2022] Open
Abstract
Background Physical activity (PA) has health benefits for people with type 2 diabetes (T2D). Indeed, regular PA is considered an important part of any T2D management plan, yet most patients adopt a sedentary lifestyle. Exercise referral schemes (ERS) have the potential to effectively promote physical activity among T2D patients, and their effectiveness may be enhanced when they are supported by computer-based technologies. The ‘TRIPL-A’ study (i.e., a TRIal to promote PhysicaL Activity among patients in the young-old age affected by T2D) aims to assess if realizing an innovative ERS, based on a strong partnership among general practitioners, specialist physicians, exercise specialists, and patients, and supported by a web-based application (WBA), can effectively lead sedentary older T2D patients to adopt an active lifestyle. Methods A randomized controlled design will be used, and an ERS, supported by a WBA, will be implemented. 300 physically inactive T2D patients (aged 65–74 years) will be assigned to either an intervention or control arm. Control arm patients will only receive behavioral counseling on physical activity and diet, while intervention arm patients will also undergo an 18-month (3 day/week), discontinuously supervised aerobic exercise training program. The trial will be divided into six three-month periods: during first, third and fifth period, an exercise specialist will supervise the training sessions and, using the WBA, prescribe exercise progression and monitor exercise adherence. Patients will exercise on their own in the other periods. Patients’ sedentary behaviors (primary outcome), PA level, fitness status, metabolic profile, psychological well-being, quality of life, and use of health care services (secondary outcomes) will be assessed at baseline and at 6, 12, and 18 months from baseline. Repeated measure ANCOVAs will be used to compare the intervention and control arm with respect to each study outcome measure. Discussion Primary and secondary outcome results will allow us to evaluate the effectiveness of an ERS, specifically designed for the management of T2D clinical conditions and supported by a WBA, in promoting PA within Italian primary care settings. Trial registration This trial is retrospectively registered under the Australian New Zealand Clinical Trials Registry (reference number: ACTRN12618001164280; registered 13 July 2018).
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Affiliation(s)
- Francesco Lucertini
- Department of Biomolecular Sciences - Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Via I Maggetti, 26/2 -61029, Urbino, PU, Italy.
| | - Carlo Ferri Marini
- Department of Biomolecular Sciences - Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Via I Maggetti, 26/2 -61029, Urbino, PU, Italy
| | - Davide Sisti
- Department of Biomolecular Sciences - Unit of Medical Statistic and Biometry, University of Urbino Carlo Bo, Piazza Rinascimento, 7-61029, Urbino, PU, Italy
| | - Vilberto Stocchi
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Via I Maggetti, 26/2-61029, Urbino, PU, Italy
| | - Ario Federici
- Department of Biomolecular Sciences - Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Via I Maggetti, 26/2 -61029, Urbino, PU, Italy
| | - Franco Gregorio
- ASUR Marche - Diabetology Unit, Via Montello, 4-60035, Jesi, Italy
| | - Donata Piangerelli
- IRCCS INRCA, Scientific Direction, Via della Montagnola, 81-60127, Ancona, Italy
| | - Carlos Chiatti
- IRCCS INRCA, Scientific Direction, Via della Montagnola, 81-60127, Ancona, Italy
| | - Antonio Cherubini
- IRCCS INRCA, Geriatria, Accettazione Geriatrica, Centro di Ricerca per l'Invecchiamento, Via della Montagnola, 81-60127, Ancona, Italy
| | - Massimo Boemi
- IRCCS INRCA, Diabetology Unit, Via della Montagnola, 81-60127, Ancona, Italy
| | - Fabio Romagnoli
- IRCCS INRCA, Diabetology Unit, Via della Montagnola, 81-60127, Ancona, Italy
| | - Michela Cucchi
- IRCCS INRCA, Diabetology Unit, Via della Montagnola, 81-60127, Ancona, Italy
| | - Federica D'Angelo
- IRCCS INRCA, Diabetology Unit, Via della Montagnola, 81-60127, Ancona, Italy
| | - Maria Paola Luconi
- IRCCS INRCA, Diabetology Unit, Via della Montagnola, 81-60127, Ancona, Italy
| | - Anna Rita Bonfigli
- IRCCS INRCA, Scientific Direction, Via della Montagnola, 81-60127, Ancona, Italy
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14
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Bammann K, Drell C, Lübs LL, Stalling I. Cluster-randomised trial on participatory community-based outdoor physical activity promotion programs in adults aged 65-75 years in Germany: protocol of the OUTDOOR ACTIVE intervention trial. BMC Public Health 2018; 18:1197. [PMID: 30352580 PMCID: PMC6199784 DOI: 10.1186/s12889-018-6124-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/15/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Despite its well-known benefits for health and well-being physical activity levels are insufficient and declining with age in Germany. Physical activity promotion programs for older adults are often not successful, one reason is insufficient relevance of intervention measures for the study population. Community-based participatory research (CBPR) is a possible key strategy for tailoring more meaningful intervention programs to a specific community. However, evidence for the effectiveness of CBPR in the general population is scarce. This study aims to formally evaluate the efficacy of a CBPR approach for developing and implementing an outdoor physical activity program for older adults. METHODS/DESIGN The OUTDOOR ACTIVE intervention trial is a cluster-randomised intervention study carried out in a random sample of eight subdistricts in the city of Bremen, Germany. The eight subdistricts are grouped into four homogenous pairs with regard to socioeconomic level and land use mix of the subdistrict. Within the pairs, the subdistricts are assigned randomly to the two study arms: participatory development and implementation of a community-based program to promote outdoor physical activity (intervention) versus no intervention (controls). For evaluation, a survey is carried out before (baseline) and after (follow-up) the intervention period. The measurements include 7-day accelerometer measurement, physical fitness test, blood pressure, basic anthropometry, and self-administered questionnaire. DISCUSSION The OUTDOOR ACTIVE intervention trial will provide detailed information on PA intervention for older adults in an urban setting. Through the participatory nature of the study it will provide valuable insights into drivers and barriers to PA in this group, and it will inform policy makers and other stakeholders how to benefit from the results. TRIAL REGISTRATION German Clinical Trials Register DRKS00015117 (Date of registration 17-07-2018).
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Affiliation(s)
- Karin Bammann
- Institute for Public Health and Nursing Sciences (IPP), University of Bremen, Bremen, Germany
| | - Carina Drell
- Institute for Public Health and Nursing Sciences (IPP), University of Bremen, Bremen, Germany
| | - Lena Lotte Lübs
- Institute for Public Health and Nursing Sciences (IPP), University of Bremen, Bremen, Germany
| | - Imke Stalling
- Institute for Public Health and Nursing Sciences (IPP), University of Bremen, Bremen, Germany
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15
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Pate RR, Frongillo EA, McIver KL, Colabianchi N, Wilson DK, Collie-Akers VL, Schultz JA, Reis J, Madsen K, Woodward-Lopez G, Berrigan D, Landgraf A, Nagaraja J, Strauss W. Associations between community programmes and policies and children's physical activity: the Healthy Communities Study. Pediatr Obes 2018; 13 Suppl 1:72-81. [PMID: 29900697 PMCID: PMC6197914 DOI: 10.1111/ijpo.12426] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 03/22/2018] [Accepted: 04/10/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Community initiatives to promote physical activity in children are common, but evidence supporting their effectiveness is limited. OBJECTIVES The objective of this study is to examine the relationships between community programmes and policies and children's physical activity in a large and diverse sample of US communities. METHODS Programmes and policies to promote children's physical activity were assessed in 130 communities by key informant interviews, and physical activity behaviours were measured by self-report and parental report in samples of children in each community (total n = 5138). Associations between composite indices of community programmes and policies and indicators of total and moderate-to-vigorous physical activity were examined without and with adjustment for demographic factors. RESULTS An index reflecting the 6-year history of the number of behaviour change strategies used in community programmes and policies was positively associated with children's moderate-to-vigorous physical activity. This association was attenuated with adjustment for demographic factors. Effect modification analyses found that the association was positive among non-Hispanic children but was negative for Hispanic children. CONCLUSIONS Community initiatives to promote physical activity in children were positively associated with children's physical activity in non-Hispanic children. Such initiatives were negatively associated with physical activity in Hispanic children, suggesting that future research should consider unique cultural factors when designing community initiatives to promote activity in this population sub-group.
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Affiliation(s)
- Russell R. Pate
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Edward A. Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Kerry L. McIver
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | | | - Dawn K. Wilson
- Department of Psychology, University of South Carolina, Columbia, South Carolina
| | - Vicki L. Collie-Akers
- Work Group for Health and Community Development, University of Kansas, Lawrence, Kansas
| | - Jerry A. Schultz
- Work Group for Health and Community Development, University of Kansas, Lawrence, Kansas
| | - Jared Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Kristine Madsen
- Division of Community Health Sciences, School of Public Health, University of California at Berkeley, Berkeley, California
| | - Gail Woodward-Lopez
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Berkeley, California
| | - David Berrigan
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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16
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Community-wide physical activity intervention based on the Japanese physical activity guidelines for adults: A non-randomized controlled trial. Prev Med 2018; 107:61-68. [PMID: 29126918 DOI: 10.1016/j.ypmed.2017.11.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/07/2017] [Accepted: 11/02/2017] [Indexed: 11/22/2022]
Abstract
UNLABELLED Very few community intervention studies that promote physical activity (PA) using guidelines and its dissemination and implementation have been conducted. Consequently, we evaluated the effectiveness of a community-wide intervention (CWI) of PA with adults based on the Japanese guidelines for promoting PA. This was a non-randomized controlled trial, with four administrative districts in Fujisawa city assigned to the intervention group and nine to the control group. The CWI, conducted from 2013 to 2015, comprised information dissemination, education, and community support. The primary outcome was change in PA participation. Secondary outcomes were CWI awareness and PA guideline knowledge. Outcomes were assessed using questionnaires distributed to two independent, random samples of 3000 community-based adults (aged ≥20years). Two separate samples-1230 adults at baseline and 1393 at the two-year follow-up-responded to the survey. The median time spent in PA did not differ between intervention and control groups after adjusting for potential confounders (adjusted difference between groups=-0.02min/day [95% confidence interval (CI): -0.11, 0.10]). However, intervention group participants were more aware of the CWI (33.8%) than were control group participants (25.2%) at the two-year follow-up (odds ratio=1.44 [95% CI: 1.06, 1.95]). A significant difference was also observed in participants' PA guideline knowledge (adjusted difference between groups=0.82% [95% CI: 0.33, 1.31]). Although significant differences in awareness and knowledge were observed between groups, this CWI did not change PA levels over two years. Future studies should investigate the long-term effects of CWIs beyond two years. TRIAL REGISTRATION NUMBER UMIN-CTR UMIN000018389.
