Face-to-face interventions for promoting physical activity

Development and Evaluation of a Community Health Program to Promote Physical Activity Among Vulnerable Community-Dwelling Older Adults: Protocol for a Prospective Cohort Study

BACKGROUND

Vulnerable older adults have a high risk of morbidity and mortality. Regular physical activity (PA) can have a positive effect on the health and health-related behavior of this specific target group. However, evidence of the impact and feasibility of community-based PA promotion interventions for vulnerable older adults is still limited.

OBJECTIVE

The BeTaSen (Bewegungs-Tandems in den Lebenswelten Chemnitzer Seniorinnen und Senioren: ein Beitrag zur kommunalen Gesundheitsförderung) study aims to evaluate the (1) impact as well as the (2) feasibility, acceptance, and usefulness of a 12-month low-threshold PA intervention program for community-dwelling vulnerable older adults.

METHODS

For our population-based prospective observational cohort study, a total of 120 vulnerable older adults (aged 75 years or older) in the area of Chemnitz (Germany) will be recruited to participate in (1) weekly neighborhood-based low-threshold PA meetings with trained mentors (activity tandems) and (2) monthly exercise meetings led by trained exercise instructors. Within the intervention, participants will be encouraged to perform the PA independently. Participants will complete assessments, which will include questionnaires as well as objective measurements of their physical, cognitive, and psychosocial health at 3 different time points (baseline, 6 months after the start, and 6 months after the end of the intervention). Additionally, a process evaluation will be performed, including questionnaires and qualitative interviews, involving the participants, mentors, and municipal project partner representatives.

RESULTS

The BeTaSen project process began in October 2021, with the start of data collection and intervention in August 2022 in the first neighborhoods of the city of Chemnitz. A total of 86 participants were recruited at the time of submission of the manuscript. Longitudinal results are expected by 2025.

CONCLUSIONS

This study's results will provide insights on (1) the PA behavior of vulnerable older adults as well as the impact of PA interventions on health-related outcomes such as cognitive, physical, and psychosocial health, and (2) the feasible and useful components of community-based PA interventions. Thus, this pilot study contributes to future recommendations and provides a basis for further research, such as the development of feasible and sustainable target group-specific interventions in community settings.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51462.

Effects of Face-to-Face and eHealth Blended Interventions on Physical Activity, Diet, and Weight-Related Outcomes among Adults: A Systematic Review and Meta-Analysis

An increasing number of studies are blending face-to-face interventions and electronic health (eHealth) interventions to jointly promote physical activity (PA) and diet among people. However, a comprehensive summary of these studies is lacking. This study aimed to synthesize the characteristics of blended interventions and meta-analyze the effectiveness of blended interventions in promoting PA, diet, and weight-related outcomes among adults. Following the PRISMA guidelines, PubMed, SPORTDiscus, PsycINFO, Embase, and Web of Science were systematically searched to identify eligible articles according to a series of inclusion criteria. The search was limited to English language literature and publication dates between January 2002 and July 2022. Effect sizes were calculated as standardized mean difference (SMD) for three intervention outcomes (physical activity, healthy diet, and weight-related). Random effect models were used to calculate the effect sizes. A sensitivity analysis and publication bias tests were conducted. Of the 1561 identified studies, 17 were eligible for the systematic review. Studies varied in participants, intervention characteristics, and outcome measures. A total of 14 studies were included in the meta-analyses. There was evidence of no significant publication bias. The meta-analyses indicated that the blended intervention could lead to a significant increase in walking steps (p < 0.001), total PA level (p = 0.01), and diet quality (p = 0.044), a significant decrease in energy intake (p = 0.004), weight (p < 0.001), BMI (p < 0.001), and waist circumferences (p = 0.008), but had no influence on more moderate-to-vigorous physical activity (MVPA) or fruit and vegetable intake among adults, compared with a control group. The study findings showed that blended interventions achieve preliminary success in promoting PA, diet, and weight-related outcomes among adults. Future studies could improve the blended intervention design to achieve better intervention effectiveness.

Blended Care Interventions to Promote Physical Activity: A Systematic Review of Randomized Controlled Trials

Background

Blended care interventions combine therapeutic guidance with digital care. Current research results show the promising role of the blended care approach in clinical care. This new way of delivering health care could have the potential to effectively promote physical activity in different public health settings.

Objective

The aim of the systematic review is to investigate the varieties of intervention characteristics of blended care interventions to promote physical activity in terms of structure, behavior change goals, behavior change techniques, and effectiveness of blended care interventions compared to a control group.

Methods

We searched for randomized controlled trials published from 2000 to March 2021 in MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, SPORTDiscus, PsycINFO, and Web of Science according to the PRISMA guidelines. Risk of bias was assessed using the Cochrane Collaboration tool. Study characteristics, intervention characteristics, and outcome data were extracted. Furthermore, the effect size on the outcome of physical activity was examined or calculated.

Results

In total, the number of reports identified from the database searches was 4828. Of these, 25 studies were included in the review, with a total of 5923 study participants. Results indicated that the characteristics of blended care interventions showed a high heterogeneity. The combinations of therapist-guided interventions and digital interventions allowed the identification of specific subgroups, but they varied in length (range 8–52 weeks, SD 16.6), intensity, and the combination of the components. The most used combination of blended care interventions to promote physical activity was the combination of one-on-one meetings via telephone and Web-based interventions. Motivational models of behavior change were used most frequently as underlying theoretical foundations. Certain behavior change techniques were used consistently across the individual components, e.g., “problem solving” in the therapist-guided component and “feedback on behavior” in the digital component. Considering the effect size of blended care interventions compared with control groups, most studies showed a small effect.

Conclusions

It can be concluded that blended care interventions have potential to promote physical activity. In the future, further high-quality studies should investigate which type of blended care intervention is effective for which target group. Additionally, insights are required on which intervention characteristics are most effective, taking into account new evidence on behavior change.

Registration This systematic literature review was registered in PROSPERO (CRD42020188556).

Supplementary Information

The online version contains supplementary material available at 10.1186/s40798-022-00489-w.

Implementation of non-pharmacological interventions for the treatment of hypertension in primary care: a narrative review of effectiveness, cost-effectiveness, barriers, and facilitators

BACKGROUND

The current guidelines for the prevention, detection, evaluation, and management of hypertension recommend six types of non-pharmacological interventions: alcohol reduction, salt intake reduction, increased potassium intake, physical activity, weight loss, and heart-healthy diets. However, the non-pharmacological interventions are still not widely used in primary care. In this paper, we, therefore, reviewed and summarised the evidence on the effectiveness, cost-effectiveness, barriers, and facilitators of non-pharmacological interventions for the treatment of hypertension in primary care.

METHODS

A thorough literature search was conducted in Embase, Google Scholar, and PubMed databases, to identify the most recent reviews or, in their absence, primary studies on alcohol reduction, salt intake reduction, potassium supplementation, physical activity, weight reduction, heart-healthy diets, and other non-pharmacological interventions for the treatment of hypertension in primary care.

RESULTS

Alcohol reduction is a non-pharmacological intervention for the treatment of hypertension in primary care with proven effectiveness, feasibility, and acceptability. Interventions for sodium intake reduction, physical activity, and weight reduction are effective but there is insufficient evidence regarding their feasibility and acceptability in primary care settings. Evidence on the effectiveness of potassium intake and heart-healthy diets is limited and inconsistent. There is a lack of evidence on the cost-effectiveness of non-pharmacological interventions in the treatment of hypertension. The most common barriers to deliver such interventions related to healthcare providers include a lack of time, knowledge, self-confidence, resources, clear guidelines, and financial incentives. The most common barriers related to patients include a lack of motivation and educational resources. Less evidence is available on facilitators of implementing non-pharmacological interventions in primary care. Besides, facilitators differed by different types of interventions.

CONCLUSIONS

Available evidence suggests that more pragmatic, clinically feasible, and logistically simple interventions are required for sodium intake reduction, physical activity, and weight reduction in primary care settings. Future studies should provide further evidence on the effectiveness of weight control, potassium intake, and heart-healthy diets. More research is also needed on cost-effectiveness and facilitators of all types of effective non-pharmacological interventions for the treatment of hypertension in primary care.

Do physical activity interventions combining self-monitoring with other components provide an additional benefit compared with self-monitoring alone? A systematic review and meta-analysis

Objective

To determine the net effect of different physical activity intervention components on step counts in addition to self-monitoring.

Design

A systematic review with meta-analysis and meta-regression.

Data sources

Five databases (PubMed, Scopus, Web of Science, ProQuest and Discus) were searched from inception to May 2022. The database search was complemented with backward and forward citation searches and search of the references from relevant systematic reviews.

Eligibility criteria

Randomised controlled trials comparing an intervention using self-monitoring (active control arm) with an intervention comprising the same treatment PLUS any additional component (intervention arm).

Data extraction and synthesis

The effect measures were mean differences in daily step count. Meta-analyses were performed using random-effects models, and effect moderators were explored using univariate and multivariate meta-regression models.

Results

Eighty-five studies with 12 057 participants were identified, with 75 studies included in the meta-analysis at postintervention and 24 at follow-up. At postintervention, the mean difference between the intervention and active control arms was 926 steps/day (95% CI 651 to 1201). At a follow-up, the mean difference was 413 steps/day (95% CI 210 to 615). Interventions with a prescribed goal and involving human counselling, particularly via phone/video calls, were associated with a greater mean difference in the daily step count than interventions with added print materials, websites, smartphone apps or incentives.

Conclusion

Physical activity interventions that combine self-monitoring with other components provide an additional modest yet sustained increase in step count compared with self-monitoring alone. Some forms of counselling, particularly remote phone/video counselling, outperformed other intervention components, such as websites and smartphone apps.

PROSPERO registered number

CRD42020199482.

Delivery fidelity of the REACT (REtirement in ACTion) physical activity and behaviour maintenance intervention for community dwelling older people with mobility limitations

BACKGROUND

Fidelity assessment of behaviour change interventions is vital to understanding trial outcomes. This study assesses the delivery fidelity of behaviour change techniques used in the Retirement in ACTion (REACT) randomised controlled trial. REACT is a community-based physical activity (PA) and behaviour maintenance intervention to prevent decline of physical functioning in older adults (≥ 65 years) at high risk of mobility-related disability in the UK.

METHODS

The delivery fidelity of intervention behaviour change techniques and delivery processes were assessed using multi-observer coding of purposively sampled in-vivo audio recordings (n = 25) of health behaviour maintenance sessions over 12-months. Delivery fidelity was scored using a modified Dreyfus scale (scores 0-5) to assess competence and completeness of delivery for each technique and delivery process. "Competent delivery" was defined as a score of 3 points or more for each item. Examples of competent intervention delivery were identified to inform recommendations for future programme delivery and training.

RESULTS

The mean intervention fidelity score was 2.5 (SD 0.45) with delivery fidelity varying between techniques/processes and intervention groups. Person-centred delivery, Facilitating Enjoyment and Promoting Autonomy were delivered competently (scoring 3.0 or more). There was scope for improvement (score 2.0-2.9) in Monitoring Progress (Acknowledging and Reviewing), Self-Monitoring, Monitoring Progress (Eliciting Benefits of Physical Activity), Goal Setting and Action Planning, Modelling, Supporting Self-Efficacy for Physical Activity and Supporting Relatedness. Managing Setbacks and Problem Solving was delivered with low fidelity. Numerous examples of both good and sub-optimal practice were identified.

CONCLUSIONS

This study highlights successes and improvements needed to enhance delivery fidelity in future implementation of the behavioural maintenance programme of the REACT intervention. Future training of REACT session leaders and assessment of delivery fidelity needs to focus on the delivery of Goal setting and Action Planning, Modelling, Supporting Relatedness, Supporting Self-Efficacy for Physical Activity, and Managing Setbacks/ Problem Solving.

