Effects of "10,000 steps Ghent": a whole-community intervention

Effects of the Population-Based "10,000 Steps Duesseldorf" Intervention for Promoting Physical Activity in Community-Dwelling Adults: Protocol for a Nonrandomized Controlled Trial

BACKGROUND

The World Health Organization recommends 150 minutes of moderate to vigorous physical activity (PA), which translates to approximately 7000 to 10,000 steps per day for adults. In Germany, less than half of the population in this age range meets this recommendation, highlighting the need for population-based intervention approaches for promoting daily PA.

OBJECTIVE

The complex community-based PA intervention "10,000 Steps Ghent," which was originally developed in Belgium and was shown to be effective for PA promotion, has been adapted for implementation and evaluation in 2 German cities. The original Belgian study is currently being replicated, and we aim to examine the effectiveness of the adapted intervention among adults living in intervention city districts in Duesseldorf when compared with those living in control city districts in Wuppertal, over the course of 1 year.

METHODS

A controlled intervention trial examining the effects of an intervention addressing multiple levels (eg, individual level: website; organizational level: PA promotion in companies; community level: media campaigns and environmental changes) is being conducted. PA and various secondary outcomes will be assessed in 2 random samples of adults aged 25 to 75 years (n=399 in each city) at baseline and after 1 year.

RESULTS

Funding for this study was obtained in March 2020. Recruitment for this study and baseline data collection were conducted from May 2021 to March 2022 (as of March 2022, 626 participants were enrolled in the study). The intervention will be implemented in Duesseldorf for 1 year from April 2022 onward, and follow-up assessments will be conducted, starting in May 2023 (until September 2023). Data analysis will be performed in fall 2023, and the results will be published in spring 2024.

CONCLUSIONS

To our knowledge, this is the first research project (currently underway in Germany) that is aimed at replicating the effects of a complex intervention for PA promotion that was previously shown to be effective in another European country.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00024873; https://tinyurl.com/4c9e8azh.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/39175.

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.

A community-wide intervention to promote physical activity: A five-year quasi-experimental study

Evidence on the effects of a community-wide intervention (CWI) on population-level physical activity (PA), especially in the long term, is limited. Therefore, we evaluated the five-year effect of CWI on promoting PA through information dissemination, education, and community support primarily targeting older adults, by incorporating Japanese guidelines, in Fujisawa City, from 2013. To assess the effect of the whole-city intervention, we distributed questionnaires in 2013, 2015, and 2018 to three independent random samples of 3,000 community-dwelling adults (aged ≥ 20 years) using a quasi-experimental study design. Three separate samples responded to the survey (41% at baseline, 46% at the two-year mark, and 48% at the five-year follow-up). The primary outcome was change in PA participation. At the five-year follow-up, PA (median: 120 minutes/day) was significantly higher than at baseline (86 minutes/day) and the two-year follow-up (90 minutes/day). The results of the multivariate analysis indicated that PA among older adults-the primary target population of the CWI-increased significantly at the five-year follow-up, compared to those aged 20-64 (mean difference of change between groups: 14.7 minutes/day, P= 0.029). Among older adults, PA was significantly lower in those with poorer perceived economic status than in their more well-off counterparts at the two-year follow-up (P= 0.003); however, there was no significant difference at the five-year follow-up (P= 1.000). There was a positive interaction between group and period (mean difference of change between groups: 40.9 minutes/day, P= 0.001). In conclusion, the five-year CWI targeting older adults, incorporating national guidelines, improved population-level PA.

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.

Citizen Science to Communicate about Public Health Messages: The Reach of a Playful Online Survey on Sitting Time and Physical Activity

There is a lack of research on how to communicate public health guidelines. Citizen science (CS) has been an effective way to involve the public in research. This study analyses the reach of a well-established CS experiment, launched during an annual national science event, to understand if it could be used as communication strategy for public health issues. A short playful online survey contained tailored health-related messages associated to an "animal totem" profile, based on the combination of sitting and physical activity levels (koala: high sitting, low activity; gorilla: high sitting, high activity; zebra: low sitting, low activity; bee: low sitting, high activity). Tweets, radio interviews, radio and online advertisements, press articles, and a press conference were used to promote the CS experiment. Google Analytics and Facebook Graph API (application programming interface) (use and spread of experiment) and descriptive statistics (attributes of adults completing the experiment) were used. A total of 6,246 adults completed the experiment, with a peak of views (n = 5,103) and completions (n = 1,209) a couple of days before the event. Completers were mostly female (65.8%), on average 37.5 years old, and had a healthy body mass index (23.8 kg/m²). Nearly half (46.4%) had the most beneficial profile ("bee"), 26.5% had the least healthy profile ("koala"). CS as part of a national science event is a good platform for health communication as 1 in 1,000 Flemish adults were reached. However, those completing the experiment were not representative of the general Flemish adult population and reported to be more physically active. Abbreviations: API: application programming interface; BMI: body mass index; CVD: cardiovascular disease; METs: metabolic equivalents.

Community-wide intervention and population-level physical activity: a 5-year cluster randomized trial

Background

Evidence from a limited number of short-term trials indicates the difficulty in achieving population-level improvements in physical activity (PA) through community-wide interventions (CWIs). We sought to evaluate the effectiveness of a 5-year CWI for promoting PA in middle-aged and older adults using a cluster randomized design.

Methods

We randomized 12 communities in Unnan, Japan, to either intervention (9) or control (3). Additionally, intervention communities were randomly allocated to three subgroups by different PA types promoted. Randomly sampled residents aged 40–79 years responded to the baseline survey (n = 4414; 74%) and were followed at 1, 3 and 5 years (78–83% response rate). The intervention was a 5-year CWI using social marketing to promote PA. The primary outcome was a change in recommended levels of PA.

Results

Compared with control communities, adults achieving recommended levels of PA increased in intervention communities [adjusted change difference = 4.6 percentage points (95% confidence interval: 0.4, 8.8)]. The intervention was effective for promoting all types of recommended PAs, i.e. aerobic (walking, 6.4%), flexibility (6.1%) and muscle-strengthening activities (5.7%). However, a bundled approach, which attempted to promote all forms of PAs above simultaneously, was not effective (1.3–3.4%, P ≥ 0.138). Linear dose–response relationships between the CWI awareness and changes in PA were observed (P ≤ 0.02). Pain intensity decreased in shoulder (intervention and control) and lower back (intervention only) but there was little change difference in all musculoskeletal pain outcomes between the groups.

Conclusions

The 5-year CWI using the focused social marketing strategy increased the population-level of PA.

Needs and Challenges Related to Multilevel Interventions: Physical Activity Examples

The theme of this commentary is to discuss the need for, and challenges of, conceptualizing, implementing, and evaluating multilevel health behavior change interventions. Ecological models, recommendations from national and international authoritative groups, and growing evidence all support the need for interventions designed to change multiple levels of influence, including individuals, social environments, organizations, built environments, and policies, to achieve population improvements in public health. Though multilevel interventions are becoming more common in practice, they are still under-used, and research on multilevel interventions is relatively rare. Drawing on examples from physical activity, several types of evidence are summarized to demonstrate that multilevel interventions are feasible and can be effective. Serious challenges to implementing and evaluating multilevel interventions include the need for teams with diverse expertise, lack of control over intervention implementation, unpredictability of timelines, managing complex teams over extended periods, and need to apply unfamiliar and less-rigorous study designs and methods. Recommendations are offered for changes in training, funding priorities, and academic incentives that could lead to more and better multilevel interventions.

What works to promote walking at the population level? A systematic review

OBJECTIVE

Interventions to promote walking have focused on individual or group-based approaches, often via the randomised controlled trial design. Walking can also be promoted using population health approaches. We systematically reviewed the effectiveness of population approaches to promote walking among individuals and populations.

DESIGN

A systematic review.

DATA SOURCES

10 electronic databases searched from January 1990 to March 2017.

ELIGIBILITY CRITERIA

Eligibility criteria include pre-experimental and postexperimental studies of the effects of population interventions to change walking, and the effects must have been compared with a 'no intervention', or comparison group/area/population, or variation in exposure; duration of ≥12 months of follow up; participants in free-living populations; and English-language articles.

