UWALK: the development of a multi-strategy, community-wide physical activity program

The effect of neighborhood walkability on changes in physical activity and sedentary behavior during a 12-week pedometer-facilitated intervention

BACKGROUND

Pedometer-facilitated interventions encourage physical activity via the accumulation of steps. Mixed evidence suggests that neighborhood walkability might influence the effectiveness of physical activity interventions, including pedometer-facilitated interventions. Our study investigated the moderating effect of neighborhood walkability on immediate (4-week) and short-term (12-week) changes in self-reported neighborhood-specific leisure and transportation walking, leisure-based moderate and vigorous-intensity physical activity, and leisure-based screen time during a pedometer-facilitated intervention (UWALK).

METHODS

This quasi-experiment undertaken in Calgary (Canada) compared behavior changes during the 12-week intervention between two neighborhood groups classified as 'walkable' or 'car dependent' based on Walk Score®. Of the 573 volunteers (adults in the contemplation and preparation stages of physical activity behavior change), 466 participated in UWALK. Surveys captured sociodemographic characteristics, perceived neighborhood walkability, neighborhood preferences, motivation, physical activity and screen-based leisure. Covariate-adjusted linear mixed models estimated the differences in physical activity and leisure screen time between the neighborhood walkability groups at baseline, 4-weeks, and 12-weeks.

RESULTS

UWALK participants included mostly females (83%) and had an average age of 49.2 years. Weekly minutes of walking for transport inside the neighborhood was higher (p < .001) among participants from walkable versus car dependent neighborhoods at baseline (42.5 vs. 21.1), 4-weeks (81.2 vs. 48.2), and 12-weeks (87.2 vs. 48.0). Regardless of neighborhood walkability, all physical activity outcomes were higher and leisure screen time lower at 4-weeks and 12-weeks compared with baseline. We found no significant neighborhood group by time interactions.

CONCLUSIONS

Pedometer-facilitated interventions may be effective for supporting short-term changes in physical activity and sedentary behavior even among adults residing in low walkable neighborhoods.

Evaluating the Dissemination and Implementation of a Community Health Worker-Based Community Wide Campaign to Improve Fruit and Vegetable Intake and Physical Activity among Latinos along the U.S.-Mexico Border

This study evaluated the dissemination and implementation of a culturally tailored community-wide campaign (CWC), Tu Salud ¡Si Cuenta! (TSSC), to augment fruit and vegetable (FV) consumption and physical activity (PA) engagement among low-income Latinos of Mexican descent living along the U.S.-Mexico Border in Texas. TSSC used longitudinal community health worker (CHW) home visits as a core vehicle to enact positive change across all socioecological levels to induce behavioral change. TSSC's reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) was examined. A dietary questionnaire and the Godin-Shepherd Exercise Questionnaire measured program effectiveness on mean daily FV consumption and weekly PA engagement, respectively. Participants were classified based on CHW home visits into "low exposure" (2-3 visits) and "high exposure" (4-5 visits) groups. The TSSC program reached low-income Latinos (n = 5686) across twelve locations. TSSC demonstrated effectiveness as, compared to the low exposure group, the high exposure group had a greater FV intake (mean difference = +0.65 FV servings daily, 95% CI: 0.53-0.77) and an increased PA (mean difference = +185.6 MET-minutes weekly, 95% CI: 105.9-265.4) from baseline to the last follow-up on a multivariable linear regression analysis. Multivariable logistic regression revealed that the high exposure group had higher odds of meeting both FV guidelines (adjusted odds ratio (AOR) = 2.03, 95% CI: 1.65-2.47) and PA guidelines (AOR = 1.36, 95% CI: 1.10-1.68) at the last follow-up. The program had a 92.3% adoption rate, with 58.3% of adopting communities meeting implementation fidelity, and 91.7% of communities maintaining TSSC. TSSC improved FV consumption and PA engagement behaviors among low-income Latinos region wide. CHW delivery and implementation funding positively influenced reach, effectiveness, adoption, and maintenance, while lack of qualified CHWs negatively impacted fidelity.