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17
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Wilson ML, Strayer TE, Davis R, Harden SM. Use of an Integrated Research-Practice Partnership to Improve Outcomes of a Community-Based Strength-Training Program for Older Adults: Reach and Effect of Lifelong Improvements through Fitness Together (LIFT). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E237. [PMID: 29385024 PMCID: PMC5858306 DOI: 10.3390/ijerph15020237] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 01/25/2018] [Accepted: 01/25/2018] [Indexed: 11/17/2022]
Abstract
Only 17% of older adults meet the recommendations for two days of full body strength training that is associated with improved functional fitness; reduced risk of falls; and reduced morbidity and mortality rates. Community-based interventions are recommended as they provide supportive infrastructure to reach older adults and impact strength training behaviors. Scalability and sustainability of these interventions is directly linked with setting-level buy-in. Adapting an intervention through an integrated research-practice partnership may improve individual and setting-level outcomes. The purpose of this study was to evaluate the initial reach and effect of a locally adapted, health educator-led strength-training intervention; Lifelong Improvements through Fitness Together (LIFT). LIFT was compared to an evidence-based exercise program, Stay Strong; Stay Healthy (SSSH). Intervention dose and mode were the same for LIFT and SSSH, but LIFT included behavioral change strategies. Older adult functional fitness was assessed before and after the 8-week strength training intervention. Health educators who delivered LIFT and SSSH were able to reach 80 and 33 participants, respectively. Participants in LIFT were able to significantly improve in all functional fitness measures whereas SSSH participants were only able to significantly improve in 5 of the 7 functional fitness measures. In conclusion, this study provides preliminary evidence that the locally adapted program reached more individuals and had improvements in functional fitness.
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Affiliation(s)
- Meghan L Wilson
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA.
| | - Thomas E Strayer
- Translational Biology, Medicine, and Health, Virginia Polytechnic Institute and State University, Roanoke, VA 24016, USA.
| | - Rebecca Davis
- Virginia Cooperative Extension, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA.
| | - Samantha M Harden
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA.
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18
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Harris MA. The relationship between physical inactivity and mental wellbeing: Findings from a gamification-based community-wide physical activity intervention. Health Psychol Open 2018; 5:2055102917753853. [PMID: 29372067 PMCID: PMC5774736 DOI: 10.1177/2055102917753853] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Mental ill health accounts for 13 per cent of total global disease burden with predictions that depression alone will be the leading cause of disease burden globally by 2030. Poor mental health is consistently associated with deprivation, low income, unemployment, poor education, poorer physical health and increased health-risk behaviour. A plethora of research has examined the relationship between physical activity and mental wellbeing; however, the influence of community-wide gamification-based physical activity interventions on mental wellbeing, to the authors' knowledge, is yet to be explored. In view of this paucity of attention, the current study examined the relationship between physical activity and mental wellbeing pre/post a community-wide, gamification-based intervention. The findings revealed that increases in mental wellbeing were significantly greater for the least active prior to the intervention, and a strong, positive correlation between increase in physical activity and increase in mental wellbeing was observed.
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Heredia NI, Lee M, Reininger BM. Exposure to a community-wide campaign is associated with physical activity and sedentary behavior among Hispanic adults on the Texas-Mexico border. BMC Public Health 2017; 17:883. [PMID: 29145821 PMCID: PMC5689162 DOI: 10.1186/s12889-017-4893-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/06/2017] [Indexed: 12/21/2022] Open
Abstract
Background Despite evidence for the use of community-wide campaigns to promote physical activity, few evaluations of community–wide campaigns in Hispanic communities exist. This study assessed the associations of exposure to a community-wide campaign with physical activity and sedentary behavior among Hispanic adults living on the Texas-Mexico border. Methods The intervention, Tu Salud ¡Si Cuenta! (Your Health Matters!; TSSC), included a newsletter, community health worker discussion, TV and radio segments, which were conducted from 2005 to 2010. We matched an intervention (N = 399) and a control community (N = 400) on demographics and used a cross-sectional assessment in 2010 with randomly sampled adults from both communities. We collected exposure to the campaign, as well as physical activity and sedentary behavior with the International Physical Activity Questionnaire. We conducted bivariate analyses and multivariable logistic regression models to assess the association of TSSC exposure and its components with meeting moderate-to-vigorous intensity physical activity (MVPA) guidelines and exhibiting excessive sedentary behavior, controlling for covariates. Results As compared to the control community, the intervention community has 3 times the odds of meeting MVPA guidelines (Adjusted OR [AOR] = 3.01, 95% CI = 1.85–4.88, p < .05) and 2 times lower odds of excessive sedentary behavior ((AOR = 0.46, 95% CI = 0.30–0.70, p < .05). Exposure in the intervention group to any component was associated with five times the odds of meeting MVPA guidelines (AOR = 5.10, 95% CI 2.88–9.03, p < .001) and 3 times lower odds of excessive sedentary behavior (AOR = 0.32, 95% CI 0.17–0.60, p < .001), compared with those unexposed in the control community. Exposure to newsletters, CHW discussions and TV segments were associated with significantly lower odds of excessive sedentary behavior and higher odds of meeting MVPA guidelines. Exposure to radio segments was only associated with a significantly higher odds of meeting MVPA guidelines (AOR = 4.21, 95% CI = 1.17–15.09). Conclusions This study provides some evidence of the association of community-wide campaigns and its components in Hispanic communities with higher levels of MVPA and lower levels of excessive sedentary behavior. Trial registration number NCT00788879 Date: November 11, 2008.
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Affiliation(s)
- Natalia I Heredia
- The University of Texas Health Science Center at Houston, School of Public Health, Center for Health Promotion and Prevention Research, 7000 Fannin St, Suite 2576E, Houston, Texas, 77030, USA.
| | - MinJae Lee
- Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Belinda M Reininger
- The University of Texas Health Science Center at Houston, School of Public Health, Brownsville Regional Campus, Houston, Texas, USA
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Physical activity: a synopsis and comment on "community-wide interventions for increasing physical activity". Transl Behav Med 2017; 7:39-42. [PMID: 27256576 DOI: 10.1007/s13142-016-0419-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
In this synopsis, we summarize and comment on Baker and colleagues' Cochrane review of studies on the population-level impact of community-wide physical activity (PA) interventions. Insufficient PA remains a major public health problem. Community-wide interventions offer an opportunity to extend reach by increasing the proportion of the population experiencing the intervention. A previous Cochrane review of community-wide PA interventions concluded that evidence for effectiveness was mixed. Hence, Baker and colleagues incorporated new data about community-based PA interventions. This Cochrane review concluded there is an overall lack of evidence that community-wide interventions improve PA outcomes at the population level. Recommendations are that future research should use high quality research design, more explicitly test ways to increase reach, and utilize objective measurements of PA to increase validity. We suggest that future research should first optimize the intervention by systematically evaluating treatment components and selecting a maximally efficient and effective treatment package.
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[Promoting a balanced diet and physical activity among children : Conditions for the successful implementation and maintenance of multi-level interventions and policies: Results of two qualitative case studies]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:1124-1138. [PMID: 28812123 DOI: 10.1007/s00103-017-2611-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND To date, conditions for successfully implementing and maintaining multi-level interventions and policies for the promotion of a balanced diet and physical activity are not well understood from the perspective of stakeholders. OBJECTIVE The aim of this article is to examine which factors are regarded as facilitating or impeding introduction, implementation and maintenance of multi-level interventions and policies from the standpoint of stakeholders. MATERIALS AND METHODS Semi-structured face-to-face interviews with stakeholders of one multi-level intervention (Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS [IDEFICS] for the prevention of childhood obesity, n = 4) and one policy (Federal state offices coordinating networks for the provision of healthy food options in schools, n = 3) were analysed using qualitative content analysis. RESULTS In both cases, the use of existing structures facilitated introduction, implementation and maintenance. Additionally, training of staff for implementation according to standardised protocols or concepts and taking structures and work conditions of settings into account during implementation were considered essential. In both cases, conflicting interests in interdisciplinary stakeholder teams regarding intervention content and implementation were identified as a barrier. A lack of political support and insecure long-term funding only played a role in regard to the implementation and maintenance of policies. On the other hand, target groups of the multi-level intervention were not sufficiently involved in the development of intervention materials which resulted in a lack of tailoring and acceptance in the target groups. CONCLUSIONS The results provide important insights into the long-term implementation of multi-level interventions and policies in different settings.
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Boulton ER, Horne M, Todd C. Multiple influences on participating in physical activity in older age: Developing a social ecological approach. Health Expect 2017; 21:239-248. [PMID: 28768065 PMCID: PMC5750764 DOI: 10.1111/hex.12608] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2017] [Indexed: 11/29/2022] Open
Abstract
Background Evidence of the benefits of engaging in physical activity (PA) is strong, yet the number of older adults meeting the recommended 150 min/wk is low. Policy to increase uptake and adherence has focussed on the health benefits of PA, but may not be the most successful approach. Objective This qualitative study sought to ask older adults what the components of a successful intervention to promote PA would be, by asking active older adults what motivated them to be active and asking inactive older adults what might encourage them to change. Design, setting and participants Focus groups and semi‐structured interviews were held with 60 community‐dwelling older adults, aged 50‐87 years. Framework analysis was used to analyse the data, and themes congruent with a social ecological model of behaviour change were developed. Findings Five themes emerged that influenced PA engagement at multiple levels: individual; interpersonal; perceived environment; community or organizational; and policy. PA engagement was determined by attitude or health status for some participants, but for the majority, PA being enjoyable, sociable, affordable, accessible, flexible and seasonal were more important than the health benefits. Discussion and conclusions A social ecological model is presented, highlighting the fact that both motivated and unmotivated older adults need to have a range of appropriately labelled, appealing and accessible activities to choose from when thinking about engaging in PA. Policymakers and practitioners need to ensure that their offers of activity sessions are easy to access and easy to remain involved in.
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Affiliation(s)
- Elisabeth R Boulton
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Manchester Academic Health Sciences Centre, Manchester, UK
| | - Maria Horne
- School of Healthcare, Faculty of Medicine and Health University of Leeds, Leeds, UK
| | - Chris Todd
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Manchester Academic Health Sciences Centre, Manchester, UK
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Heise TL, Romppel M, Molnar S, Buchberger B, van den Berg A, Gartlehner G, Lhachimi SK. Community gardening, community farming and other local community-based gardening interventions to prevent overweight and obesity in high-income and middle-income countries: protocol for a systematic review. BMJ Open 2017; 7:e016237. [PMID: 28619783 PMCID: PMC5726067 DOI: 10.1136/bmjopen-2017-016237] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/01/2017] [Accepted: 05/03/2017] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION The worldwide prevalence of overweight/obesity has continued to rise over the last decades. To reverse this trend, public health authorities are exploring cost-effective interventions, especially in high-income and middle-income countries. Community gardening offers a unique opportunity for individuals to enhance physical activity levels and improve their diet. However, synthesised evidence on the short-term or long-term effectiveness and on the costs of community gardening interventions to prevent overweight/obesity remains limited. Therefore, this review will investigate: (1) the effectiveness of voluntary participation in community gardening compared with no or a control intervention on overweight/obesity and associated health outcomes, (2) effects on different subgroups of populations and (3) the costs of community gardening interventions. METHODS AND ANALYSIS We will conduct a systematic review, limited to evaluations of community gardening interventions with controlled quantitative and interrupted time series designs. To identify relevant articles, we will systematically search 12 academic and 5 grey literature databases, as well as 2 trial registers and 6 websites. Articles will then be assessed for eligibility based on a predefined set of criteria. At least two independent reviewers will assess each article for relevance, before evaluating the methodological quality and potential bias of the studies. Data relevant to the objectives of this review will be extracted and cross-validated. Any disagreements will be mediated by a third reviewer. If feasible, meta-analyses of primary outcomes (overweight/obesity, physical activity, food intake, energy intake) will be conducted. We will use the Grading of Recommendations Assessment, Development and Evaluation method to assess the overall quality of evidence. ETHICS AND DISSEMINATION For this review, no ethical approval is required as we will only extract and analyse secondary data. We aim to submit the final review manuscript to an open access journal for publication and disseminate results via conferences and social media. TRIAL REGISTRATION NUMBER International Prospective Register of Systematic Reviews (PROSPERO)(CRD42017043696).