RESULTS

12 studies were identified from mostly urban high-income countries (one focusing on using tax, incentivising the loss of parking spaces; and one using policy only, permitting off-leash dogs in city parks). Five studies used mass media with either environment (n=2) or community (n=3) approaches. Four studies used environmental changes that were combined with policies. One study had scaled up school-based approaches to promote safe routes to schools. We found mass media, community initiatives and environmental change approaches increased walking (range from 9 to 75 min/week).

Community-wide physical activity intervention based on the Japanese physical activity guidelines for adults: A non-randomized controlled trial

Very few community intervention studies that promote physical activity (PA) using guidelines and its dissemination and implementation have been conducted. Consequently, we evaluated the effectiveness of a community-wide intervention (CWI) of PA with adults based on the Japanese guidelines for promoting PA. This was a non-randomized controlled trial, with four administrative districts in Fujisawa city assigned to the intervention group and nine to the control group. The CWI, conducted from 2013 to 2015, comprised information dissemination, education, and community support. The primary outcome was change in PA participation. Secondary outcomes were CWI awareness and PA guideline knowledge. Outcomes were assessed using questionnaires distributed to two independent, random samples of 3000 community-based adults (aged ≥20years). Two separate samples-1230 adults at baseline and 1393 at the two-year follow-up-responded to the survey. The median time spent in PA did not differ between intervention and control groups after adjusting for potential confounders (adjusted difference between groups=-0.02min/day [95% confidence interval (CI): -0.11, 0.10]). However, intervention group participants were more aware of the CWI (33.8%) than were control group participants (25.2%) at the two-year follow-up (odds ratio=1.44 [95% CI: 1.06, 1.95]). A significant difference was also observed in participants' PA guideline knowledge (adjusted difference between groups=0.82% [95% CI: 0.33, 1.31]). Although significant differences in awareness and knowledge were observed between groups, this CWI did not change PA levels over two years. Future studies should investigate the long-term effects of CWIs beyond two years.

TRIAL REGISTRATION NUMBER

UMIN-CTR UMIN000018389.

Views of policy makers and health promotion professionals on factors facilitating implementation and maintenance of interventions and policies promoting physical activity and healthy eating: results of the DEDIPAC project

Background

The uptake, implementation, and maintenance of effective interventions promoting physical activity (PA) and a healthy diet and the implementation of policies targeting these behaviors are processes not well understood. We aimed to gain a better understanding of what health promotion professionals and policy makers think are important factors facilitating adoption, implementation, and maintenance of multi-level interventions and policies promoting healthy eating and PA in Belgium, Germany, Ireland, Norway, and Poland.

Methods

Six interventions and six policies were identified based on pre-defined criteria. Forty semi-structured interviews were conducted with stakeholders from various sectors to elicit information on factors impacting adoption, implementation, and maintenance of these interventions and policies. All interview transcripts were coded in NVivo, using a common categorization matrix. Coding in the respective countries was done by one researcher and validated by a second researcher.

Results

Active involvement of relevant stakeholders and good communication between coordinating organizations were described as important factors contributing to successful adoption and implementation of both interventions and policies. Additional facilitating factors included sufficient training of staff and tailoring of materials to match needs of various target groups. The respondents indicated that maintenance of implemented interventions/policies depended on whether they were embedded in existing or newly created organizational structures in different settings and whether continued funding was secured.

Conclusions

Despite considerable heterogeneity of interventions and health policies in the five countries, stakeholders across these countries identify similar factors facilitating adoption, implementation, and maintenance of these interventions and policies.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4929-9) contains supplementary material, which is available to authorized users.

Physical activity: a synopsis and comment on "community-wide interventions for increasing physical activity"

In this synopsis, we summarize and comment on Baker and colleagues' Cochrane review of studies on the population-level impact of community-wide physical activity (PA) interventions. Insufficient PA remains a major public health problem. Community-wide interventions offer an opportunity to extend reach by increasing the proportion of the population experiencing the intervention. A previous Cochrane review of community-wide PA interventions concluded that evidence for effectiveness was mixed. Hence, Baker and colleagues incorporated new data about community-based PA interventions. This Cochrane review concluded there is an overall lack of evidence that community-wide interventions improve PA outcomes at the population level. Recommendations are that future research should use high quality research design, more explicitly test ways to increase reach, and utilize objective measurements of PA to increase validity. We suggest that future research should first optimize the intervention by systematically evaluating treatment components and selecting a maximally efficient and effective treatment package.

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

UWALK is a multi-strategy, multi-sector, theory-informed, community-wide approach using e and mHealth to promote physical activity in Alberta, Canada. The aim of UWALK is to promote physical activity, primarily via the accumulation of steps and flights of stairs, through a single over-arching brand. This paper describes the development of the UWALK program. A social ecological model and the social cognitive theory guided the development of key strategies, including the marketing and communication activities, establishing partnerships with key stakeholders, and e and mHealth programs. The program promotes the use of physical activity monitoring devices to self-monitor physical activity. This includes pedometers, electronic devices, and smartphone applications. In addition to entering physical activity data manually, the e and mHealth program provides the function for objective data to be automatically uploaded from select electronic devices (Fitbit®, Garmin and the smartphone application Moves) The RE-AIM framework is used to guide the evaluation of UWALK. Funding for the program commenced in February 2013. The UWALK brand was introduced on April 12, 2013 with the official launch, including the UWALK website on September 20, 2013. This paper describes the development and evaluation framework of a physical activity promotion program. This program has the potential for population level dissemination and uptake of an ecologically valid physical activity promotion program that is evidence-based and theoretically framed.

A population-based survey on physical inactivity and leisure time physical activity among adults in Chiang Mai, Thailand, 2014

Background

Reducing physical inactivity among the population is a challenge for many nations. Targeting leisure time physical activity (LTPA) may be useful in increasing overall physical activity as it is assumed it is associated with a higher degree of free choice and personal preference than physical activity at work and during travel. The study explored the prevalence of physical inactivity and focused on the overall level of energy expenditure and energy level spent during leisure time among those who were physically inactive and assessed the stages of change for LTPA among those who were physically inactive.

Methods

A population-based survey was conducted in 2014 in Chiang Mai, Thailand using a stratified two-stage cluster sampling technique. The Global Physical Activity Questionnaire (GPAQ) was used to collect the data on physical activity. Sufficient levels of physical activity (PA) were defined as ≥150 min/week of moderate-intensity PA or ≥75 min/week of vigorous-intensity PA or ≥600 metabolic equivalent of task (MET)-minutes/week. Weighted analyses were used to estimate the prevalence of physical inactivity, the total energy expenditure and expenditure during LTPA as well as stages of change among the physically inactive population.

Results

A total of 1744 people (808 men and 936 women), aged 15 to 64 years, participated in the study. We estimated that a quarter (26%) of the population were physically inactive. Physical inactivity was more commonly found among women than men in most age groups. LTPA contributed a small proportion of overall PA. On average, physically inactive men spent 132.8 MET-minutes/week and inactive women spent 208.2 MET-minutes/week in overall PA which is well below the 600 MET-minutes/week recommend by the World Health Organization. Around 75% of physically inactive people had no intention of engaging in regular LTPA.

Conclusion

About a quarter of the investigative population were physically inactive. Most physically inactive members of the population participate in low levels of LTPA, but the majority has no intention of increasing PA during leisure time. A large-scale health promotion program is needed, and it should focus on an approach for the pre-contemplated population.

Time to 're-think' physical activity promotion for young people? Results from a repeated cross-sectional study

BACKGROUND

The aim of this study was to investigate the relationship between knowledge of the current UK physical activity (PA) guidelines and amount of daily PA using a sample population of 11-16 year olds in Northern Ireland.

METHODS

Cross-sectional survey data from the 2010 and 2013 Young Persons' Behaviour and Attitudes Survey of 10,790 young people provided information on PA, knowledge of guidelines and socio-demographic characteristics. Multinomial logistic regression was used to investigate the associations between knowledge and amount of daily PA.

RESULTS

Results from 2013 showed 67.0% of respondents were aware of PA guidelines with 15.4% reporting meeting them. Males were more likely to meet PA guidelines than females (OR 3.36, 95% CI 2.47, 4.59). Males who were active for 60 min or more, 7 days per week were less likely to be aware of guidelines (OR = 1.51, 95% CI 1.02, 2.24). For females, knowledge of PA guidelines had no significant association with amount of daily PA (OR = 1.74, 95% CI 0.99, 3.07). Those who did not enjoy being active were less likely to meet the guidelines (OR = 0.05, 95% CI 0.02, 0.12).

