1
|
Drahota A, Udell JE, Mackenzie H, Pugh MT. Psychological and educational interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2024; 10:CD013480. [PMID: 39360568 PMCID: PMC11448480 DOI: 10.1002/14651858.cd013480.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
BACKGROUND Older adults are at increased risk of both falls and fall-related injuries. Falls have multiple causes and many interventions exist to try and prevent them, including educational and psychological interventions. Educational interventions aim to increase older people's understanding of what they can do to prevent falls and psychological interventions can aim to improve confidence/motivation to engage in activities that may prevent falls. This review is an update of previous evidence to focus on educational and psychological interventions for falls prevention in community-dwelling older people. OBJECTIVES To assess the benefits and harms of psychological interventions (such as cognitive behavioural therapy; with or without an education component) and educational interventions for preventing falls in older people living in the community. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, four other databases, and two trials registries to June 2023. We also screened reference lists and conducted forward-citation searching. SELECTION CRITERIA We included randomised controlled trials of community-dwelling people aged 60 years and older exploring the effectiveness of psychological interventions (such as cognitive behavioural therapy) or educational interventions (or both) aiming to prevent falls. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our primary outcome was rate of falls. We also explored: number of people falling; people with fall-related fractures; people with falls that required medical attention; people with fall-related hospital admission; fall-related psychological outcomes (i.e. concerns about falling); health-related quality of life; and adverse events. MAIN RESULTS We included 37 studies (six on cognitive behavioural interventions; three on motivational interviewing; three on other psychological interventions; nine on multifactorial (personalised) education; 12 on multiple topic education; two on single topic education; one with unclear education type; and one psychological plus educational intervention). Studies randomised 17,478 participants (71% women; mean age 73 years). Most studies were at high or unclear risk of bias for one or more domains. Cognitive behavioural interventions Cognitive behavioural interventions make little to no difference to the number of fallers (risk ratio (RR) 0.92, 95% confidence interval (CI) 0.82 to 1.02; 4 studies, 1286 participants; low-certainty evidence), and there was a slight reduction in concerns about falling (standardised mean difference (SMD) -0.30, 95% CI -0.42 to -0.19; 3 studies, 1132 participants; low-certainty evidence). The evidence is very uncertain or missing about the effect of cognitive behavioural interventions on other outcomes. Motivational interviewing The evidence is very uncertain about the effect of motivational interviewing on rate of falls, number of fallers, and fall-related psychological outcomes. No evidence is available on the effects of motivational interviewing on people experiencing fall-related fractures, falls requiring medical attention, fall-related hospital admission, or adverse events. Other psychological interventions The evidence is very uncertain about the effect of health coaching on rate of falls, number of fallers, people sustaining a fall-related fracture, or fall-related hospital admission; the effect of other psychological interventions on these outcomes was not measured. The evidence is very uncertain about the effect of health coaching, guided imagery, and mental practice on fall-related psychological outcomes. The effect of other psychological interventions on falls needing medical attention or adverse events was not measured. Multifactorial education Multifactorial (personalised) education makes little to no difference to the rate of falls (rate ratio 0.95, 95% CI 0.77 to 1.17; 2 studies, 777 participants; low-certainty evidence). The effect of multifactorial education on people experiencing fall-related fractures was very imprecise (RR 0.66, 95% CI 0.29 to 1.48; 2 studies, 510 participants; low-certainty evidence), and the evidence is very uncertain about its effect on the number of fallers. There was no evidence for other outcomes. Multiple component education Multiple component education may improve fall-related psychological outcomes (MD -2.94, 95% CI -4.41 to -1.48; 1 study, 459 participants; low-certainty evidence). However, the evidence is very uncertain about its effect on all other outcomes. Single topic education The evidence is very uncertain about the effect of single-topic education on rate of falls, number of fallers, and people experiencing fall-related fractures. There was no evidence for other outcomes. Psychological plus educational interventions Motivational interviewing/coaching combined with multifactorial (personalised) education likely reduces the rate of falls (although the size of this effect is not clear; rate ratio 0.65, 95% CI 0.43 to 0.99; 1 study, 430 participants; moderate-certainty evidence), but makes little to no difference to the number of fallers (RR 0.93, 95% CI 0.76 to 1.13; 1 study, 430 participants; high-certainty evidence). It probably makes little to no difference to falls-related psychological outcomes (MD -0.70, 95% CI -1.81 to 0.41; 1 study, 353 participants; moderate-certainty evidence). There were no adverse events detected (1 study, 430 participants; moderate-certainty evidence). There was no evidence for psychological plus educational intervention on other outcomes. AUTHORS' CONCLUSIONS The evidence suggests that a combined psychological and educational intervention likely reduces the rate of falls (but not fallers), without affecting adverse events. Overall, the evidence for individual psychological interventions or delivering education alone is of low or very-low certainty; future research may change our confidence and understanding of the effects. Cognitive behavioural interventions may improve concerns about falling slightly, but this may not help reduce the number of people who fall. Certain types of education (i.e. multiple component education) may also help reduce concerns about falling, but not necessarily reduce the number of falls. Future research should adhere to reporting standards for describing the interventions used and explore how these interventions may work, to better understand what could best work for whom in what situation. There is a particular dearth of evidence for low- to middle-income countries.
Collapse
Affiliation(s)
- Amy Drahota
- School of Dental, Health and Care Professions, University of Portsmouth, Portsmouth, UK
| | - Julie E Udell
- Department of Psychology, Sport and Health Sciences, University of Portsmouth, Portsmouth, UK
| | - Heather Mackenzie
- Centre for Higher Education Practice, University of Southampton, Southampton, UK
| | - Mark T Pugh
- School of Dental, Health and Care Professions, University of Portsmouth, Portsmouth, UK
- Department of Rheumatology, The Isle of Wight NHS Trust, Newport, UK
| |
Collapse
|
2
|
McMahon SK, Lewis BA, Guan W, Wang Q, Hayes SM, Wyman JF, Rothman AJ. Effect of Intrapersonal and Interpersonal Behavior Change Strategies on Physical Activity Among Older Adults: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e240298. [PMID: 38421648 PMCID: PMC10905305 DOI: 10.1001/jamanetworkopen.2024.0298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/04/2024] [Indexed: 03/02/2024] Open
Abstract
Importance Despite guidelines that recommend physical activity (PA), little is known about which types of behavior change strategies (BCSs) effectively promote sustained increases in PA in older adults who are insufficiently active. Objective To determine whether intrapersonal BCSs (eg, goal setting) or interpersonal BCSs (eg, peer-to-peer sharing or learning) combined with the Otago Exercise Program (17 strength and balance exercises and a walking program that are learned and individually tailored, with instruction to perform 3 times per week at home or location of choice) and a wearable PA monitor help older adults sustain increases in their PA. Design, Setting, and Participants This 2 × 2 factorial randomized clinical trial (Community-Based Intervention Effects on Older Adults' Physical Activity) of community-dwelling older adults 70 years or older with PA levels below minimum national PA guidelines was conducted in urban community centers. Dates of enrollment were from November 17, 2017, to June 15, 2021, with final follow-up assessments completed on September 2, 2022. Interventions Participants were randomized to intrapersonal (eg, goal setting) BCSs, interpersonal (eg, problem-solving with peer-to-peer sharing and learning) BCSs, intrapersonal and interpersonal BCSs, or an attention control group. All interventions included a PA monitor and 8 weekly small-group meetings with discussion, practice, and instructions to implement the exercise program and relevant BCSs independently between meetings and after the intervention. Main Outcomes and Measures The primary outcome was daily minutes of objectively measured total PA (light, moderate, or vigorous intensities) averaged over 7 to 10 days, measured at baseline and after the intervention at 1 week, 6 months, and 12 months. Results Among 309 participants (mean [SD] age, 77.4 [5.0] years; 240 women [77.7%]), 305 (98.7%) completed the intervention, and 302 (97.7%) had complete data. Participants receiving PA interventions with interpersonal BCS components exhibited greater increases in total PA than did those who did not at 1 week (204 vs 177 PA minutes per day; adjusted difference, 27.1 [95% CI, 17.2-37.0]; P < .001), 6 months (195 vs 175 PA minutes per day; adjusted difference, 20.8 [95% CI, 10.0-31.6]; P < .001), and 12 months (195 vs 168 PA minutes per day; adjusted difference, 27.5 [95% CI, 16.2-38.8]; P < .001) after the intervention. Compared with participants who did not receive interventions with intrapersonal BCS components, participants who received intrapersonal BCSs exhibited no significant changes in total PA at 1 week (192 vs 190 PA minutes per day; adjusted difference, 1.8 [95% CI, -8.6 to 12.2]; P = .73), 6 months (183 vs 187 PA minutes per day; adjusted difference, -3.9 [95% CI, -15.0 to 7.1]; P = .49), or 12 months (177 vs 186 PA minutes per day; adjusted difference, -8.8 [95% CI, -20.5 to 2.9]; P = .14) after the intervention. Interactions between intrapersonal and interpersonal BCSs were not significant. Conclusions and Relevance In this randomized clinical trial, older adults with low levels of PA who received interpersonal BCSs, the exercise program, and a PA monitor exhibited significant increases in their PA for up to 12 months after the intervention. Intrapersonal BCSs elicited no significant PA changes and did not interact with interpersonal BCSs. Our findings suggest that because effects of a PA intervention on sustained increases in older adults' PA were augmented with interpersonal but not intrapersonal BCSs, approaches to disseminating and implementing the intervention should be considered. Trial Registration ClinicalTrials.gov Identifier: NCT03326141.