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Affiliation(s)
- Thomas L Heise
- Institute for Public Health and Nursing Research - IPP, Health Sciences Bremen, University of Bremen, Bremen, Germany
- Research Group for Evidence-Based Public Health, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Matthias Romppel
- Institute for Public Health and Nursing Research - IPP, Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Sandra Molnar
- Department of Non-Drug Interventions, Institute for Quality and Efficiency in Health Care - IQWiG, Cologne, Germany
| | - Barbara Buchberger
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Agnes van den Berg
- Faculty of Spatial Sciences, Department of Cultural Geography, University of Groningen, Groningen, The Netherlands
| | - Gerald Gartlehner
- Department for Evidence-based Medicine and Clinical Epidemiology, Danube University Krems, Krems, Austria
- RTI-International, Research Triangle Park, North Carolina, USA
| | - Stefan K Lhachimi
- Institute for Public Health and Nursing Research - IPP, Health Sciences Bremen, University of Bremen, Bremen, Germany
- Research Group for Evidence-Based Public Health, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
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Cauchi D, Glonti K, Petticrew M, Knai C. Environmental components of childhood obesity prevention interventions: an overview of systematic reviews. Obes Rev 2016; 17:1116-1130. [PMID: 27432025 DOI: 10.1111/obr.12441] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/05/2016] [Accepted: 05/23/2016] [Indexed: 02/05/2023]
Abstract
Childhood obesity has a complex multi-factorial aetiology grounded in environmental and individual level factors that affect behaviour and outcomes. An ecological, systems-based approach to addressing childhood obesity is increasingly being advocated. The primary aim of this review is to summarize the evidence reported in systematic reviews on the effectiveness of population-level childhood obesity prevention interventions that have an environmental component. We conducted a systematic review of reviews published since 1995, employing a standardized search strategy in nine databases. Inclusion criteria required that reviews be systematic and evaluated at least one population-level, environmental intervention in any setting aimed at preventing or reducing obesity in children (5-18 years). Sixty-three reviews were included, ten of which were of high quality. Results show modest impact of a broad range of environmental strategies on anthropometric outcomes. Systematic reviews vary in methodological quality, and not all relevant primary studies may be included in each review. To ensure relevance of our findings to practice, we also report on relevant underlying primary studies, providing policy-relevant recommendations based on the evidence reviewed. Greater standardization of review methods and reporting structures will benefit policymakers and public health professionals seeking informed decision-making.
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Affiliation(s)
- D Cauchi
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - K Glonti
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - M Petticrew
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - C Knai
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Nour M, Chen J, Allman-Farinelli M. Efficacy and External Validity of Electronic and Mobile Phone-Based Interventions Promoting Vegetable Intake in Young Adults: Systematic Review and Meta-Analysis. J Med Internet Res 2016; 18:e58. [PMID: 27059765 PMCID: PMC4841894 DOI: 10.2196/jmir.5082] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/07/2015] [Accepted: 01/22/2016] [Indexed: 11/28/2022] Open
Abstract
Background Young adults (18–35 years) remain among the lowest vegetable consumers in many western countries. The digital era offers opportunities to engage this age group in interventions in new and appealing ways. Objective This systematic review evaluated the efficacy and external validity of electronic (eHealth) and mobile phone (mHealth) -based interventions that promote vegetable intake in young adults. Methods We searched several electronic databases for studies published between 1990 and 2015, and 2 independent authors reviewed the quality and risk of bias of the eligible papers and extracted data for analyses. The primary outcome of interest was the change in vegetable intake postintervention. Where possible, we calculated effect sizes (Cohen d and 95% CIs) for comparison. A random effects model was applied to the data for meta-analysis. Reach and representativeness of participants, intervention implementation, and program maintenance were assessed to establish external validity. Published validation studies were consulted to determine the validity of tools used to measure intake. We applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to evaluate the overall quality of the body of evidence. Results Of the 14 studies that met the selection criteria, we included 12 in the meta-analysis. In the meta-analysis, 7 studies found positive effects postintervention for fruit and vegetable intake, Cohen d 0.14–0.56 (pooled effect size 0.22, 95% CI 0.11–0.33, I2=68.5%, P=.002), and 4 recorded positive effects on vegetable intake alone, Cohen d 0.11–0.40 (pooled effect size 0.15, 95% CI 0.04–0.28, I2=31.4%, P=.2). These findings should be interpreted with caution due to variability in intervention design and outcome measures. With the majority of outcomes documented as a change in combined fruit and vegetable intake, it was difficult to determine intervention effects on vegetable consumption specifically. Measurement of intake was most commonly by self-report, with 5 studies using nonvalidated tools. Longer-term follow-up was lacking from most studies (n=12). Risk of bias was high among the included studies, and the overall body of evidence was rated as low quality. The applicability of interventions to the broader young adult community was unclear due to poor description of external validity components. Conclusions Preliminary evidence suggests that eHealth and mHealth strategies may be effective in improving vegetable intake in young adults; whether these small effects have clinical or nutritional significance remains questionable. With studies predominantly reporting outcomes as fruit and vegetable intake combined, we suggest that interventions report vegetables separately. Furthermore, to confidently establish the efficacy of these strategies, better-quality interventions are needed for young adults, using valid measures of intake, with improved reporting on costs, sustainability and long-term effects of programs. Trial registration PROSPERO International Prospective Register of Systematic Reviews: CRD42015017763; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015017763 (Archived by WebCite at http://www.webcitation.org/6fLhMgUP4)
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Affiliation(s)
- Monica Nour
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, Australia.
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A tool to measure complexity in public health interventions: Its statistical properties and meta-regression approach to adjust it in meta-analysis. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2016. [DOI: 10.1016/j.cegh.2015.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Hendrie GA, Lease HJ, Bowen J, Baird DL, Cox DN. Strategies to increase children's vegetable intake in home and community settings: a systematic review of literature. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 26924706 DOI: 10.1111/mcn.12276] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 11/30/2015] [Accepted: 11/30/2015] [Indexed: 12/21/2022]
Abstract
A systematic review was undertaken to identify intervention characteristics associated with increasing consumption of vegetables in children (2-12 years). PubMed, PsychINFO and CABabstracts were used to identify studies published between 2004-2014 that had measures of vegetable consumption, a minimum of 3-month follow-up and were conducted in home and community settings (outside of schools). Twenty-two studies were included in the review. Details of the study design, population, setting, intervention characteristics, target behaviour, behaviour change techniques used and vegetable intake were extracted. Study quality and intensity were scored. Overall, 12/22 studies were effective short-term, and 6/10 were effective long-term (6 + months); mean short-term change in vegetable intake was 29%, equating to an increase of a quarter to a half of a serving of vegetables. Intervention effectiveness was associated with number of settings targeted and frequency of contact but not length of intervention. Planning for social support, vegetable exposure and provision of staff training were commonly used behaviour change techniques in effective interventions. This review has identified strategies that may optimise effectiveness of future home-based and community-based interventions aiming to increase vegetable intake in young children.
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Affiliation(s)
- Gilly A Hendrie
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Food and Nutrition, Adelaide, South Australia, Australia
| | - Haidee J Lease
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Food and Nutrition, Adelaide, South Australia, Australia
| | - Jane Bowen
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Food and Nutrition, Adelaide, South Australia, Australia
| | - Danielle L Baird
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Food and Nutrition, Adelaide, South Australia, Australia
| | - David N Cox
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Food and Nutrition, Adelaide, South Australia, Australia
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Seekamp S, Dollman J, Gilbert-Hunt S. Previously inactive rural adults' experiences of commencing and maintaining a walking routine following participation in a walking intervention. Aust J Rural Health 2015; 24:207-12. [PMID: 26694686 DOI: 10.1111/ajr.12254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study aimed to richly describe previously inactive Riverland adults' experiences of commencing and maintaining a walking routine following participation in a walking intervention. DESIGN Qualitative description using semi-structured in-depth interviews and thematic analysis. SETTING Riverland, South Australia. PARTICIPANTS Nine adults (four men and five women) aged between 40 and 65 years. INTERVENTION Six-week walking intervention included issuing of pedometers, setting goals, completing logs and weekly emails to remind participants to wear their pedometers, recording of steps and provision of strategies for increasing daily steps. MAIN OUTCOME MEASURES Rich description of participants' experiences represented by four themes and a number of subthemes, supported by direct quotes. RESULTS Four themes: taking care of me through my walk, pedometers and accountability as motivators, fitting walking in and commencing and maintaining a walking routine. CONCLUSIONS The participants' experience of commencing a walking routine differed from maintaining a walking routine. Future attempts to support maintenance of a walking routine may be strengthened through identifying and including ways to provide accountability for walking to others beyond the intervention as well as strategies that support the integration of walking into every activity. Furthermore, future walking interventions should enable participants to tailor their walks to their own preferences and mental health benefits of walking should be promoted at least as much as the physical benefits.
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Affiliation(s)
- Sarah Seekamp
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - James Dollman
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Susan Gilbert-Hunt
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Horodyska K, Luszczynska A, Hayes CB, O'Shea MP, Langøien LJ, Roos G, van den Berg M, Hendriksen M, De Bourdeaudhuij I, Brug J. Implementation conditions for diet and physical activity interventions and policies: an umbrella review. BMC Public Health 2015; 15:1250. [PMID: 26678996 PMCID: PMC4683715 DOI: 10.1186/s12889-015-2585-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 12/08/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This umbrella review aimed at identifying evidence-based conditions important for successful implementation of interventions and policies promoting a healthy diet, physical activity (PA), and a reduction in sedentary behaviors (SB). In particular, we examined if the implementation conditions identified were intervention-specific or policy-specific. This study was undertaken as part of the DEterminants of DIet and Physical Activity (DEDIPAC) Knowledge Hub, a joint action as part of the European Joint Programming Initiative a Healthy Diet for a Healthy Life. METHODS A systematic review of reviews and stakeholder documents was conducted. Data from nine scientific literature databases were analyzed (95 documents met the inclusion criteria). Additionally, published documentation of eight major stakeholders (e.g., World Health Organization) were systematically searched (17 documents met the inclusion criteria). The RE-AIM framework was used to categorize elicited conditions. Across the implementation conditions 25 % were identified in at least four documents and were subsequently classified as having obtained sufficient support. RESULTS We identified 312 potential conditions relevant for successful implementation; 83 of these received sufficient support. Using the RE-AIM framework eight implementation conditions that obtained support referred to the reach in the target population; five addressed efficacy of implementation processes; 24 concerned adoption by the target staff, setting, or institutions; 43 referred to consistency, costs, and adaptations made in the implementation process; three addressed maintenance of effects over time. The vast majority of implementation conditions (87.9 %; 73 of 83) were supported by documents referring to both interventions and policies. There were seven policy-specific implementation conditions, which focused on increasing complexities of coexisting policies/legal instruments and their consequences for implementation, as well as politicians' collaboration in implementation. CONCLUSIONS The use of the proposed list of 83 conditions for successful implementation may enhance the implementation of interventions and policies which pursue identification of the most successful actions aimed at improving diet, PA and reducing SB.