Mobile-Health based physical activities co-production policies towards cardiovascular diseases prevention: findings from a mixed-method systematic review

BACKGROUND

Cardiovascular disease (CVD) is the first cause of death globally, with huge costs worldwide. Most cases of CVD could be prevented by addressing behavioural risk factors. Among these factors, there is physical and amateur sports activity (PASA), which has a linear negative correlation with the risk of CVD. Nevertheless, attempts to encourage PASA, as exercise prescription programmes, achieved little impact at the community-wide level. A new frontier to promote PASA is represented by mobile health tools, such as exergaming, mobile device apps, health wearables, GPS/GIS and virtual reality. Nevertheless, there has not yet been any evident turnabout in patient active involvement towards CVD prevention, and inactivity rates are even increasing. This study aims at framing the state of the art of the literature about the use of m-health in supporting PASA, as a user-centric innovation strategy, to promote co-production health policies aiming at CVD prevention.

METHODS

A mixed-method systematic literature review was conducted in the fields of health and healthcare management to highlight the intersections between PASA promotion and m-health tools in fostering co-produced services focused on CVD prevention. The literature has been extracted by the PRISMA logic application. The resulting sample has been first statistically described by a bibliometric approach and then further investigated with a conceptual analysis of the most relevant contributions, which have been qualitatively analysed.

RESULTS

We identified 2,295 studies, on which we ran the bibliometric analysis. After narrowing the research around the co-production field, we found 10 papers relevant for the concept analysis of contents. The interest about the theme has increased in the last two decades, with a high prevalence of contributions from higher income countries and those with higher CVD incidence. The field of research is highly multi-disciplinary; most of documents belong to the medical field, with only a few interconnections with the technology and health policy spheres. Although the involvement of patients is recognized as fundamental for CVD prevention through PASA, co-design schemes are still lacking at the public management level.

CONCLUSIONS

While the link between the subjects of motor activity, medicine and technology is clear, the involvement of citizens in the service delivery process is still underinvestigated, especially the issue concerning how "value co-creation" could effectively be applied by public agencies. In synthesis, the analysis of the role of co-production as a system coordination method, which is so important in designing and implementing preventive care, is still lacking.

Scaling a Community-Wide Campaign Intervention to Manage Hypertension and Weight Loss

Public health impacts can be achieved when evidence-based interventions are implemented to those most in need. Too often implementation never or slowly occurs. The community-wide campaign intervention Tu Salud ¡Si Cuenta! has evidence of improving health outcomes related to chronic disease among low-income, Latinos. Using the RE-AIM Framework, this study examined if the scaled-up version of the intervention is associated with improvements in hypertension and obesity in 12 locations. Each element of the RE-AIM framework was examined. For "Effectiveness," we examined outcomes overall and by implementing location. We used linear and logistic regression to assess if exposure in the intervention was associated with improvement in hypertension and weight loss. Participants were stratified into "low exposure" (2-3 outreach visits) vs. "high exposure" (4-5 outreach visits). Based on the RE-AIM Framework, the intervention "reached" its intended population of low-income Latinos, demonstrated "effectiveness" in improving hypertension and obesity, was "adopted" at a high level in all but one site, was "implemented" with fidelity to the intervention model with moderate success across locations, and showed high "maintenance" over time. For effectiveness specifically, we found that out of 5,019 participants, 2,508 (50%) had a baseline hypertensive blood pressure (BP) reading. Of the 2,508, 1,245 (49.9%) recovered to normal blood pressure or pre-hypertension stage by last follow-up. After adjusting for baseline BP and potential confounders in multivariable linear regression models, the high exposure group had significantly more reduction in systolic BP (adjusted mean difference in % change = -0.96; p = 0.002) and diastolic BP (adjusted mean difference in % change = -1.61; p < 0.0001) compared to the low exposure group. After controlling for baseline weight and other confounders, the high exposure group had significantly greater decrease in weight compared to the low exposure group (adjusted mean difference in % change = -1.28; p < 0.0001). Results from the multivariable logistic regression models indicated that compared to the low exposure group the high exposure group was more likely to achieve a clinically significant minimum 5% weight loss [adjusted odds ratio (OR) = 2.97; p < 0.0001). This study contributes evidence that a Community-Wide Campaign model holds promise for addressing hypertension and obesity among low-income Latinos.