Collapse
Affiliation(s)
| | - Beth A. Lewis
- School of Kinesiology, University of Minnesota, Minneapolis
| | - Weihua Guan
- School of Public Health, University of Minnesota, Minneapolis
| | - Qi Wang
- School of Public Health, University of Minnesota, Minneapolis
| | | | - Jean F. Wyman
- School of Nursing, University of Minnesota, Minneapolis
| | | |
Collapse
|
3
|
Wu S, Li G, Shi B, Ge H, Chen S, Zhang X, He Q. Comparative effectiveness of interventions on promoting physical activity in older adults: A systematic review and network meta-analysis. Digit Health 2024; 10:20552076241239182. [PMID: 38601186 PMCID: PMC11005496 DOI: 10.1177/20552076241239182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 02/27/2024] [Indexed: 04/12/2024] Open
Abstract
Background Despite the well-established health benefits of physical activity, a large population of older adults still maintain sedentary life style or physical inactivity. This network meta-analysis (NMA) aimed to compare the effectiveness of wearable activity tracker-based intervention (WAT), electronic and mobile health intervention (E&MH), structured exercise program intervention (SEP), financial incentive intervention (FI) on promoting physical activity and reducing sedentary time in older adults. Methods The systematic review based on PRISMA guidelines, a systematic literature search of PubMed, Web of Science, Google Scholar, EMbase, Cochrane Library, Scopus were searched from inception to December 10th 2022. The randomized controlled trials (RCT) were included. Two reviewers independently conducted study selection, data extraction, risk of bias and certainty of evidence assessment. The effect measures were standard mean differences (SMD) and 95% confidence interval (CI) in daily steps, moderate-to-vigorous physical activity (MVPA) and sedentary time. Results A total of 69 studies with 14,120 participants were included in the NMA. Among these included studies, the results of daily steps, MVPA and sedentary time was reported by 55, 25 and 15 studies, respectively. The NMA consistency model analysis suggested that the following interventions had the highest probability (surface under the cumulative ranking, SUCRA) of being the best when compared with control: FI + WAT for daily steps (SUCRA = 96.6%; SMD = 1.32, 95% CI:0.77, 1.86), WAT + E&MH + SEP for MVPA (SUCRA = 91.2%; SMD = 0.94, 95% CI: 0.36, 1.52) and WAT + E&MH + SEP for sedentary time (SUCRA = 80.3%; SMD = -0.50, 95% CI: -0.87, -0.14). The quality of the evidences of daily steps, MVPA and sedentary time was evaluated by very low, very low and low, respectively. Conclusions In this NMA, there's low quality evidence that financial incentive combined with wearable activity tracker is the most effective intervention for increasing daily steps of older adults, wearable activity tracker combined with electronic and mobile health and structured exercise program is the most effective intervention to help older adults to increase MVPA and reduce sedentary time.
Collapse
Affiliation(s)
- Shuang Wu
- School of Physical Education, Shandong University, Jinan, China
| | - Guangkai Li
- School of Physical Education, Shandong University, Jinan, China
| | - Beibei Shi
- School of Physical Education, Shandong University, Jinan, China
| | - Hongli Ge
- School of Physical Education, Shandong University, Jinan, China
| | - Si Chen
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xianliang Zhang
- School of Physical Education, Shandong University, Jinan, China
| | - Qiang He
- School of Physical Education, Shandong University, Jinan, China
| |
Collapse
|
4
|
Ylitalo KR, Smith J, Cox W, Lucas R, Niceler B, Umstattd Meyer MR. The role of self-regulation strategies in physical activity behavior change: results from an exercise prescription program at a Federally Qualified Health Center. PSYCHOL HEALTH MED 2023; 28:2798-2812. [PMID: 36351200 PMCID: PMC10166767 DOI: 10.1080/13548506.2022.2143540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/31/2022] [Indexed: 11/10/2022]
Abstract
Physical activity (PA) improves quality of life and prevents chronic disease, yet many adults are inactive. Planning with health care providers in the form of exercise "prescriptions" may increase PA, but the role of individual psychosocial factors within exercise prescription programs is not well understood. Therefore, the purpose of this study is to describe the role of self-regulation strategies (e.g., goal setting, self-monitoring, reinforcements) in PA behavior change within the context of an exercise prescription program. Patients at a large, Federally Qualified Health Center with an on-site exercise facility (ie, "Wellness Center") referral were eligible to exercise with a personal fitness advisor. Self-reported PA and use of 15 self-regulation strategies were measured via survey at two time points and merged with electronic health records and attendance data. Patients (n = 151) were, on average, 50.3 ± 13.3 years and mostly female (76.8%). Almost one-third (30.5%) were Hispanic/Latino, 48.3% were non-Hispanic Black, and 20.5% were non-Hispanic white. Participants completed 10.7 ± 12.0 in-person exercise sessions with a fitness advisor. Between baseline and follow-up, the self-regulation strategies that had the largest change in frequency over time were keeping track of PA (p < 0.001), thinking about surroundings (p < 0.001), rewarding yourself for PA (p < 0.001), making PA more enjoyable (p < 0.001), setting goals (p < 0.001), and trying different kinds of PA (p < 0.001). Among exercise prescription program participants, the total self-regulation strategies score was significantly associated with physical activity at follow-up (p = 0.04). Leveraging self-regulatory skill-building activities within the context of exercise prescription programs in clinical settings may provide a personalized and multicomponent approach to PA promotion. Self-regulation strategy training for fitness advisors and/or health care providers has great potential for supporting long-term health behaviors like PA for managing chronic disease among underserved patients.
Collapse
Affiliation(s)
| | - Jordan Smith
- Department of Public Health, Baylor University, Waco, TX, USA
- Baylor Scott & White Health, Waco, TX, USA
| | | | | | | | | |
Collapse
|
5
|
Mols I, van Dijk M, De Roo ML, Tournoy J, Van Grootven B. Barriers and facilitators for physical activity on acute geriatric and rehabilitation wards: a survey study. Acta Clin Belg 2023; 78:452-458. [PMID: 37519042 DOI: 10.1080/17843286.2023.2239546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES During hospitalisation, physical inactivity is common among older patients and is associated with adverse outcomes, e.g. functional decline. This study identified barriers and facilitators of physical activity with geriatric patients during hospital admission. METHODS This is a cross-sectional descriptive study, on two acute geriatric units and one rehabilitation unit, using a researcher-administered survey methodology in patients 70 years or older. A new questionnaire was developed based on a literature review, and was administered bedside and face-to-face with the older patients. RESULTS 72 patients, mean age 83.6 years, completed the questionnaire. 88.9% of the participants found physical activity important during hospitalisation. The main patient-related determinants were fear of falling and symptoms of current illness (e.g. pain). The main environmental-related determinants were the presence of medical devices, and the availability of walking aids. Half of the patients felt motivated by the hospital staff, and one out of six participants felt discouraged. Receiving more assistance for walking and having access to other types of physical activity was expected to increase physical activity. Additionally, motivation from family would be a facilitator for 44.4% of the participants. CONCLUSION Promoting physical activity on acute geriatric units will require interventions at different levels. Most importantly, focusing on interpersonal motivators and positive reinforcement by hospital staff could be beneficial strategies to increase the physical activity of older hospitalised patients.
Collapse
Affiliation(s)
- Ine Mols
- Biomedical Science Group, KU Leuven, Leuven, Belgium
| | - Margreet van Dijk
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Maaike L De Roo
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Jos Tournoy
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Bastiaan Van Grootven
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
| |
Collapse
|
6
|
Choma EA, Hayes S, Lewis BA, Rothman AJ, Wyman JF, Guan W, McMahon SK. Technical Assistance Received by Older Adults to Use Commercially Available Physical Activity Monitors (Ready Steady 3.0 Trial): Ad-Hoc Descriptive Longitudinal Study. JMIR Mhealth Uhealth 2023; 11:e47891. [PMID: 37997772 PMCID: PMC10690145 DOI: 10.2196/47891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/11/2023] [Accepted: 09/22/2023] [Indexed: 11/25/2023] Open
Abstract
Background Despite evidence that regular physical activity (PA) among older adults confers numerous health and functional benefits, PA participation rates are low. Using commercially available wearable PA monitors (PAMs) is one way to augment PA promotion efforts. However, while expert recommendations exist for the specific information needed at the beginning of PAM ownership and the general ongoing need for structures that support as-needed technical troubleshooting, information is lacking about the type, frequency, and modes of assistance needed during initial and long-term ownership. Objective This paper describes problems reported and technical assistance received by older adults who used PAMs during the 18 months they participated in a community-based PA trial: Ready Steady 3.0 (RS3). Methods This was an ad-hoc longitudinal analysis of process variables representing technical problems reported and assistance received by 113 RS3 study participants in the 18 months after their orientation to PAMs. Variables included date of contact, problem(s) reported, mode of technical assistance, and whether the equipment was replaced. The descriptive analysis included frequencies and incidence rates of distinct contacts, types of problems, and technical assistance modes. Results On average, participants were aged 77 (SD 5.2) years. Most identified as female (n=87, 77%), reported experience using smartphones (n=92, 81.4%), and used the PAM between 2 and 18 months. Eighty-two participants (72.6%) reported between 1 to 9 problems with using PAMs, resulting in a total of 150 technical assistance contacts with a mean of 1.3 (SD 1.3) contacts. The incidence rate of new, distinct contacts for technical assistance was 99 per 100 persons per year from 2018 to 2021. The most common problems were wearing the PAM (n=43, 28.7%), reading its display (n=23, 15.3%), logging into its app (n=20, 13.3%), charging it (n=18, 12%), and synchronizing it to the app (n=16, 10.7%). The modalities of technical assistance were in person (n=53, 35.3%), by telephone (n=51, 34%), by email (n=25, 16.7%), and by postal mail (n=21, 14%). Conclusions In general, the results of this study show that after receiving orientation to PAMs, problems such as uncomfortable wristbands, difficulty using the PAM or its related app, and obtaining or interpreting relevant personal data were occasionally reported by participants in RS3. Trained staff helped participants troubleshoot and solve these technical problems primarily in person or by phone. Results also underscore the importance of involving older adults in the design, usability testing, and supportive material development processes to prevent technical problems for the initial and ongoing use of PAMs. Clinicians and researchers should further assess technical assistance needed by older adults, accounting for variations in PAM models and wear time, while investigating additional assistance strategies, such as proactive support, short GIF videos, and video calls.
Collapse
Affiliation(s)
- Elizabeth A Choma
- Department of Physical Therapy, Whitworth University, SpokaneWA, United States
| | - Shannon Hayes
- School of Nursing, University of Minnesota, MinneapolisMN, United States
| | - Beth A Lewis
- School of Kinesiology, University of Minnesota, MinneapolisMN, United States
| | - Alexander J Rothman
- Department of Psychology, University of Minnesota, MinneapolisMN, United States
| | - Jean F Wyman
- School of Nursing, University of Minnesota, MinneapolisMN, United States
| | - Weihua Guan
- Division of Biostatistics, School of Public Health, University of Minnesota, MinneapolisMN, United States
| | - Siobhan K McMahon
- School of Nursing, University of Minnesota, MinneapolisMN, United States
| |
Collapse
|
7
|
McMahon SK, Macheledt K, Choma EA, Lewis BA, Guan W, Wyman JF, Rothman AJ. Rethinking how and when to report descriptions of behavior change content within interventions: a case study of an ongoing physical activity trial (ready steady 3.0). Transl Behav Med 2023; 13:368-379. [PMID: 36757385 PMCID: PMC10255763 DOI: 10.1093/tbm/ibac092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Specifications of what and how much health behavior change (BC) content within research interventions are needed to advance BC science, its implementation, and dissemination. We analyzed the types and dosages of the smallest potentially active BC ingredients and associated behavioral prescriptions intended to be delivered in an ongoing physical activity optimization trial for older adults (Ready Steady 3.0 [RS3]). We defined BC types as behavior change techniques (BCT) and behavioral prescriptions. Our protocol integrated the BCT Taxonomy coding procedures with BCT roles (primary or secondary) and, when relevant, linkages to behavioral prescriptions. Primary BCTs targeted theoretical mechanisms of action, whereas secondary BCTs supported primary BCT delivery. Behavioral prescriptions represented what participants were encouraged to do with each primary BCT in RS3 (ascertain, practice, implement). We assessed dosage parameters of duration, frequency, and amount in each BCT and prescription. Results provided a catalog of in-depth, multidimensional content specifications with 12 primary BCTs, each supported by 2-7 secondary BCTs, with dosages ranging from 2 to 8 weeks, 1 to 8 contacts, and 5 to 451 minutes. Minutes spent on behavioral prescriptions varied: ascertain (1 to 41), practice (5 to 315), and implement (0 to 38). Results can be organized and summarized in varied ways (e.g., by content component) to strengthen future assessments of RS3 fidelity and intervention refinement. Results highlight potential benefits of this early, integrated approach to analyzing BC content and frames questions about how such information might be incorporated and disseminated with reporting research outcomes.