CONCLUSIONS

Knowledge did not appear to be an important predictor of PA in young people. Consequently, threshold based messaging containing recommended minimum PA guideline information may not be appropriate for this age group. Re-branding PA promotion to include the use of humour may offer a new direction for public health messaging based around fun and enjoyment.

Feasibility and acceptance of exercise recommendations (10,000 steps a day) within routine German health check (Check-Up 35/GOÄ29)-study protocol

BACKGROUND

Benefits of exercise to prevent non-communicable diseases are well-documented. Limited data exists to promote physical activity in healthy but sedentary and/or overweight people. Brief interventions within routine German health checks may be an effective way to reach these patients.

METHODS/DESIGN

The quasi-experimental, multi-center prospective feasibility study is designed for general practices in Cologne (intervention group) and Düsseldorf (control group), up to 20 per region. Eight to 10 inactive and/or overweight patients per practice will be recruited for a total of 300. General practitioners and at least one of their nurses for the intervention group will be trained in motivational interviewing and familiarized with low-threshold recommendations for exercise (activities of daily life (ADL), target of 10,000 steps/day) and additional tools (pedometers, activity diaries). Participants in the control group will only receive general advice (150 min of exercise/week). The primary aims are to evaluate the feasibility of this intervention and to determine whether it is possible to reach a mean increase of 1000 steps/day in the target group within 6 months. Secondary objectives focus on the number of patients who reach a target of 10,000 steps/day and their improvements in quality of life and decrease in body mass index, waist circumference, and blood pressure.

DISCUSSION

The study will assess whether it is feasible to run brief interventions within the GP setting can promote an active lifestyle in overweight and/or inactive patients.

Comparative Effectiveness of Two Walking Interventions on Participation, Step Counts, and Health

Purpose:

To (1) compare the effects of two worksite-based walking interventions on employee participation rates; (2) compare average daily step counts between conditions, and; (3) examine the effects of increases in average daily step counts on biometric and psychologic outcomes.

Design:

We conducted a cluster-randomized trial in which six employer groups were randomly selected and randomly assigned to condition.

Setting:

Four manufacturing worksites and two office-based worksite served as the setting.

Subjects:

A total of 474 employees from six employer groups were included.

Intervention:

A standard walking program was compared to an enhanced program that included incentives, feedback, competitive challenges, and monthly wellness workshops.

Measures:

Walking was measured by self-reported daily step counts. Survey measures and biometric screenings were administered at baseline and 3, 6, and 9 months after baseline.

Analysis:

Analysis used linear mixed models with repeated measures.

Results:

During 9 months, participants in the enhanced condition averaged 726 more steps per day compared with those in the standard condition (p < .001). A 1000-step increase in average daily steps was associated with significant weight loss for both men (−3.8 lbs.) and women (−2.1 lbs.), and reductions in body mass index (−0.41 men, −0.31 women). Higher step counts were also associated with improvements in mood, having more energy, and higher ratings of overall health.

Conclusions:

An enhanced walking program significantly increases participation rates and daily step counts, which were associated with weight loss and reductions in body mass index.

Reach and effectiveness of an integrated community-based intervention on physical activity and healthy eating of older adults in a socioeconomically disadvantaged community

The aim of this study is to assess the reach and effectiveness of an integrated community-based intervention designed to promote physical activity and healthy eating among older adults in a socioeconomically disadvantaged community in the Netherlands. The intervention was evaluated with a controlled pre-post quasi-experimental design, with 430 randomly selected older adults participating in the intervention group and 213 in a control group at baseline. The intervention included a local media campaign and environmental approaches (e.g., community involvement) and was implemented during a 3-month high-intensity period, followed by a 6-month low-intensity one. Levels of physical activity and fruit and vegetable consumption were assessed at baseline and at 3 and 9 months after baseline. At the follow-up measurements, the intervention had reached respectively 68 and 69% of the participants in the intervention group. No significant differences were found between the intervention group and the control group in changes to any outcome except for transport-related PA at 3 and 9 months follow-up. The systematically developed community-based intervention reached a relatively large proportion of the participants, but had only small effects on the levels of physical activity and healthy eating in older adults in the short and medium term.

Measuring the Effectiveness of Mass-Mediated Health Campaigns Through Meta-Analysis

A meta-analytic review was undertaken to examine the effects of mass communication campaigns on changes in behavior, knowledge, and self-efficacy in the general public. A review of the academic literature was undertaken and identified 1,638 articles from 1966 through 2012. Using strict inclusion criteria, we included 63 studies for coding and analyses. Results from these efforts indicated that campaigns produced positive effects in behavior change (r = .05, k = 61) and knowledge (r = .10, k = 26) but failed to produce significant increases in self-efficacy (r = .02, k = 14). Several moderators (e.g., health topic, the theory underlying the campaign) were examined in relation to campaign principles that are prescribed to increase campaign effects. The major findings are reviewed, and the implications for future campaign design are discussed.

Validity of the Stages of Change in Steps instrument (SoC-Step) for achieving the physical activity goal of 10,000 steps per day

BACKGROUND

Physical activity (PA) offers numerous benefits to health and well-being, but most adults are not sufficiently physically active to afford such benefits. The 10,000 steps campaign has been a popular and effective approach to promote PA. The Transtheoretical Model posits that individuals have varying levels of readiness for health behavior change, known as Stages of Change (Precontemplation, Contemplation, Preparation, Action, and Maintenance). Few validated assessment instruments are available for determining Stages of Change in relation to the PA goal of 10,000 steps per day. The purpose of this study was to assess the criterion-related validity of the SoC-Step, a brief 10,000 steps per day Stages of Change instrument.

METHODS

Participants were 504 Australian adults (176 males, 328 females, mean age = 50.8 ± 13.0 years) from the baseline sample of the Walk 2.0 randomized controlled trial. Measures included 7-day accelerometry (Actigraph GT3X), height, weight, and self-reported intention, self-efficacy, and SoC-Step: Stages of Change relative to achieving 10,000 steps per day. Kruskal-Wallis H tests with pairwise comparisons were used to determine whether participants differed by stage, according to steps per day, general health, body mass index, intention, and self-efficacy to achieve 10,000 steps per day. Binary logistic regression was used to test the hypothesis that participants in Maintenance or Action stages would have greater likelihood of meeting the 10,000 steps goal, in comparison to participants in the other three stages.

RESULTS

Consistent with study hypotheses, participants in Precontemplation had significantly lower intention scores than those in Contemplation (p = 0.003) or Preparation (p < 0.001). Participants in Action or Maintenance stages were more likely to achieve ≥10,000 steps per day (OR = 3.11; 95 % CI = 1.66,5.83) compared to those in Precontemplation, Contemplation, or Preparation. Intention (p < 0.001) and self-efficacy (p < 0.001) to achieve 10,000 steps daily differed by stage, and participants in the Maintenance stage had higher general health status and lower body mass index than those in Precontemplation, Contemplation and Preparation stages (p < 0.05).

CONCLUSIONS

This brief SoC-Step instrument appears to have good criterion-related validity for determining Stages of Change related to the public health goal of 10,000 steps per day.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry reference: ACTRN12611000157976 World Health Organization Universal Trial Number: U111-1119-1755.

Engagement and Nonusage Attrition With a Free Physical Activity Promotion Program: The Case of 10,000 Steps Australia

BACKGROUND

Data from controlled trials indicate that Web-based interventions generally suffer from low engagement and high attrition. This is important because the level of exposure to intervention content is linked to intervention effectiveness. However, data from real-life Web-based behavior change interventions are scarce, especially when looking at physical activity promotion.

OBJECTIVE

The aims of this study were to (1) examine the engagement with the freely available physical activity promotion program 10,000 Steps, (2) examine how the use of a smartphone app may be helpful in increasing engagement with the intervention and in decreasing nonusage attrition, and (3) identify sociodemographic- and engagement-related determinants of nonusage attrition.

METHODS

Users (N=16,948) were grouped based on which platform (website, app) they logged their physical activity: Web only, app only, or Web and app. Groups were compared on sociodemographics and engagement parameters (duration of usage, number of individual and workplace challenges started, and number of physical activity log days) using ANOVA and chi-square tests. For a subsample of users that had been members for at least 3 months (n=11,651), Kaplan-Meier survival curves were estimated to plot attrition over the first 3 months after registration. A Cox regression model was used to determine predictors of nonusage attrition.