Associations between objectively-measured and self-reported neighbourhood walkability on adherence and steps during an internet-delivered pedometer intervention

BACKGROUND

Accumulating evidence suggests that the built environment is associated with physical activity. The extent to which the built environment may support adherence to physical activity interventions is unclear. The aim of this study was to investigate whether the neighbourhood built environment constrains or facilitates adherence and steps taken during a 12-week internet-delivered pedometer-based physical activity intervention (UWALK).

METHOD

The study was undertaken in Calgary (Canada) between May 2016 and August 2017. Inactive adults (n = 573) completed a telephone survey measuring sociodemographic characteristics and perceived neighbourhood walkability. Following the survey, participants were mailed a pedometer and instructions for joining UWALK. Participants were asked to report their daily pedometer steps into the online program on a weekly basis for 12 weeks (84 days). Walk Score® estimated objective neighbourhood walkability and the Neighbourhood Environment Walkability Scale-Abbreviated (NEWS-A) measured participants self-reported neighbourhood walkability. Regression models estimated covariate-adjusted associations of objective and self-reported walkability with: 1) adherence to the UWALK intervention (count of days with steps reported and count of days with 10000 steps reported), and; 2) average daily pedometer steps.

RESULTS

On average, participants undertook 8565 (SD = 3030) steps per day, reported steps on 67 (SD = 22.3) of the 84 days, and achieved ≥10000 steps on 22 (SD = 20.5) of the 84 days. Adjusting for covariates, a one-unit increase in self-reported walkability was associated on average with 45.76 (95CI 14.91, 76.61) more daily pedometer steps. Walk Score® was not significantly associated with steps. Neither objective nor self-reported walkability were significantly associated with the UWALK adherence outcomes.

CONCLUSION

The neighbourhood built environment may support pedometer-measured physical activity but may not influence adherence to pedometer interventions. Perceived walkability may be more important than objectively-measured walkability in supporting physical activity during pedometer interventions.

Random forest algorithms for recognizing daily life activities using plantar pressure information: a smart-shoe study

Background

Wearable activity trackers are regarded as a new opportunity to deliver health promotion interventions. Indeed, while the prediction of active behaviors is currently primarily relying on the processing of accelerometer sensor data, the emergence of smart clothes with multi-sensing capacities is offering new possibilities. Algorithms able to process data from a variety of smart devices and classify daily life activities could therefore be of particular importance to achieve a more accurate evaluation of physical behaviors. This study aims to (1) develop an activity recognition algorithm based on the processing of plantar pressure information provided by a smart-shoe prototype and (2) to determine the optimal hardware and software configurations.

Method

Seventeen subjects wore a pair of smart-shoe prototypes composed of plantar pressure measurement insoles, and they performed the following nine activities: sitting, standing, walking on a flat surface, walking upstairs, walking downstairs, walking up a slope, running, cycling, and completing office work. The insole featured seven pressure sensors. For each activity, at least four minutes of plantar pressure data were collected. The plantar pressure data were cut in overlapping windows of different lengths and 167 features were extracted for each window. Data were split into training and test samples using a subject-wise assignment method. A random forest model was trained to recognize activity. The resulting activity recognition algorithms were evaluated on the test sample. A multi hold-out procedure allowed repeating the operation with 5 different assignments. The analytic conditions were modulated to test (1) different window lengths (1–60 seconds), (2) some selected sensor configurations and (3) different numbers of data features.

Results

A window length of 20 s was found to be optimum and therefore used for the rest of the analysis. Using all the sensors and all 167 features, the smart shoes predicted the activities with an average success of 89%. “Running” demonstrated the highest sensitivity (100%). “Walking up a slope” was linked with the lowest performance (63%), with the majority of the false negatives being “walking on a flat surface” and “walking upstairs.” Some 2- and 3-sensor configurations were linked with an average success rate of 87%. Reducing the number of features down to 20 does not alter significantly the performance of the algorithm.