Collapse
Affiliation(s)
| | - Kait Macheledt
- University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Elizabeth A Choma
- DPT Doctor of Physical Therapy Program, Whitworth University, Spokane, WA, USA
| | | | - Weihua Guan
- University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Jean F Wyman
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | | |
Collapse
|
8
|
Bowen PG, Affuso O, Opoku-Agyeman W, Mixon VR, Clay OJ. Texting Older Sisters to Step to Manage Obesity in Older Black Women: A Feasibility Study. Am J Prev Med 2022; 63:S56-S66. [PMID: 35725141 DOI: 10.1016/j.amepre.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 03/05/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Black women are disproportionately classified as overweight or obese and physically inactive. Social support and culturally relevant and age-appropriate physical active interventions are needed to reduce inactivity and to prevent weight gain among this group. Mobile-health text messages have shown to be an acceptable, feasible and interactive way to promote physical activity among older Black women. STUDY DESIGN This feasibility, 12-week RCT, deployed between August 2020 and December 2020, aimed to determine the feasibility and effectiveness of a mobile health intervention that focused on increasing physical activity behaviors among community-dwelling, older Black women who were age ≥60 years and classified with overweight or obesity. SETTING/PARTICIPANTS Community-dwelling, older Black women. INTERVENTION The intervention group received physical activity promotion text messages daily, whereas the control group received 1 neutral message related to general health information weekly. MEASURES At baseline and post intervention assessments, researchers obtained HbA1c levels, weight, BMI, waist circumference, and questionnaires related to physical activity. Post-intervention satisfaction was also collected through a survey. RESULTS The intervention group had an average increase of approximately 700 steps per day more than the control group, lost more waist circumference inches (2.2) than the controls, and averaged more pound loss (2.5) than controls. The control group had a greater HbA1c reduction, whereas the intervention group remained stable. The text messages were 100% readable, and 95% of the women stated the study was motivational. Overall, 12% of participants suggested that future studies should include more in-person social support, and 8.3% said that daily text messages were too much. CONCLUSIONS Findings suggest that a mobile health physical activity intervention that uses self-monitoring techniques in conjunction with motivational cues, is an acceptable delivery method and a promising strategy to increase physical activity behaviors among this population, which is feasible, potentially efficacious, and low cost. TRIAL REGISTRATION NCT04114071.
Collapse
Affiliation(s)
- Pamela G Bowen
- Nursing - Acute, Chronic & Continuing Care Department, School of Nursing, The University of Alabama at Birmingham, Birmingham, Alabama.
| | - Olivia Affuso
- School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - William Opoku-Agyeman
- School of Health and Applied Human Sciences, College of Health & Human Services, University of North Carolina Wilmington, Wilmington, North Carolina
| | - Veronica R Mixon
- Department of Psychology, Florida Agricultural and Mechanical University, Tallahassee, Florida
| | - Olivio J Clay
- Department of Psychology, College of Arts and Sciences, The University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
9
|
Clapp JD, Madden DR, Pakdaman S. Drinking with Friends: Measuring the Two-week Ecology of Drinking Behaviors. Am J Health Behav 2022; 46:96-113. [PMID: 35501964 DOI: 10.5993/ajhb.46.2.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: Despite the substantial influence these acute alcohol-related problems cause globally, past research has failed historically to capture the dynamic nature of drinking events, including how multiple factors (ie, individual, group, and environmental) interact to affect event-level intoxication. Fortunately, technology (eg, transdermal alcohol monitors) and smartphone surveys have provided researchers with new avenues to measure the complex nature of alcohol consumption. This paper presents the methods of a pilot study that sought to measure event-level alcohol consumption in a natural drinking group of college students. Methods: Ten groups of friends (N=49) were followed for 2 weeks with daily diary surveys, continuous activity trackers, hourly geographic ecological momentary assessments (EMAs) on 4 separate drinking occasions, and a transdermal alcohol monitor during one group-based social event. Results: On average, participants responded to > 75% of both daily diaries and EMAs and were compliant with activity trackers on 96% of monitoring days. Over 90% of the sample had usable transdermal data and after smoothing, peak transdermal alcohol contents ranged from 0.13 to 0.395 during the observation evening. Conclusion: The lessons learned during this pilot study can provide a building block for future work in this area, especially as data collection in alcohol research rapidly advances.
Collapse
Affiliation(s)
- John D. Clapp
- John D. Clapp, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States; College of Social Work, The Ohio State University, Columbus, OH, United States; Keck School of Medicine,
Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States; Institute for Addiction Science, University of Southern California, Los Angeles, CA, United States
| | - Danielle R. Madden
- Danielle R. Madden, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States; College of Social Work, The Ohio State University, Columbus, OH, United States; Institute for
Addiction Science, University of Southern California, Los Angeles, CA, United States
| | - Sheila Pakdaman
- Sheila Pakdaman, Keck School of Medicine, Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States; Institute for Addiction Science, University of Southern California, Los Angeles, CA, United States;,
| |
Collapse
|
10
|
Barrows J, Fleury J. Pilot randomized controlled trial of the Yoga for HEART intervention in community-dwelling older adults. Geriatr Nurs 2022; 44:184-191. [PMID: 35217325 DOI: 10.1016/j.gerinurse.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 11/04/2022]
Abstract
Physical activity reduces cardiovascular risk; however, many older adults do not engage in recommended levels. Theory-based interventions supporting motivation for physical activity are limited. This pilot study evaluated the feasibility of Yoga for Health Empowerment and Realizing Transformation (HEART), a theory-based intervention combining motivation and yoga-based physical activity. Feasibility was addressed as acceptability, demand, implementation fidelity, and limited efficacy in promoting physical activity, cardiovascular health, and mechanisms of action. Sedentary older adults (m = 65 years old, sd = 8.5) were randomized to Yoga for HEART (n=8) or Active Control (n=7) conditions. Yoga for HEART was: (a) acceptable, (b) retention 73%, (c) implemented as planned. A significant main effect for body mass index (BMI) was found in Yoga for HEART participants (p = .02). No significant effects were found for physical activity, other cardiovascular outcomes, or mechanisms of action. Yoga for HEART is feasible and recommended for further testing.
Collapse
Affiliation(s)
- Jennifer Barrows
- Edson College of Nursing and Health Innovation, Arizona State University, 550 N. 3(rd) St., Phoenix, AZ 85004, United States; Present address: Children's Hospital of Orange County, 1201 W. La Veta Ave., Orange, CA 92868, United States.
| | - Julie Fleury
- Edson College of Nursing and Health Innovation, Arizona State University, 550 N. 3(rd) St., Phoenix, AZ 85004, United States.
| |
Collapse
|
11
|
Blackwood J, Suzuki R, Karczewski H. Perceived Neighborhood Walkability is Associated with Recent Falls in Urban Dwelling Older Adults. J Geriatr Phys Ther 2022; 45:E8-E15. [PMID: 33734155 PMCID: PMC8687612 DOI: 10.1519/jpt.0000000000000300] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE In rural communities, perceptions of neighborhood walkability, the rating of how easy it is to walk in an area, influence engagement in physical activity outside the home. This has not been studied in older adults residing in urban settings. Additionally, it is not known how perceived walkability is associated with falls. Therefore, the purpose of this study was to first describe the perceptions of neighborhood walkability in urban-dwelling older adults based on recent fall history and then examine associations between recent falls and neighborhood walkability constructs after controlling for fall risk factors. METHODS Urban-dwelling older adults (N = 132) 65 years and older without cognitive dysfunction or uncontrolled comorbidity completed a survey assessing health status, physical activity, and walkability using the Neighborhood Environment Walkability Scale-Abbreviated. Group assignment was based on recent fall history. Between-group comparisons of demographic and walkability constructs were completed using analysis of variance. Logistic regression was used to examine associations between walkability constructs and recent falls after controlling for covariates. RESULTS AND DISCUSSION Poorer perception of land use was significantly associated with recent falls. Questions assessing the ease of walking to a store or transit stop may be valuable in understanding fall risk in older adults living in urban settings. CONCLUSIONS Perceptions of neighborhood walkability are lower in urban-dwelling older adults with a history of falling.
Collapse
Affiliation(s)
| | - Rie Suzuki
- Public Health and Health Sciences Department, University of Michigan-Flint, Flint
| | | |
Collapse
|
12
|
Landoll RR, Vargas SE, Samardzic KB, Clark MF, Guastaferro K. The preparation phase in the multiphase optimization strategy (MOST): a systematic review and introduction of a reporting checklist. Transl Behav Med 2021; 12:291-303. [PMID: 34850214 DOI: 10.1093/tbm/ibab146] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Multicomponent behavioral interventions developed using the multiphase optimization strategy (MOST) framework offer important advantages over alternative intervention development models by focusing on outcomes within constraints relevant for effective dissemination. MOST consists of three phases: preparation, optimization, and evaluation. The preparation phase is critical to establishing the foundation for the optimization and evaluation phases; thus, detailed reporting is critical to enhancing rigor and reproducibility. A systematic review of published research using the MOST framework was conducted. A structured framework was used to describe and summarize the use of MOST terminology (i.e., preparation phase and optimization objective) and the presentation of preparation work, the conceptual model, and the optimization. Fifty-eight articles were reviewed and the majority focused on either describing the methodology or presenting results of an optimization trial (n = 38, 66%). Although almost all articles identified intervention components (96%), there was considerable variability in the degree to which authors fully described other elements of MOST. In particular, there was less consistency in use of MOST terminology. Reporting on the MOST preparation phase is varied, and there is a need for increased focus on explicit articulation of key design elements and rationale of the preparation phase. The proposed checklist for reporting MOST studies would significantly advance the use of this emerging methodology and improve implementation and dissemination of MOST. Accurate reporting is essential to reproducibility and rigor of scientific trials as it ensures future research fully understands not only the methodology, but the rationale for intervention and optimization decisions.