Brief physical activity counselling by physiotherapists (BEHAVIOUR): protocol for an effectiveness-implementation hybrid type II cluster randomised controlled trial

BACKGROUND

Physical inactivity is a leading risk factor for chronic disease. Brief physical activity counselling delivered within healthcare systems has been shown to increase physical activity levels; however, implementation efforts have mostly targeted primary healthcare and uptake has been sub-optimal. The Brief Physical Activity Counselling by Physiotherapists (BEHAVIOUR) trial aims to address this evidence-practice gap by evaluating (i) the effectiveness of a multi-faceted implementation strategy, relative to usual practice for improving the proportion of patients receiving brief physical activity counselling as part of their routine hospital-based physiotherapy care and (ii) effectiveness of brief physical activity counselling embedded in routine physiotherapy care, relative to routine physiotherapy care, at improving physical activity levels among patients receiving physiotherapy care.

METHODS

Effectiveness-implementation hybrid type II cluster randomised controlled trial with embedded economic evaluation, qualitative study and culturally adapted patient-level outcome measures. The trial will be conducted across five hospitals in a local health district in Sydney, Australia, with a lower socioeconomic and culturally diverse population. The evidence-based intervention is brief physical activity counselling informed by the 5As counselling model and behavioural theory, embedded into routine physiotherapy care. The multi-faceted strategy to support the implementation of the counselling intervention was developed with key stakeholders guided by the Consolidated Framework for Implementation Research and the Capabilities, Opportunities, Motivation-Behaviour (COM-B) theoretical model, and consists of clinician education and training, creating a learning collaborative, tailored strategies to address community referral barriers, team facilitation, and audit and feedback. Thirty teams of physiotherapists will be randomised to receive the multi-faceted implementation strategy immediately or after a 9-month delay. Each physiotherapy team will recruit an average of 10 patients (n=300) to collect effectiveness outcomes at baseline and 6 months. The primary effectiveness outcome is self-reported planned physical activity using the Incidental and Planned Exercise Questionnaire, and the primary implementation outcome is reach (proportion of eligible new physiotherapy patients who receive brief physical activity counselling). Secondary effectiveness and implementation outcomes will also be collected.

DISCUSSION

This project focuses on physiotherapists as health professionals with the requisite skills and patterns of practice to tackle the increasing burden of chronic disease in a high-risk population.

TRIAL REGISTRATION

ANZCTR, ACTRN12621000194864 . Registered on 23 February 2021.

Web-Based Versus Print-Based Physical Activity Intervention for Community-Dwelling Older Adults: Crossover Randomized Trial

Background

Fewer than half of older German adults engage in the recommended levels of endurance training.

Objective

The study aim is to compare the acceptance and effectiveness of two interventions for physical activity (PA) promotion among initially inactive community-dwelling older adults ≥60 years in a 9-month, crossover randomized trial.

Methods

Participants were recruited in person and randomized to one of the following interventions for self-monitoring PA: a print-based intervention (PRINT: 113/242, 46.7%) or a web-based intervention (WEB: 129/242, 53.3%). Furthermore, 29.5% (38/129) of those in the web-based intervention group received a PA tracker in addition to WEB (WEB+). After randomization, the participants and researchers were not blinded. The participants’ baseline intervention preferences were retrospectively assessed. All the intervention groups were offered 10 weekly face-to-face group sessions. Afterward, participants could choose to stay in their group or cross over to one of the other groups, and group sessions were continued monthly for another 6 months. 3D accelerometers to assess PA and sedentary behavior (SB) at baseline (T0), 3-month follow-up (T1), and 9-month follow-up (T2) were used. Adherence to PA recommendations, attendance of group sessions, and intervention acceptance were assessed using self-administered paper-based questionnaires. Linear mixed models were used to calculate differences in moderate to vigorous PA (MVPA) and SB between time points and intervention groups.

Results

Of the 242 initially recruited participants, 91 (37.6%) were randomized to the WEB group; 38 (15.7%) to the WEB+ group; and 113 (46.7%) to the PRINT group. Overall, 80.6% (195/242) of the participants completed T1. Only 0.4% (1/242) of the participants changed from the WEB group to the PRINT group and 6.2% (15/242) moved from the PRINT group to the WEB group (WEB-WEB: 103/249, (41.4%); PRINT-PRINT: 76/249, 30.5%) when offered to cross over at T1. Furthermore, 66.1% (160/242) of participants completed T2. MVPA in minutes per day increased between baseline and T1, but these within-group changes disappeared after adjusting for covariates. MVPA decreased by 9 minutes per day between baseline and T2 (β_time=−9.37, 95% CI −18.58 to −0.16), regardless of the intervention group (WEB vs PRINT: β_group*time=−3.76, 95% CI −13.33 to 5.82, WEB+ vs PRINT: β_group*time=1.40, 95% CI −11.04 to 13.83). Of the participants, 18.6% (38/204) met the PA recommendations at T0, 16.4% (26/159) at T1, and 20.3% (28/138) at T2. For SB, there were no significant group differences or group-by-time interactions at T1 or T2. Intervention acceptance was generally high. The use of intervention material was high to moderate at T1 and decreased by T2.

Conclusions

There was little movement between intervention groups at T1 when given the choice, and participation was not associated with increases in PA or decreases in SB over time.

Trial Registration

German Clinical Trials Register DRKS00016073; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016073

Visualising health risks with medical imaging for changing recipients' health behaviours and risk factors: Systematic review with meta-analysis

BACKGROUND

There is ongoing clinical and research interest in determining whether providing personalised risk information could motivate risk-reducing health behaviours. We aimed to assess the impact on behaviours and risk factors of feeding back to individuals' images of their bodies generated via medical imaging technologies in assessing their current disease status or risk.

METHODS AND FINDINGS

A systematic review with meta-analysis was conducted using Cochrane methods. MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched up to July 28, 2021, with backward and forward citation searches up to July 29, 2021. Eligible studies were randomised controlled trials including adults who underwent medical imaging procedures assessing current health status or risk of disease, for which personal risk may be reduced by modifying behaviour. Trials included an intervention group that received the imaging procedure plus feedback of visualised results and assessed subsequent risk-reducing health behaviour. We examined 12,620 abstracts and included 21 studies, involving 9,248 randomised participants. Studies reported on 10 risk-reducing behaviours, with most data for smoking (8 studies; n = 4,308), medication use (6 studies; n = 4,539), and physical activity (4 studies; n = 1,877). Meta-analysis revealed beneficial effects of feedback of visualised medical imaging results on reduced smoking (risk ratio 1.11, 95% confidence interval [CI] 1.01 to 1.23, p = 0.04), healthier diet (standardised mean difference [SMD] 0.30, 95% CI 0.11 to 0.50, p = 0.003), increased physical activity (SMD 0.11, 95% CI 0.003 to 0.21, p = 0.04), and increased oral hygiene behaviours (SMD 0.35, 95% CI 0.13 to 0.57, p = 0.002). In addition, single studies reported increased skin self-examination and increased foot care. For other behavioural outcomes (medication use, sun protection, tanning booth use, and blood glucose testing) estimates favoured the intervention but were not statistically significant. Regarding secondary risk factor outcomes, there was clear evidence for reduced systolic blood pressure, waist circumference, and improved oral health, and some indication of reduced Framingham risk score. There was no evidence of any adverse effects, including anxiety, depression, or stress, although these were rarely assessed. A key limitation is that there were some concerns about risk of bias for all studies, with evidence for most outcomes being of low certainty. In particular, valid and precise measures of behaviour were rarely used, and there were few instances of preregistered protocols and analysis plans, increasing the likelihood of selective outcome reporting.

CONCLUSIONS

In this study, we observed that feedback of medical images to individuals has the potential to motivate risk-reducing behaviours and reduce risk factors. Should this promise be corroborated through further adequately powered trials that better mitigate against risk of bias, such interventions could usefully capitalise upon the widespread and growing use of medical imaging technologies in healthcare.

The effect of initial support on fitness center use in new fitness center members. A randomized controlled trial

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There is a lack of research on what fitness centers do to support new members.

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The effect of initial support delivered via telephone and e-mail was investigated.

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There was an effect on bookings with a fitness trainer first six months.

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There was no effect on days with visits or membership duration during four years.

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More visits the first six months were associated with longer membership duration.

This provider and participant blinded parallel-group randomized controlled trial aimed to investigate if initial support given to new members via telephone and e-mail, compared to self-directed use, had an effect on booking with a fitness trainer, number of visits to the center, and membership duration. Participants included 356 new members, 174 randomized to the intervention group, and 182 to the control group. The intervention group received support to use the fitness center facilities through two phone calls and one e-mail over the first eight weeks of their membership. The control group got usual practice, which is self-directed use.

Participants in the intervention group were more likely to book at least one session with a fitness trainer during the first six months (odds ratio 1.6, 95% confidence interval (CI) 1.0–2.5). However, the intervention did not influence the number of visits (mean difference after four years −11.7 days, 95% CI −34.8 to 11.3) or time to membership termination during the follow-up period (hazard ratio 1.1, 95% CI 0.8–1.3).

In conclusion, initial support to use the fitness center facilities given to new fitness center members via telephone and e-mail increased the proportion of bookings with a fitness trainer during the first months of the membership, but it did not have an effect on the number of visits or membership termination during four years.

Are family medicine residents trained to counsel patients on physical activity? The Canadian experience and a call to action

Physical inactivity is a leading risk factor for non-communicable diseases (NCDs) and early mortality. Family physicians have an important role in providing physical activity counselling to patients to help prevent and treat NCDs. Lack of training on physical activity counselling is a barrier in undergraduate medical education, yet little is known regarding physical activity teaching in postgraduate family medicine residency. We assessed the provision, content and future direction of physical activity teaching in Canadian postgraduate family medicine residency programs to address this data gap. Fewer than half of Canadian Family Medicine Residency Programme directors reported providing structured physical activity counselling education to residents. Most directors reported no imminent plans to change the content or amount of teaching. These results reflect significant gaps between the recommendations of WHO, which calls on doctors to prescribe physical activity, and the current curricular content and needs of family medicine residents. Almost all directors agreed that online educational resources developed to assist residents in physical activity prescription would be beneficial. By describing the provision, content and future direction of physical activity training in family medicine, physicians and medical educators can develop competencies and resources to meet this need. When we equip our future physicians with the necessary tools, we can improve patient outcomes and do our part to reduce the global epidemic of physical inactivity and chronic disease.

Interventions for promoting physical activity in people with neuromuscular disease

BACKGROUND

The World Health Organization (WHO) recommends that people of all ages take regular and adequate physical activity. If unable to meet the recommendations due to health conditions, international guidance advises being as physically active as possible. Evidence from community interventions of physical activity indicate that people living with medical conditions are sometimes excluded from participation in studies. In this review, we considered the effects of activity-promoting interventions on physical activity and well-being in studies, as well as any adverse events experienced by participants living with inherited or acquired neuromuscular diseases (NMDs).  OBJECTIVES: To assess the effects of interventions designed to promote physical activity in people with NMD compared with no intervention or alternative interventions.

SEARCH METHODS

On 30 April 2020, we searched Cochrane Neuromuscular Specialised Register, CENTRAL, Embase, MEDLINE, and ClinicalTrials.Gov. WHO ICTRP was not accessible at the time.

SELECTION CRITERIA

We considered randomised or quasi-randomised trials, including cross-over trials, of interventions designed to promote physical activity in people with NMD compared to no intervention or alternative interventions. We specifically included studies that reported physical activity as an outcome measure. Our main focus was studies in which promoting physical activity was a stated aim but we also included studies in which physical activity was assessed as a secondary or exploratory outcome.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane procedures.