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Affiliation(s)
- Karolina Horodyska
- Department of Psychology, SWPS University of Social Sciences and Humanities, 30b Ostrowskiego St, 53238, Wroclaw, Poland.
| | - Aleksandra Luszczynska
- Department of Psychology, SWPS University of Social Sciences and Humanities, 30b Ostrowskiego St, 53238, Wroclaw, Poland.
- Trauma, Health, & Hazards Center, University of Colorado, 1861 Austin Bluffs Pkwy, Colorado Springs, CO, 80933-7150, USA.
| | - Catherine B Hayes
- Department of Public Health and Primary Care, Trinity College Dublin, Centre for Health Sciences, Tallaght Hospital, Dublin 24, Ireland.
| | - Miriam P O'Shea
- Department of Public Health and Primary Care, Trinity College Dublin, Centre for Health Sciences, Tallaght Hospital, Dublin 24, Ireland.
| | - Lars J Langøien
- Department for Physical Education, Norwegian School of Sport Sciences, P.O. BOX 4014, Ullevål Stadion, N-0806, Oslo, Norway.
| | - Gun Roos
- SIFO - National Institute for Consumer Research, P.O. BOX 4682, Nydalen, N-0405, Oslo, Norway.
| | - Matthijs van den Berg
- National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721, Bilthoven, The Netherlands.
| | - Marieke Hendriksen
- National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721, Bilthoven, The Netherlands.
| | - Ilse De Bourdeaudhuij
- Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium.
| | - Johannes Brug
- VU University Medical Center, Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
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Smit E, Leenaars KEF, Wagemakers MAE, Molleman GRM, Koelen MA, van der Velden J. Evaluation of the role of Care Sport Connectors in connecting primary care, sport, and physical activity, and residents' participation in the Netherlands: study protocol for a longitudinal multiple case study design. BMC Public Health 2015; 15:510. [PMID: 26597675 PMCID: PMC4657375 DOI: 10.1186/s12889-015-1841-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 05/14/2015] [Indexed: 11/10/2022] Open
Abstract
Background The number of people with one or more chronic diseases is increasing, but this trend could be reduced by promoting physical activity. Therefore, in 2012, the Dutch Ministry of Health, Welfare, and Sport introduced Care Sport Connectors (CSCs), to whom a broker role has been ascribed. The defined outcome of CSCs role is an increased number of residents participating in local sports facilities and being physically active in their own neighbourhood. To realize this, primary care and sports professionals need to collaborate, and local sports facilities and neighbourhoods need to offer accessible physical activities for people in the locality, including people with one or more chronic diseases or at increased risk of chronic disease(s). Adequate scientific research is needed to assess CSCs’ impact on: 1) connecting primary care, sport, and physical activity and 2) increasing the number of residents who engage in physical activity to promote their health. Methods and design To study the role and the impact of CSCs, a longitudinal multiple case study will be conducted, in nine municipalities spread over the Netherlands, from 2014 until 2017. A mixed methodology will be used to perform action research and process evaluation. Study I focuses on the expected alliances of CSCs and the preconditions that facilitate or hinder CSCs in the formation of these alliances. The study population will consist of intermediary target groups. A literature review, interviews, focus groups, and document analysis will be undertaken. Study II will concentrate on lifestyle program participants to identify health and physical activity behavior changes. For this purpose, interviews, literature studies, a Delphi study, fitness tests, and questionnaires will be used. Discussion Linking and integrating results gained by multiple methods, at different levels, will provide a validated assessment of CSCs’ impact on connecting the primary care and sports sectors. This will reveal changes in residents’ physical activity behavior, and also the circumstances under which this will happen. The assessment in combination with general lessons learned from the different case studies will make it possible to determine whether CSCs are able to fulfill the policy aspiration and whether it would be beneficial to extend this function. Trial registration Nederlands Trialregister NTR4986. Registered 14 December 2014.
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Affiliation(s)
- E Smit
- Academic Collaborative Centre AMPHI, Primary Health Care, Radboud university medical center, P.O. Box 9101, , 6500 HB, Nijmegen, The Netherlands.
| | - K E F Leenaars
- Department of Social Sciences, Health and Society Group, Wageningen University & Research Centre, P.O. Box 8130, Wageningen, The Netherlands.
| | - M A E Wagemakers
- Department of Social Sciences, Health and Society Group, Wageningen University & Research Centre, P.O. Box 8130, Wageningen, The Netherlands.
| | - G R M Molleman
- Academic Collaborative Centre AMPHI, Primary Health Care, Radboud university medical center, P.O. Box 9101, , 6500 HB, Nijmegen, The Netherlands.
| | - M A Koelen
- Department of Social Sciences, Health and Society Group, Wageningen University & Research Centre, P.O. Box 8130, Wageningen, The Netherlands.
| | - J van der Velden
- Academic Collaborative Centre AMPHI, Primary Health Care, Radboud university medical center, P.O. Box 9101, , 6500 HB, Nijmegen, The Netherlands.
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Howlett N, Trivedi D, Troop NA, Chater AM. What are the most effective behaviour change techniques to promote physical activity and/or reduce sedentary behaviour in inactive adults? A systematic review protocol. BMJ Open 2015; 5:e008573. [PMID: 26246078 PMCID: PMC4538267 DOI: 10.1136/bmjopen-2015-008573] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/01/2015] [Accepted: 07/02/2015] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Large proportions of the population are not meeting recommended levels of physical activity and have increasingly sedentary lifestyles. Low levels of physical activity are predictive of poor health outcomes and time spent sedentary is related to a host of risk factors independently of physical activity levels. Building an evidence base of the best approaches to intervene in the lifestyles of inactive individuals is crucial in preventing long-term disease, disability and higher mortality rates. METHODS AND ANALYSIS Systematic searches will be conducted on all relevant databases (eg, PubMed, Scopus, CINAHL, PsycINFO). Studies will be included if they assess interventions aimed at changing physical activity or sedentary behaviour levels in adults (over 18) who are inactive and do not suffer from chronic conditions. Studies must also be randomised controlled trials (RCTs), have a primary outcome of physical activity or sedentary behaviour, and measure outcomes at least 6 months after intervention completion. Studies will be coded using the Behaviour Change Technique (BCT) taxonomy v1 and Template for Intervention Description and Replication (TIDieR) guidelines. 2 reviewers will independently screen full-text articles and extract data on study characteristics, participants, BCTs, intervention features and outcome measures. Study quality will also be assessed independently by 2 reviewers using the Cochrane risk of bias tool. A meta-analysis will be considered if there is sufficient homogeneity across outcomes. GRADE criteria will be used to assess quality of evidence. DISSEMINATION This will be the first review to systematically appraise interventions aimed at changing the physical activity or sedentary behaviour of inactive individuals using RCT designs with a 6-month follow-up post-intervention. This review will better inform intervention designers targeting inactive populations and inform the design of a future complex intervention. REVIEW REGISTRATION NUMBER This protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 17 October 2014 (registration number: CRD42014014321).
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Affiliation(s)
- Neil Howlett
- Department of Psychology, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Daksha Trivedi
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Nicholas A Troop
- Department of Psychology, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Angel Marie Chater
- Research Department of Practice and Policy, Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, London, UK
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Kamada M, Kitayuguchi J, Abe T, Taguri M, Inoue S, Ishikawa Y, Harada K, Lee IM, Bauman A, Miyachi M. Community-wide promotion of physical activity in middle-aged and older Japanese: a 3-year evaluation of a cluster randomized trial. Int J Behav Nutr Phys Act 2015; 12:82. [PMID: 26100607 PMCID: PMC4484628 DOI: 10.1186/s12966-015-0242-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 06/12/2015] [Indexed: 02/05/2023] Open
Abstract
Background Promotion of physical activity (PA) is a key strategy to prevent non-communicable diseases. However, evidence on the effectiveness of community-wide interventions (CWIs) for promoting PA is limited. Purpose To evaluate the effectiveness of a 3-year CWI for promoting PA in middle-aged and older adults compared with usual public health services. This study is an extension to an original 1-year investigation study. Design Cluster randomized controlled trial with community as unit of randomization and individual as unit of analysis. Setting/participants 12 communities in Unnan, Japan were randomly allocated to the intervention (9) or the control (3). Additionally intervention communities were randomly allocated to aerobic activity promotion (Group A), flexibility and muscle-strengthening activities promotion (Group FM), or aerobic, flexibility, and muscle-strengthening activities promotion (Group AFM), each consisting of three communities. Randomly-sampled 4414 residents aged 40 to 79 years responded to the baseline survey (74 %), and were analyzed in 2013–2014. Intervention A 3-year CWI based on social marketing, to promote PA from 2009 to 2012. Main outcome measures The primary outcome was a change in regular aerobic, flexibility, and/or muscle-strengthening activities, defined by (1) engaging in 150 mins/week or more of walking, (2) engaging in daily flexibility activity, or (3) engaging 2 or more days/week in muscle-strengthening activities, evaluated at the individual level. Secondary outcomes were changes in specific types of PA and musculoskeletal pain. Outcomes were measured at baseline and at 1 and 3 years (2009, 2010, and 2012). Results The CWI did not significantly increase the proportion of adults who reached recommended levels of aerobic, flexibility, and/or muscle-strengthening activities (adjusted change difference = 1.6 % [95 % CI: −3.5, 6.6]). In the subgroup analysis, compared to the controls, adults doing flexibility activity daily significantly increased in Group FM (6.3 % [95 % CI: 1.9, 10.7]). In Group A and AFM for PA outcomes and in all groups for pain outcomes, there was no significant change compared to controls. Conclusions The CWI did not achieve significant increase in the proportion of adults who reached recommended PA levels. However, it might be effective in promoting flexibility activity in middle-aged and older Japanese. Trial registration UMIN-CTR UMIN000002683. Electronic supplementary material The online version of this article (doi:10.1186/s12966-015-0242-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Masamitsu Kamada
- Department of Health Promotion and Exercise, National Institute of Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636, Japan. .,Division of Preventive Medicine, Brigham & Women's Hospital, Harvard Medical School, 900 Commonwealth Ave East, Boston, MA, 02215, USA. .,Physical Education and Medicine Research Center UNNAN, 1212-3 Mitoya, Mitoya-cho, Unnan, Shimane, 690-2404, Japan.
| | - Jun Kitayuguchi
- Physical Education and Medicine Research Center UNNAN, 1212-3 Mitoya, Mitoya-cho, Unnan, Shimane, 690-2404, Japan.
| | - Takafumi Abe
- Physical Education and Medicine Research Center UNNAN, 1212-3 Mitoya, Mitoya-cho, Unnan, Shimane, 690-2404, Japan.
| | - Masataka Taguri
- Department of Biostatistics and Epidemiology, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Shigeru Inoue
- Department of Preventive Medicine and Public Health, Tokyo Medical University, 6-1-1, Shinjuku, Shinjuku-ku, Tokyo, 160-8402, Japan.
| | - Yoshiki Ishikawa
- Department of Health and Social Behavior, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Kazuhiro Harada
- Department of Functioning Activation, National Centre for Geriatrics and Gerontology, 7-430 Morioka-machi, Obu, Aichi, 474-8511, Japan.
| | - I-Min Lee
- Division of Preventive Medicine, Brigham & Women's Hospital, Harvard Medical School, 900 Commonwealth Ave East, Boston, MA, 02215, USA. .,Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Adrian Bauman
- School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Motohiko Miyachi
- Department of Health Promotion and Exercise, National Institute of Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636, Japan.