Collapse
Affiliation(s)
- Ryan R Landoll
- Department of Family Medicine, Uniformed Services University of the Health Sciences School of Medicine, Bethesda, MD, USA
| | - Sara E Vargas
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kristen B Samardzic
- Department of Obstetrics and Gynecology, Naval Medical Center San Diego, San Diego, CA, USA
| | - Madison F Clark
- Department of Family Medicine, Uniformed Services University of the Health Sciences School of Medicine, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Kate Guastaferro
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, USA
| |
Collapse
|
13
|
Houghton LC, Gibbons MP, Shekelle J, Oakley-Girvan I, Watterson JL, Magsamen-Conrad K, Jones C, Gokal K. Free Time For Wellness: a co-designed intervention utilizing social networks to encourage physical activity for cancer prevention among low resourced mothers. BMC Public Health 2021; 21:1805. [PMID: 34620141 PMCID: PMC8499394 DOI: 10.1186/s12889-021-11775-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity is central to chronic disease prevention. Low resource mothers face structural barriers preventing them from increasing their physical activity to reduce their chronic disease risk. We co-designed an intervention, with the ultimate goal of building social cohesion through social media to increase physical activity for low resourced mothers in urban settings. METHODS In 2019, we interviewed 10 mothers of children (< 12 years) living in Washington Heights, Manhattan. The interviews were transcribed and coded for themes that guided the creation of a co-design workshop. Washington Heights-based mothers (n = 16) attended a co-design workshop to generate the blueprint for the Free Time for Wellness intervention. RESULTS Mothers in our sample had limited time, external support and resources, which hindered them from increasing their physical activity; we learned that in addition to physical health, mental health was a concern for participants. Participants had varying degrees of self-efficacy and trust in social media. Bringing mothers and researchers together in a co-design workshop, we identified types of physical activities they would enjoy participating in, the ideal time to do so, the kind of childcare they needed, and their preferences for communication with the community champion. The interviews and workshop highlighted the need for a community space that mothers and children could co-occupy. The intervention was designed to be 3 months' worth of sample programming with one activity per week, rotating between dance, yoga, food pantry visits and group playdates. Participants were invited to bring their children to a space with one room for the 'participants only' activity and a second room in which professional childcare providers supervised the children. CONCLUSIONS Through this two-phased co-design process, we created an intervention with mothers in an urban community with the goal of using social media to bring them together for wellness, primarily through increased physical activity. Despite the co-design of this intervention with a specific community, there are some universal applications of our findings, and of the use of co-design workshops, to other settings.
Collapse
Affiliation(s)
- Lauren C. Houghton
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY 10032 USA
- Herbert Irving Comprehensive Cancer Center, 1130 St Nicholas Avenue, New York, NY 10032 USA
| | - Marley P. Gibbons
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY 10032 USA
| | - Jeanette Shekelle
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY 10032 USA
| | - Ingrid Oakley-Girvan
- The Public Health Institute, The Data and Technology Proving Ground Program, 555 12th Ave, 10th Floor, Oakland, CA 94607 USA
- Medable Inc, 525 University Ave, Ste A70, Palo Alto, CA 94301 USA
| | - Jessica L. Watterson
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
- Center for Healthcare Organizational and Innovation Research (CHOIR), School of Public Health, University of California, Berkeley, 50 University Hall, Berkeley, CA 94704 USA
| | - Kate Magsamen-Conrad
- Department of Communication Studies, The University of Iowa, 257 Becker Communication Studies Building, Iowa City, IA 52245 USA
- Holden Comprehensive Care Center, 200 Hawkins Drive, Iowa City, IA 52242 USA
| | - Cheryl Jones
- Manchester Centre for Health Economics, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Kajal Gokal
- National Centre for Sport and Exercise Medicine (NCSEM), School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, LE11 3TU UK
- The Centre for Lifestyle Medicine and Behaviour, School of Sport, Exercise and Health Sciences, Loughborough University, LE11 3TU Leicestershire, UK
| |
Collapse
|
14
|
Social Support and Physical Activity in Older Adults: Identifying Predictors Using Data From the Canadian Longitudinal Study on Aging. J Aging Phys Act 2021; 30:136-147. [PMID: 34348225 DOI: 10.1123/japa.2020-0393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/02/2021] [Accepted: 03/09/2021] [Indexed: 11/18/2022]
Abstract
This study examined which of nine forms of social support were the strongest predictors of physical activity in older adults, and to what degree these associations were moderated by eight demographic indicators of groups at increased risk of social isolation. Baseline data from 21,491 adults aged 65 and older who were participants of the Canadian Longitudinal Study on Aging were analyzed using multiple regression. Greater social network size, social contact with network members, and participation in community-related activities predicted greater physical activity, whereas being in a domestic partnership and perceiving more tangible support to be available were negatively associated. The strength and direction of these associations varied by sex, living arrangement, and income. Given the findings, various forms of social support should be incorporated in physical activity interventions but tailored to meet the needs of different segments of the aging population.
Collapse
|
15
|
St Fleur RG, St George SM, Leite R, Kobayashi M, Agosto Y, Jake-Schoffman DE. Use of Fitbit Devices in Physical Activity Intervention Studies Across the Life Course: Narrative Review. JMIR Mhealth Uhealth 2021; 9:e23411. [PMID: 34047705 PMCID: PMC8196365 DOI: 10.2196/23411] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/31/2021] [Accepted: 04/06/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Commercial off-the-shelf activity trackers (eg, Fitbit) allow users to self-monitor their daily physical activity (PA), including the number of steps, type of PA, amount of sleep, and other features. Fitbits have been used as both measurement and intervention tools. However, it is not clear how they are being incorporated into PA intervention studies, and their use in specific age groups across the life course is not well understood. OBJECTIVE This narrative review aims to characterize how PA intervention studies across the life course use Fitbit devices by synthesizing and summarizing information on device selection, intended use (intervention vs measurement tool), participant wear instructions, rates of adherence to device wear, strategies used to boost adherence, and the complementary use of other PA measures. This review provides intervention scientists with a synthesis of information that may inform future trials involving Fitbit devices. METHODS We conducted a search of the Fitabase Fitbit Research Library, a database of studies published between 2012 and 2018. Of the 682 studies available on the Fitabase research library, 60 interventions met the eligibility criteria and were included in this review. A supplemental search in PubMed resulted in the inclusion of 15 additional articles published between 2019 and 2020. A total of 75 articles were reviewed, which represented interventions conducted in childhood; adolescence; and early, middle, and older adulthood. RESULTS There was considerable heterogeneity in the use of Fitbit within and between developmental stages. Interventions for adults typically required longer wear periods, whereas studies on children and adolescents tended to have more limited device wear periods. Most studies used developmentally appropriate behavior change techniques and device wear instructions. Regardless of the developmental stage and intended Fitbit use (ie, measurement vs intervention tool), the most common strategies used to enhance wear time included sending participants reminders through texts or emails and asking participants to log their steps or synchronize their Fitbit data daily. The rates of adherence to the wear time criteria were reported using varying metrics. Most studies supplemented the use of Fitbit with additional objective or self-reported measures for PA. CONCLUSIONS Overall, the heterogeneity in Fitbit use across PA intervention studies reflects its relative novelty in the field of research. As the use of monitoring devices continues to expand in PA research, the lack of uniformity in study protocols and metrics of reported measures represents a major issue for comparability purposes. There is a need for increased transparency in the prospective registration of PA intervention studies. Researchers need to provide a clear rationale for the use of several PA measures and specify the source of their main PA outcome and how additional measures will be used in the context of Fitbit-based interventions.
Collapse
Affiliation(s)
- Ruth Gaelle St Fleur
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sara Mijares St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Rafael Leite
- Department of Psychology, University of Miami, Coral Gables, FL, United States
| | - Marissa Kobayashi
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Yaray Agosto
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Danielle E Jake-Schoffman
- Department of Health, Education, and Behavior, University of Florida, Gainesville, FL, United States
| |
Collapse
|
16
|
McMahon SK, Lewis BA, Guan W, Wyman JF, Rothman AJ. Community-based intervention effects on older adults' physical activity and falls: Protocol and rationale for a randomized optimization trial (Ready Steady3.0). Contemp Clin Trials 2020; 101:106238. [PMID: 33285280 DOI: 10.1016/j.cct.2020.106238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/25/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
The Ready Steady 3.0 trial is designed to test the main and interactive effects of two behavior change intervention components, within an 8-week physical activity intervention, on older adults' physical activity (PA). Each component is comprised of behavior change strategies that emphasize two different evidence-based ways to motivate older adults to be active: interpersonal and intrapersonal. 308 adults ≥70 years old will be randomized to 1 of 4 conditions in a 2 × 2 full factorial trial in which the two factors represent the receipt (No, Yes) of interpersonal or intrapersonal behavior change strategies. Participants will also receive two core intervention components: the Otago Exercise Program adapted for small groups and a PA monitor. Interventions across conditions will be delivered during 8 weekly, small group, meetings in community settings. The primary outcome of PA, measured objectively, and secondary outcomes of falls and the quality of life will be assessed at baseline and post-intervention: 1 week, 6 months, and 12 months. Findings will enable the identification of behavior change content that contributes to physical activity outcomes within a physical activity intervention for older adults. This study is one of the first to use the MOST framework to guide the development of a community-based physical activity intervention for older adults to reduce the public health problems of low PA and falls. The results will enable the optimization of behavior change content within a PA intervention for older adults and, in turn, other PA interventions for older adults.
Collapse
Affiliation(s)
- Siobhan K McMahon
- University of Minnesota, School of Nursing, 5-140 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, USA.
| | - Beth A Lewis
- University of Minnesota, School of Kinesiology, 1900 University Ave SE, Minneapolis, MN 55455, USA.
| | - Weihua Guan
- University of Minnesota, School of Public Health, 420 Delaware St SE, Minneapolis, MN 55455, USA.
| | - Jean F Wyman
- University of Minnesota, School of Nursing, 5-140 Weaver-Densford Hall, 308 Harvard Street SE, Minneapolis, MN 55455, USA.
| | - Alexander J Rothman
- University of Minnesota, Psychology, 75 East River Road, Minneapolis, MN 55455, USA.
| |
Collapse
|
17
|
McMahon SK, Lewis B, Oakes JM, Wyman JF, Guan W, Rothman AJ. Examining Potential Psychosocial Mediators in a Physical Activity Intervention for Older Adults. West J Nurs Res 2020; 42:581-592. [PMID: 31470769 PMCID: PMC7684560 DOI: 10.1177/0193945919871697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The purpose of this study was to examine psychosocial constructs targeted as potential mediators in a prior physical activity (PA) intervention study. This secondary analysis used data from 102 older adults randomized to one of four conditions-within a 2 (Interpersonal Strategies: yes, no) x 2 (Intrapersonal Strategies: yes, no) factorial design. We tested intervention effects on social support, self-efficacy, self-regulation, and goal attainment, and whether these constructs mediated intervention effects on PA. Participants who received interventions with interpersonal strategies, compared to those who did not, increased their readiness (post-intervention), the self-regulation subscale of self-assessment, and goal attainment (post-intervention, 6-months). Participants who received interventions with intrapersonal strategies, compared to those who did not, increased their social support from family (post-intervention). There was no statistically significant mediation. To understand mechanisms through which interventions increase older adults' PA and to improve intervention effectiveness, researchers should continue to examine potential psychosocial mediators.Clinical Trial Registry: NCT02433249.