MAIN RESULTS

The review included 13 studies (795 randomised participants from 12 studies; number of participants unclear in one study) of different interventions to promote physical activity. Most studies randomised a minority of invited participants. No study involved children or adolescents and nine studies reported minimal entry criteria for walking. Participants had one of nine inherited or acquired NMDs. Types of intervention included structured physical activity support, exercise support (as a specific form of physical activity), and behaviour change support that included physical activity or exercise. Only one included study clearly reported that the aim of intervention was to increase physical activity. Other studies reported or planned to analyse the effects of intervention on physical activity as a secondary or exploratory outcome measure. Six studies did not report results for physical activity outcomes, or the data were not usable. We judged 10 of the 13 included studies at high or unclear risk of bias from incomplete physical activity outcome reporting. We did not perform a meta-analysis for any comparison because of differences in interventions and in usual care. We also found considerable variation in how studies reported physical activity as an outcome measure. The studies that reported physical activity measurement did not always clearly report intention-to-treat (ITT) analysis or whether final assessments occurred during or after intervention. Based on prespecified measures, we included three comparisons in our summary of findings. A physical activity programme (weight-bearing) compared to no physical activity programme One study involved adults with diabetic peripheral neuropathy (DPN) and reported weekly duration of walking during and at the end of a one-year intervention using a StepWatch ankle accelerometer. Based on the point estimate and low-certainty evidence, intervention may have led to an important increase in physical activity per week; however, the 95% confidence interval (CI) included the possibility of no difference or an effect in either direction at three months (mean difference (MD) 34 minutes per week, 95% CI -92.19 to 160.19; 69 participants), six months (MD 68 minutes per week, 95% CI -55.35 to 191.35; 74 participants), and 12 months (MD 49 minutes per week, 95% CI -75.73 to 173.73; 70 participants). Study-reported effect estimates for foot lesions and full-thickness ulcers also included the possibility of no difference, a higher, or lower risk with intervention. A sensor-based, interactive exercise programme compared to no sensor-based, interactive exercise programme One study involved adults with DPN and reported duration of walking over 48 hours at the end of four weeks' intervention using a t-shirt embedded PAMSys sensor. It was not possible to draw conclusions about the effectiveness of the intervention from the very low-certainty evidence (MD -0.64 hours per 48 hours, 95% CI -2.42 to 1.13; 25 participants). We were also unable to draw conclusions about impact on the Physical Component Score (PCS) for quality of life (MD 0.24 points, 95% CI -5.98 to 6.46; 35 participants; very low-certainty evidence), although intervention may have made little or no difference to the Mental Component Score (MCS) for quality of life (MD 5.10 points, 95% CI -0.58 to 10.78; 35 participants; low-certainty evidence). A functional exercise programme compared to a stretching exercise programme One study involved adults with spinal and bulbar muscular atrophy and reported a daily physical activity count at the end of 12 weeks' intervention using an Actical accelerometer. It was not possible to draw conclusions about the effectiveness of either intervention (requiring compliance) due to low-certainty evidence and unconfirmed measurement units (MD -8701, 95% CI -38,293.30 to 20,891.30; 43 participants). Functional exercise may have made little or no difference to quality of life compared to stretching (PCS: MD -1.10 points, 95% CI -5.22 to 3.02; MCS: MD -1.10 points, 95% CI -6.79 to 4.59; 49 participants; low-certainty evidence). Although studies reported adverse events incompletely, we found no evidence of supported activity increasing the risk of serious adverse events.

AUTHORS' CONCLUSIONS

We found a lack of evidence relating to children, adolescents, and non-ambulant people of any age. Many people living with NMD did not meet randomised controlled trial eligibility criteria. There was variation in the components of supported activity intervention and usual care, such as physical therapy provision. We identified variation among studies in how physical activity was monitored, analysed, and reported. We remain uncertain of the effectiveness of promotional intervention for physical activity and its impact on quality of life and adverse events. More information is needed on the ITT population, as well as more complete reporting of outcomes. While there may be no single objective measure of physical activity, the study of qualitative and dichotomous change in self-reported overall physical activity might offer a pragmatic approach to capturing important change at an individual and population level.

Current Practice of Physical Activity Counselling within Physiotherapy Usual Care and Influences on Its Use: A Cross-Sectional Survey

Physical activity counselling has demonstrated effectiveness at increasing physical activity when delivered in healthcare, but is not routinely practised. This study aimed to determine (1) current use of physical activity counselling by physiotherapists working within publicly funded hospitals; and (2) influences on this behaviour. A cross-sectional survey of physiotherapists was conducted across five hospitals within a local health district in Sydney, Australia. The survey investigated physiotherapists' frequency of incorporating 15 different elements of physical activity counselling into their usual healthcare interactions, and 53 potential influences on their behaviour framed by the COM-B (Capability, Opportunity, Motivation-Behaviour) model. The sample comprised 84 physiotherapists (79% female, 48% <5 years of experience). Physiotherapists reported using on average five (SD:3) elements of physical activity counselling with at least 50% of their patients who could be more active. A total of 70% of physiotherapists raised or discussed overall physical activity, but less than 10% measured physical activity or contacted community physical activity providers. Physiotherapists reported on average 25 (SD:9) barriers influencing their use of physical activity counselling. The most common barriers were related to "opportunity", with 57% indicating difficulty locating suitable community physical activity opportunities and >90% indicating their patients lacked financial and transport opportunities. These findings confirm that physical activity counselling is not routinely incorporated in physiotherapy practice and help to identify implementation strategies to build clinicians' opportunities and capabilities to deliver physical activity counselling.

Promoting Physical Activity Among Older Adults Using Community-Based Participatory Research With an Adapted PRECEDE-PROCEED Model Approach: The AEQUIPA/OUTDOOR ACTIVE Project

PURPOSE

The PRECEDE-PROCEED model (PPM) is a community-based participatory research (CBPR) framework for health promotion, yet the direct application of the PPM into practice is unclear. This paper describes how the PPM was adapted for the development and application of a pilot intervention study to promote outdoor physical activity (PA) in older adults (OUTDOOR ACTIVE). We illustrate the steps and adaptations we applied to put the PPM into practice and present the developed interventions.

DESIGN

The PPM was adapted by incorporating a socio-ecological model. This ensured the design of any resultant intervention would explicitly address multi-level determinants of physical activity. The list of possible program components to select from for the design of an intervention was also extended.

SETTING

Bremen, Germany.

PARTICIPANTS

Participants in the intervention development were 924 noninstitutionalized older adults, aged 65-75 years (response: 25.2%), living in Bremen-Hemelingen, Germany. For implementation of the intervention and to ensure sustainability, several groups of stakeholders were involved throughout the process.

METHODS

A mixed method design was employed (e.g., focus groups, quantitative survey) to identify determinants. A round table and participatory workshops were held to involve the target group and community stakeholders in the design of an intervention using the adapted PPM model.

RESULTS

A conceptual model was developed illustrating the integration of a socio-ecological model into the PPM. The model received ecological validity, as it was affirmed by community stakeholders as an appropriate method for designing a community-level PA intervention. Target goals to address PA determinants were selected by target group members. An intervention to meet the goals was developed and implemented with target group input.

CONCLUSION

The adapted PPM is a promising starting point for developing multi-level interventions. Steps should be taken to ensure all social groups are participating in the process and all levels of determinants are addressed.

Physical activity coaching for adults with mobility limitations: protocol for the ComeBACK pragmatic hybrid effectiveness-implementation type 1 randomised controlled trial

INTRODUCTION

Mobility limitation is common and often results from neurological and musculoskeletal health conditions, ageing and/or physical inactivity. In consultation with consumers, clinicians and policymakers, we have developed two affordable and scalable intervention packages designed to enhance physical activity for adults with self-reported mobility limitations. Both are based on behaviour change theories and involve tailored advice from physiotherapists.

METHODS AND ANALYSIS

This pragmatic hybrid effectiveness-implementation type 1 randomised control trial (n=600) will be undertaken among adults with self-reported mobility limitations. It aims to estimate the effects on physical activity of: (1) an enhanced 6-month intervention package (one face-to-face physiotherapy assessment, tailored physical activity plan, physical activity phone coaching from a physiotherapist, informational/motivational resources and activity monitors) compared with a less intensive 6-month intervention package (single session of tailored phone advice from a physiotherapist, tailored physical activity plan, unidirectional text messages, informational/motivational resources); (2) the enhanced intervention package compared with no intervention (6-month waiting list control group); and (3) the less intensive intervention package compared with no intervention (waiting list control group). The primary outcome will be average steps per day, measured with the StepWatch Activity Monitor over a 1-week period, 6 months after randomisation. Secondary outcomes include other physical activity measures, measures of health and functioning, individualised mobility goal attainment, mental well-being, quality of life, rate of falls, health utilisation and intervention evaluation. The hybrid effectiveness-implementation design (type 1) will be used to enable the collection of secondary implementation outcomes at the same time as the primary effectiveness outcome. An economic analysis will estimate the cost-effectiveness and cost-utility of the interventions compared with no intervention and to each other.

ETHICS AND DISSEMINATION

Ethical approval has been obtained by Sydney Local Health District, Royal Prince Alfred Zone. Dissemination will be via publications, conferences, newsletters, talks and meetings with health managers.

TRIAL REGISTRATION NUMBER

ACTRN12618001983291.

The effect of individualized, theory-based counselling intervention on active aging and quality of life among older people (the AGNES intervention study)

BACKGROUND

We define active aging as a striving for activities as per one's goals, capacities and opportunities.

AIM

To test the 1-year counselling intervention effects on active aging.

METHODS

In this two-arm single-blinded randomized controlled trial, the intervention group received individually tailored counselling supporting autonomous motivation for active life (one face-to-face session, four phone calls and supportive written material, n = 101) and the control group written health information (n = 103). Participants were community-dwelling men and women aged 75 or 80 years with intermediate mobility function and without cognitive impairment. The primary outcome was active aging total score measured with the University of Jyväskylä Active Aging Scale (UJACAS, range 0-272, higher values indicate more activity) and secondary outcomes were its subscores for goals, ability, opportunity and activity (range 0-68) and a quality of life (QoL) score. Measures took place at pre-trial, mid-trial (6 months) and post-trial (12 months), except for QoL only pre and post-trial. Data were analyzed with intention-to-treat principles using GEE-models.

RESULTS

The UJACAS total score increased in the intervention group slightly more than in the control group (group by time p-value = 0.050, effect size 0.011, net benefit 2%), but the group effect was not statistically significant. A small effect was observed for the activity subscore (p = 0.007).

DISCUSSION

The individualized counselling supporting autonomous motivation for active life increased the UJACAS score slightly.

CONCLUSIONS

It may be possible to promote active aging with individualized counselling, but the effect is small and it is unclear whether the change is meaningful.

Knowledge, attitude, and practices on exercise among pregnant females attending Al-Wazarat Health Center, Riyadh, Saudi Arabia

BACKGROUND

The consequences of physical inactivity during pregnancy are one of the major problems among pregnant women in Saudi. To explore the pattern of exercise and to know the beliefs and reasons for not doing physical activity (PA) emphasized the need for conducting this study. This study aimed to improve the level of knowledge and practice of PA among women during pregnancy.

METHODS

A cross-sectional study was performed using quota sampling.

RESULTS

41.62% of pregnant women had high level of physical activity (PA) awareness and practice and 58.37% had a low level of awareness and practice. Statistical difference was found between the two groups in terms of parity, education level, work status, and family income. Pregnant women preferred walking as exercise. They are aware about PA benefits during pregnancy, but perceived that tiredness was the greatest barrier for physical activity.

CONCLUSION

This study recommends conducting well-designed intervention sessions to promote PA awareness and practice among pregnant women, especially those with low education, low income, and low number of children.

Interventions outside the workplace for reducing sedentary behaviour in adults under 60 years of age

BACKGROUND

Adults spend a majority of their time outside the workplace being sedentary. Large amounts of sedentary behaviour increase the risk of type 2 diabetes, cardiovascular disease, and both all-cause and cardiovascular disease mortality.