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Kesten JM, Guell C, Cohn S, Ogilvie D. From the concrete to the intangible: understanding the diverse experiences and impacts of new transport infrastructure. Int J Behav Nutr Phys Act 2015; 12:72. [PMID: 26041652 PMCID: PMC4470025 DOI: 10.1186/s12966-015-0230-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 05/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Changes to the environment that support active travel have the potential to increase population physical activity. The Cambridgeshire Guided Busway is an example of such an intervention that provides new traffic-free infrastructure for walking, cycling and public transport. This qualitative investigation explored the diverse experiences of new transport infrastructure and its impacts on active travel behaviours. METHODS Thirty-eight adult participants from the Commuting and Health in Cambridge natural experimental study were purposively selected according to their demographic and travel behaviour change characteristics and invited to participate in semi-structured interviews between February and June 2013. A mixed-method, following-a-thread approach was used to construct two contrasting vignettes (stories) to which the participants were asked to respond as part of the interviews. Inductive thematic qualitative analysis of the interview data was performed with the aid of QSR NVivo8. RESULTS Perceptions of the busway's attributes were important in shaping responses to it. Some participants rarely considered the new transport infrastructure or described it as unappealing because of its inaccessibility or inconvenient routing. Others located more conveniently for access points experienced the new infrastructure as an attractive travel option. Likewise, the guided buses and adjacent path presented ambiguous spaces which were received in different ways, depending on travel preferences. While new features such as on board internet access or off-road cycling were appreciated, shortcomings such as overcrowded buses or a lack of path lighting were barriers to use. The process of adapting to the environmental change was discussed in terms of planning and trialling new behaviours. The establishment of the busway in commuting patterns appeared to be influenced by whether the anticipated benefits of change were realised. CONCLUSIONS This study examined the diverse responses to an environmental intervention that may help to explain small or conflicting aggregate effects in quantitative outcome evaluation studies. Place and space features, including accessibility, convenience, pleasantness and safety relative to the alternative options were important for the acceptance of the busway. Our findings show how environmental change supporting active travel and public transport can encourage behaviour change for some people in certain circumstances.
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Affiliation(s)
- Joanna May Kesten
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box, 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
| | - Cornelia Guell
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box, 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
| | - Simon Cohn
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - David Ogilvie
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box, 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
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Peckham S, Falconer J, Gillam S, Hann A, Kendall S, Nanchahal K, Ritchie B, Rogers R, Wallace A. The organisation and delivery of health improvement in general practice and primary care: a scoping study. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03290] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThis project examines the organisation and delivery of health improvement activities by and within general practice and the primary health-care team. The project was designed to examine who delivers these interventions, where they are located, what approaches are developed in practices, how individual practices and the primary health-care team organise such public health activities, and how these contribute to health improvement. Our focus was on health promotion and ill-health prevention activities.AimsThe aim of this scoping exercise was to identify the current extent of knowledge about the health improvement activities in general practice and the wider primary health-care team. The key objectives were to provide an overview of the range and type of health improvement activities, identify gaps in knowledge and areas for further empirical research. Our specific research objectives were to map the range and type of health improvement activity undertaken by general practice staff and the primary health-care team based within general practice; to scope the literature on health improvement in general practice or undertaken by health-care staff based in general practice and identify gaps in the evidence base; to synthesise the literature and identify effective approaches to the delivery and organisation of health improvement interventions in a general practice setting; and to identify the priority areas for research as defined by those working in general practice.MethodsWe undertook a comprehensive search of the literature. We followed a staged selection process involving reviews of titles and abstracts. This resulted in the identification of 1140 papers for data extraction, with 658 of these papers selected for inclusion in the review, of which 347 were included in the evidence synthesis. We also undertook 45 individual and two group interviews with primary health-care staff.FindingsMany of the research studies reviewed had some details about the type, process or location, or who provided the intervention. Generally, however, little attention is paid in the literature to examining the impact of the organisational context on the way services are delivered or how this affects the effectiveness of health improvement interventions in general practice. We found that the focus of attention is mainly on individual prevention approaches, with practices engaging in both primary and secondary prevention. The range of activities suggests that general practitioners do not take a population approach but focus on individual patients. However, it is clear that many general practitioners see health promotion as an integral part of practice, whether as individual approaches to primary or secondary health improvement or as a practice-based approach to improving the health of their patients. Our key conclusion is that there is currently insufficient good evidence to support many of the health improvement interventions undertaken in general practice and primary care more widely.Future ResearchFuture research on health improvement in general practice and by the primary health-care team needs to move beyond clinical research to include delivery systems and be conducted in a primary care setting. More research needs to examine areas where there are chronic disease burdens – cancer, dementia and other disabilities of old age. Reviews should be commissioned that examine the whole prevention pathway for health problems that are managed within primary care drawing together research from general practice, pharmacy, community engagement, etc.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Stephen Peckham
- Centre for Health Services Studies, University of Kent, Kent, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jane Falconer
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Steve Gillam
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alison Hann
- Public Health and Policy Studies, Swansea University, Swansea, UK
| | - Sally Kendall
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hertfordshire, UK
| | - Kiran Nanchahal
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Benjamin Ritchie
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca Rogers
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Wallace
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Social Policy, University of Lincoln, Lincoln, UK
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Benjamin Neelon SE, Namenek Brouwer RJ, Østbye T, Evenson KR, Neelon B, Martinie A, Bennett G. A community-based intervention increases physical activity and reduces obesity in school-age children in North Carolina. Child Obes 2015; 11:297-303. [PMID: 25938983 PMCID: PMC4486143 DOI: 10.1089/chi.2014.0130] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Community-based interventions are promising approaches to obesity prevention, but few studies have prospectively evaluated them. The aim of this study was to evaluate a natural experiment—a community intervention designed to promote active living and decrease obesity within a small southern town. METHODS In 2011, community leaders implemented the Mebane on the Move intervention—a community-wide effort to promote physical activity (PA) and decrease obesity among residents of Mebane, North Carolina. We measured child PA and BMI before and after the intervention, using a nearby town not implementing an intervention as the comparison. In total, we assessed 64 children from Mebane and 40 from the comparison community 6 months before, as well as 34 and 18 children 6 months after the intervention. We assessed PA with accelerometers worn for 7 days and calculated BMI z-scores using children's height and weight. We conducted multivariable linear regressions examining pre- to postintervention change in minutes of PA and BMI z-score, adjusting for confounders. RESULTS At follow-up, children in Mebane modestly increased their moderate-to-vigorous PA (1.3 minutes per hour; 95% confidence interval (CI): 0.2, 2.3; p=0.03) and vigorous activity (0.8 minutes per hour; 95% CI: 0.1, 1.5; p=0.04) more than comparison children. In intervention children, BMI z-scores decreased 0.5 units (kg/m(2); 95% CI: -0.9, -0.02; p=0.045), compared to children in the comparison community. CONCLUSIONS We observed positive effects on PA level and weight status of children in Mebane, despite high rates of attrition, suggesting that the community-based intervention may have been successful.
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Affiliation(s)
- Sara E. Benjamin Neelon
- Department of Community and Family Medicine, Duke University Medical Center, Duke University, Durham, NC.,Duke Global Health Institute, Durham, NC
| | | | - Truls Østbye
- Department of Community and Family Medicine, Duke University Medical Center, Duke University, Durham, NC.,Duke Global Health Institute, Durham, NC
| | - Kelly R. Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina–Chapel Hill, Chapel Hill, NC
| | - Brian Neelon
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | | | - Gary Bennett
- Department of Psychology and Neuroscience, Duke University, Durham, NC
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Amiri Farahani L, Asadi-Lari M, Mohammadi E, Parvizy S, Haghdoost AA, Taghizadeh Z. Community-based physical activity interventions among women: a systematic review. BMJ Open 2015; 5:e007210. [PMID: 25833668 PMCID: PMC4390687 DOI: 10.1136/bmjopen-2014-007210] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Review and assess the effectiveness of community-based physical activity interventions among women aged 18-65 years. DESIGN Systematic review METHODS To find relevant articles, the researcher selected reports published in English between 1 January 2000 and 31 March 2013. Systematic search was to find controlled-trial studies that were conducted to uncover the effect of community-based interventions to promote physical activity among women 18-65 years of age, in which physical activity was reported as one of the measured outcomes. The methodological quality assessment was performed using a critical appraisal sheet. Also, the levels of evidence were assessed for the types of interventions. RESULTS The literature search identified nine articles. Four of the studies were randomised and the others studies had high methodological quality. There was no evidence, on the basis of effectiveness, for social cognitive theory-based interventions and inconclusive evidence of effectiveness for the rest of interventions. CONCLUSIONS There is insufficient evidence to assess the effectiveness of community-based interventions for enhancing physical activity among women. There is a need for high-quality randomised clinical trials with adequate statistical power to determine whether multicomponent and community-based intervention programmes increase physical activity among women, as well as to determine what type of interventions have a more effective and sustainable impact on women's physical activity.