Collapse
Affiliation(s)
| | - Beth Lewis
- School of Kinesiology, University of Minnesota, Minneapolis, MN, USA
| | - J Michael Oakes
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Jean F Wyman
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Weihua Guan
- Division of Biostatistics, School of Public Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | | |
Collapse
|
18
|
Ylitalo KR, Cox W, Gutierrez M, Benavidez G, Umstattd Meyer MR, Niceler B, Griggs JO. A Prescription for Wellness: Exercise Referrals at a Federally Qualified Health Center. J Prim Care Community Health 2020; 11:2150132720942396. [PMID: 32674714 PMCID: PMC7370562 DOI: 10.1177/2150132720942396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction/Objectives: Physical activity (PA) improves quality of life and prevents chronic disease, but many adults are inactive. Planning with a health care provider in the form of an exercise "prescription" or referral may increase PA, but determinants of referral utilization are not well understood among underserved populations. This study examined sociodemographic and theory-based psychosocial determinants of exercise referral program utilization. Methods: Patients at a large, federally qualified health center with an on-site exercise facility (ie, "Wellness Center") referral were eligible to exercise with a personal fitness advisor. Self-reported PA behavior, self-efficacy, and self-regulation strategies were measured via survey and merged with electronic health records and attendance data. Negative binomial regression was used to estimate the rate of Wellness Center utilization. Results: Patients with exercise referrals (n = 1136) were, on average, 45.6 ± 14.6 years, 78.8% female, and 78.0% Hispanic/Latino or non-Hispanic Black. Approximately half (593/1136; 52.2%) initiated exercise at the Wellness Center; initiators completed 8.8 ± 12.4 visits during follow-up. Older age was associated with higher utilization (P < .001) and patients meeting PA recommendations had lower utilization than patients not meeting recommendations (incident rate ratio = 0.72, 95% CI 0.53-0.97; P = .03). Baseline self-efficacy (P < .001) and self-regulation strategies (P = .03) were significantly associated with follow-up PA, even after adjusting for baseline PA. Conclusions: In this racially/ethnically diverse patient population, older and less active patients at baseline had higher program utilization. Patients with higher self-efficacy and self-regulation strategies reported higher PA over time. Community health centers have a unique opportunity to support PA through exercise referral programs to public health priority populations.
Collapse
Affiliation(s)
| | - Wendy Cox
- Heart of Texas Community Health Center, Waco, TX, USA
| | | | | | | | - Brock Niceler
- Heart of Texas Community Health Center, Waco, TX, USA
| | | |
Collapse
|
19
|
Liao J, Xiao HY, Li XQ, Sun SH, Liu SX, Yang YJ, Xu DR. A Social Group-Based Information-Motivation-Behavior Skill Intervention to Promote Acceptability and Adoption of Wearable Activity Trackers Among Middle-Aged and Older Adults: Cluster Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e14969. [PMID: 32271151 PMCID: PMC7180511 DOI: 10.2196/14969] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 01/03/2020] [Accepted: 02/10/2020] [Indexed: 01/13/2023] Open
Abstract
Background Wearable activity trackers offer potential to optimize behavior and support self-management. To assist older adults in benefiting from mobile technologies, theory-driven deployment strategies are needed to overcome personal, technological, and sociocontextual barriers in technology adoption. Objective To test the effectiveness of a social group–based strategy to improve the acceptability and adoption of activity trackers by middle-aged and older adults. Methods A cluster randomized controlled trial was conducted among 13 groups of middle-aged and older adults (≥45 years) performing group dancing (ie, square dancing) as a form of exercise in Guangzhou from November 2017 to October 2018. These dancing groups were randomized 1:1 into two arms, and both received wrist-worn activity trackers and instructions at the baseline face-to-face assessment. Based on the Information-Motivation-Behavior Skill framework, the intervention arm was also given a tutorial on the purpose of exercise monitoring (Information), encouraged to participate in exercise and share their exercise records with their dancing peers (Motivation), and were further assisted with the use of the activity tracker (Behavior Skill). We examined two process outcomes: acceptability evaluated by a 14-item questionnaire, and adoption assessed by the uploaded step count data. Intention-to-treat analysis was applied, with the treatment effects estimated by multilevel models. Results All dancing groups were followed up for the postintervention reassessment, with 61/69 (88%) participants of the intervention arm (7 groups) and 56/80 (70%) participants of the control arm (6 groups). Participants’ sociodemographic characteristics (mean age 62 years, retired) and health status were comparable between the two arms, except the intervention arm had fewer female participants and lower cognitive test scores. Our intervention significantly increased the participants’ overall acceptability by 6.8 points (95% CI 2.2-11.4), mainly driven by promoted motivation (adjusted group difference 2.0, 95% CI 0.5-3.6), increased usefulness (adjusted group difference 2.5, 95% CI 0.9-4.1), and better perceived ease of use (adjusted group difference 1.2, 95% CI 0.1-2.4), whereas enjoyment and comfort were not increased (adjusted group difference 0.9, 95% CI –0.4-2.3). Higher adoption was also observed among participants in the intervention arm, who were twice as likely to have valid daily step account data than their controlled counterparts (adjusted incidence relative risk [IRR]=2.0, 95% CI 1.2-3.3). The average daily step counts (7803 vs 5653 steps/day for the intervention and control, respectively) were similar between the two arms (adjusted IRR=1.4, 95% CI 0.7-2.5). Conclusions Our social group–based deployment strategy incorporating information, motivation, and behavior skill components effectively promoted acceptability and adoption of activity trackers among community-dwelling middle-aged and older adults. Future studies are needed to examine the long-term effectiveness and apply this social engagement strategy in other group settings or meeting places. Trial Registration Chinese Clinical Trial Registry ChiCTR-IOC-17013185; https://tinyurl.com/vedwc7h.
Collapse
Affiliation(s)
- Jing Liao
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, China
| | - Hai-Yan Xiao
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xue-Qi Li
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Shu-Hua Sun
- Division of Health Management, Shayuan Primary Health Care Center, Guangzhou, China
| | - Shi-Xing Liu
- Division of Health Management, Shayuan Primary Health Care Center, Guangzhou, China
| | - Yung-Jen Yang
- Taiwanese Society of Geriatric Psychiatry, Taiwan, China
| | - Dong Roman Xu
- Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
20
|
Rowland SA, Cohen MZ, Pullen CH, Schulz PS, Berg KE, Kupzyk KA, Pozehl BJ, Yates BC. Vicarious Experience to Affect Physical Activity in Women: A Randomized Control Trial. West J Nurs Res 2020; 42:286-292. [PMID: 31204610 PMCID: PMC9179930 DOI: 10.1177/0193945919856575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
People compare themselves to others for self-evaluation, practical information, and motivation for healthy behaviors. The effect of active peer models on comparative thinking is unknown. The purpose of this 12-week, randomized, two-group pilot study was to evaluate the effect of a workplace peer modeling intervention on self-efficacy, motivation, and comparative thinking. The attention control group (ACG; n = 24) received general health information. The intervention group (n = 26) met with active peer models, received an exercise prescription and information. No significant group by time interaction effects were found. Comparisons on ability (how well am I doing), opinions (what should I think or believe), future self (think about my future), and modeling (be like someone else) all increased in the intervention group (n = 21) but decreased in the ACG (n = 22). Active peer models may support physical activity behavior change through specific lines of comparative thinking.
Collapse
|
21
|
Krishnamurthi N, Fleury J, Belyea M, Shill HA, Abbas JJ. ReadySteady intervention to promote physical activity in older adults with Parkinson's disease: Study design and methods. Contemp Clin Trials Commun 2020; 17:100513. [PMID: 32211555 PMCID: PMC7083754 DOI: 10.1016/j.conctc.2019.100513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/16/2019] [Accepted: 12/30/2019] [Indexed: 02/02/2023] Open
Abstract
The main motor impairments of gait and balance experienced by people with Parkinson's disease (PD) contribute to a sedentary lifestyle, resulting in poor physical conditioning, loss of functional independence, and reduced quality of life. Despite the known benefits of physical activity in PD, the majority of older adults with PD are insufficiently active. Few studies incorporate behavioral change approaches to promoting physical activity in PD. The main goal of this research is to foster community mobility in older adults with PD by promoting physical activity and improving gait patterns using a theory-based behavioral change intervention. The ReadySteady intervention combines wellness motivation theory with polestriding physical activity, which has been shown to be beneficial for people with PD. The intervention will be tested using a randomized controlled design, including inactive older adults diagnosed with PD. Participants will be randomly assigned the 12-week ReadySteady intervention, 12-week polestriding, and education intervention, or 12-week education intervention. Thirty-six older adults with PD will participate in each of the interventions. Level of physical activity, clinical scores, quantitative measures of gait and balance control, and motivational variables for each intervention will be measured at three time points: pre-intervention, post-intervention (12 weeks), and follow-up (24 weeks). If the intervention is beneficial, it may serve as a sustainable addition to current practice in health promotion efforts serving the PD population.
Collapse
Affiliation(s)
- Narayanan Krishnamurthi
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, 85004, USA
| | - Julie Fleury
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, 85004, USA
| | - Michael Belyea
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, 85004, USA
| | - Holly A. Shill
- Muhammad Ali Parkinson Center, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA
| | - James J. Abbas
- Center for Adaptive Neural Systems, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, 85287, USA
| |
Collapse
|
22
|
Cajita MI, Kline CE, Burke LE, Bigini EG, Imes CC. Feasible but Not Yet Efficacious: A Scoping Review of Wearable Activity Monitors in Interventions Targeting Physical Activity, Sedentary Behavior, and Sleep. CURR EPIDEMIOL REP 2020; 7:25-38. [PMID: 33365227 DOI: 10.1007/s40471-020-00229-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Purpose of Review The present review aimed to explore the range and characteristics of interventions that utilize WAM and descriptively summarize the efficacy of these interventions. Recent Findings A total of 65 articles (61 studies) were included in this review. Most of the WAM-based interventions (n=58) were designed to improve physical activity (PA). Interventions targeting sedentary behavior (SB) were much less common (n=12), and even less frequent were WAM-based sleep interventions (n=3). Most studies tested the feasibility of WAM-based interventions; hence, efficacy of these interventions in improving PA, SB, and/or sleep could not be conclusively determined. Nonetheless, WAM-based interventions showed considerable potential in increasing PA and decreasing SB. Summary WAM-based PA interventions exhibited preliminary efficacy in increasing PA. Although not as many interventions were focused on SB, current interventions also showed potential in decreasing sedentary time. Meanwhile, more evidence is needed to determine the utility of WAM in improving sleep. Major challenges with including WAM as part of interventions are reduced engagement in using the devices over time and the rapid changes in technology resulting in devices becoming obsolete soon after completion of an efficacy trial.