OBJECTIVES

Primary • To assess effects on sedentary time of non-occupational interventions for reducing sedentary behaviour in adults under 60 years of age Secondary • To describe other health effects and adverse events or unintended consequences of these interventions • To determine whether specific components of interventions are associated with changes in sedentary behaviour • To identify if there are any differential effects of interventions based on health inequalities (e.g. age, sex, income, employment) SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL, PsycINFO, SportDiscus, and ClinicalTrials.gov on 14 April 2020. We checked references of included studies, conducted forward citation searching, and contacted authors in the field to identify additional studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) and cluster RCTs of interventions outside the workplace for community-dwelling adults aged 18 to 59 years. We included studies only when the intervention had a specific aim or component to change sedentary behaviour.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened titles/abstracts and full-text articles for study eligibility. Two review authors independently extracted data and assessed risk of bias. We contacted trial authors for additional information or data when required. We examined the following primary outcomes: device-measured sedentary time, self-report sitting time, self-report TV viewing time, and breaks in sedentary time.

MAIN RESULTS

We included 13 trials involving 1770 participants, all undertaken in high-income countries. Ten were RCTs and three were cluster RCTs. The mean age of study participants ranged from 20 to 41 years. A majority of participants were female. All interventions were delivered at the individual level. Intervention components included personal monitoring devices, information or education, counselling, and prompts to reduce sedentary behaviour. We judged no study to be at low risk of bias across all domains. Seven studies were at high risk of bias for blinding of outcome assessment due to use of self-report outcomes measures. Primary outcomes Interventions outside the workplace probably show little or no difference in device-measured sedentary time in the short term (mean difference (MD) -8.36 min/d, 95% confidence interval (CI) -27.12 to 10.40; 4 studies; I² = 0%; moderate-certainty evidence). We are uncertain whether interventions reduce device-measured sedentary time in the medium term (MD -51.37 min/d, 95% CI -126.34 to 23.59; 3 studies; I² = 84%; very low-certainty evidence) We are uncertain whether interventions outside the workplace reduce self-report sitting time in the short term (MD -64.12 min/d, 95% CI -260.91 to 132.67; I² = 86%; very low-certainty evidence). Interventions outside the workplace may show little or no difference in self-report TV viewing time in the medium term (MD -12.45 min/d, 95% CI -50.40 to 25.49; 2 studies; I² = 86%; low-certainty evidence) or in the long term (MD 0.30 min/d, 95% CI -0.63 to 1.23; 2 studies; I² = 0%; low-certainty evidence). It was not possible to pool the five studies that reported breaks in sedentary time given the variation in definitions used. Secondary outcomes Interventions outside the workplace probably have little or no difference on body mass index in the medium term (MD -0.25 kg/m², 95% CI -0.48 to -0.01; 3 studies; I² = 0%; moderate-certainty evidence). Interventions may have little or no difference in waist circumference in the medium term (MD -2.04 cm, 95% CI -9.06 to 4.98; 2 studies; I² = 65%; low-certainty evidence). Interventions probably have little or no difference on glucose in the short term (MD -0.18 mmol/L, 95% CI -0.30 to -0.06; 2 studies; I² = 0%; moderate-certainty evidence) and medium term (MD -0.08 mmol/L, 95% CI -0.21 to 0.05; 2 studies, I² = 0%; moderate-certainty evidence) Interventions outside the workplace may have little or no difference in device-measured MVPA in the short term (MD 1.99 min/d, 95% CI -4.27 to 8.25; 4 studies; I² = 23%; low-certainty evidence). We are uncertain whether interventions improve device-measured MVPA in the medium term (MD 6.59 min/d, 95% CI -7.35 to 20.53; 3 studies; I² = 70%; very low-certainty evidence). We are uncertain whether interventions outside the workplace improve self-reported light-intensity PA in the short-term (MD 156.32 min/d, 95% CI 34.34 to 278.31; 2 studies; I² = 79%; very low-certainty evidence). Interventions may have little or no difference on step count in the short-term (MD 226.90 steps/day, 95% CI -519.78 to 973.59; 3 studies; I² = 0%; low-certainty evidence) No data on adverse events or symptoms were reported in the included studies.

AUTHORS' CONCLUSIONS

Interventions outside the workplace to reduce sedentary behaviour probably lead to little or no difference in device-measured sedentary time in the short term, and we are uncertain if they reduce device-measured sedentary time in the medium term. We are uncertain whether interventions outside the workplace reduce self-reported sitting time in the short term. Interventions outside the workplace may result in little or no difference in self-report TV viewing time in the medium or long term. The certainty of evidence is moderate to very low, mainly due to concerns about risk of bias, inconsistent findings, and imprecise results. Future studies should be of longer duration; should recruit participants from varying age, socioeconomic, or ethnic groups; and should gather quality of life, cost-effectiveness, and adverse event data. We strongly recommend that standard methods of data preparation and analysis are adopted to allow comparison of the effects of interventions to reduce sedentary behaviour.

Effectiveness of adult community-based physical activity interventions with objective physical activity measurements and long-term follow-up: a systematic review and meta-analysis

OBJECTIVE

To identify randomised controlled trials (RCTs) of physical activity (PA) interventions with objective PA outcomes in adults and to evaluate whether intervention effects were sustained beyond 12 months.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Seven databases (Medline, Embase, PsycINFO, Web of Science, Cochrane library, CINAHL (Cumulative Index of Nursing and Allied Health Literature) and ASSIA (Applied Social Sciences Index and Abstracts)) were searched from January 2000 until December 2019.

ELIGIBILITY CRITERIA

RCTs reporting objective PA outcomes beyond 12 months with community-based participants aged ≥18 years were included; those where controls received active interventions, including advice to increase PA levels, were excluded.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers completed extraction of aggregate data and assessed risk of bias. Meta-analyses used random-effects models at different follow-up points. Primary outcomes were daily steps and weekly minutes of moderate-to-vigorous PA (MVPA).

RESULTS

Of 33 282 records identified, nine studies (at generally low risk of bias) were included, five in meta-analyses with 12 months to 4 year follow-up. We observed 12 month increases for intervention vs control participants in steps/day (mean difference (MD)=554 (95% CIs: 384 to 724) p<0.0001, I²=0%; 2446 participants; four studies) and weekly MVPA minutes (MD=35 (95% CI: 27 to 43) p<0.0001, I²=0%; 2647 participants; four studies). Effects were sustained up to 4 years for steps/day (MD=494 (95% CI: 251 to 738) p<0.0001, I²=0%; 1944 participants; four studies) and weekly MVPA minutes (MD=25 (95% CI: 13 to 37) p<0.0001, I²=0%; 1458 participants; three studies).

CONCLUSIONS

There are few PA interventions with objective follow-up beyond 12 months, more studies are needed. However, this review provided evidence of PA intervention effects beyond 12 months and sustained up to 4 years for both steps/day and MVPA. These findings have important implications for potential long-term health benefits.

PROSPERO REGISTRATION NUMBER

CRD42017075753.

Implementation and Effects of Information Technology-Based and Print-Based Interventions to Promote Physical Activity Among Community-Dwelling Older Adults: Protocol for a Randomized Crossover Trial

BACKGROUND

Despite the known health benefits of physical activity (PA), less than half and less than one-third of older adults in Germany reach the PA recommendations for endurance training and strength training, respectively, of the World Health Organization. The aim of this study is to investigate the implementation and effectiveness over the course of 9 months of two interventions (information technology [IT]-based vs print-based) for PA promotion among initially inactive older adults in a randomized, crossover trial. This study is part of a large research consortium (2015-2021) investigating different aspects of PA promotion. The IT-based intervention was previously developed and refined, while the print-based intervention was newly developed during this funding phase.

OBJECTIVE

We aim to compare the effectiveness and examine the preferences of study participants regarding both delivery modes.

METHODS

Our target sample size was 390 initially inactive community-dwelling older adults aged ≥60 years at baseline (3-month follow-up [T1]: expected n=300; 9-month follow-up [T2]: expected n=240) who were randomized to one of two interventions for self-monitoring PA: IT-based (50%) or print-based (50%) intervention. In addition, 30% of the IT-based intervention group received a PA tracker. At T1, participants in both groups could choose whether they prefered to keep their assigned intervention or cross over to the other group for the following 6 months (T2). Participants' intervention preferences at baseline were collected retrospectively to run a post hoc matched-mismatched analysis. During the initial 3-month intervention period, both intervention groups were offered weekly group sessions that were continued monthly between T1 and T2. A self-administered questionnaire and 3D accelerometers were employed to assess changes in PA between baseline, T1, and T2. Adherence to PA recommendations, attendance at group sessions, and acceptance of the interventions were also tracked.

RESULTS

The funding period started in February 2018 and ends in January 2021. We obtained institutional review board approval for the study from the Medical Association in Bremen on July 3, 2018. Data collection was completed on January 31, 2020, and data cleaning and analysis started in February 2020. We expect to publish the first results by the end of the funding period.

CONCLUSIONS

Strategies to promote active aging are of particular relevance in Germany, as 29% of the population is projected to be ≥65 years old by 2030. Regular PA is a key contributor to healthy aging. This study will provide insights into the acceptance and effectiveness of IT-based vs print-based interventions to promote PA in initially inactive individuals aged ≥60 years. Results obtained in this study will improve the existing evidence base on the effectiveness of community-based PA interventions in Germany and will inform efforts to anchor evidence-based PA interventions in community structures and organizations via an allocation of permanent health insurance funds.

TRIAL REGISTRATION

German Registry of Clinical Trials DRKS00016073; https://tinyurl.com/y983586m.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/15168.

Effects of two web-based interventions promoting physical activity among older adults compared to a delayed intervention control group in Northwestern Germany: Results of the PROMOTE community-based intervention trial

Regular physical activity (PA) is of central importance for healthy ageing. However, in Germany, only 42% of older adults currently reach the PA recommendations of the World Health Organization. The aim of this study was to examine the effects of two web-based interventions on PA in adults aged 65-75 years living in Northwestern Germany compared to a delayed intervention control group (CG). 589 older adults were randomized to one of the three groups. Participants in intervention group 1 (IG1) received access to a web-based intervention for ten weeks assisting them in self-tracking PA behavior. Participants in IG2 received the intervention of IG1 and additionally an activity tracker to objectively track PA behavior. To analyze differences in objectively measured moderate-to-vigorous PA and sedentary time between baseline and follow-up (12 weeks after baseline), linear mixed models were used. The interaction effects revealed a decrease in minutes spent on moderate-to-vigorous PA in bouts of 10 min by 11 min per week in IG1 participants (β = -11.08, 95% CI: (-35.03; 12.87)). In comparison, IG2 participants were 7 min more physically active at follow-up (β = 7.48, 95% CI: (-17.64; 32.60)). Sedentary time in bouts of 30 min per week increased in IG1 participants (β = 106.77, 95% CI: (-47.69; 261.23)) and decreased in IG2 participants at follow-up (β = -16.45, 95% CI: (-178.83; 145.94)). Participation in the two web-based interventions did not lead to significant increases in moderate-to-vigorous PA or significant decreases in sedentary time compared to the CG. The study was registered at the German Clinical Trials Register (DRKS00010052, 07-11-2016).

Telephone-Based Coaching and Prompting for Physical Activity: Short- and Long-Term Findings of a Randomized Controlled Trial (Movingcall)

This study analyzed the short- and long-term efficacy of telephone coaching and short message service (SMS) prompting for physical activity (PA) promotion. Two-hundred-and-eighty-eight adults (age: 42 ± 11 years) were assigned randomly to three intervention arms: The intervention groups received 12 bi-weekly telephone calls with (coaching and SMS group) or without (coaching group) additional SMS prompts (n = 48 SMS). The control group received a single written PA recommendation. Self-reported and objective moderate-to-vigorous physical activity (MVPA) levels were assessed by a structured interview and by accelerometer at baseline, after the intervention (6 months), as well as after a no-contact follow-up (12 months). At post-test, self-reported MVPA increased by 173 min/week (95% CI 95 to 252) in the coaching group and by 165 min/week (95% CI 84 to 246) in the coaching and SMS group compared to control. These group differences remained similar in the follow-up test. For the objectively assessed MVPA, the coaching group increased by 32 min/week (95% CI 0.1 to 63) and the coaching and SMS group by 34 min/week (95% CI 1.6 to 66) compared to the control group. In the follow-up test, the objective MVPA levels of the intervention groups no longer differed from baseline, but group differences persisted as the control group decreased below baseline. Additional SMS prompts did not result in a further increase in PA. Telephone coaching can be considered an effective tool for PA promotion.