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Affiliation(s)
- Leila Amiri Farahani
- Department of Midwifery, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Asadi-Lari
- DG Int'l Relations Department, MOHME, IR Iran Head- Oncopathology Research Centre, IUMS, Tehran, Iran
| | - Eesa Mohammadi
- Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Soroor Parvizy
- Department of Pediatric Nursing, Nursing and Midwifery Faculty, Iran University of Medical Sciences, Tehran, Iran
- Centre for educational Research in Medical Sciences (CERMS) Iran University of Medical Sciences, Tehran, Iran
| | - Ali Akbar Haghdoost
- The Research Centre for Modelling in Health, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ziba Taghizadeh
- Faculty Member of Nursing and Midwifery Care Research Centre, Nursing and Midwifery School, Tehran University of Medical Sciences, Tehran, Iran
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Grande AJ, Hoffmann T, Glasziou P. Searching for randomized controlled trials and systematic reviews on exercise. A descriptive study. SAO PAULO MED J 2015; 133:109-14. [PMID: 26018880 PMCID: PMC10496626 DOI: 10.1590/1516-3180.2013.8040011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 12/04/2013] [Accepted: 06/11/2014] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE The current paradigm of science is to accumulate as much research data as possible, with less thought given to navigation or synthesis of the resulting mass, which hampers locating and using the research. The aim here was to describe the number of randomized controlled trials (RCTs) and systematic reviews (SRs) focusing on exercise, and their journal sources, that have been indexed in PubMed over time. DESIGN AND SETTING Descriptive study conducted at Bond University, Australia. METHOD To find RCTs, a search was conducted in PubMed Clinical Queries, using the category "Therapy" and the Medical Subject Headings (MeSH) term "Exercise". To find SRs, a search was conducted in PubMed Clinical Queries, using the category "Therapy", the MeSH term "Exercise" and various methodological filters. RESULTS Up until 2011, 9,354 RCTs about exercise were published in 1,250 journals and 1,262 SRs in 513 journals. Journals in the area of Sports Science published the greatest number of RCTs and journals categorized as belonging to "Other health professions" area (for example nursing or psychology) published the greatest number of SRs. The Cochrane Database of Systematic Reviews was the principal source for SRs, with 9.8% of the total, while the Journal of Strength and Conditioning Research and Medicine & Science in Sports & Exercise published 4.4% and 5.0% of the RCTs, respectively. CONCLUSIONS The rapid growth and resulting scatter of RCTs and SRs on exercise presents challenges for locating and using this research. Solutions for this issue need to be considered.
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Affiliation(s)
| | - Tammy Hoffmann
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Paul Glasziou
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
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Clare L, Nelis SM, Jones IR, Hindle JV, Thom JM, Nixon JA, Cooney J, Jones CL, Tudor Edwards R, Whitaker CJ. The Agewell trial: a pilot randomised controlled trial of a behaviour change intervention to promote healthy ageing and reduce risk of dementia in later life. BMC Psychiatry 2015; 15:25. [PMID: 25880911 PMCID: PMC4337106 DOI: 10.1186/s12888-015-0402-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 02/02/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Lifestyle factors represent prime targets for behaviour change interventions to promote healthy ageing and reduce dementia risk. We evaluated a goal-setting intervention aimed at promoting increased cognitive and physical activity and improving mental and physical fitness, diet and health. METHODS This was a pilot randomised controlled trial designed to guide planning for a larger-scale investigation, provide preliminary evidence regarding efficacy, and explore feasibility and acceptability. Primary outcomes were engagement in physical and cognitive activity. Participants aged over 50 living independently in the community were recruited through a community Agewell Centre. Following baseline assessment participants were randomly allocated to one of three conditions: control (IC) had an interview in which information about activities and health was discussed; goal-setting (GS n = 24) had an interview in which they set behaviour change goals relating to physical, cognitive and social activity, health and nutrition; and goal-setting with mentoring (GM, n = 24) had the goal-setting interview followed by bi-monthly telephone mentoring. Participants and researchers were blinded to group assignment. Participants were reassessed after 12 months. RESULTS Seventy-five participants were randomised (IC n = 27, GS n = 24, GM n = 24). At 12-month follow-up, the two goal-setting groups, taken together (GS n = 21, GM n = 22), increased their level of physical (effect size 0.37) and cognitive (effect size 0.15) activity relative to controls (IC n = 27). In secondary outcomes, the two goal-setting groups taken together achieved additional benefits compared to control (effect sizes ≥ 0.2) in memory, executive function, cholesterol level, aerobic capacity, flexibility, balance, grip strength, and agility. Adding follow-up mentoring produced further benefits compared to goal-setting alone (effect sizes ≥ 0.2) in physical activity, body composition, global cognition and memory, but not in other domains. Implementation of the recruitment procedure, assessment and intervention was found to be feasible and the approach taken was acceptable to participants, with no adverse effects. CONCLUSIONS A brief, low-cost goal-setting intervention is feasible and acceptable, and has the potential to achieve increased activity engagement. TRIAL REGISTRATION Current Controlled Trials ISRCTN30080637.
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Affiliation(s)
- Linda Clare
- Research in Ageing and Cognitive Health, School of Psychology, Bangor University, Bangor, Gwynedd, LL57 2AS, UK.
| | - Sharon M Nelis
- Research in Ageing and Cognitive Health, School of Psychology, Bangor University, Bangor, Gwynedd, LL57 2AS, UK.
| | - Ian R Jones
- Wales Institute of Social & Economic Research, Data & Methods, Cardiff University, Cardiff, UK.
| | - John V Hindle
- School of Medical Sciences, Bangor University, Bangor, UK.
| | - Jeanette M Thom
- School of Medicine, University of New South Wales, New South Wales, Australia.
| | - Julie A Nixon
- Research in Ageing and Cognitive Health, School of Psychology, Bangor University, Bangor, Gwynedd, LL57 2AS, UK.
| | - Jennifer Cooney
- School of Sports, Health and Exercise Sciences, Bangor University, Bangor, UK.
| | - Carys L Jones
- Centre for Health Economics and Medicines Evaluation, IMSCaR, Bangor University, Bangor, UK.
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation, IMSCaR, Bangor University, Bangor, UK.
| | - Christopher J Whitaker
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK.
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Abstract
This study addresses the methodological trends in the development of systematic reviews in public health, and examines the reviews of the Cochrane Public Health Group in order to exemplify syntheses of evidence in public health and its implementation and impact on practice and research.
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Saeterdal I, Lewin S, Austvoll‐Dahlgren A, Glenton C, Munabi‐Babigumira S. Interventions aimed at communities to inform and/or educate about early childhood vaccination. Cochrane Database Syst Rev 2014; 2014:CD010232. [PMID: 25408540 PMCID: PMC10880811 DOI: 10.1002/14651858.cd010232.pub2] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND A range of strategies are used to communicate with parents, caregivers and communities regarding child vaccination in order to inform decisions and improve vaccination uptake. These strategies include interventions in which information is aimed at larger groups in the community, for instance at public meetings, through radio or through leaflets. This is one of two reviews on communication interventions for childhood vaccination. The companion review focuses on face-to-face interventions for informing or educating parents. OBJECTIVES To assess the effects of interventions aimed at communities to inform and/or educate people about vaccination in children six years and younger. SEARCH METHODS We searched CENTRAL, MEDLINE, EMBASE and five other databases up to July 2012. We searched for grey literature in the Grey Literature Report and OpenGrey. We also contacted authors of included studies and experts in the field. There were no language, date or settings restrictions. SELECTION CRITERIA Individual or cluster-randomised and quasi-randomised controlled trials, interrupted time series (ITS) and repeated measures studies, and controlled before-and-after (CBA) studies. We included interventions aimed at communities and intended to inform and/or educate about vaccination in children six years and younger, conducted in any setting. We defined interventions aimed at communities as those directed at a geographic area, and/or interventions directed to groups of people who share at least one common social or cultural characteristic. Primary outcomes were: knowledge among participants of vaccines or vaccine-preventable diseases and of vaccine service delivery; child immunisation status; and unintended adverse effects. Secondary outcomes were: participants' attitudes towards vaccination; involvement in decision-making regarding vaccination; confidence in the decision made; and resource use or cost of intervention. DATA COLLECTION AND ANALYSIS Two authors independently reviewed the references to identify studies for inclusion. We extracted data and assessed risk of bias in all included studies. MAIN RESULTS We included two cluster-randomised trials that compared interventions aimed at communities to routine immunisation practices. In one study from India, families, teachers, children and village leaders were encouraged to attend information meetings where they received information about childhood vaccination and could ask questions. In the second study from Pakistan, people who were considered to be trusted in the community were invited to meetings to discuss vaccine coverage rates in their community and the costs and benefits of childhood vaccination. They were asked to develop local action plans and to share the information they had been given and continue the discussions in their communities.The trials show low certainty evidence that interventions aimed at communities to inform and educate about childhood vaccination may improve knowledge of vaccines or vaccine-preventable diseases among intervention participants (adjusted mean difference 0.121, 95% confidence interval (CI) 0.055 to 0.189). These interventions probably increase the number of children who are vaccinated. The study from India showed that the intervention probably increased the number of children who received vaccinations (risk ratio (RR) 1.67, 95% CI 1.21 to 2.31; moderate certainty evidence). The study from Pakistan showed that there is probably an increase in the uptake of both measles (RR 1.63, 95% CI 1.03 to 2.58) and DPT (diptheria, pertussis and tetanus) (RR 2.17, 95% CI 1.43 to 3.29) vaccines (both moderate certainty evidence), but there may be little or no difference in the number of children who received polio vaccine (RR 1.01, 95% CI 0.97 to 1.05; low certainty evidence). There is also low certainty evidence that these interventions may change attitudes in favour of vaccination among parents with young children (adjusted mean difference 0.054, 95% CI 0.013 to 0.105), but they may make little or no difference to the involvement of mothers in decision-making regarding childhood vaccination (adjusted mean difference 0.043, 95% CI -0.009 to 0.097).The studies did not assess knowledge among participants of vaccine service delivery; participant confidence in the vaccination decision; intervention costs; or any unintended harms as a consequence of the intervention. We did not identify any studies that compared interventions aimed at communities to inform and/or educate with interventions directed to individual parents or caregivers, or studies that compared two interventions aimed at communities to inform and/or educate about childhood vaccination. AUTHORS' CONCLUSIONS This review provides limited evidence that interventions aimed at communities to inform and educate about early childhood vaccination may improve attitudes towards vaccination and probably increase vaccination uptake under some circumstances. However, some of these interventions may be resource intensive when implemented on a large scale and further rigorous evaluations are needed. These interventions may achieve most benefit when targeted to areas or groups that have low childhood vaccination rates.'