Conclusion

High-performance human behavior recognition using plantar pressure data only is possible. In the future, smart-shoe devices could contribute to the evaluation of daily physical activities. Minimalist configurations integrating only a small number of sensors and computing a reduced number of selected features could maintain a satisfying performance. Future experiments must include a more heterogeneous population.

Public Libraries and Walkable Neighborhoods

Public libraries constitute a ubiquitous social infrastructure found in nearly every community in the United States and Canada. The hypothesis of this study is that public libraries can be understood as important supports of walking in neighborhoods, not only as walkable destinations, but also as providers of programs that increase walking in communities. Recent work by public health scholars has analyzed how libraries contribute to community health. This particular topic has not previously been researched. As such, a qualitative, exploratory approach guides this study. Grounded theory techniques are used in a content analysis of a corpus of 94 online articles documenting this phenomenon. Results show that across North America public librarians endeavor to support walking through programs oriented around stories, books, and local history, as well as through walking groups and community partnerships. While this exploratory study has many limitations, it does set the stage for future, more rigorous research on the contributions public libraries and public librarians make to walking in neighborhoods. The principal conclusion of this study is that additional research is needed to comprehensively understand the intersection between public librarianship and public health.

A systematic review of physical activity-based behaviour change interventions reaching men with prostate cancer

PURPOSE

Men who are survivors of prostate cancer report a variety of psychological and physical factors contributing to a lower quality of life, and physical activity can assist to mitigate these issues. This review aims to provide a summary of physical activity behaviour change trials targeting prostate cancer survivors, assess the feasibility of these interventions and, if possible, identify intervention and study characteristics associated with significant intervention effects.

METHOD

Four databases (PubMed, CINAHL, PsycINFO and EMBASE) were systematically searched for randomised controlled trials containing at least one behavioural outcome relating to physical activity published up until July 2016. Forward and backwards, hand, key author citation searching and known research were also considered.

RESULTS

From a total of 13, 828 titles, the search resulted in 12 studies (6 prostate cancer only and 6 mixed cancer interventions), eight of which found positive results most often related immediately to post-intervention aerobic activity. Factors relating to efficacy were not conclusive due to the heterogeneity of studies and lack of cancer-specific data in mixed cancer trials. Future research focusing on intervention reach, maintenance of intervention effects and resistance training outcomes is needed.

CONCLUSION

There is preliminary evidence to suggest that a variety of physical activity behaviour change interventions targeting men with a history of prostate cancer can be efficacious, at least in the short term. Experimental studies are required to identify key intervention features.

IMPLICATIONS FOR CANCER SURVIVORS

Physical activity interventions can assist prostate cancer survivors in relation to short-term lifestyle change, though more evidence is required to improve the clarity of factors related to efficacy.

Using Fitness Trackers and Smartwatches to Measure Physical Activity in Research: Analysis of Consumer Wrist-Worn Wearables

Background

New fitness trackers and smartwatches are released to the consumer market every year. These devices are equipped with different sensors, algorithms, and accompanying mobile apps. With recent advances in mobile sensor technology, privately collected physical activity data can be used as an addition to existing methods for health data collection in research. Furthermore, data collected from these devices have possible applications in patient diagnostics and treatment. With an increasing number of diverse brands, there is a need for an overview of device sensor support, as well as device applicability in research projects.

Objective

The objective of this study was to examine the availability of wrist-worn fitness wearables and analyze availability of relevant fitness sensors from 2011 to 2017. Furthermore, the study was designed to assess brand usage in research projects, compare common brands in terms of developer access to collected health data, and features to consider when deciding which brand to use in future research.

Methods

We searched for devices and brand names in six wearable device databases. For each brand, we identified additional devices on official brand websites. The search was limited to wrist-worn fitness wearables with accelerometers, for which we mapped brand, release year, and supported sensors relevant for fitness tracking. In addition, we conducted a Medical Literature Analysis and Retrieval System Online (MEDLINE) and ClinicalTrials search to determine brand usage in research projects. Finally, we investigated developer accessibility to the health data collected by identified brands.