Exercise-Based Interventions to Enhance Long-Term Sustainability of Physical Activity in Older Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Exercise is a form of physical activity (PA). PA is an important marker of health and quality of life in older adults. The purpose of this study was to conduct a systematic review of the literature to assess the effect of exercise-based interventions on an at least six-month follow up PA measure, and to describe the specific strategies implemented during the intervention to strengthen the sustainability of PA in community-dwelling 65+ year-old adults. We registered and conducted a systematic review and meta-analysis (PROSPERO: CRD42017070892) of randomized clinical trials (RCT). We searched three electronic databases during January 2018 to identify RCT assessing any type of exercise-based intervention. Studies had to report a pre-, post-, and at least 6-month post-intervention follow-up. To be included, at least one PA outcome had to be assessed. The effect of exercise-based interventions was assessed compared to active (e.g., a low-intensity type of exercise, such as stretching or toning activities) and non-active (e.g., usual care) control interventions at several time points. Secondary analyses were conducted, restricted to studies that reported specific strategies to enhance the sustainability of PA. The intervention effect was measured on self-reported and objective measures of time spent in PA, by means of standardized mean differences. Standardized mean differences of PA level were pooled. Pooled estimates of effect were computed with the DerSimonian-Laird method, applying a random effects model. The risk of bias was also assessed. We included 12 studies, comparing 18 exercise intervention groups to four active and nine non-active control groups. Nine studies reported specific strategies to enhance the long-term sustainability of PA. The strategies were mostly related to the self-efficacy, self-control, and behavior capability principles based on the social cognitive theory. Exercise interventions compared to active control showed inconclusive and heterogeneous results. When compared to non-active control, exercise interventions improved PA time at the six-months follow up (standardized mean difference (SMD) 0.30; 95%CI 0.15 to 0.44; four studies; 724 participants; I2 0%), but not at the one- or two-years follow-ups. No data were available on the mid- and long-term effect of adding strategies to enhance the sustainability of PA. Exercise interventions have small clinical benefits on PA levels in community-dwelling older adults, with a decline in the observed improvement after six months of the intervention cessation.

Effect of counselling on health-promoting lifestyle and the quality of life in Iranian middle-aged women: a randomised controlled clinical trial

BACKGROUND

Promotion of healthy lifestyle is an important strategy. This study was conducted to determine the effects of counselling on health-promoting lifestyle and quality of life in middle-aged women.

METHODS

This randomised, controlled, clinical trial was conducted on 102 middle-aged women presenting to health centers in Tabriz, Iran, in 2016-17. Using stratified blocking based on age (40-50 and 50-60 age groups) with block sizes of four and six, eligible middle-aged women were randomly allocated to the intervention and control groups. The intervention group received health-promoting lifestyle counselling over three 45-min sessions. The control group received the routine care provided by health centers. The Health Promoting Lifestyle Profile- II (HPLP-II) and quality of life survey (SF-36) were completed in both group before and four and eight weeks after completion of the intervention. Data were analyzed using the independent t-test and the repeated measures analysis of variance (ANOVA).

RESULTS

After adjustment for the baseline values, the repeated measures ANOVA showed that the mean scores of health-promoting lifestyle (adjusted mean difference = 0.91, 95% confidence interval: 0.83 to 0.99, P < 0.001) and quality of life (18.2, 15.75 to 20.66, P < 0.001) were significantly higher in the intervention compared to the control group after the intervention.

CONCLUSION

Counselling can improve health-promoting lifestyle and quality of life in middle-aged women.

TRIAL REGISTRATION

IRCT2015122610324N27. Registered 4 February 2016.

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

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).

Health-Promotion Intervention Increases Self-Reported Physical Activity in Sub-Saharan African University Students: A Randomized Controlled Pilot Study

To evaluate the efficacy of a health-promotion intervention in increasing self-reported physical activity among university students in Sub-Saharan Africa. Randomly selected second-year students at a university in South Africa were randomized to an intervention based on social cognitive theory: health-promotion, targeting physical activity and fruit, vegetable, and fat consumption; or HIV risk-reduction, targeting sexual-risk behaviors. Participants completed assessments via audio computer-assisted self-interviewing pre-intervention and 6 and 12 months post-intervention. A total of 176 were randomized with 171 (97.2%) retained 12 months post-intervention. Generalized-estimating-equations analyses indicated that the health-promotion-intervention participants were more likely to meet physical-activity guidelines than were control participants, post-intervention, adjusting for pre-intervention physical activity (odds ratio [OR] = 3.35; 95% CI: 1.33-8.41). Health-promotion participants reported a greater number of days they did vigorous-intensity (risk ratio [RR] = 2.01; 95% CI: 1.43-2.83) and moderate-intensity (RR = 1.40; 95% CI: 1.01-1.95) aerobic activity, but not strength-building activity (RR = 1.37; 95% CI: 0.091-2.07). The intervention reduced self-reported servings of fried foods (mean difference = -0.31; 95% CI: -0.60, -0.02). The findings suggest that theory-based, contextually appropriate interventions may increase physical activity among university students in Sub-Saharan Africa.

A cumulative meta-analysis of the effects of individual physical activity interventions targeting healthy adults

Despite a large and increasing evidence base on physical activity interventions, the high rates of physical inactivity and associated chronic diseases are continuing to increase globally. The purpose of this cumulative meta-analysis was to investigate the evolution of randomized controlled trial evidence of individual-level physical activity interventions to asses if new trials are contributing novel evidence to the field. Through a two-staged search process, primary studies examining the effects of interventions targeted at increasing physical activity within healthy adult populations were pooled and selected from eligible systematic reviews. Cumulative meta-analyses were performed on effect sizes immediately post-intervention (n = 62), and for long-term behaviour change (≥12-month post-baseline; n = 27). Sufficiency and stability of the evidence was assessed through application of pre-published indicators. Meta-analyses suggest overall positive intervention effects on physical activity. The evidence base for effectiveness immediately post-intervention reached levels of sufficiency and stability in 2007; and for long-term follow-up in 2011. In the time since, intervention effectiveness has not substantially changed, and further trials are unlikely to change the direction and magnitude of effect. Substantial evidence exists demonstrating that physical activity interventions can modify individual behaviour in controlled settings. Researchers are urged to shift focus towards investigating the optimization, implementation, sustainability and cost-effectiveness of interventions.

Using affective judgement to increase physical activity in British adults

Mobile phone apps have been shown to increase physical activity (PA), but existing apps fail to target the emotional aspects of PA, which influence whether individuals are active. We developed an app that encourages individuals to focus on the emotional aspects of PA. We aimed to assess the acceptability of this app, and conduct a preliminary evaluation of efficacy. The app was developed in collaboration with users through focus groups. Seven users tested the app over 4 months and provided feedback on acceptability, aesthetics and functionality in a follow-up focus group. Results were summarized descriptively. Before testing the app, participants completed a questionnaire assessing their current PA and psychological antecedents of PA. A second questionnaire was completed at the follow-up focus group. Change scores are reported for each participant and overall.The social and reminder aspects facilitated motivation to be active and many found it easy to integrate into their lives. Most suggested modifications. Small improvements in number of minutes spent walking per week were observed (overall mean change +25 min) and some psychological antecedents of PA (overall mean change for social support for PA +0.14, self-efficacy for PA +0.17, outcome expectations about PA +0.20; all five-point scales), but reductions were seen in other domains. The app was acceptable to users, although developments are required. Testing with a small number of individuals, offering preliminary evidence of efficacy of this app, provides justification for further evaluation on a larger scale.

Efficacy of a Community-Based Technology-Enabled Physical Activity Counseling Program for People With Knee Osteoarthritis: Proof-of-Concept Study

Background

Current practice guidelines emphasize the use of physical activity as the first-line treatment of knee osteoarthritis; however, up to 90% of people with osteoarthritis are inactive.

Objective

We aimed to assess the efficacy of a technology-enabled counseling intervention for improving physical activity in people with either a physician-confirmed diagnosis of knee osteoarthritis or having passed two validated criteria for early osteoarthritis.

Methods

We conducted a proof-of-concept randomized controlled trial. The immediate group received a brief education session by a physical therapist, a Fitbit Flex, and four biweekly phone calls for activity counseling. The delayed group received the same intervention 2 months later. Participants were assessed at baseline (T0) and at the end of 2 months (T1), 4 months (T2), and 6 months (T3). Outcomes included (1) mean time on moderate-to-vigorous physical activity (MVPA ≥3 metabolic equivalents [METs], primary outcome), (2) mean time on MVPA ≥4 METs, (3) mean daily steps, (4) mean time on sedentary activities, (5) Knee Injury and Osteoarthritis Outcome Score (KOOS), and (6) Partners in Health scale. Mixed-effects repeated measures analysis of variance was used to assess five planned contrasts of changes in outcome measures over measurement periods. The five contrasts were (1) immediate T1-T0 vs delayed T1-T0, (2) delayed T2-T1 vs delayed T1-T0, (3) mean of contrast 1 and contrast 2, (4) immediate T1-T0 vs delayed T2-T1, and (5) mean of immediate T2-T1 and delayed T3-T2. The first three contrasts estimate the between-group effects. The latter two contrasts estimate the effect of the 2-month intervention delay on outcomes.

Results

We recruited 61 participants (immediate: n=30; delayed: n=31). Both groups were similar in age (immediate: mean 61.3, SD 9.4 years; delayed: mean 62.1, SD 8.5 years) and body mass index (immediate: mean 29.2, SD 5.5 kg/m²; delayed: mean 29.2, SD 4.8 kg/m²). Contrast analyses revealed significant between-group effects in MVPA ≥3 METs (contrast 1 coefficient: 26.6, 95% CI 4.0-49.1, P=.02; contrast 3 coefficient: 26.0, 95% CI 3.1-49.0, P=.03), daily steps (contrast 1 coefficient: 1699.2, 95% CI 349.0-3049.4, P=.02; contrast 2 coefficient: 1601.8, 95% CI 38.7-3164.9, P=.045; contrast 3 coefficient: 1650.5, 95% CI 332.3-2968.7; P=.02), KOOS activity of daily living subscale (contrast 1 coefficient: 6.9, 95% CI 0.1-13.7, P=.047; contrast 3 coefficient: 7.2, 95% CI 0.8-13.6, P=.03), and KOOS quality of life subscale (contrast 1 coefficient: 7.4, 95% CI 0.0-14.7, P=.049; contrast 3 coefficient: 7.3, 95% CI 0.1-14.6, P=.048). We found no significant effect in any outcome measures due to the 2-month delay of the intervention.

Conclusions

Our counseling program improved MVPA ≥3 METs, daily steps, activity of daily living, and quality of life in people with knee osteoarthritis. These findings are important because an active lifestyle is an important component of successful self-management.

Trial Registration

ClinicalTrials.gov NCT02315664; https://clinicaltrials.gov/ct2/show/NCT02315664 (Archived by WebCite at http://www.webcitation.org/6ynSgUyUC)

Cluster randomized controlled trial of a multilevel physical activity intervention for older adults

BACKGROUND

Older adults are the least active population group. Interventions in residential settings may support a multi-level approach to behavior change.

METHODS

In a cluster randomized control trial, 11 San Diego retirement communities were assigned to a physical activity (PA) intervention or a healthy aging attention control condition. Participants were 307 adults over 65 years old. The multilevel PA intervention was delivered with the assistance of peer leaders, who were trained older adult from the retirement communities. Intervention components included individual counseling & self-monitoring with pedometers, group education sessions, group walks, community advocacy and pedestrian community change projects. Intervention condition by time interactions were tested using generalized mixed effects regressions. The primary outcomes was accelerometer measured physical activity. Secondary outcomes were blood pressure and objectively measured physical functioning.