RESULTS

In the overall sample, user groups differed significantly in all sociodemographics and engagement parameters. Engagement with the program was highest for Web-and-app users. In the subsample, 50.00% (5826/11,651) of users stopped logging physical activity through the program after 30 days. Cox regression showed that user group predicted nonusage attrition: Web-and-app users (hazard ratio=0.86, 95% CI 0.81-0.93, P<.001) and app-only users (hazard ratio=0.63, 95% CI 0.58-0.68, P<.001) showed a reduced attrition risk compared to Web-only users. Further, having a higher number of individual challenges (hazard ratio=0.62, 95% CI 0.59-0.66, P<.001), workplace challenges (hazard ratio=0.94, 95% CI 0.90-0.97, P<.001), physical activity logging days (hazard ratio=0.921, 95% CI 0.919-0.922, P<.001), and steps logged per day (hazard ratio=0.99999, 95% CI 0.99998-0.99999, P<.001) were associated with reduced nonusage attrition risk as well as older age (hazard ratio=0.992, 95% CI 0.991-0.994, P<.001), being male (hazard ratio=0.85, 95% CI 0.82-0.89, P<.001), and being non-Australian (hazard ratio=0.87, 95% CI 0.82-0.91, P<.001).

CONCLUSIONS

Compared to other freely accessible Web-based health behavior interventions, the 10,000 Steps program showed high engagement. The use of an app alone or in addition to the website can enhance program engagement and reduce risk of attrition. Better understanding of participant reasons for reducing engagement can assist in clarifying how to best address this issue to maximize behavior change.

Community-wide promotion of physical activity in middle-aged and older Japanese: a 3-year evaluation of a cluster randomized trial

Background

Promotion of physical activity (PA) is a key strategy to prevent non-communicable diseases. However, evidence on the effectiveness of community-wide interventions (CWIs) for promoting PA is limited.

Purpose

To evaluate the effectiveness of a 3-year CWI for promoting PA in middle-aged and older adults compared with usual public health services. This study is an extension to an original 1-year investigation study.

Design

Cluster randomized controlled trial with community as unit of randomization and individual as unit of analysis.

Setting/participants

12 communities in Unnan, Japan were randomly allocated to the intervention (9) or the control (3). Additionally intervention communities were randomly allocated to aerobic activity promotion (Group A), flexibility and muscle-strengthening activities promotion (Group FM), or aerobic, flexibility, and muscle-strengthening activities promotion (Group AFM), each consisting of three communities. Randomly-sampled 4414 residents aged 40 to 79 years responded to the baseline survey (74 %), and were analyzed in 2013–2014.

Intervention

A 3-year CWI based on social marketing, to promote PA from 2009 to 2012.

Main outcome measures

The primary outcome was a change in regular aerobic, flexibility, and/or muscle-strengthening activities, defined by (1) engaging in 150 mins/week or more of walking, (2) engaging in daily flexibility activity, or (3) engaging 2 or more days/week in muscle-strengthening activities, evaluated at the individual level. Secondary outcomes were changes in specific types of PA and musculoskeletal pain. Outcomes were measured at baseline and at 1 and 3 years (2009, 2010, and 2012).

Results

The CWI did not significantly increase the proportion of adults who reached recommended levels of aerobic, flexibility, and/or muscle-strengthening activities (adjusted change difference = 1.6 % [95 % CI: −3.5, 6.6]). In the subgroup analysis, compared to the controls, adults doing flexibility activity daily significantly increased in Group FM (6.3 % [95 % CI: 1.9, 10.7]). In Group A and AFM for PA outcomes and in all groups for pain outcomes, there was no significant change compared to controls.

Conclusions

The CWI did not achieve significant increase in the proportion of adults who reached recommended PA levels. However, it might be effective in promoting flexibility activity in middle-aged and older Japanese.

Trial registration

UMIN-CTR UMIN000002683.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-015-0242-0) contains supplementary material, which is available to authorized users.

A community-based intervention increases physical activity and reduces obesity in school-age children in North Carolina

BACKGROUND

Community-based interventions are promising approaches to obesity prevention, but few studies have prospectively evaluated them. The aim of this study was to evaluate a natural experiment—a community intervention designed to promote active living and decrease obesity within a small southern town.

METHODS

In 2011, community leaders implemented the Mebane on the Move intervention—a community-wide effort to promote physical activity (PA) and decrease obesity among residents of Mebane, North Carolina. We measured child PA and BMI before and after the intervention, using a nearby town not implementing an intervention as the comparison. In total, we assessed 64 children from Mebane and 40 from the comparison community 6 months before, as well as 34 and 18 children 6 months after the intervention. We assessed PA with accelerometers worn for 7 days and calculated BMI z-scores using children's height and weight. We conducted multivariable linear regressions examining pre- to postintervention change in minutes of PA and BMI z-score, adjusting for confounders.

RESULTS

At follow-up, children in Mebane modestly increased their moderate-to-vigorous PA (1.3 minutes per hour; 95% confidence interval (CI): 0.2, 2.3; p=0.03) and vigorous activity (0.8 minutes per hour; 95% CI: 0.1, 1.5; p=0.04) more than comparison children. In intervention children, BMI z-scores decreased 0.5 units (kg/m(2); 95% CI: -0.9, -0.02; p=0.045), compared to children in the comparison community.

CONCLUSIONS

We observed positive effects on PA level and weight status of children in Mebane, despite high rates of attrition, suggesting that the community-based intervention may have been successful.

Investigating the effect of a 3-month workplace-based pedometer-driven walking programme on health-related quality of life in meat processing workers: a feasibility study within a randomized controlled trial

BACKGROUND

In New Zealand, meat processing populations face many health problems as a result of the nature of work in meat processing industries. The primary aim of this study was to examine the feasibility of using a pedometer-based intervention to increase physical activity and improve health-related outcomes in a population of meat processing workers.

METHODS

A single-blinded randomized controlled trial (RCT) was conducted. A convenience sample of meat workers (n = 58; mean age 41.0 years; range: 18-65) participated in the trial. Participants were randomly allocated into two groups. Intervention participants (n = 29) utilized a pedometer to self monitor their activity, whilst undertaking a brief intervention, and educational material. Control participants (n = 29) received educational material only. The primary outcomes of ambulatory activity, and health-related quality of life, were evaluated at baseline, immediately following the 12-week intervention and three months post-intervention.

RESULTS

Fifty three participants completed the program (91.3% adherence). Adherence with the intervention group was high, 93% (n = 27/29), and this group increased their mean daily step count from 5993 to 9792 steps per day, while the control group steps changed from 5788 to 6551 steps per day from baseline. This increase in step counts remained significant within the intervention group p < 0.005; at three months post-intervention representing a 59% increase over baseline scores. There were significant group changes with large effect sizes for step count change (d = 1.94) and self-reported physical activity (p < 0.005; d = 2.59) at 12 weeks intervention. Further, results showed non-significant between-group differences in physical component (PCS) and mental component (MCS) scores (PCS: p = 0.44; MGD = 0.99, 95% CI, -1.6 to 3.6; ES = 0.14, and

MCS

p = 0.90, MGD = 0.15; 95% CI, -2.3 to 2.6, ES = 0.022) at 12 weeks intervention.

CONCLUSIONS

This research provides important information for a larger (RCT) in the future: results demonstrated that a pedometer-driven walking intervention in combination with goal setting, and self-monitoring supported by weekly e-mails are feasible and potentially effective in increasing step count within the workplace setting over the short term.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12613000087752.

Mismatch between perceived and objectively measured land use mix and street connectivity: associations with neighborhood walking

Studies on the mismatch between objective and perceived measures of walkability and walking provide insights into targeting interventions. These studies focused on those living in more walkable environments, but perceiving them as less walkable. However, it is equally important to understand how the other mismatch (living in less walkable areas, but perceiving them as walkable) is related to walking. This study examined how the mismatch between perceived and objective walkability measures (i.e., living in less walkable areas, but perceiving them as walkable, and living in more walkable areas, but perceiving them as less walkable) was associated with walking. Baseline data from adult participants (n = 1466) of the RESIDential Environment Project (Perth, Australia in 2004-06) collected self-report neighborhood walking for recreation and transport in a usual week and participants' perceptions of street connectivity and land use mix in their neighborhood. The exposure was the mismatch between objective and perceived measures of these. Multilevel logistic regression examined associations of walking with the mismatch between perceived and objective walkability measures. Perceiving high walkable attributes as low walkable was associated with lower levels of walking, while perceiving a low walkable attribute as walkable was associated with higher levels of walking. Walking interventions must create more pedestrian-friendly environments as well as target residents' perceptions.