Collapse
Affiliation(s)
- Maan Isabella Cajita
- University of Illinois at Chicago, College of Nursing, 845 S. Damen Ave., Chicago, IL, USA
| | - Christopher E Kline
- University of Pittsburgh, Department of Health and Physical Activity, Pittsburgh, PA, USA
| | - Lora E Burke
- University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA
| | - Evelyn G Bigini
- University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA
| | | |
Collapse
|
23
|
McMahon SK, Park YS, Lewis B, Guan W, Oakes JM, Wyman JF, Rothman AJ. Older Adults' Utilization of Community Resources Targeting Fall Prevention and Physical Activity. THE GERONTOLOGIST 2020; 59:436-446. [PMID: 29401219 DOI: 10.1093/geront/gnx210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite the availability of community resources, fall and inactivity rates remain high among older adults. Thus, in this article, we describe older adults' self-reported awareness and use of community resources targeting fall prevention and physical activity. RESEARCH DESIGN AND METHODS In-depth, semistructured interviews were conducted in Phase 1 with community center leaders (n = 5) and adults (n = 16) ≥70 years old whose experience with community programs varied. In Phase 2, surveys were administered to intervention study participants (n = 102) who were ≥70 years old, did not have a diagnosis of dementia, and reported low levels of physical activity. RESULTS Four themes emerged from Phase 1 data: (a) identifying a broad range of local community resources; (b) learning from trusted sources; (c) the dynamic gap between awareness and use of community resources; and (d) using internal resources to avoid falls. Phase 2 data confirmed these themes; enabled the categorization of similar participant-identified resources (10); and showed that participants who received encouragement to increase community resource use, compared to those who did not, had significantly greater odds of using ≥1 resource immediately postintervention, but not 6 months' postintervention. DISCUSSION AND IMPLICATIONS Although participants in this study were aware of a broad range of local community resources for physical activity, they used resources that support walking most frequently. Additionally, receiving encouragement to use community resources had short-term effects only. Findings improve our understanding of resources that need bolstering or better dissemination and suggest researchers identify best promotion, dissemination, implementation strategies.
Collapse
Affiliation(s)
| | | | - Beth Lewis
- School of Kinesiology, Behavioral Aspects of Physical Activity, University of Minnesota, Minneapolis
| | - Weihua Guan
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis
| | - J Michael Oakes
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Jean F Wyman
- School of Nursing, University of Minnesota, Minneapolis
| | | |
Collapse
|
24
|
Gallis JA, Bennett GG, Steinberg DM, Askew S, Turner EL. Randomization procedures for multicomponent behavioral intervention factorial trials in the multiphase optimization strategy framework: challenges and recommendations. Transl Behav Med 2019; 9:1047-1056. [PMID: 30590759 PMCID: PMC6875651 DOI: 10.1093/tbm/iby131] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The multiphase optimization strategy (MOST) is an increasingly popular framework to prepare, optimize, and evaluate multicomponent behavioral health interventions. Within this framework, it is common to use a factorial trial to assemble an optimized multicomponent intervention by simultaneously testing several intervention components. With the possibility of a large number of conditions (unique combinations of components) and a goal to balance conditions on both sample size (for statistical efficiency) and baseline covariates (for internal validity), such trials face additional randomization challenges compared to the standard two-arm trial. The purpose of the current paper is to compare and contrast potential randomization methods for factorial trials in the context of MOST and to provide guidance for the reporting of those methods. We describe the principles, advantages, and disadvantages of several randomization methods in the context of factorial trials. We then provide examples to examine current practice in the MOST-related literature and provide recommendations for reporting of randomization. We identify two key randomization decisions for MOST-related factorial trials: (i) whether to randomize to components or conditions and (ii) whether to use restricted randomization techniques, such as stratification, permuted blocks, and minimization. We also provide a checklist to assist researchers in ensuring complete reporting of randomization methods used. As more investigators use factorial trials within the MOST framework for assembling optimized multicomponent behavioral interventions, appropriate implementation and rigorous reporting of randomization procedures will be essential for ensuring the efficiency and validity of the results.
Collapse
Affiliation(s)
- John A Gallis
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Gary G Bennett
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Global Digital Health Science Center, Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Dori M Steinberg
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Global Digital Health Science Center, Duke Global Health Institute, Duke University, Durham, NC, USA
- School of Nursing, Duke University, Durham, NC, USA
| | - Sandy Askew
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Global Digital Health Science Center, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Elizabeth L Turner
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| |
Collapse
|
25
|
Lindsay-Smith G, Eime R, O’Sullivan G, Harvey J, van Uffelen JGZ. A mixed-methods case study exploring the impact of participation in community activity groups for older adults on physical activity, health and wellbeing. BMC Geriatr 2019; 19:243. [PMID: 31477054 PMCID: PMC6720859 DOI: 10.1186/s12877-019-1245-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 08/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Regular physical activity (PA) has many health benefits but declines with age. Community multi-activity groups offering volunteer-led socially-oriented activity programs could provide an opportunity for older people to maintain or increase PA levels and promote their health. The aim of this study was to examine the potential effect of becoming a member of an existing community activity group on PA levels, physical and mental health-related quality of life (HR QoL), comparing any impacts associated with participation in physical activity or social activity programs. METHODS This mixed-methods case study, combining a longitudinal quantitative-survey with qualitative focus groups to contextualise the survey results, focused on an Australian community organisation called Life Activities Clubs (LACs). LACs provide various physical activities (e.g. walking, cycling, dancing) and social activities (e.g. book groups, dine-outs, craft). Data were collected using a self-report survey administered at baseline, six and twelve-months after joining and group differences between participants of PA programs (PA group) and social programs (social group) were analysed using linear mixed-models. Two focus groups with LAC members were held, one representing each activity type and analysed using content and thematic analysis. RESULTS 35 people (mean age 67) completed the surveys and 11 people participated in the focus groups. PA levels and physical health-related QoL were maintained over 1 year in the PA group, and declined between baseline and 12-months in the social group. Focus groups suggested social aspects of PA programs increased motivation to maintain regular attendance and do more PA than participants would on their own and that physical activities provided health benefits. Mental HR QoL did not change in either group, focus groups suggested this was because the social aspects of both types of program provide benefits relating to mental health including stress relief, enjoyment and adapting to major life events, to prevent a decline in QoL. CONCLUSIONS Community PA programs appear to maintain PA levels and physical HR QoL in older adults, and both social and PA programs may maintain mental HR QoL. Incorporating both types of program into one organisation may also encourage less physically active members to try physical activities.
Collapse
Affiliation(s)
| | - Rochelle Eime
- Institute for Health and Sport, Victoria University, Melbourne, Australia
- School of Health and Life Sciences, Federation University, Ballarat, Australia
| | - Grant O’Sullivan
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Jack Harvey
- School of Health and Life Sciences, Federation University, Ballarat, Australia
| | - Jannique G. Z. van Uffelen
- Institute for Health and Sport, Victoria University, Melbourne, Australia
- Department of Movement Sciences, Physical Activity, Sports and Health Research Group, KU Leuven - University of Leuven, B-3000 Leuven, Belgium
| |
Collapse
|
26
|
Haslam SA, Haslam C, Jetten J, Cruwys T, Bentley S. Group life shapes the psychology and biology of health: The case for a sociopsychobio model. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2019. [DOI: 10.1111/spc3.12490] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
27
|
Sansano-Nadal O, Giné-Garriga M, Brach JS, Wert DM, Jerez-Roig J, Guerra-Balic M, Oviedo G, Fortuño J, Gómara-Toldrà N, Soto-Bagaria L, Pérez LM, Inzitari M, Solà I, Martin-Borràs C, Roqué M. Exercise-Based Interventions to Enhance Long-Term Sustainability of Physical Activity in Older Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2527. [PMID: 31311165 PMCID: PMC6678490 DOI: 10.3390/ijerph16142527] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/12/2019] [Accepted: 07/14/2019] [Indexed: 01/28/2023]
Abstract
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.
Collapse
Affiliation(s)
- Oriol Sansano-Nadal
- Department of Physical Activity and Sport Sciences. Faculty of Psychology, Education and Sport Sciences (FPCEE) Blanquerna, Ramon Llull University, Císter 34, 08022 Barcelona, Spain
| | - Maria Giné-Garriga
- Department of Physical Activity and Sport Sciences. Faculty of Psychology, Education and Sport Sciences (FPCEE) Blanquerna, Ramon Llull University, Císter 34, 08022 Barcelona, Spain.
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK.
- Department of Physical Therapy. Faculty of Health Sciences (FCS) Blanquerna, Ramon Llull University, Padilla 326-332, 08025 Barcelona, Spain.