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Affiliation(s)
- Ingvil Saeterdal
- Norwegian Knowledge Centre for the Health ServicesHealth Economics and Drugs UnitPO Box 7004St Olavs PlassOsloNorwayN‐0130
| | - Simon Lewin
- Norwegian Knowledge Centre for the Health ServicesGlobal Health UnitBox 7004 St OlavsplassOsloNorwayN‐0130
- Medical Research Council of South AfricaHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
| | | | - Claire Glenton
- Norwegian Knowledge Centre for the Health ServicesGlobal Health UnitBox 7004 St OlavsplassOsloNorwayN‐0130
| | - Susan Munabi‐Babigumira
- Norwegian Knowledge Centre for the Health ServicesGlobal Health UnitBox 7004 St OlavsplassOsloNorwayN‐0130
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Azevedo LB, Burges Watson D, Haighton C, Adams J. The effect of dance mat exergaming systems on physical activity and health-related outcomes in secondary schools: results from a natural experiment. BMC Public Health 2014; 14:951. [PMID: 25217144 PMCID: PMC4169828 DOI: 10.1186/1471-2458-14-951] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 09/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exergaming has been proposed as an innovative method for physical activity promotion. However, large effectiveness studies are rare. In January 2011, dance mat systems were introduced in secondary schools in two districts in England with the aim of promoting an innovative opportunity for physical activity. The aim of this natural experiment was to examine the effect of introducing the dance mat exergaming systems on physical activity and health-related outcomes in 11-13 year old students using a non-randomised controlled design and mixed methods. METHODS Participants were recruited from five schools in intervention districts (n = 280) and two schools in neighbouring control districts (n = 217). Data on physical activity (accelerometer), anthropometrics (weight, BMI and percentage of body fat), aerobic fitness (20-m multistage shuttle run test), health-related quality of life (Kidscreen questionnaire), self-efficacy (children's physical activity self-efficacy survey), school attendance, focus groups with children and interviews with teachers were collected at baseline and approximately 12 months follow-up. RESULTS There was a negative intervention effect on total physical activity (-65.4 cpm CI: -12.6 to -4.7), and light and sedentary physical activity when represented as a percentage of wear time (Light: -2.3% CI: -4.5 to 0.2; Sedentary: 3.3% CI: 0.7 to 5.9). However, compliance with accelerometers at follow-up was poor. There was a significant positive intervention effect on weight (-1.7 kg, 95% CI: -2.9 to -0.4), BMI (-0.9 kg/m2, 95% CI: -1.3 to -0.4) and percentage of body fat (-2.2%, 95% CI: -4.2 to -0.2). There was also evidence of improvement in some health-related quality of life parameters: psychological well-being (2.5, 95% CI: 0.1 to 4.8) and autonomy and parent relation (4.2, 95% CI: 1.4 to 7.0). CONCLUSIONS The implementation of a dance mat exergaming scheme was associated with improvement in anthropometric measurements and parameters of health-related quality of life. However, the mechanisms of these benefits are unclear as there was insufficient data from physical activity to draw robust conclusions. Qualitative findings suggest that there was declining support for the initiative over time, meaning that potential benefits may not have been achieved.
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Affiliation(s)
- Liane B Azevedo
- />Health and Social Care Institute, Parkside West, Teesside University, Middlesbrough, TS1 3BA UK
| | - Duika Burges Watson
- />School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK
| | - Catherine Haighton
- />Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jean Adams
- />Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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Reis RS, Yan Y, Parra DC, Brownson RC. Assessing participation in community-based physical activity programs in Brazil. Med Sci Sports Exerc 2014; 46:92-8. [PMID: 23846162 DOI: 10.1249/mss.0b013e3182a365ae] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to develop and validate a risk prediction model to examine the characteristics that are associated with participation in community-based physical activity programs in Brazil. METHODS We used pooled data from three surveys conducted from 2007 to 2009 in state capitals of Brazil with 6166 adults. A risk prediction model was built considering program participation as an outcome. The predictive accuracy of the model was quantified through discrimination (C statistic) and calibration (Brier score) properties. Bootstrapping methods were used to validate the predictive accuracy of the final model. RESULTS The final model showed sex (women: odds ratio [OR] = 3.18, 95% confidence interval [CI] = 2.14-4.71), having less than high school degree (OR = 1.71, 95% CI = 1.16-2.53), reporting a good health (OR = 1.58, 95% CI = 1.02-2.24) or very good/excellent health (OR = 1.62, 95% CI = 1.05-2.51), having any comorbidity (OR = 1.74, 95% CI = 1.26-2.39), and perceiving the environment as safe to walk at night (OR = 1.59, 95% CI = 1.18-2.15) as predictors of participation in physical activity programs. Accuracy indices were adequate (C index = 0.778, Brier score = 0.031) and similar to those obtained from bootstrapping (C index = 0.792, Brier score = 0.030). CONCLUSIONS Sociodemographic and health characteristics as well as perceptions of the environment are strong predictors of participation in community-based programs in selected cities of Brazil.
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Affiliation(s)
- Rodrigo S Reis
- 1School of Health and Biosciences, Pontificia Universidade Catolica do Parana, Curitiba, BRAZIL; 2Department of Physical Education, Federal University of Parana, Curitiba, BRAZIL; 3Division of Public Health Sciences, Division of Biostatistics, Washington University School of Medicine, St. Louis, MO; 4Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO; and 5Division of Public Health Sciences and Alvin J. Siteman Cancer Center, School of Medicine, Washington University in St. Louis, St. Louis, MO
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Goodman A, Sahlqvist S, Ogilvie D. New walking and cycling routes and increased physical activity: one- and 2-year findings from the UK iConnect Study. Am J Public Health 2014; 104:e38-46. [PMID: 25033133 PMCID: PMC4151955 DOI: 10.2105/ajph.2014.302059] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated the effects of providing new high-quality, traffic-free routes for walking and cycling on overall levels of walking, cycling, and physical activity. METHODS 1796 adult residents in 3 UK municipalities completed postal questionnaires at baseline (2010) and 1-year follow-up (2011), after the construction of the new infrastructure. 1465 adults completed questionnaires at baseline and 2-year follow-up (2012). Transport network distance from home to infrastructure defined intervention exposure and provided a basis for controlled comparisons. RESULTS Living nearer the infrastructure did not predict changes in activity levels at 1-year follow-up but did predict increases in activity at 2 years relative to those living farther away (15.3 additional minutes/week walking and cycling per km nearer; 12.5 additional minutes/week of total physical activity). The effects were larger among participants with no car. CONCLUSIONS These new local routes may mainly have displaced walking or cycling trips in the short term but generated new trips in the longer term, particularly among those unable to access more distant destinations by car. These findings support the potential for walking and cycling infrastructure to promote physical activity.
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Affiliation(s)
- Anna Goodman
- Anna Goodman, Shannon Sahlqvist, and David Ogilvie are with the Medical Research Council Epidemiology Unit and the UK Clinical Research Collaboration Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK. Anna Goodman is also with the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. Shannon Sahlqvist is also with the Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
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Solomon E, Rees T, Ukoumunne OC, Metcalf B, Hillsdon M. The Devon Active Villages Evaluation (DAVE) trial of a community-level physical activity intervention in rural south-west England: a stepped wedge cluster randomised controlled trial. Int J Behav Nutr Phys Act 2014; 11:94. [PMID: 25198068 PMCID: PMC4105855 DOI: 10.1186/s12966-014-0094-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 07/08/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The majority of adults are not meeting the guidelines for physical activity despite activity being linked with numerous improvements to long-term health. In light of this, researchers have called for more community-level interventions. The main objective of the present study was to evaluate whether a community-level physical activity intervention increased the activity levels of rural communities. METHODS 128 rural villages (clusters) were randomised to receive the intervention in one of four time periods between April 2011 and December 2012. The Devon Active Villages intervention provided villages with 12 weeks of physical activity opportunities for all age groups, including at least three different types of activities per village. Each village received an individually tailored intervention, incorporating a local needs-led approach. Support was provided for a further 12 months following the intervention. The evaluation study used a stepped wedge cluster randomised controlled trial design. All 128 villages were measured at each of five data collection periods using a postal survey. The primary outcome of interest was the proportion of adults reporting sufficient physical activity to meet internationally recognised guidelines. Minutes spent in moderate-and-vigorous activity per week was analysed as a secondary outcome. To compare between intervention and control modes, random effects linear regression and marginal logistic regression models were implemented for continuous and binary outcomes respectively. RESULTS 10,412 adults (4693 intervention, 5719 control) completed the postal survey (response rate 32.2%). The intervention did not increase the odds of adults meeting the physical activity guideline (adjusted OR 1.02, 95% CI: 0.88 to 1.17; P = 0.80), although there was weak evidence of an increase in minutes of moderate-and-vigorous-intensity activity per week (adjusted mean difference = 171, 95% CI: -16 to 358; P = 0.07). The ineffectiveness of the intervention may have been due to its low penetration-only 16% of intervention mode participants reported awareness of the intervention and just 4% reported participating in intervention events. CONCLUSIONS A community-level physical activity intervention providing tailored physical activity opportunities to rural villages did not improve physical activity levels in adults. Greater penetration of such interventions must be achieved if they are to increase physical activity prevalence at the community level. TRIAL REGISTRATION Current Controlled Trials ISRCTN37321160.
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Affiliation(s)
- Emma Solomon
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, St Luke’s Campus, Heavitree Road, Exeter EX1 2 LU, UK
| | - Tim Rees
- PenCLAHRC, University of Exeter Medical School, Veysey Building, Salmon Pool Lane, Exeter EX2 4SG, UK
| | - Obioha C Ukoumunne
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, St Luke’s Campus, Heavitree Road, Exeter EX1 2 LU, UK
| | - Brad Metcalf
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, St Luke’s Campus, Heavitree Road, Exeter EX1 2 LU, UK
| | - Melvyn Hillsdon
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, St Luke’s Campus, Heavitree Road, Exeter EX1 2 LU, UK
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Brand T, Pischke CR, Steenbock B, Schoenbach J, Poettgen S, Samkange-Zeeb F, Zeeb H. What works in community-based interventions promoting physical activity and healthy eating? A review of reviews. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:5866-88. [PMID: 24886756 PMCID: PMC4078553 DOI: 10.3390/ijerph110605866] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/14/2014] [Accepted: 05/20/2014] [Indexed: 01/02/2023]
Abstract
Chronic diseases, such as type II diabetes, are on the rise worldwide. There is consistent evidence that physical activity and healthy eating are important lifestyle factors which affect the risk for chronic diseases. Community-based interventions are of particular public health interest as they reach target groups in their natural living environment and may thus achieve high population-level impacts. We conducted a systematic literature search to assess the effectiveness of community-based interventions to promote physical activity and healthy eating. Specifically, we searched for promising intervention strategies in this setting. We narratively summarized the results of 18 systematic reviews. Among children and adolescents, we found moderate evidence for effects on weight change in primary school-aged children for interventions containing a school component. The evidence for interventions aimed at general adult populations was inconclusive. Self-monitoring, group-based components, and motivational signs to encourage stair use were identified as promising strategies to increase physical activity. Among adults at risk for type II diabetes, evidence was found for beneficial effects on weight change and diabetes incidence. However, interventions for this group were not integrated in more comprehensive community-based approaches.
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Affiliation(s)
- Tilman Brand
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstrasse 30, 28359 Bremen, Germany.
| | - Claudia R Pischke
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstrasse 30, 28359 Bremen, Germany.
| | - Berit Steenbock
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstrasse 30, 28359 Bremen, Germany.
| | - Johanna Schoenbach
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstrasse 30, 28359 Bremen, Germany.
| | - Saskia Poettgen
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstrasse 30, 28359 Bremen, Germany.
| | - Florence Samkange-Zeeb
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstrasse 30, 28359 Bremen, Germany.
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstrasse 30, 28359 Bremen, Germany.