RESULTS

Over 70% of the sample were 80 years or older. PA significantly increased in the intervention condition (56 min of moderate-vigorous PA per week; 119 min of light PA) compared with the control condition and remained significantly higher across the 12 month study. Men and participants under 84 years old benefited most from the intervention. There was a significant decrease in systolic (p < .007) and diastolic (p < .02) blood pressure at 6 months. Physical functioning improved but the changes were not statistically significant.

CONCLUSIONS

Intervention fidelity was high demonstrating feasibility. Changes in PA and blood pressure achieved were comparable to other studies with much younger participants. Men, in particular, avoided a year-long decline in PA.

TRIAL REGISTRATION

clincialtrials.gov Identifier: NCT01155011 .

Feasibility and preliminary efficacy of an exercise telephone counseling intervention for hematologic cancer survivors: a phase II randomized controlled trial

BACKGROUND

Supervised exercise interventions produce the largest improvements in patient-reported outcomes in cancer survivors but their scalability has been questioned. Telephone counseling has been proposed as a more feasible alternative but its impact on exercise behavior and health outcomes have been modest. Basing telephone counseling exercise (TCE) interventions on the theoretical advances described in the multi-process action control framework (M-PAC) may improve these outcomes.

PURPOSE

To assess the feasibility and preliminary efficacy of a M-PAC-based TCE intervention for increasing aerobic exercise behavior in hematologic cancer survivors (HCS).

METHODS

We recruited 51 HCS who were randomized to either a weekly TCE group (n = 26) or a self-directed exercise (SDE) group (n = 25). Participants completed online measures of self-reported aerobic exercise behavior, quality of life (QoL), fatigue, and program satisfaction at baseline and post-intervention (12 weeks).

RESULTS

Adherence to the TCE intervention was 93% and retention was 100%. Participants receiving TCE increased their weekly aerobic exercise by 218 min compared to 93 min in the SDE group [mean-adjusted between-group difference (MBGD_adj) = 139, 95%CI = 65 to 213, p < .001, effect size (d) = 2.19]. Clinically meaningful QoL improvements favored the TCE group for mental health (MBGD_adj = 3.7, 95%CI = - 0.4 to 7.9, p = .08, d = 0.42) and mental health component (MBGD_adj = 3.6, 95%CI = - 0.8 to 8.1, p = .10, d = 0.35) subscales.

CONCLUSIONS

The 12-week TCE intervention substantially increased exercise behavior and may have meaningfully improved QoL in HCS.

IMPLICATIONS FOR CANCER SURVIVORS

Though more definitive trials are needed, remote TCE interventions based on the M-PAC may improve exercise behavior and QoL in HCS and perhaps other cancer survivor groups.

TRIAL REGISTRATION NUMBER

Clinical Trials ID: NCT03052777.

The effectiveness of interventions aimed at increasing physical activity in adults with persistent musculoskeletal pain: a systematic review and meta-analysis

BACKGROUND

Individuals with persistent musculoskeletal pain (PMP) have an increased risk of developing co-morbid health conditions and for early-mortality compared to those without pain. Despite irrefutable evidence supporting the role of physical activity in reducing these risks; there has been limited synthesis of the evidence, potentially impacting the optimisation of these forms of interventions. This review examines the effectiveness of interventions in improving levels of physical activity and the components of these interventions.

METHODS

Randomised and quasi-randomised controlled trials were included in this review. The following databases were searched from inception to March 2016: CENTRAL in the Cochrane Library, Cochrane Database of Systematic Reviews (CDSR), MEDLINE, Embase, CINAHL, PsycINFO and AMED. Two reviewers independently screened citations, assessed eligibility, extracted data, assessed risk of bias and coded intervention content using the behaviour change taxonomy (BCTTv1) of 93 hierarchically clustered techniques. GRADE was used to rate the quality of the evidence.

RESULTS

The full text of 276 articles were assessed for eligibility, twenty studies involving 3441 participants were included in the review. Across the studies the mean number of BCTs coded was eight (range 0-16); with 'goal setting' and 'instruction on how to perform the behaviour' most frequently coded. For measures of subjective physical activity: interventions were ineffective in the short term, based on very low quality evidence; had a small effect in the medium term based on low quality evidence (SMD 0.25, 95% CI 0.01 to 0.48) and had a small effect in the longer term (SMD 0.21 95% CI 0.08 to 0.33) based on moderate quality evidence. For measures of objective physical activity: interventions were ineffective - based on very low to low quality evidence.

CONCLUSIONS

There is some evidence supporting the effectiveness of interventions in improving subjectively measured physical activity however, the evidence is mostly based on low quality studies and the effects are small. Given the quality of the evidence, further research is likely/very likely to have an important impact on our confidence in effect estimates and is likely to change the estimates. Future studies should provide details on intervention components and incorporate objective measures of physical activity.

Assessment of fidelity in individual level behaviour change interventions promoting physical activity among adults: a systematic review

BACKGROUND

Behaviour change interventions that promote physical activity have major implications for health and well-being. Measuring intervention fidelity is crucial in determining the extent to which an intervention is delivered as intended, therefore increasing scientific confidence about effectiveness. However, we lack a clear overview of how well intervention fidelity is typically assessed in physical activity trials.

METHODS

A systematic literature search was conducted to identify peer - reviewed physical activity promotion trials that explicitly measured intervention fidelity. Methods used to assess intervention fidelity were categorised, narratively synthesised and critiqued using assessment criteria from NIH Behaviour Change Consortium (BCC) Treatment Fidelity Framework (design, training, delivery, receipt and enactment).

RESULTS

Twenty eight articles reporting of twenty one studies used a wide variety of approaches to measure intervention fidelity. Delivery was the most common domain of intervention fidelity measured. Approaches used to measure fidelity across all domains varied from researcher coding of observational data (using checklists or scales) to participant self-report measures. There was considerable heterogeneity of methodological approaches to data collection with respect to instruments used, attention to psychometric properties, rater-selection, observational method and sampling strategies.

CONCLUSIONS

In the field of physical activity interventions, fidelity measurement is highly heterogeneous both conceptually and methodologically. Clearer articulation of the core domains of intervention fidelity, along with appropriate measurement approaches for each domain are needed to improve the methodological quality of fidelity assessment in physical activity interventions. Recommendations are provided on how this situation can be improved.

Impact of educational interventions on primary prevention of cardiovascular disease: A systematic review with a focus on physical activity

Background: Evidence from epidemiological and experimental studies illustrates the beneficial impact of healthy lifestyle behaviours on cardiovascular risk.

Objectives: To assess the effectiveness of primary care health education interventions designed to promote healthy lifestyles on physical activity levels and cardiovascular risk.

Methods: A computer-aided search on PubMed and Scopus was performed to identify relevant studies published from January 2000 to October 2016. Two authors independently selected studies for inclusion and extracted data, including intervention characteristics and outcome measures, namely physical activity and cardiovascular risk or risk factors.

Results: Of the 212 identified studies, 15 met the inclusion criteria. The 15 studies enrolled 6727 participants; the sample size varied between 74 and 878 adults. Fourteen studies assessed physical activity by questionnaire and only one study used accelerometry. Eight of the 15 studies showed improvements in the physical activity levels after the intervention, ranging from 5% to 26% in those where significant changes between groups were detected. Most studies reported significant positive effects of the health education interventions on cardiovascular risk factors, mainly on lipid profile, blood pressure and cardiovascular risk score.

Conclusion: The health education interventions, in primary care, seem to improve daily physical activity, cardiovascular risk factors and risk score.

Promotion of physical activity interventions for community dwelling older adults: A systematic review of reviews

OBJECTIVES

While there is strong evidence that regular participation in physical activity (PA) brings numerous health benefits to older adults, and interventions to effectively promote PA are being developed and tested, the characteristics and components of the most effective interventions remain unclear. This systematically conducted review of systematic reviews evaluated the effects and characteristics of PA promotion interventions aimed at community dwelling people over 50 years old.

METHODS

Major databases were searched for reviews from January 1990 to May 2015. TIDieR guidelines aided data extraction and the ROBIS tool was used to assess the risk of bias. Primary outcomes were objective and self-reported levels of PA. Indicators of psychological wellbeing and participation rates were secondary outcomes.

RESULTS

Of 1284 records identified, 19 reviews met inclusion criteria and eight included meta-analyses. Interventions typically incorporated behaviour change techniques (BCTs) and were delivered as face-to-face, remote, group, individual or as combined interventions. Despite their heterogeneity, interventions often resulted in sustained improvements in PA over the study period, typically at 12 months, and led to improvements in general wellbeing. However, ways to ensure effective maintenance beyond one year are unclear. Certain intervention components were more clearly associated with positive effects (e.g. tailoring promotion strategy with combination of cognitive and behavioural elements, low to moderate intensity activity recommended). We found no evidence that certain other intervention characteristics were superior in achieving positive outcomes (e.g. mode of delivery, setting, professional background of the intervention provider, type of PA recommended).

CONCLUSION

The evidence suggests that interventions to promote PA among older adults are generally effective but there is uncertainty around the most beneficial intervention components. There are indications that purely cognitive strategies and BCTs might be less suitable for older adults than motivators more meaningful to them, including social and environmental support, and enjoyment coming from being physically active. A whole system-oriented approach is required that is tailored to meet the needs of older adults and aligned with social, individual and environmental factors.

A systematic review of lifestyle counseling for diverse patients in primary care

Prior research and systematic reviews have examined strategies related to weight management, less is known about lifestyle and behavioral counseling interventions optimally suited for implementation in primary care practices generally, and among racial and ethnic patient populations. Primary care practitioners may find it difficult to access and use available research findings on effective behavioral and lifestyle counseling strategies and to assess their effects on health behaviors among their patients. This systematic review compiled existing evidence from randomized trials to inform primary care providers about which lifestyle and behavioral change interventions are shown to be effective for changing patients' diet, physical activity and weight outcomes. Searches identified 444 abstracts from all sources (01/01/2004-05/15/2014). Duplicate abstracts were removed, selection criteria applied and dual abstractions conducted for 106 full text articles. As of June 12, 2015, 29 articles were retained for inclusion in the body of evidence. Randomized trials tested heterogeneous multi-component behavioral interventions for an equally wide array of outcomes in three population groups: diverse patient populations (23 studies), African American patients only (4 studies), and Hispanic/Mexican American/Latino patients only (2 studies). Significant and consistent findings among diverse populations showed that weight and physical activity related outcomes were more amenable to change via lifestyle and behavioral counseling interventions than those associated with diet modification. Evidence to support specific interventions for racial and ethnic minorities was promising, but insufficient based on the small number of studies.

Development and evaluation of two web-based interventions for the promotion of physical activity in older adults: study protocol for a community-based controlled intervention trial

Background

Regular physical activity (PA) is a key contributor to healthy ageing. However, despite known health benefits, only one third of older adults in Germany reach the PA levels recommended for persons aged 65 years and above by the World Health Organization. The aim of the current study is to evaluate the effectiveness of two web-based interventions for the initiation and maintenance of regular PA (i.e., intervention groups 1 and 2) compared to a delayed intervention control group of older adults aged 65 to 75 years.

Methods/Design

Study participants will be randomly assigned to one of three study arms in five communities in the Bremen-Oldenburg metropolitan region: a) Participants in the first arm will receive access to a web-based intervention for 10 weeks allowing them to track their weekly PA (subjective self-monitoring, intervention group 1); b) participants in the second arm will receive access to the web-based intervention for 10 weeks and, in addition, track PA using Fitbit Zips (objective self-monitoring, intervention group 2); c) participants in the delayed intervention control group will receive access to the intervention implemented in the first study arm after completion of the 12-week follow-up in the other two groups within each community. In addition, weekly group meetings in the communities will be offered to study participants in the intervention groups providing the opportunity to address questions related to the use of the website and to practice PA in groups (e.g., neighborhood walks, strength and balance exercises). To evaluate short-term effects of the intervention on physical and psychological health, PA, physical fitness, and cognitive and psychological variables will be assessed at baseline and 12-week follow-up.