| | - Jennifer S Brach
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Forbes Tower, 3600 Atwood St, Pittsburgh, PA 15260, USA
| | - David M Wert
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Forbes Tower, 3600 Atwood St, Pittsburgh, PA 15260, USA
| | - Javier Jerez-Roig
- Department of Physical Activity and Sport Sciences. Faculty of Psychology, Education and Sport Sciences (FPCEE) Blanquerna, Ramon Llull University, Císter 34, 08022 Barcelona, Spain
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK
- Research group on Methodology, Methods, Models and Outcome of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, University of Vic-Central University of Catalonia (UVIC-UCC), Sagrada Família 7, 08500 Vic, Spain
| | - Myriam Guerra-Balic
- Department of Physical Activity and Sport Sciences. Faculty of Psychology, Education and Sport Sciences (FPCEE) Blanquerna, Ramon Llull University, Císter 34, 08022 Barcelona, Spain
| | - Guillermo Oviedo
- Department of Physical Activity and Sport Sciences. Faculty of Psychology, Education and Sport Sciences (FPCEE) Blanquerna, Ramon Llull University, Císter 34, 08022 Barcelona, Spain
| | - Jesús Fortuño
- Department of Physical Activity and Sport Sciences. Faculty of Psychology, Education and Sport Sciences (FPCEE) Blanquerna, Ramon Llull University, Císter 34, 08022 Barcelona, Spain
| | - Natàlia Gómara-Toldrà
- Department of Physical Therapy. Faculty of Health Sciences (FCS) Blanquerna, Ramon Llull University, Padilla 326-332, 08025 Barcelona, Spain
| | - Luis Soto-Bagaria
- Intermediate Care Hospital, Parc Sanitari Pere Virgili, Avinguda de Vallcarca 169-205, 08023 Barcelona, Spain
- RE-FiT Barcelona Research Group, Vall d'Hebrón Institute of Research (VHIR), Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Laura Mónica Pérez
- Intermediate Care Hospital, Parc Sanitari Pere Virgili, Avinguda de Vallcarca 169-205, 08023 Barcelona, Spain
- RE-FiT Barcelona Research Group, Vall d'Hebrón Institute of Research (VHIR), Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Marco Inzitari
- Intermediate Care Hospital, Parc Sanitari Pere Virgili, Avinguda de Vallcarca 169-205, 08023 Barcelona, Spain
- RE-FiT Barcelona Research Group, Vall d'Hebrón Institute of Research (VHIR), Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain
| | - Ivan Solà
- Iberoamerican Cochrane Centre. Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Sant Antoni Marià Claret 167, pavilion 18, 08025 Barcelona, Spain
- CIBER Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
| | - Carme Martin-Borràs
- Department of Physical Activity and Sport Sciences. Faculty of Psychology, Education and Sport Sciences (FPCEE) Blanquerna, Ramon Llull University, Císter 34, 08022 Barcelona, Spain
- Department of Physical Therapy. Faculty of Health Sciences (FCS) Blanquerna, Ramon Llull University, Padilla 326-332, 08025 Barcelona, Spain
| | - Marta Roqué
- Iberoamerican Cochrane Centre. Institute of Biomedical Research Sant Pau (IIB-Sant Pau), Sant Antoni Marià Claret 167, pavilion 18, 08025 Barcelona, Spain
- CIBER Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
- Institute on Health and Aging, Universitat Autònoma de Barcelona (UAB), Sant Antoni Marià Claret 171 (Casa Convalecencia), 08041 Barcelona, Spain
| |
Collapse
|
28
|
Tedesco S, Sica M, Ancillao A, Timmons S, Barton J, O'Flynn B. Validity Evaluation of the Fitbit Charge2 and the Garmin vivosmart HR+ in Free-Living Environments in an Older Adult Cohort. JMIR Mhealth Uhealth 2019; 7:e13084. [PMID: 31219048 PMCID: PMC6607774 DOI: 10.2196/13084] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/08/2019] [Accepted: 02/09/2019] [Indexed: 01/26/2023] Open
Abstract
Background Few studies have investigated the validity of mainstream wrist-based activity trackers in healthy older adults in real life, as opposed to laboratory settings. Objective This study explored the performance of two wrist-worn trackers (Fitbit Charge 2 and Garmin vivosmart HR+) in estimating steps, energy expenditure, moderate-to-vigorous physical activity (MVPA) levels, and sleep parameters (total sleep time [TST] and wake after sleep onset [WASO]) against gold-standard technologies in a cohort of healthy older adults in a free-living environment. Methods Overall, 20 participants (>65 years) took part in the study. The devices were worn by the participants for 24 hours, and the results were compared against validated technology (ActiGraph and New-Lifestyles NL-2000i). Mean error, mean percentage error (MPE), mean absolute percentage error (MAPE), intraclass correlation (ICC), and Bland-Altman plots were computed for all the parameters considered. Results For step counting, all trackers were highly correlated with one another (ICCs>0.89). Although the Fitbit tended to overcount steps (MPE=12.36%), the Garmin and ActiGraph undercounted (MPE 9.36% and 11.53%, respectively). The Garmin had poor ICC values when energy expenditure was compared against the criterion. The Fitbit had moderate-to-good ICCs in comparison to the other activity trackers, and showed the best results (MAPE=12.25%), although it underestimated calories burned. For MVPA levels estimation, the wristband trackers were highly correlated (ICC=0.96); however, they were moderately correlated against the criterion and they overestimated MVPA activity minutes. For the sleep parameters, the ICCs were poor for all cases, except when comparing the Fitbit with the criterion, which showed moderate agreement. The TST was slightly overestimated with the Fitbit, although it provided good results with an average MAPE equal to 10.13%. Conversely, WASO estimation was poorer and was overestimated by the Fitbit but underestimated by the Garmin. Again, the Fitbit was the most accurate, with an average MAPE of 49.7%. Conclusions The tested well-known devices could be adopted to estimate steps, energy expenditure, and sleep duration with an acceptable level of accuracy in the population of interest, although clinicians should be cautious in considering other parameters for clinical and research purposes.
Collapse
Affiliation(s)
| | - Marco Sica
- Tyndall National Institute, University College Cork, Cork, Ireland
| | - Andrea Ancillao
- Tyndall National Institute, University College Cork, Cork, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, University College Cork, Cork, Ireland
| | - John Barton
- Tyndall National Institute, University College Cork, Cork, Ireland
| | - Brendan O'Flynn
- Tyndall National Institute, University College Cork, Cork, Ireland
| |
Collapse
|
29
|
Schneider A, Cabral C, Herd N, Hay A, Kesten JM, Anderson E, Lane I, Beck C, Michie S. Reducing Primary Care Attendance Intentions for Pediatric Respiratory Tract Infections. Ann Fam Med 2019; 17:239-249. [PMID: 31085528 PMCID: PMC6827624 DOI: 10.1370/afm.2392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 01/21/2019] [Accepted: 02/12/2019] [Indexed: 01/21/2023] Open
Abstract
PURPOSE The aim of this study was to evaluate a theory and evidence-based, parent-targeted online intervention, combining microbiological local syndromic surveillance data, symptom information, and home-care advice, to reduce primary care attendance for self-limiting, low-risk pediatric respiratory tract infections (RTIs). METHODS The effect of this novel intervention on primary care attendance intentions was evaluated in an online experimental study. A representative sample of mothers (n = 806) was randomly assigned to receive the intervention material before (intervention) or after (control) answering questions concerning attendance intentions for an RTI illness scenario and mediating factors. Both groups provided feedback on the material. Group comparisons, linear regression, and path analyses were conducted. RESULTS Intervention participants reported lower attendance intentions compared with control participants (d = 0.69, 95% CI, 0.55-0.83), an effect that remained when controlling for demographic and clinical characteristics (B = -1.62, 95% CI, -1.97 to -1.30). The path model highlighted that the intervention effect (B = -0.33, 95% CI, -0.40 to -0.26) was mostly indirect and mediated by infection and antibiotic knowledge, symptom severity concerns, and social norm perceptions concerning attendance. Information on when to attend was rated as the most important intervention component 227 times, followed by symptoms rated 186 times. Information on circulating viruses was rated as least important 274 times. CONCLUSIONS The intervention was effective in reducing primary care attendance intentions by increasing knowledge, lowering attendance motivation, and reducing the need for additional resources. The contribution of individual intervention components and effects on behavioral outcomes requires further testing.
Collapse
Affiliation(s)
- Annegret Schneider
- University College London, London, United Kingdom .,NIHR Health Protection Research Unit in Evaluation of Interventions, Bristol, United Kingdom
| | | | - Natalie Herd
- University College London, London, United Kingdom.,NIHR Health Protection Research Unit in Evaluation of Interventions, Bristol, United Kingdom
| | - Alastair Hay
- NIHR Health Protection Research Unit in Evaluation of Interventions, Bristol, United Kingdom.,University of Bristol, Bristol, United Kingdom
| | - Joanna May Kesten
- NIHR Health Protection Research Unit in Evaluation of Interventions, Bristol, United Kingdom.,University of Bristol, Bristol, United Kingdom.,NIHR Collaboration for Leadership in Applied Health Research and Care West, Bristol, United Kingdom
| | - Emma Anderson
- NIHR Health Protection Research Unit in Evaluation of Interventions, Bristol, United Kingdom.,University of Bristol, Bristol, United Kingdom
| | - Isabel Lane
- University of Bristol, Bristol, United Kingdom
| | | | - Susan Michie
- University College London, London, United Kingdom.,NIHR Health Protection Research Unit in Evaluation of Interventions, Bristol, United Kingdom
| |
Collapse
|
30
|
Using formative research with older adults to inform a community physical activity programme: Get Healthy, Get Active. Prim Health Care Res Dev 2018; 20:e60. [PMID: 29976266 PMCID: PMC8512642 DOI: 10.1017/s1463423618000373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim The purpose of this formative study was to explore current knowledge and attitudes towards physical activity, as well as perceived barriers, facilitators and opportunities for physical activity participation among older adults living in the community. The findings have subsequently informed the design, delivery and recruitment strategies of a local community physical activity intervention programme which forms part of Sport England’s national Get Healthy, Get Active initiative. Background There is a growing public health concern regarding the amount of time spent in sedentary and physical activity behaviours within the older adult population. Methods Between March and June 2016, 34 participants took part in one of six focus groups as part of a descriptive formative study. A homogenous purposive sample of 28 community dwelling white, British older adults (six male), aged 65–90 years (M=78, SD=7 years) participated in one of five focus group sessions. An additional convenience pragmatic sub-sample of six participants (three male), aged 65–90 years (M=75, SD=4 years), recruited from an assisted living retirement home participated in a sixth focus group. Questions for focus groups were structured around the PRECEDE stage of the PRECEDE–PROCEDE model of health programme design, implementation and evaluation. Questions addressed knowledge, attitudes and beliefs towards physical activity, as well as views on barriers and opportunities for physical activity participation. All data were transcribed verbatim. Thematic analysis was then conducted with outcomes represented as pen profiles. Findings Consistent views regarding both the potential physical and psychosocial benefits of physical activity were noted regardless of living status. The themes of, opportunities and awareness for physical activity participation, cost, transport, location and season/weather varied between participants living in an assisted living retirement home and community dwelling older adults. Further comparative research on the physical activity requirements of older adults living in assisted living versus community settings are warranted.