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McCormack GR, Shiell A, Doyle-Baker PK, Friedenreich CM, Sandalack BA. Subpopulation differences in the association between neighborhood urban form and neighborhood-based physical activity. Health Place 2014; 28:109-15. [PMID: 24797923 DOI: 10.1016/j.healthplace.2014.04.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 03/31/2014] [Accepted: 04/02/2014] [Indexed: 11/30/2022]
Abstract
This study investigated whether associations between the neighborhood built environment and neighborhood-based physical activity (PA) varied by sociodemographic and health-related characteristics. A random sample of adults (n=2006) completed telephone- and self-administered questionnaires. Questionnaires captured PA, sociodemographic, and health-related characteristics. Neighborhood-based PA (MET-minutes/week) was compared across low, medium, and high walkable neighborhoods for each sociodemographic (sex, age, dependents, education, income, motor vehicle access, and dog ownership) and health-status (general health and weight status) subpopulation. With few exceptions, subpopulations residing in high walkable neighborhoods undertook more (p<0.05) neighborhood-based PA than their counterparts in less walkable neighborhoods. Improving neighborhood walkability is a potentially effective population health intervention for increasing neighborhood-based PA.
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Affiliation(s)
- Gavin R McCormack
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive N.W., Calgary, Alberta, Canada, T2N 4Z6.
| | - Alan Shiell
- The Centre of Excellence in Intervention and Prevention Science (CEIPS), Melbourne, Victoria, Australia
| | | | - Christine M Friedenreich
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive N.W., Calgary, Alberta, Canada, T2N 4Z6; Department of Population Health Research, Alberta Health Services, Alberta, Canada
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Lager KE, Mistri AK, Khunti K, Haunton VJ, Sett AK, Wilson AD. Interventions for improving modifiable risk factor control in the secondary prevention of stroke. Cochrane Database Syst Rev 2014:CD009103. [PMID: 24789063 DOI: 10.1002/14651858.cd009103.pub2] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND People with stroke or transient ischaemic attack (TIA) are at increased risk of future stroke and other cardiovascular events. Evidence-based strategies for secondary stroke prevention have been established. However, the implementation of prevention strategies could be improved. OBJECTIVES To assess the effects of stroke service interventions for implementing secondary stroke prevention strategies on modifiable risk factor control, including patient adherence to prescribed medications, and the occurrence of secondary cardiovascular events. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (April 2013), the Cochrane Effective Practice and Organisation of Care Group Trials Register (April 2013), CENTRAL (The Cochrane Library 2013, issue 3), MEDLINE (1950 to April 2013), EMBASE (1981 to April 2013) and 10 additional databases. We located further studies by searching reference lists of articles and contacting authors of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) that evaluated the effects of organisational or educational and behavioural interventions (compared with usual care) on modifiable risk factor control for secondary stroke prevention. DATA COLLECTION AND ANALYSIS Two review authors selected studies for inclusion and independently extracted data. One review author assessed the risk of bias for the included studies. We sought missing data from trialists. MAIN RESULTS This review included 26 studies involving 8021 participants. Overall the studies were of reasonable quality, but one study was considered at high risk of bias. Fifteen studies evaluated predominantly organisational interventions and 11 studies evaluated educational and behavioural interventions for patients. Results were pooled where appropriate, although some clinical and methodological heterogeneity was present. The estimated effects of organisational interventions were compatible with improvements and no differences in the modifiable risk factors mean systolic blood pressure (mean difference (MD) -2.57 mmHg; 95% confidence interval (CI) -5.46 to 0.31), mean diastolic blood pressure (MD -0.90 mmHg; 95% CI -2.49 to 0.68), blood pressure target achievement (OR 1.24; 95% CI 0.94 to 1.64) and mean body mass index (MD -0.68 kg/m(2); 95% CI -1.46 to 0.11). There were no significant effects of organisational interventions on lipid profile, HbA1c, medication adherence or recurrent cardiovascular events. Educational and behavioural interventions were not generally associated with clear differences in any of the review outcomes, with only two exceptions. AUTHORS' CONCLUSIONS Pooled results indicated that educational interventions were not associated with clear differences in any of the review outcomes. The estimated effects of organisational interventions were compatible with improvements and no differences in several modifiable risk factors. We identified a large number of ongoing studies, suggesting that research in this area is increasing. The use of standardised outcome measures would facilitate the synthesis of future research findings.
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Affiliation(s)
- Kate E Lager
- Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester, UK, LE1 6TP
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Stephens SK, Cobiac LJ, Veerman JL. Improving diet and physical activity to reduce population prevalence of overweight and obesity: an overview of current evidence. Prev Med 2014; 62:167-78. [PMID: 24534460 DOI: 10.1016/j.ypmed.2014.02.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 01/27/2014] [Accepted: 02/05/2014] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The aim of this study is to provide an overview of interventions to reduce or prevent overweight or obesity and improve diet or physical activity. METHODS A review of meta-analyses and/or systematic reviews of these interventions in any setting or age group were conducted. Narrative systematic reviews were included for intervention categories with limited meta-analyses available. Summary measures including weighted mean difference, standardised mean difference, and I-squared, were examined. RESULTS A total of 60 meta-analyses and 23 systematic reviews met the inclusion criteria. Dietary interventions and multi-component interventions targeting overweight and obesity appeared to have the greatest effects, particularly in comparison with workplace or technology or internet-based interventions. Pharmaceutical and surgical interventions produced favourable results for specific population sub-groups (i.e. morbidly obese). Population-wide strategies such as policy interventions have not been widely analysed. The effectiveness of the interventions to assist in maintaining behaviour or weight change remains unclear. CONCLUSIONS Various individually targeted interventions were shown to reduce body weight, although effect sizes were typically modest, and the durability of effects has been questioned. New approaches to evaluating population-based interventions, such as taxes and regulation, are recommended. Future research modelling the long-term effects of interventions across the lifespan would also be beneficial.
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Affiliation(s)
- Samantha K Stephens
- The University of Queensland, School of Population Health, Brisbane, Queensland, Australia.
| | - Linda J Cobiac
- The University of Queensland, School of Population Health, Brisbane, Queensland, Australia.
| | - J Lennert Veerman
- The University of Queensland, School of Population Health, Brisbane, Queensland, Australia.
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Recio-Rodríguez JI, Martín-Cantera C, González-Viejo N, Gómez-Arranz A, Arietaleanizbeascoa MS, Schmolling-Guinovart Y, Maderuelo-Fernandez JA, Pérez-Arechaederra D, Rodriguez-Sanchez E, Gómez-Marcos MA, García-Ortiz L. Effectiveness of a smartphone application for improving healthy lifestyles, a randomized clinical trial (EVIDENT II): study protocol. BMC Public Health 2014; 14:254. [PMID: 24628961 PMCID: PMC4003852 DOI: 10.1186/1471-2458-14-254] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 03/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND New technologies could facilitate changes in lifestyle and improve public health. However, no large randomized, controlled studies providing scientific evidence of the benefits of their use have been made. The aims of this study are to develop and validate a smartphone application, and to evaluate the effect of adding this tool to a standardized intervention designed to improve adherence to the Mediterranean diet and to physical activity. An evaluation is also made of the effect of modifying habits upon vascular structure and function, and therefore on arterial aging. METHODS/DESIGN A randomized, double-blind, multicenter, parallel group clinical trial will be carried out. A total of 1215 subjects under 70 years of age from the EVIDENT trial will be included. Counseling common to both groups (control and intervention) will be provided on adaptation to the Mediterranean diet and on physical activity. The intervention group moreover will receive training on the use of a smartphone application designed to promote a healthy diet and increased physical activity, and will use the application for three months. The main study endpoints will be the changes in physical activity, assessed by accelerometer and the 7-day Physical Activity Recall (PAR) interview, and adaptation to the Mediterranean diet, as evaluated by an adherence questionnaire and a food frequency questionnaire (FFQ). Evaluation also will be made of vascular structure and function based on central arterial pressure, the radial augmentation index, pulse velocity, the cardio-ankle vascular index, and carotid intima-media thickness. DISCUSSION Confirmation that the new technologies are useful for promoting healthier lifestyles and that their effects are beneficial in terms of arterial aging will have important clinical implications, and may contribute to generalize their application in favor of improved population health. TRIAL REGISTRATION Clinical Trials.gov Identifier: NCT02016014.
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Affiliation(s)
- José I Recio-Rodríguez
- The Alamedilla Health Center, Castilla y León Health Service, USAL, IBSAL, Salamanca, Spain
| | - Carlos Martín-Cantera
- Primary Health care Research Unit of Barcelona, Primary Healthcare University Research Institute IDIAP-Jordi Gol, Barcelona, Spain
| | | | - Amparo Gómez-Arranz
- Casa de Barco Health Center, Castilla y León Health Service, Valladolid, Spain
| | | | - Yolanda Schmolling-Guinovart
- Río Tajo Health Center, Castilla-La Mancha Health Service, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | | | | | | | - Manuel A Gómez-Marcos
- The Alamedilla Health Center, Castilla y León Health Service, USAL, IBSAL, Salamanca, Spain
| | - Luis García-Ortiz
- The Alamedilla Health Center, Castilla y León Health Service, USAL, IBSAL, Salamanca, Spain
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Salvador EP, Ribeiro EH, Garcia LM, Andrade DR, Guimaraes VM, Aoki MS, Florindo AA. Interventions for physical activity promotion applied to the primary healthcare settings for people living in regions of low socioeconomic level: study protocol for a non-randomized controlled trial. ACTA ACUST UNITED AC 2014; 72:8. [PMID: 24624930 PMCID: PMC3977937 DOI: 10.1186/2049-3258-72-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 11/27/2013] [Indexed: 12/05/2022]
Abstract
Background Regular physical activity practice has been widely recommended for promoting health, but the physical activity levels remain low in the population. Therefore, the study of interventions to promote physical activity is essential. Objective: To present the methodology of two physical activity interventions from the “Ambiente Ativo” (“Active Environment”) project. Methods 12-month non-randomized controlled intervention trial. 157 healthy and physically inactive individuals were selected: health education (n = 54) supervised exercise (n = 54) and control (n = 49). Intervention based on health education: a multidisciplinary team of health professionals organized the intervention in group discussions, phone calls, SMS and educational material. Intervention based on supervised exercise program: consisted of offering an exercise program in groups supervised by physical education professionals involving strength, endurance and flexibility exercises. The physical activity level was assessed by the International Physical Activity Questionnaire (long version), physical activities recalls, pedometers and accelerometers over a seven-day period. Result This study described two different proposals for promoting physical activity that were applied to adults attended through the public healthcare settings. The participants were living in a region of low socioeconomic level, while respecting the characteristics and organization of the system and its professionals, and also adapting the interventions to the realities of the individuals attended. Conclusion Both interventions are applicable in regions of low socioeconomic level, while respecting the social and economic characteristics of each region. Trial registration ClinicalTrials.gov NCT01852981
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Affiliation(s)
- Emanuel P Salvador
- Health Sicence Department, Cruzeiro do Sul University, Sao Paulo, Brazil.
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