Discussion

This study will provide answers regarding acceptance and effectiveness of web-based interventions promoting uptake and maintenance of regular PA in persons aged 65–75 years. Study findings will contribute to a growing body of evidence in Germany concerning the role of community-based interventions for the promotion of PA and healthy ageing in older adults.

Trial registration

German Clinical Trials Register DRKS00010052 (Date of registration 07–11-2016).

Feasibility of an implementation strategy for the integration of health promotion in routine primary care: a quantitative process evaluation

BACKGROUND

Process evaluation is recommended to improve the understanding of underlying mechanisms related to clinicians, patients, context and intervention delivery that may impact on trial or program results, feasibility and transferability to practice. The aim of this study was to assess the feasibility of the Prescribe Healthy Life (PVS from the Spanish "Prescribe Vida Saludable") implementation strategy for enhancing the adoption and implementation of an evidence-based health promotion intervention in primary health care.

METHODS

A descriptive study of 2-year implementation indicators for the PVS clinical intervention was conducted in four primary health care centers. A multifaceted collaborative modeling implementation strategy was developed to enhance the integration of a clinical intervention to promote healthy lifestyles into clinical practice. Process indicators were assessed for intervention reach, adoption, implementation, sustainability and their variability at center, practice, and patient levels.

RESULTS

Mean rates of adoption by means of active collaboration among the three main professional categories (family physicians, nurses and administrative personnel) were 75% in all centers. Just over half of the patients that attended (n = 11650; 51.9%) were reached in terms of having their lifestyle habits assessed, while more than a third (33.7%; n = 7433) and almost 10% (n = 2175) received advice or a printed prescription for at least one lifestyle change, respectively. Only 3.7% of the target population received a repeat prescription. These process indicators significantly (p < 0.001) varied by center, lifestyle habit and patient characteristics. Sustainability of intervention components changed thorough the implementation period within centers.

CONCLUSIONS

The implementation strategy used showed moderate-to-good performance on process indicators related to adoption, reach, and implementation of the evidence-based healthy lifestyle promotion intervention in the context of routine primary care. Sources of heterogeneity and instability in these indicators may improve our understanding of factors required to attain adequate program adoption and implementation through improved implementation strategies.

Feasibility and preliminary efficacy of the 'HEYMAN' healthy lifestyle program for young men: a pilot randomised controlled trial

Background

In young men, unhealthy lifestyle behaviours can be detrimental to their physical and/or mental health and set them on a negative health trajectory into adulthood. Despite this, there is a lack of evidence to guide development of effective health behaviour change interventions for young men. This study assessed the feasibility and preliminary efficacy of the ‘HEYMAN’ (Harnessing Ehealth to enhance Young men’s Mental health, Activity and Nutrition) healthy lifestyle program for young men.

Methods

A pilot RCT with 50 young men aged 18–25 years randomised to the HEYMAN intervention (n = 26) or waitlist control (n = 24). HEYMAN was a 3-month intervention, targeted for young men to improve eating habits, activity levels and well-being. Intervention development was informed by a participatory research model (PRECEDE-PROCEED). Intervention components included eHealth support (website, wearable device, Facebook support group), face-to-face sessions (group and individual), a personalised food and nutrient report, home-based resistance training equipment and a portion control tool. Outcomes included: feasibility of research procedures (recruitment, randomisation, data collection and retention) and of intervention components. Generalized linear mixed models estimated the treatment effect at 3-months for the primary outcomes: pedometer steps/day, diet quality, well-being and several secondary outcomes.

Results

A 7-week recruitment period was required to enrol 50 young men. A retention rate of 94% was achieved at 3-months post-intervention. Retained intervention participants (n = 24) demonstrated reasonable usage levels for most program components and also reported reasonable levels of program component acceptability for attractiveness, comprehension, usability, support, satisfaction and ability to persuade, with scores ranging from 3.0 to 4.6 (maximum 5). No significant intervention effects were observed for the primary outcomes of steps/day (1012.7, 95% CI = −506.2, 2531.6, p = 0.191, d = 0.36), diet quality score (3.6, 95% CI = −0.4, 7.6, p = 0.081, d = 0.48) or total well-being score (0.4, 95% CI = −1.6, 2.5, p = 0.683, d = 0.11). Significant intervention effects were found for daily vegetable servings, energy-dense, nutrient-poor foods, MVPA, weight, BMI, fat mass, waist circumference and cholesterol (all p < 0.05).

Conclusions

The HEYMAN program demonstrated feasibility in assisting young men to make some positive lifestyle changes. This provides support for the conduct of a larger, fully-powered RCT, but with minor amendments to research procedures and intervention components required.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12616000350426.

Electronic supplementary material

The online version of this article (doi:10.1186/s12937-017-0227-8) contains supplementary material, which is available to authorized users.

Efficacy of interventions to improve physical activity levels in individuals with stroke: a systematic review protocol

INTRODUCTION

Stroke is a leading health problem worldwide and an important cause of disability. Stroke survivors show low levels of physical activity, and increases in physical activity levels may improve function and health status. Therefore, the aims are to identify which interventions that have been employed to increase physical activity levels with stroke survivors, to verify their efficacy and to identify the gaps in the literature.

METHODS AND ANALYSIS

A systematic review of randomised controlled trials that investigated the efficacy of interventions aiming at increasing physical activity levels of stroke survivors will be conducted. Electronic searches will be performed in the MEDLINE, Physiotherapy Evidence Database (PEDro), Excerpta Medica (EMBASE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Scientific Electronic Library Online (SCIELO) databases. Hand searches of the reference lists of the included studies or relevant reviews will also be employed. Two independent reviewers will screen all the retrieved titles, abstracts and full texts. A third reviewer will be referred to solve any disagreements. The quality of the included studies will be assessed by the PEDro Rating Scale. This systematic review will also include a qualitative synthesis. Meta-analyses will be performed, if the studies are sufficiently homogeneous. This review will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. The quality of the evidence regarding physical activity will be assessed, according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

DISCUSSION

This systematic review will provide information on which interventions are effective for increasing physical activity levels of stroke survivors. This evidence may be important for clinical decision-making and will allow the identification of gaps in the literature that may be useful for the definition of future research goals and the planning of new trials.

TRIAL REGISTRATION NUMBER

CRD42016037750.

Using Web 2.0 applications to promote health-related physical activity: findings from the WALK 2.0 randomised controlled trial

Background/Aim

Web 2.0 internet technology has great potential in promoting physical activity. This trial investigated the effectiveness of a Web 2.0-based intervention on physical activity behaviour, and the impact on website usage and engagement.

Methods

504 (328 women, 126 men) insufficiently active adult participants were randomly allocated to one of two web-based interventions or a paper-based Logbook group. The Web 1.0 group participated in the existing 10 000 Steps programme, while the Web 2.0 group participated in a Web 2.0-enabled physical activity intervention including user-to-user interaction through social networking capabilities. ActiGraph GT3X activity monitors were used to assess physical activity at four points across the intervention (0, 3, 12 and 18 months), and usage and engagement were assessed continuously through website usage statistics.

Results

Treatment groups differed significantly in trajectories of minutes/day of physical activity (p=0.0198), through a greater change at 3 months for Web 2.0 than Web 1.0 (7.3 min/day, 95% CI 2.4 to 12.3). In the Web 2.0 group, physical activity increased at 3 (mean change 6.8 min/day, 95% CI 3.9 to 9.6) and 12 months (3.8 min/day, 95% CI 0.5 to 7.0), but not 18 months. The Logbook group also increased physical activity at 3 (4.8 min/day, 95% CI 1.8 to 7.7) and 12 months (4.9 min/day, 95% CI 0.7 to 9.1), but not 18 months. The Web 1.0 group increased physical activity at 12 months only (4.9 min/day, 95% CI 0.5 to 9.3). The Web 2.0 group demonstrated higher levels of website engagement (p=0.3964).

Conclusions

In comparison to a Web 1.0 intervention, a more interactive Web 2.0 intervention, as well as the paper-based Logbook intervention, improved physical activity in the short term, but that effect reduced over time, despite higher levels of engagement of the Web 2.0 group.

Trial registration number

ACTRN12611000157976.

Effect of a Primary Care Walking Intervention with and without Nurse Support on Physical Activity Levels in 45- to 75-Year-Olds: The Pedometer And Consultation Evaluation (PACE-UP) Cluster Randomised Clinical Trial

BACKGROUND

Pedometers can increase walking and moderate-to-vigorous physical activity (MVPA) levels, but their effectiveness with or without support has not been rigorously evaluated. We assessed the effectiveness of a pedometer-based walking intervention in predominantly inactive adults, delivered by post or through primary care nurse-supported physical activity (PA) consultations.

METHODS AND FINDINGS

A parallel three-arm cluster randomised trial was randomised by household, with 12-mo follow-up, in seven London, United Kingdom, primary care practices. Eleven thousand fifteen randomly selected patients aged 45-75 y without PA contraindications were invited. Five hundred forty-eight self-reporting achieving PA guidelines were excluded. One thousand twenty-three people from 922 households were randomised between 2012-2013 to one of the following groups: usual care (n = 338); postal pedometer intervention (n = 339); and nurse-supported pedometer intervention (n = 346). Of these, 956 participants (93%) provided outcome data (usual care n = 323, postal n = 312, nurse-supported n = 321). Both intervention groups received pedometers, 12-wk walking programmes, and PA diaries. The nurse group was offered three PA consultations. Primary and main secondary outcomes were changes from baseline to 12 mo in average daily step-counts and time in MVPA (in ≥10-min bouts), respectively, measured objectively by accelerometry. Only statisticians were masked to group. Analysis was by intention-to-treat. Average baseline daily step-count was 7,479 (standard deviation [s.d.] 2,671), and average time in MVPA bouts was 94 (s.d. 102) min/wk. At 12 mo, mean steps/d, with s.d. in parentheses, were as follows: control 7,246 (2,671); postal 8,010 (2,922); and nurse support 8,131 (3,228). PA increased in both intervention groups compared with the control group; additional steps/d were 642 for postal (95% CI 329-955) and 677 for nurse support (95% CI 365-989); additional MVPA in bouts (min/wk) were 33 for postal (95% CI 17-49) and 35 for nurse support (95% CI 19-51). There were no significant differences between the two interventions at 12 mo. The 10% (1,023/10,467) recruitment rate was a study limitation.

CONCLUSIONS

A primary care pedometer-based walking intervention in predominantly inactive 45- to 75-y-olds increased step-counts by about one-tenth and time in MVPA in bouts by about one-third. Nurse and postal delivery achieved similar 12-mo PA outcomes. A primary care pedometer intervention delivered by post or with minimal support could help address the public health physical inactivity challenge.

CLINICAL TRIAL REGISTRATION

isrctn.com ISRCTN98538934.

Physical activity levels in adults with intellectual disabilities: A systematic review

Despite evidence that inactivity is a major factor causing ill health in people with intellectual disabilities (pwID) there are gaps in our knowledge of their physical activity (PA). To date, there is no published systematic review of their PA levels. Therefore, we performed a systematic review from January-October 2015, comprising studies from across the globe to establish PA levels, determine how they were measured, and what factors influenced PA in adults with intellectual disabilities (awID). Five databases were searched. Studies were included if written in English, peer-reviewed, had primary research data, and measured PA levels of awID. Quality was assessed using a 19-item checklist. Meta-summary of the findings was performed and a meta-analysis of factors influencing PA using multiple regression. Fifteen studies were included consisting of 3159 awID, aged 16-81 years, 54% male and 46% female. Only 9% of participants achieved minimum PA guidelines. PA levels were measured using objective and subjective methods. ID severity, living in care, gender, and age were independently significantly correlated with the number of participants achieving PA guidelines with the strongest predictor being ID severity (Beta 0.631, p < 0.001). Findings should be in the context that most of the participants were in the mild/moderate range of ID severity and none of the studies objectively measured PA in people with profound ID. To inform measurement and intervention design for improved PA, we recommend that there is an urgent need for future PA studies in awID population to include all disability severity levels. PROSPERO registration number CRD42015016675.