Early Success Is Vital in Minimal Worksite Wellness Interventions at Small Worksites

INTERVENTION

In an effort to increase physical activity, 15 workplaces participated in a minimal-contact 10,000-steps-a-day program sponsored by the Sedgwick County Health Department in 2007 and 2008. Pedometers were provided to measure participants' weekly steps for the 10-week intervention.

METHOD

Participants were defined as those who completed the preregistration survey and logged at least 1 week of results. Registrants were defined as those who completed a registration survey but did not log any weekly results. The primary dependent variable was whether or not participants achieved weekly success, as measured by achieving at least 70,000 steps in a week. A secondary dependent variable was participants' number of steps each week during the weeks they logged results. Repeated measures logistic regression analysis was conducted to identify factors associated with weekly success.

RESULTS

Of the 2,515 registrants, 1,292 (51%) were participants. The average number of weeks of participation for this 10-week intervention was 5.6 weeks (SD = 3.4). Those from small employers (n < 750) were more likely (OR = 2.0) than those from large organizations (n > 750) to become participants. Participants who achieved at least 70,000 steps in the first week of the intervention were 7.3 times more likely than participants who walked less than 70,000 steps in the first week to achieve 70,000 steps each week for all 10 weeks.

CONCLUSIONS

Results from implementing a minimal-contact 10,000-step intervention can be maximized by targeting small worksites and supporting employees to achieve 70,000 steps in their first week.

Community wide interventions for increasing physical activity

BACKGROUND

Multi-strategic community wide interventions for physical activity are increasingly popular but their ability to achieve population level improvements is unknown.

OBJECTIVES

To evaluate the effects of community wide, multi-strategic interventions upon population levels of physical activity.

SEARCH METHODS

We searched the Cochrane Public Health Group Segment of the Cochrane Register of Studies,The Cochrane Library, MEDLINE, MEDLINE in Process, EMBASE, CINAHL, LILACS, PsycINFO, ASSIA, the British Nursing Index, Chinese CNKI databases, EPPI Centre (DoPHER, TRoPHI), ERIC, HMIC, Sociological Abstracts, SPORT Discus, Transport Database and Web of Science (Science Citation Index, Social Sciences Citation Index, Conference Proceedings Citation Index). We also scanned websites of the EU Platform on Diet, Physical Activity and Health; Health-Evidence.org; the International Union for Health Promotion and Education; the NIHR Coordinating Centre for Health Technology (NCCHTA); the US Centre for Disease Control and Prevention (CDC) and NICE and SIGN guidelines. Reference lists of all relevant systematic reviews, guidelines and primary studies were searched and we contacted experts in the field. The searches were updated to 16 January 2014, unrestricted by language or publication status.

SELECTION CRITERIA

Cluster randomised controlled trials, randomised controlled trials, quasi-experimental designs which used a control population for comparison, interrupted time-series studies, and prospective controlled cohort studies were included. Only studies with a minimum six-month follow up from the start of the intervention to measurement of outcomes were included. Community wide interventions had to comprise at least two broad strategies aimed at physical activity for the whole population. Studies which randomised individuals from the same community were excluded.

DATA COLLECTION AND ANALYSIS

At least two review authors independently extracted the data and assessed the risk of bias. Each study was assessed for the setting, the number of included components and their intensity. The primary outcome measures were grouped according to whether they were dichotomous (per cent physically active, per cent physically active during leisure time, and per cent physically inactive) or continuous (leisure time physical activity time (time spent)), walking (time spent), energy expenditure (as metabolic equivalents or METS)). For dichotomous measures we calculated the unadjusted and adjusted risk difference, and the unadjusted and adjusted relative risk. For continuous measures we calculated percentage change from baseline, unadjusted and adjusted.

MAIN RESULTS

After the selection process had been completed, 33 studies were included. A total of 267 communities were included in the review (populations between 500 and 1.9 million). Of the included studies, 25 were set in high income countries and eight were in low income countries. The interventions varied by the number of strategies included and their intensity. Almost all of the interventions included a component of building partnerships with local governments or non-governmental organisations (NGOs) (29 studies). None of the studies provided results by socio-economic disadvantage or other markers of equity. However, of those included studies undertaken in high income countries, 14 studies were described as being provided to deprived, disadvantaged or low socio-economic communities. Nineteen studies were identified as having a high risk of bias, 10 studies were unclear, and four studies had a low risk of bias. Selection bias was a major concern with these studies, with only five studies using randomisation to allocate communities. Four studies were judged as being at low risk of selection bias although 19 studies were considered to have an unclear risk of bias. Twelve studies had a high risk of detection bias, 13 an unclear risk and four a low risk of bias. Generally, the better designed studies showed no improvement in the primary outcome measure of physical activity at a population level.All four of the newly included, and judged to be at low risk of bias, studies (conducted in Japan, United Kingdom and USA) used randomisation to allocate the intervention to the communities. Three studies used a cluster randomised design and one study used a stepped wedge design. The approach to measuring the primary outcome of physical activity was better in these four studies than in many of the earlier studies. One study obtained objective population representative measurements of physical activity by accelerometers, while the remaining three low-risk studies used validated self-reported measures. The study using accelerometry, conducted in low income, high crime communities of USA, emphasised social marketing, partnership with police and environmental improvements. No change in the seven-day average daily minutes of moderate to vigorous physical activity was observed during the two years of operation. Some program level effect was observed with more people walking in the intervention community, however this result was not evident in the whole community. Similarly, the two studies conducted in the United Kingdom (one in rural villages and the other in urban London; both using communication, partnership and environmental strategies) found no improvement in the mean levels of energy expenditure per person per week, measured from one to four years from baseline. None of the three low risk studies reporting a dichotomous outcome of physical activity found improvements associated with the intervention.Overall, there was a noticeable absence of reporting of benefit in physical activity for community wide interventions in the included studies. However, as a group, the interventions undertaken in China appeared to have the greatest possibility of success with high participation rates reported. Reporting bias was evident with two studies failing to report physical activity measured at follow up. No adverse events were reported.The data pertaining to cost and sustainability of the interventions were limited and varied.

AUTHORS' CONCLUSIONS

Although numerous studies have been undertaken, there is a noticeable inconsistency of the findings in the available studies and this is confounded by serious methodological issues within the included studies. The body of evidence in this review does not support the hypothesis that the multi-component community wide interventions studied effectively increased physical activity for the population, although some studies with environmental components observed more people walking.

A RE-AIM evaluation of evidence-based multi-level interventions to improve obesity-related behaviours in adults: a systematic review (the SPOTLIGHT project)

BACKGROUND

This systematic literature review describes the potential public health impact of evidence-based multi-level interventions to improve obesity-related behaviours in adults, using the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework.

METHODS

Electronic databases (PubMed, Embase, and The Cochrane Library) were searched to identify intervention studies published between January 2000 and October 2013. The following inclusion criteria were used: (1) the study included at least one outcome measure assessing obesity-related behaviours (i.e. diet, physical activity or sedentary behaviour), (2) the study collected data over at least one year and (3) the study's intervention targeted adults, was conducted in a specified geographical area or worksite, and was multi-level (i.e. targeting both individual and environmental level). Evidence of RE-AIM of the selected interventions was assessed. Potential public health impact of an intervention was evaluated if information was provided on at least four of the five RE-AIM dimensions.

RESULTS

Thirty-five multi-level interventions met the inclusion criteria. RE-AIM evaluation revealed that the included interventions generally had the potential to: reach a large number of people (on average 58% of the target population was aware of the intervention); achieve the assumed goals (89% found positive outcomes); be broadly adopted (the proportion of intervention deliverers varied from 9% to 92%) and be sustained (sixteen interventions were maintained). The highest potential public health impact was found in multi-level interventions that: 1) focused on all levels at the beginning of the planning process, 2) guided the implementation process using diffusion theory, and 3) used a website to disseminate the intervention.

CONCLUSIONS

Although most studies underreported results within the RE-AIM dimensions, the reported Reach, Effectiveness, Adoption, Implementation and Maintenance were positively evaluated. However, more information on external validity and sustainability is needed in order to take informed decisions on the choice of interventions that should be implemented in real-world settings to accomplish long-term changes in obesity-related behaviours.