Results

We identified 423 unique devices from 132 different brands. Forty-seven percent of brands released only one device. Introduction of new brands peaked in 2014, and the highest number of new devices was introduced in 2015. Sensor support increased every year, and in addition to the accelerometer, a photoplethysmograph, for estimating heart rate, was the most common sensor. Out of the brands currently available, the five most often used in research projects are Fitbit, Garmin, Misfit, Apple, and Polar. Fitbit is used in twice as many validation studies as any other brands and is registered in ClinicalTrials studies 10 times as often as other brands.

Conclusions

The wearable landscape is in constant change. New devices and brands are released every year, promising improved measurements and user experience. At the same time, other brands disappear from the consumer market for various reasons. Advances in device quality offer new opportunities for research. However, only a few well-established brands are frequently used in research projects, and even less are thoroughly validated.

Consumer physical activity tracking device ownership and use among a population-based sample of adults

Consumer physical activity tracking devices (PATs) have gained popularity to support individuals to be more active and less sedentary throughout the day. Wearable PATs provide real-time feedback of various fitness-related metrics such as tracking steps, sedentary time, and distance walked. The purpose of this study was to examine the prevalence and correlates of PAT ownership and use among a population-based sample of adults. A representative sample of adults ≥18 years (N = 1,215) from Alberta, Canada were recruited through random-digit dialing and responded to a questionnaire via computer-assisted telephone interviewing methods in summer 2016. Questionnaires assessed demographic and health behaviour variables, and items were designed to assess PAT ownership and usage. Logistic regression analysis (odds ratios) was used to assess correlates of PAT ownership and use. On average, participants (N = 1,215) were 53.9 (SD 16.7) years and 50.1% were female. Of the sample, 19.6% (n = 238) indicated they currently own and use a PAT. Participants who owned a PAT wore their device on average 23.2 days within the past month. Currently owning a PAT was significantly associated with being female (OR = 1.41, CI: 1.10 to 1.82), being <60 years of age (OR = 1.86, CI: 1.37 to 2.53), having at least some post secondary education (OR = 1.88, CI: 1.36 to 2.60), having a BMI ≥25 (OR = 1.52, CI: 1.16 to 1.99), and meeting physical activity guidelines (OR = 1.45, CI: 1.12 to 1.88). Similar correlates emerged for PAT use. Correlates significantly associated with PAT use and ownership included being female, being less than 60 years of age, having a post-secondary education, meeting physical activity guidelines, and being overweight/obese. This is the first study to examine characteristics of PAT ownership and use among Canadian adults.

"VelaMente?!" - Sailin in a Crew to Improve Self-Efficacy in People with Psychosocial Disabilities: A Randomized Controlled Trial

INTRODUCTION

It has been proposed that sailing can improve quality of life, personal and social skills of people with severe psychosocial disabilities. This study aimed to assess the efficacy of a psychosocial rehabilitative intervention focused on sailing on quality of life, self-efficacy and sense of coherence in people with severe psychosocial disabilities.

METHODS

The study was a randomized, with parallel groups, waiting-list controlled trial. Participants were 51 people with severe psychosocial disabilities. The intervention was a structured course to learn sailing in a crew lasting three months. A randomized group began the sailing course immediately after a pre-treatment assessment; the waitlist group began the sailing course after a three months period of treatments as usual. Participants were assessed before and after the sailing course, or the waiting list period, on the General Self-Efficacy scale (GSES), Sense Of Coherence scale (SOC) and Health Survey-short form (SF-12).

RESULTS

Self-efficacy significantly increased after the sailing course and decreased after treatment as usual (p=0.015). Sense of coherence and the levels of quality of life tended to improve after the sailing course, albeit below levels of statistical significance.

CONCLUSION

When compared to more traditional psychosocial rehabilitative activities, an intervention focused on sailing in a crew positively impacts the sense of coherence and the levels of quality of life and significantly improves self-efficacy of people with severe psychosocial disabilities. Further longitudinal research is required.