Collapse
|
31
|
Keogh A, Matthews J, Hurley DA. An assessment of physiotherapist's delivery of behaviour change techniques within the SOLAS feasibility trial. Br J Health Psychol 2018; 23:908-932. [PMID: 29888520 DOI: 10.1111/bjhp.12323] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 05/22/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To investigate physiotherapist's (PTs) fidelity to 31 protocol-listed behaviour change techniques (BCTs) during a group-based self-management intervention. This study also explored the PTs delivery of these BCTs beyond the present or absent dichotomy, using a third variable, partial delivery (i.e., attempted). DESIGN Assessment of the intervention arm of the Self-management of Osteoarthritis and Low back pain through Activity and Skills (SOLAS) cluster, randomized controlled feasibility trial, using quantitative methods. METHODS Eight PTs delivered six SOLAS classes each, of which 50% were audio-recorded and transcribed. Transcripts were coded by two raters using the Behaviour Change Technique Taxonomy v1 and an intervention-specific manual and assessed for the delivery (i.e., full, partial, or absent) of the 31 BCTs and their target behaviours. Fidelity was calculated as fully delivered BCTs listed as a percentage of those due to take place within each class. RESULTS Physiotherapists delivered a mean 20.5 BCTs per class (68.3%; range = 64.9-72.4%). Of these, 17 BCTs were fully delivered in each class representing moderate fidelity to the protocol (56.8%; range = 53.5-59.3%). A further 3.5 BCTs per class (11.5%; range = 8.7-14.8%) were partially delivered. BCTs associated with 'goals and planning' were often poorly delivered. CONCLUSIONS Delivering the SOLAS intervention BCTs with high fidelity was not feasible. The assessment of partial delivery of BCTs provided greater insight into the techniques that should be removed from the protocol or that may require further training. Complex interventions should consider a list of 'core' or mandatory BCTs alongside 'optional' BCTs, depending on the target behaviour, and the needs of individual participants. Statement of contribution What is already known on this subject? BCTs are the smallest active components of behavioural interventions, yet typically their effectiveness is determined through meta-analyses. Attempted delivery of BCTs is often unaccounted for yet may provide valuable insight into difficulty with delivery. There is a need to investigate BCT implementation beyond simple presence/absence to identify protocol refinements or required BCT training. What does this study add? BCT delivery was assessed in greater depth than previous research, including partial delivery. Highlights the need for appropriate training in BCTs that are difficult to deliver, particularly those associated with 'goals and planning' Highlights the need for intervention-specific criteria as to what constitutes 'high', 'moderate', and 'low' fidelity.
Collapse
Affiliation(s)
- Alison Keogh
- UCD School of Public Health, Physiotherapy and Sports Science, Health Sciences Centre, University College Dublin, Belfield, Ireland
| | - James Matthews
- UCD School of Public Health, Physiotherapy and Sports Science, Health Sciences Centre, University College Dublin, Belfield, Ireland
| | - Deirdre A Hurley
- UCD School of Public Health, Physiotherapy and Sports Science, Health Sciences Centre, University College Dublin, Belfield, Ireland
| |
Collapse
|
32
|
Gill DL, Fasczewski KS, Reifsteck EJ, Rothberger SM, Davis PG. Evaluation of an exercise programme for post-bariatric surgery patients: views of participants. Obes Sci Pract 2018; 4:259-267. [PMID: 29951216 PMCID: PMC6010004 DOI: 10.1002/osp4.165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 02/01/2018] [Accepted: 02/05/2018] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Exercise programmes typically are evaluated with fitness assessments and psychological survey measures but seldom include participants' insights. The purpose of this study was to evaluate the benefits, facilitators and barriers of a 12-week exercise programme for post-bariatric surgery patients from the participants' perspective. METHOD Over a 2-year period, 20 patients recently having undergone bariatric surgery completed a 12-week programme that included participation in structured exercise and in focus groups designed to supplement standard evaluation data and provide insight into participants' views. RESULTS Participants were highly adherent to the programme, and focus group results reflected a clear positive evaluations. Benefits included helpful information, developing commitment, physical fitness and social support; notably, weight was seldom mentioned. Participants cited structure, accountability and group support as facilitators of exercise. Participants cited few barriers, although very few had set plans for continuing exercise after programme completion. CONCLUSION Participants saw many benefits to the exercise programme, and those benefits reflected lifestyle changes rather than a focus on weight. Programme structure, accountability and the support of the group were facilitators to exercise. Participants cited few barriers. However, the lack of plans for continued exercise suggested the need for a transition phase to help participants continue an active lifestyle after the 12-week structured programme.
Collapse
Affiliation(s)
- D. L. Gill
- Department of KinesiologyUniversity of North Carolina at GreensboroGreensboroNCUSA
| | - K. S. Fasczewski
- Department of Health and Exercise ScienceAppalachian State UniversityBooneNCUSA
| | - E. J. Reifsteck
- Department of KinesiologyUniversity of North Carolina at GreensboroGreensboroNCUSA
| | - S. M. Rothberger
- Technology Center to Promote Healthy LifestyleUniversity of South CarolinaColumbiaSCUSA
| | - P. G. Davis
- Department of KinesiologyUniversity of North Carolina at GreensboroGreensboroNCUSA
| |
Collapse
|
33
|
McCallum C, Rooksby J, Gray CM. Evaluating the Impact of Physical Activity Apps and Wearables: Interdisciplinary Review. JMIR Mhealth Uhealth 2018; 6:e58. [PMID: 29572200 PMCID: PMC5889496 DOI: 10.2196/mhealth.9054] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/01/2018] [Accepted: 01/07/2018] [Indexed: 01/02/2023] Open
Abstract
Background Although many smartphone apps and wearables have been designed to improve physical activity, their rapidly evolving nature and complexity present challenges for evaluating their impact. Traditional methodologies, such as randomized controlled trials (RCTs), can be slow. To keep pace with rapid technological development, evaluations of mobile health technologies must be efficient. Rapid alternative research designs have been proposed, and efficient in-app data collection methods, including in-device sensors and device-generated logs, are available. Along with effectiveness, it is important to measure engagement (ie, users’ interaction and usage behavior) and acceptability (ie, users’ subjective perceptions and experiences) to help explain how and why apps and wearables work. Objectives This study aimed to (1) explore the extent to which evaluations of physical activity apps and wearables: employ rapid research designs; assess engagement, acceptability, as well as effectiveness; use efficient data collection methods; and (2) describe which dimensions of engagement and acceptability are assessed. Method An interdisciplinary scoping review using 8 databases from health and computing sciences. Included studies measured physical activity, and evaluated physical activity apps or wearables that provided sensor-based feedback. Results were analyzed using descriptive numerical summaries, chi-square testing, and qualitative thematic analysis. Results A total of 1829 abstracts were screened, and 858 articles read in full. Of 111 included studies, 61 (55.0%) were published between 2015 and 2017. Most (55.0%, 61/111) were RCTs, and only 2 studies (1.8%) used rapid research designs: 1 single-case design and 1 multiphase optimization strategy. Other research designs included 23 (22.5%) repeated measures designs, 11 (9.9%) nonrandomized group designs, 10 (9.0%) case studies, and 4 (3.6%) observational studies. Less than one-third of the studies (32.0%, 35/111) investigated effectiveness, engagement, and acceptability together. To measure physical activity, most studies (90.1%, 101/111) employed sensors (either in-device [67.6%, 75/111] or external [23.4%, 26/111]). RCTs were more likely to employ external sensors (accelerometers: P=.005). Studies that assessed engagement (52.3%, 58/111) mostly used device-generated logs (91%, 53/58) to measure the frequency, depth, and length of engagement. Studies that assessed acceptability (57.7%, 64/111) most often used questionnaires (64%, 42/64) and/or qualitative methods (53%, 34/64) to explore appreciation, perceived effectiveness and usefulness, satisfaction, intention to continue use, and social acceptability. Some studies (14.4%, 16/111) assessed dimensions more closely related to usability (ie, burden of sensor wear and use, interface complexity, and perceived technical performance). Conclusions The rapid increase of research into the impact of physical activity apps and wearables means that evaluation guidelines are urgently needed to promote efficiency through the use of rapid research designs, in-device sensors and user-logs to assess effectiveness, engagement, and acceptability. Screening articles was time-consuming because reporting across health and computing sciences lacked standardization. Reporting guidelines are therefore needed to facilitate the synthesis of evidence across disciplines.
Collapse
Affiliation(s)
- Claire McCallum
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - John Rooksby
- School of Computing Science, University of Glasgow, Glasgow, United Kingdom
| | - Cindy M Gray
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| |
Collapse
|
34
|
Strath SJ, Rowley TW. Wearables for Promoting Physical Activity. Clin Chem 2017; 64:53-63. [PMID: 29118062 DOI: 10.1373/clinchem.2017.272369] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/19/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND The rapid expansion and popularity of consumer-wearable physical activity monitors (WPAMs) has enabled the integration of technology into physical activity (PA) intervention, deployment, and evaluation. This brief review reports on the accuracy of consumer-WPAMs, considers the intervention effects of using consumer-WPAMs, and offers future considerations as the proliferation of this area of product development and consumer use continues to escalate. CONTENT The studies reviewed document the utility for consumer-WPAMs to objectively assess PA, with output metrics similar to research-grade activity monitors. Early intervention efficacy for the use of consumer-WPAMs to increase PA holds considerable promise. Substantial increases in moderate- to vigorous-intensity PA (MVPA) have been reported across different research study designs and populations in which consumer-WPAMs have been used in isolation or in conjunction with other behavioral change strategies. The utility of consumer-WPAMs is currently being investigated in clinical populations, notably showing increases in PA in individuals at risk for cancer or post cancer survivors, in those with chronic obstructive pulmonary disease, and in postsurgical patients. There has been a proliferation of registered trials at clinicaltrials.gov, and an increase of disseminated works regarding the use of consumer-WPAMs is expected. SUMMARY There are many research studies documenting the validity and intervention effectiveness of consumer-WPAMs; evidence is emerging on the health benefits linked to use of such devices. Future work on the long-term effects of consumer-WPAMs on behavior and health is warranted, and prospects appear exciting as wearable technology advances and adoption increases.
Collapse
Affiliation(s)
- Scott J Strath
- Department of Kinesiology, University of Wisconsin-Milwaukee, Milwaukee WI; .,Center for Aging & Translational Research, University of Wisconsin-Milwaukee, Milwaukee WI
| | - Taylor W Rowley
- Department of Kinesiology, University of Wisconsin-Milwaukee, Milwaukee WI
| |
Collapse
|
35
|
Buchanan DT, Vitiello MV, Bennett K. Feasibility and Efficacy of a Shared Yoga Intervention for Sleep Disturbance in Older Adults With Osteoarthritis. J Gerontol Nurs 2017; 43:1-10. [PMID: 28399315 DOI: 10.3928/00989134-20170405-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 02/16/2017] [Indexed: 02/28/2024]
Abstract
The purpose of the current study was to test the feasibility and efficacy of a shared yoga (SY) program for sleep disturbance in older adults with osteoarthritis (OA). Participants (ages 50 to 72) with insomnia related to OA were randomized to 12 weeks of SY (n = 9) or individual yoga (IY; n = 7). The sample was 53% male and 41% self-identified as a race other than White/Caucasian. The groups did not significantly differ in class attendance, home practice, or change scores on efficacy outcomes. Pre-post comparisons in all participants showed statistically significant improvements on the Insomnia Severity Index and Patient-Reported Outcomes Measurement System sleep disturbance scale. Findings support the overall feasibility of the program, both in the shared and individual formats. Efficacy data suggest that this yoga program may improve sleep, but given the study limitations, further research is needed to draw conclusions. [Journal of Gerontological Nursing, xx(x), xx-xx.].
Collapse
|