Cost-Effectiveness of Population-Level Physical Activity Interventions: A Systematic Review

Objective.

This systematic review synthesizes the evidence on the cost-effectiveness of population-level interventions to promote physical activity.

Data Source.

A systematic literature search was conducted between May and August 2013 in four databases: PubMed, Scopus, Web of Science, and SPORTDiscus.

Study Inclusion and Exclusion Criteria.

Only primary and preventive interventions aimed at promoting and maintaining physical activity in wide population groups were included. An economic evaluation of both effectiveness and cost was required. Secondary interventions and interventions targeting selected population groups or focusing on single individuals were excluded.

Data Extraction.

Interventions were searched for in six different categories: (1) environment, (2) built environment, (3) sports clubs and enhanced access, (4) schools, (5) mass media and community-based, and (6) workplace.

Data Synthesis.

The systematic search yielded 2058 articles, of which 10 articles met the selection criteria. The costs of interventions were converted to costs per person per day in 2012 U.S. dollars. The physical activity results were calculated as metabolic equivalent of task hours (MET-hours, or MET-h) gained per person per day. Cost-effectiveness ratios were presented as dollars per MET-hours gained. The intervention scale and the budget impact of interventions were taken into account.

Results.

The most efficient interventions to increase physical activity were community rail-trails ($.006/MET-h), pedometers ($.014/MET-h), and school health education programs ($.056/MET-h).

Conclusion.

Improving opportunities for walking and biking seems to increase physical activity cost-effectively. However, it is necessary to be careful in generalizing the results because of the small number of studies. This review provides important information for decision makers.

Mass media health communication campaigns combined with health-related product distribution: a community guide systematic review

CONTEXT

Health communication campaigns including mass media and health-related product distribution have been used to reduce mortality and morbidity through behavior change. The intervention is defined as having two core components reflecting two social marketing principles: (1) promoting behavior change through multiple communication channels, one being mass media, and (2) distributing a free or reduced-price product that facilitates adoption and maintenance of healthy behavior change, sustains cessation of harmful behaviors, or protects against behavior-related disease or injury.

EVIDENCE ACQUISITION

Using methods previously developed for the Community Guide, a systematic review (search period, January 1980-December 2009) was conducted to evaluate the effectiveness of health communication campaigns that use multiple channels, including mass media, and distribute health-related products. The primary outcome of interest was use of distributed health-related products.

EVIDENCE SYNTHESIS

Twenty-two studies that met Community Guide quality criteria were analyzed in 2010. Most studies showed favorable behavior change effects on health-related product use (a median increase of 8.4 percentage points). By product category, median increases in desired behaviors ranged from 4.0 percentage points for condom promotion and distribution campaigns to 10.0 percentage points for smoking-cessation campaigns.

CONCLUSIONS

Health communication campaigns that combine mass media and other communication channels with distribution of free or reduced-price health-related products are effective in improving healthy behaviors. This intervention is expected to be applicable across U.S. demographic groups, with appropriate population targeting. The ability to draw more specific conclusions about other important social marketing practices is constrained by limited reporting of intervention components and characteristics.

New walking and cycling routes and increased physical activity: one- and 2-year findings from the UK iConnect Study

OBJECTIVES

We evaluated the effects of providing new high-quality, traffic-free routes for walking and cycling on overall levels of walking, cycling, and physical activity.

METHODS

1796 adult residents in 3 UK municipalities completed postal questionnaires at baseline (2010) and 1-year follow-up (2011), after the construction of the new infrastructure. 1465 adults completed questionnaires at baseline and 2-year follow-up (2012). Transport network distance from home to infrastructure defined intervention exposure and provided a basis for controlled comparisons.

RESULTS

Living nearer the infrastructure did not predict changes in activity levels at 1-year follow-up but did predict increases in activity at 2 years relative to those living farther away (15.3 additional minutes/week walking and cycling per km nearer; 12.5 additional minutes/week of total physical activity). The effects were larger among participants with no car.

CONCLUSIONS

These new local routes may mainly have displaced walking or cycling trips in the short term but generated new trips in the longer term, particularly among those unable to access more distant destinations by car. These findings support the potential for walking and cycling infrastructure to promote physical activity.

Key enablers to facilitate healthy behavior change: workshop summary

The increases in preventable chronic diseases and the rising costs of health care are unsustainable. The US Army Surgeon General's vision to transition from a health care system to a system of health requires the identification of key health enablers to facilitate the adoption of healthy behaviors. In support of this vision, the US Army Telemedicine and Advanced Technology Research Center hosted a workshop in April 2013 titled "Incentives to Create and Sustain Change for Health." Members of government and academia participated to identify key health enablers that could ultimately be leveraged by technology. The key health enablers discussed included (1) public health messaging, (2) changing health habits and the environmental influence on health, (3) goal setting and tracking, (4) the role of incentives in behavior-change intervention, and (5) the role of peer and social networks on change. This report summarizes leading evidence and the group consensus on evidence-based practices with respect to the key enablers in creating healthy behavior change.

Who do we reach? Campaign evaluation of Find Thirty every day® using awareness profiles in a Western Australian cohort

Mass media campaigns are part of a comprehensive, population-based approach to communicate physical activity behavior change. Campaign awareness is the most frequently reported, short-term comparable measure of campaign effectiveness. Most mass media campaigns report those who were aware with those who are unaware of campaigns. Few campaigns follow awareness in the same respondent, over time, during a mass media campaign to track different patterns of awareness or awareness profiles--"never," "early," "late," or "always"--that may emerge. Using awareness profiles, the authors (a) address any demographic differences between groups and (b) assess changes in physical activity. Find Thirty every day® was a populationwide mass media campaign delivered in Western Australia. The cohort comprised 405 participants, who completed periodic telephone interviews over 2 years. Almost one third (30.4%) were "never aware" of the campaign. More than one third recalled the campaign at one or more time points--"early aware." Ten percent became aware at Time 2 and stayed aware of the campaign across the remaining time. Examining within and across the awareness profiles, only gender was significant. This article provides an approach to profiling awareness, whereby people cycle in and out and few people are "always aware" over a 2-year period. It presents possible implications and considerations for future campaign planners interested in establishing and maintaining campaign awareness with adult populations.

24-weeks Pilates-aerobic and educative training to improve body fat mass in elderly Serbian women

Background

The purpose of this study was to examine the differences in anthropometric measurements using an aerobic and Pilates exercise program which lasted 24 weeks.

Method

This was a clinical intervention study of 303 women over the age of 60 living in Novi Sad, Serbia. Changes in body mass index and skinfold thickness were estimated through height, weight, and anthropometric measurements. The program comprised Pilates exercises for upper- and lower-body strength, agility, and aerobic capacity.

Results

Fat mass (FM) improved significantly (pre-test, 32.89%, 8.65; post-test, 28.25%, 6.58; P<0.01). Bone diameters and muscle perimeters showed no significant changes pre- and post-test (P>0.05), but there was a higher correlation between FM (%) and waist–hip ratio (rho, 0.80; P<0.01).

Conclusion

A mixed program of aerobics and Pilates, controls and improves baseline muscle mass and decreases FM values, without causing deterioration during practice and follow-up exercises.

Critical success factors for physical activity promotion through community partnerships

OBJECTIVES

To define key factors of effective evidence-based policy implementation for physical activity promotion by use of a partnership approach.

METHODS

Using Parent and Harvey's model for sport and physical activity community-based partnerships, we defined determinants of implementation based on 13 face-to-face interviews with network organisations and 39 telephone interviews with partner organisations. Furthermore, two quantitative data-sets (n = 991 and n = 965) were used to measure implementation.

RESULTS

In total, nine variables were found to influence implementation. Personal contact was the most powerful variable since its presence contributed to success while its absence led to a negative outcome. Four contributed directly to success: political motive, absence of a metropolis, high commitment and more qualified staff. Four others resulted in a less successful implementation: absence of positive merger effects, exposure motive and governance, and dispersed leadership.

CONCLUSIONS

Community networks are a promising instrument for the implementation of evidence-based policies. However, determinants of both formation and management of partnerships influence the implementation success. During partnership formation, special attention should be given to partnership motives while social skills are of utmost importance for the management.