Developing the Stroke Exercise Preference Inventory (SEPI)

BACKGROUND

Physical inactivity is highly prevalent after stroke, increasing the risk of poor health outcomes including recurrent stroke. Tailoring of exercise programs to individual preferences can improve adherence, but no tools exist for this purpose in stroke.

METHODS

We identified potential questionnaire items for establishing exercise preferences via: (i) our preliminary Exercise Preference Questionnaire in stroke, (ii) similar tools used in other conditions, and (iii) expert panel consultations. The resulting 35-item questionnaire (SEPI-35) was administered to stroke survivors, along with measures of disability, depression, anxiety, fatigue and self-reported physical activity. Exploratory factor analysis was used to identify a factor structure in exercise preferences, providing a framework for item reduction. Associations between exercise preferences and personal characteristics were analysed using multivariable regression.

RESULTS

A group of 134 community-dwelling stroke survivors (mean age 64.0, SD 13.3) participated. Analysis of the SEPI-35 identified 7 exercise preference factors (Supervision-support, Confidence-challenge, Health-wellbeing, Exercise context, Home-alone, Similar others, Music-TV). Item reduction processes yielded a 13-item version (SEPI-13); in analysis of this version, the original factor structure was maintained. Lower scores on Confidence-challenge were significantly associated with disability (p = 0.002), depression (p = 0.001) and fatigue (p = 0.001). Self-reported barriers to exercise were particularly prevalent in those experiencing fatigue and anxiety.

CONCLUSIONS

The SEPI-13 is a brief instrument that allows assessment of exercise preferences and barriers in the stroke population. This new tool can be employed by health professionals to inform the development of individually tailored exercise interventions.

The Functional Fitness MOT Test Battery for Older Adults: Protocol for a Mixed-Method Feasibility Study

Background

Increasing physical activity (PA) brings many health benefits, but engaging people in higher levels of PA after their 60s is not straightforward. The Functional Fitness MOT (FFMOT) is a new approach which aims to raise awareness about the importance of components of fitness (strength, balance, flexibility), highlight benefits of PA, engages older people in health behavior change discussions, and directs them to local activity resources. This battery of tests combined with a brief motivational interview has not been tested in terms of feasibility or effectiveness.

Objective

To assess whether the FFMOT, provided in a health care setting, is appealing to older patients of a community physiotherapy service and to understand the views and perceptions of the older people undergoing the FFMOT regarding the intervention, as well as the views of the physiotherapy staff delivering the intervention. Secondary aims are to assess the feasibility of carrying out a phase 2 pilot randomized controlled trial of the FFMOT, in the context of a community physiotherapy service, by establishing whether enough patients can be recruited and retained in the study, and enough outcome data can be generated.

Methods

A mixed-methods feasibility study will be conducted in two physiotherapy outpatient clinics in the United Kingdom. A total of 30 physically inactive, medically stable older adults over the age of 60 will be provided with an individual FFMOT, comprising a set of six standardized, validated, age-appropriate tests aimed at raising awareness of the different components of fitness. The results of these tests will be used to provide the participants with feedback on performance in comparison to sex and age-referenced norms. This will be followed by tailored advice on how to become more active and improve fitness, including advice on local opportunities to be more active. Subsequently, participants will be invited to attend a focus group to discuss barriers and motivators to being more active, health behavior change, and the scope for individuals to improve their PA levels. To inform the design of a future trial, descriptive (eg, recruitment and retention rates), quantitative (Community Healthy Activities Model Program for Seniors; CHAMPS physical activity questionnaire), and qualitative data (focus group discussions, semi-structured staff interviews) will be collected.

Results

Recruitment and enrolment for the trial started in September 2015. Follow-up will be completed in June 2016. Results are expected to be available at the end of 2016.

Discussion

Allied health professionals play a key role in encouraging older adults to increase their PA, but with little evidence on how best to do this within their clinical practice. The purpose of this feasibility study is to examine the introduction of a new service: The FFMOT. The views and perceptions of the older people undergoing the FFMOT and relating to its delivery in clinical practice will be explored. Data, which will inform the feasibility of a randomized controlled trial of effectiveness of the FFMOT in promoting improved PA, will be reported.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): ISRCTN38950042; http://www.isrctn.com/ISRCTN38950042

Recruitment, screening, and baseline participant characteristics in the WALK 2.0 study: A randomized controlled trial using web 2.0 applications to promote physical activity

OBJECTIVE

To describe in detail the recruitment methods and enrollment rates, the screening methods, and the baseline characteristics of a sample of adults participating in the Walk 2.0 Study, an 18 month, 3-arm randomized controlled trial of a Web 2.0 based physical activity intervention.

METHODS

A two-fold recruitment plan was developed and implemented, including a direct mail-out to an extract from the Australian Electoral Commission electoral roll, and other supplementary methods including email and telephone. Physical activity screening involved two steps: a validated single-item self-report instrument and the follow-up Active Australia Questionnaire. Readiness for physical activity participation was also based on a two-step process of administering the Physical Activity Readiness Questionnaire and, where needed, further clearance from a medical practitioner.

RESULTS

Across all recruitment methods, a total of 1244 participants expressed interest in participating, of which 656 were deemed eligible. Of these, 504 were later enrolled in the Walk 2.0 trial (77% enrollment rate) and randomized to the Walk 1.0 group (n = 165), the Walk 2.0 group (n = 168), or the Logbook group (n = 171). Mean age of the total sample was 50.8 years, with 65.2% female and 79.1% born in Australia.

CONCLUSION

The results of this recruitment process demonstrate the successful use of multiple strategies to obtain a diverse sample of adults eligible to take part in a web-based physical activity promotion intervention. The use of dual screening processes ensured safe participation in the intervention. This approach to recruitment and physical activity screening can be used as a model for further trials in this area.

Effectiveness of eHealth interventions for the promotion of physical activity in older adults: a systematic review protocol

BACKGROUND

It is known that regular physical activity (PA) is associated with improvements in physical, psychological, cognitive, and functional health outcomes. The World Health Organization recommends 150 min of moderate exercise per week for older adults to achieve these health benefits. However, only 20-60 % of adults aged 60 years and above currently meet these recommendations for exercise. The widespread use of the internet and mobile phones among older adults may open new opportunities to promote PA in this population. Findings of previous reviews suggest that eHealth interventions are effective in promoting PA in adults of various ages. However, to date, none of these reviews have provided a differentiated picture of engagement in such interventions and effects on PA among older adults. Also, we are unaware of any studies comparing effects of participation in eHealth vs. traditional paper-and-pencil interventions on PA in this population. The aim of this systematic review and meta-analysis is to compare the effectiveness of eHealth interventions promoting PA in older adults aged 55 years and above with either a non-eHealth PA intervention or a group that is not exposed to any intervention.

METHODS

Eight electronic databases (MEDLINE, EMBASE, CINAHL, CENTRAL, PEI, PsycINFO, Web of Science, and OpenGrey) will be searched to identify experimental and quasi-experimental studies examining the effectiveness of eHealth interventions for PA promotion in adults aged 55 years and above. Two authors will independently select and review references, extract data, and assess the quality of the included studies by using the Cochrane Collaboration's risk of bias tool. Disagreements between authors will be resolved by discussion involving a third author. If feasible, a meta-analysis will be conducted. Narrative synthesis using harvest plots will be performed, should a meta-analysis not be feasible.

DISCUSSION

The proposed systematic review will be the first review that compares the effectiveness of eHealth interventions promoting PA in older adults aged 55 years and above with control groups exposed to a non-eHealth intervention or to no intervention. The results of this review will provide new information regarding the question whether eHealth interventions are an effective intervention vehicle for PA promotion in this population.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42015023875.

A 12-Week Exercise Program for Pregnant Women with Obesity to Improve Physical Activity Levels: An Open Randomised Preliminary Study

OBJECTIVE

To evaluate whether a 12-week supervised exercise program promotes an active lifestyle throughout pregnancy in pregnant women with obesity.

METHODS

In this preliminary randomised trial, pregnant women (body mass index ≥ 30 kg/m2) were allocated to either standard care or supervised training, from 15 to 27 weeks of gestation. Physical activity was measured by accelerometry at 14, 28 and 36 weeks, while fitness (oxygen consumption (VO2) at the anaerobic threshold), nutrition (caloric intake and macronutrients percentage) and anthropometry were assessed at 14 and 28 weeks of gestation. Analyses were performed using repeated measures ANOVA.

RESULTS

A total of fifty (50) women were randomised, 25 in each group. There was no time-group interaction for time spent at moderate and vigorous activity (pinteraction = 0.064), but the exercise group's levels were higher than controls' at all times (pgroup effect = 0.014). A significant time-group interaction was found for daily physical activity (p = 0.023); similar at baseline ((22.0 ± 6.7 vs 21.8 ± 7.3) x 10(4) counts/day) the exercise group had higher levels than the control group following the intervention ((22.8 ± 8.3 vs 19.2 ± 4.5) x 10(4) counts/day, p = 0.020) and at 36 weeks of gestation ((19.2 ± 1.5 vs 14.9 ± 1.5) x 10(4) counts/day, p = 0.034). Exercisers also gained less weight than controls during the intervention period despite similar nutritional intakes (difference in weight change = -0.1 kg/week, 95% CI -0.2; -0.02, p = 0.016) and improved cardiorespiratory fitness (difference in fitness change = 8.1%, 95% CI 0.7; 9.5, p = 0.041).

CONCLUSIONS

Compared with standard care, a supervised exercise program allows pregnant women with obesity to maintain fitness, limit weight gain and attenuate the decrease in physical activity levels observed in late pregnancy.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01610323.

Fast tracking the design of theory-based KT interventions through a consensus process

BACKGROUND

Despite available evidence for optimal management of spinal pain, poor adherence to guidelines and wide variations in healthcare services persist. One of the objectives of the Canadian Chiropractic Guideline Initiative is to develop and evaluate targeted theory- and evidence-informed interventions to improve the management of non-specific neck pain by chiropractors. In order to systematically develop a knowledge translation (KT) intervention underpinned by the Theoretical Domains Framework (TDF), we explored the factors perceived to influence the use of multimodal care to manage non-specific neck pain, and mapped behaviour change techniques to key theoretical domains.

METHODS

Individual telephone interviews exploring beliefs about managing neck pain were conducted with a purposive sample of 13 chiropractors. The interview guide was based upon the TDF. Interviews were digitally recorded, transcribed verbatim and analysed by two independent assessors using thematic content analysis. A 15-member expert panel formally met to design a KT intervention.

RESULTS

Nine TDF domains were identified as likely relevant. Key beliefs (and relevant domains of the TDF) included the following: influence of formal training, colleagues and patients on clinicians (Social Influences); availability of educational material (Environmental Context and Resources); and better clinical outcomes reinforcing the use of multimodal care (Reinforcement). Facilitating factors considered important included better communication (Skills); audits of patients' treatment-related outcomes (Behavioural Regulation); awareness and agreement with guidelines (Knowledge); and tailoring of multimodal care (Memory, Attention and Decision Processes). Clinicians conveyed conflicting beliefs about perceived threats to professional autonomy (Social/Professional Role and Identity) and speed of recovery from either applying or ignoring the practice recommendations (Beliefs about Consequences). The expert panel mapped behaviour change techniques to key theoretical domains and identified relevant KT strategies and modes of delivery to increase the use of multimodal care among chiropractors.

CONCLUSIONS

A multifaceted KT educational intervention targeting chiropractors' management of neck pain was developed. The KT intervention consisted of an online education webinar series, clinical vignettes and a video underpinned by the Brief Action Planning model. The intervention was designed to reflect key theoretical domains, behaviour change techniques and intervention components. The effectiveness of the proposed intervention remains to be tested.