A systematic review of the clinimetric properties of measures of habitual physical activity in primary school aged children with cerebral palsy

Regular participation in physical activity is an important determinant of health for children and adolescents with cerebral palsy (CP). However, there is little consensus on the most valid or reliable method to measure physical activity in this population. This study aimed to systematically review the psychometric properties of habitual physical activity (HPA) measures in primary school-aged children with CP. Databases were systematically searched for measures assessing physical activity over more than one day and had evidence of validity, reliability and/or clinical utility in children aged 6-12 years with CP. Ten measures met inclusion criteria and their quality was assessed in twelve studies. Quality of the included studies was appraised using the consensus-based standards for the selection of health measurement instruments (COSMIN) checklist. Measures were moderately to strongly correlated to criterion measures, with study quality rated as Fair (+) to Poor (0). Only four measures had evidence of reliability. Accelerometers provide a valid measure of HPA with good clinical utility; however they do not have documented reliability in this population. No one measure appears ideal to record HPA in primary school-age children with CP and further research is necessary to determine the psychometric properties of HPA measurement instruments in this population.

'10 000 Steps Flanders': evaluation of the state-wide dissemination of a physical activity intervention in Flanders

The aim of the study was to evaluate the impact of the state-wide dissemination of a physical activity (PA) intervention in Flanders. In 2011, a random sample was taken of the entire adult (25-75 years) population of Flanders. Data of the Flemish sample were compared with baseline data of the intervention and control group of '10 000 Steps Ghent' (2005). In total, data of the International Physical Activity Questionnaire were available of 2556 respondents (1675 of the comparison sample and 881 of the Flemish sample). Pedometer data were obtained by 269 respondents of the Flemish sample and by 1236 respondents of the comparison sample. Compared with the comparison sample of 2005, the Flemish sample reported more walking (P < 0.001), moderate (P < 0.001), vigorous (P < 0.001), work-related (P < 0.001), leisure time (P = 0.01) and household PA (P = 0.03). Step count analyses revealed that the Flemish sample took more pedometer-based daily step counts (P < 0.001) than the comparison sample. Furthermore, a higher proportion of respondents reaching the 10 000 steps/day goal (P = 0.005) was found in the Flemish sample. A positive effect of '10 000 Steps Flanders' was found. Results indicate that a state-wide approach based on socio-ecological models is an effective strategy to promote PA in a large population.

Community-based efforts to promote physical activity: a systematic review of interventions considering mode of delivery, study quality and population subgroups

OBJECTIVES

Despite the known benefits of physical activity, the majority of adults in developed countries lead sedentary lifestyles. The community setting is a promising venue for physical activity-promoting interventions. Our objectives were to investigate the effectiveness of community-based physical activity interventions by mode of delivery, study quality and to analyse intervention effectiveness in different subgroups in the population.

DESIGN

We conducted a systematic literature review in Medline and other databases to identify controlled, community-based physical activity interventions published between 2001 and 2012.

METHODS

We performed several post hoc subgroup comparisons for mode of delivery, study quality and selected population characteristics, using net per cent change in physical activity outcomes between baseline and follow-up as an effect measure.

RESULTS

We identified 55 studies on exercise/walking sessions, face-to-face counselling, public campaigns and interventions by mail, the Internet and telephone presenting data on 20,532 participants. Overall, half of the studies reported positive physical activity outcomes (total net per cent change: 16.4%; p=0.159; net per cent change for high-quality studies, i.e. studies meeting more than 5 out of 7 quality criteria: 16.2%; p=0.010). Interventions using face-to-face counselling or group sessions were most effective (net per cent change: 35.0%; p=0.014). Net per cent change was also higher in studies exclusively tailored to women (27.7%; p=0.005) or specific ethnic groups (38.9%; p=0.034).

CONCLUSIONS

This systematic review supports the effectiveness of community-based physical activity interventions in high-quality studies. Our results suggest that interventions using personal contact as well as tailored interventions are most promising.

A community-wide campaign to promote physical activity in middle-aged and elderly people: a cluster randomized controlled trial

BACKGROUND

We aimed to evaluate the effectiveness of a community-wide campaign (CWC) for promoting physical activity in middle-aged and elderly people.

METHODS

A cluster randomized controlled trial (RCT) with a community as the unit of randomization was performed using a population-based random-sampled evaluation by self-administered questionnaires in the city of Unnan, Shimane Prefecture, Japan. The evaluation sample included 6000 residents aged 40 to 79 years. We randomly allocated nine communities to the intervention group and three to the control group. The intervention was a CWC from 2009 to 2010 to promote physical activity, and it comprised information, education, and support delivery. The primary outcome was a change in engaging in regular aerobic, flexibility, and/or muscle-strengthening activities evaluated at the individual level.

RESULTS

In total, 4414 residents aged 40-79 years responded to a self-administered questionnaire (73.6% response rate). Awareness of the CWC was 79% in the intervention group. Awareness and knowledge were significantly different between the intervention and control groups, although there were no significant differences in belief and intention. The 1-year CWC did not significantly promote the recommended level of physical activity (adjusted odds ratio: 0.97; 95% confidence interval: 0.84-1.14).

CONCLUSIONS

This cluster RCT showed that the CWC did not promote physical activity in 1 year. Significant differences were observed in awareness and knowledge between intervention and control groups as short-term impacts of the campaign.

TRIAL REGISTRATION

UMIN-CTR UMIN000002683.

Exercise: Why It is a Challenge for Both the Nonconscious and Conscious Mind

The epidemic of physical inactivity is an important societal and individual problem. Despite the well-documented health effects of physical activity, only 22% of the population exercises regularly enough to get the physiological and psychological benefits ( S. N. Blair, 1993 , Physical activity, physical fitness, and health. Research Quarterly for Exercise and Sport, Vol. 64, pp. 365–376.) Why does 78% fail to do so? The problem is largely psychological and attributable to the processes of nonconscious and conscious mind. This paper reviews research on how nonconscious and conscious processing affects human behavior in general and exercise behavior in particular. Although there generally is no question about the effect of the nonconscious mind on human behavior, “unconsciously operating motives” in and of themselves are incapable of igniting and sustaining this complex behavior—at least until the behavior has been repeated with regularity and long enough to become consistently prompted by situational cues (as is the case for 22% of the population). There is even some evidence to suggest that the nonconscious mind actually works against exercise by embracing cues and excuses for not exercising. A related problem for both the nonconscious and conscious mind, especially that of the occasional exerciser (54% of the population), is that exercise poses a threat to one's sense of freedom and choice (i.e., “you must do it or else”). The resultant psychological reactance leads to attempts to restore this freedom, but it is often accomplished by giving in to temptations (e.g., TV watching). Although people recognize fitness and health as important human conditions, they often pursue these goals by using exercise as a means toward another end (e.g., to lose weight). In doing so, they struggle cognitively with their need for autonomy while trying to balance it in interpersonal and leisure contexts. Such struggle depletes finite self-control resources and makes people more vulnerable to temptations. The net result is that both the nonconscious mind and the conscious mind fail to turn most people into rational thinkers and “self as doers,” who would do what is best for their health.

Relationship between parent and child pedometer-determined physical activity: a sub-study of the CANPLAY surveillance study

Background

Understanding parental influences on their children’s physical activity (PA) provides insight into developing effective family-based interventions. This study examines whether children’s objectively monitored PA is associated with that of their parents.

Methods

Participants (children and parents) were recruited to a sub-study of the Canadian Fitness and Lifestyle Research Institute’s annual Canadian Physical Activity Levels among Youth (CANPLAY) surveillance study. In total, 539 of 1,187 eligible children (age range 5–19 years) and at least one of their parents participated. Participants logged pedometer steps for 7 days. Descriptive statistics were used to examine parental mean daily steps by their children’s age, sex and steps/day. Associations between steps/day for parents and children (controlling for their age and sex) were estimated using general linear and logistic regression.

Results

Children’s mean steps/day did not differ by parents’ age or sex, nor by whether one or both parents participated in the study. There were quantifiable relationships between parents’ and children’s steps/day. For every 1,000 step increase in a father’s steps/day, his son’s increased by 329–407 steps/day and his daughter’s increased by 273 steps/day (adjusted model only). Every 1,000 step increase in a mother’s steps/day was associated with 263–439 extra steps/day for her son’s steps/day and 195–219 steps/day for her daughter. A 3,000 step increment in a father’s or mother’s steps/day was associated with 1.9-2.5 fold increase in the odds that their child’s activity level would be in the upper two tertiles of steps/day.

Conclusions

These cross-sectional data indicate that children’s PA is related to that of their parents in distinct and quantifiable ways. Interventions are warranted to evaluate the direction of this relationship, confirm the magnitude of influence, and illuminate mediating and moderating mechanisms by which both parents may have influence over their own children’s PA.

Sedentary behavior, physical activity, and psychological health of Korean older adults with hypertension: effect of an empowerment intervention

The aim of this study was to determine the effect of an 8-week empowerment intervention on sedentary behavior, physical activity, and psychological health in Korean older adults with hypertension. Using a quasi-experimental design, older adults participated in either an experimental group (n = 27) or control group (n = 21). The experimental group received an empowerment intervention including lifestyle modification education, group discussion, and exercise training for 8 weeks, and the control group received standard hypertension education. After 8 weeks, participants in the experimental group had significantly decreased sedentary behavior, increased physical activity, increased self-efficacy for physical activity, and increased perceived health (p < 0.05). However, no significant group difference was found for depression. Findings from this study suggest that empowerment interventions may be more effective than standard education in decreasing sedentary behavior and increasing physical activity, self-efficacy for physical activity, and perceived health in Korean older adults with hypertension.

Fostering change in back pain beliefs and behaviors: when public education is not enough

Mass media campaigns designed to alter societal views and individual behaviors about back pain have been undertaken and evaluated in multiple countries. In contrast to the original Australian campaign, subsequent campaigns have been less successful, with improvements observed in beliefs without the corresponding changes in related behaviors. This article summarizes the results of a literature review, expert panel, and workshop held at the Melbourne International Forum XI: Primary Care Research on Low Back Pain in March 2011 on the role and interplay of various social behavior change strategies, including public education, law and legislation, healthy public policy, and social marketing in achieving a sustained reduction in the societal burden of back pain. Given the complexities inherent to health-related behaviors change, the Rothschild framework is applied in which behavior change strategies are viewed on a continuum from public education at one end through law and health policy at the other. Educational endeavors should likely be augmented with social marketing endeavors and supportive laws and health policy to foster sustained change in outcomes such as work disability and health utilization. Practical suggestions are provided for future interventions aimed at changing back pain-related behaviors. Evaluation of previous back pain mass media campaigns reveals that education alone is unlikely to foster positive and persisting behavioral change without concomitant strategies.

Effects of Find Thirty every day®

Background. Internationally, over the last four decades large-scale mass media campaigns have been delivered to promote physical activity and its associated health benefits. In 2002-2005, the first Western Australian statewide adult physical activity campaign Find Thirty. It’s Not a Big Exercise was launched. In 2007, a new iteration of the campaign was proposed with new objectives, executions, and tag line Find Thirty every day®. Purpose. This article reports on the population-level effects of the Find Thirty every day® campaign from 2008 to 2010, with a focus on changes in awareness, intention, and physical activity. Methods. Evaluation of the campaign involved pre- and posttest serial cross-sectional surveys. Baseline data were collected in May 2008, and subsequent surveys in 2009 and 2010. Samples sizes were as follows: baseline ( n = 972), first follow-up ( n = 938), and second follow-up ( n = 937). Data were derived from self-reported responses to a random-sample computer-assisted telephone interview. Results. Total awareness increased from 30.4% at baseline to 48.5% at second follow-up. Total awareness was higher in women and low socioeconomic status adults. Intention was 21.0%, double that reported at baseline. There were positive significant changes from baseline to first follow-up across all four categories: walking, moderate, vigorous, and total physical activity. There also were positive significant changes for self-reported walking from baseline to second follow-up. Conclusion. Find Thirty every day® resulted in an increase in awareness, intention, walking, vigorous intensity, and total level of physical activity in priority target groups. Campaign effects should be further examined by subgroups to identify the most receptive population segments.

Web-based, computer-tailored, pedometer-based physical activity advice: development, dissemination through general practice, acceptability, and preliminary efficacy in a randomized controlled trial

BACKGROUND

Computer tailoring is a relatively innovative and promising physical activity intervention approach. However, few computer-tailored physical activity interventions in adults have provided feedback based on pedometer use.

OBJECTIVES

To (1) describe the development of a Web-based, pedometer-based, computer-tailored step advice intervention, (2) report on the dissemination of this tool through general practice, (3) report on its perceived acceptability, and (4) evaluate the preliminary efficacy of this tool in comparison with a standard intervention.

METHODS

We recruited 92 participants through general practitioners and randomly assigned them to a standard condition (receiving a pedometer-only intervention, n = 47) and a tailored condition (receiving a pedometer plus newly developed, automated, computer-tailored step advice intervention, n = 45). Step counts, self-reported data obtained via telephone interview on physical activity, time spent sitting, and body mass index were assessed at baseline and postintervention. The present sample was mostly female (54/92, 59%), highly educated (59/92, 64%), employed (65/92, 71%), and in good health (62/92, 67%).

RESULTS

Recruitment through general practitioners was poor (n = 107, initial response rate 107/1737, 6.2%); however, the majority of participants (50/69, 73%) believed it is useful that general practitioners help patients find ways to increase physical activity. In the tailored condition, 30/43 (70%) participants requested the computer-tailored step advice and the majority found it understandable (21/21, 100%), credible (17/18, 94%), relevant (15/18, 83%), not too long (13/18, 72%), instructive (13/18, 72%), and encouraging to increase steps (16/24, 67%). Daily step counts increased from baseline (mean 9237, SD 3749 steps/day) to postintervention (mean 11,876, SD 4574 steps/day) in the total sample (change of 2639, 95% confidence interval 105-5172; F(1 )= 5.0, P = .04). No interaction or other time effects were found.

CONCLUSIONS

The majority of participants in the tailored condition accepted the step advice and indicated it was useful. However, in this selected sample of adults, the tailored condition did not show superior effects compared with the standard condition.

The perception of the neighborhood environment changes after participation in a pedometer based community intervention

Background

The aim of this study was to investigate whether the perception of the neighbourhood environment alters when changing the physical activity behaviour through a pedometer intervention.

Findings

The intervention was implemented for 15 weeks in a small village in Germany, and was based on the individual baseline activity level. Eighty-two inhabitants participated in the study and completed an environmental questionnaire before and after the intervention. Results showed that after the intervention the participants perceived a lower distance to local facilities, a higher availability of bike lanes and infrastructures, a better maintenance of infrastructure, a better network and a safer traffic situation.

Conclusion

This suggests that a change in the levels of physical activity merges the levels of exposure to the environment which results in different environmental perceptions.

Recruiting participants to walking intervention studies: a systematic review

PURPOSE

Most researchers who are conducting physical activity trials face difficulties in recruiting participants who are representative of the population or from specific population groups. Participants who are often the hardest to recruit are often those who stand to benefit most (the least active, from ethnic and other minority groups, from neighbourhoods with high levels of deprivation, or have poor health). The aim of our study was to conduct a systematic review of published literature of walking interventions, in order to identify the impact, characteristics, and differential effects of recruitment strategies among particular population groups.

METHODS

We conducted standard searches for studies from four sources, (i) electronic literature databases and websites, (ii) grey literature from internet sources, (iii) contact with experts to identify additional "grey" and other literature, and (iv) snowballing from reference lists of retrieved articles. Included studies were randomised controlled trials, controlled before-and-after experimental or observational qualitative studies, examining the effects of an intervention to encourage people to walk independently or in a group setting, and detailing methods of recruitment.

RESULTS

Forty seven studies met the inclusion criteria. The overall quality of the descriptions of recruitment in the studies was poor with little detail reported on who undertook recruitment, or how long was spent planning/preparing and implementing the recruitment phase. Recruitment was conducted at locations that either matched where the intervention was delivered, or where the potential participants were asked to attend for the screening and signing up process. We identified a lack of conceptual clarity about the recruitment process and no standard metric to evaluate the effectiveness of recruitment.

CONCLUSION

Recruitment concepts, methods, and reporting in walking intervention trials are poorly developed, adding to other limitations in the literature, such as limited generalisability. The lack of understanding of optimal and equitable recruitment strategies evident from this review limits the impact of interventions to promote walking to particular social groups. To improve the delivery of walking interventions to groups which can benefit most, specific attention to developing and evaluating targeted recruitment approaches is recommended.

Physical activity mass media campaigns and their evaluation: a systematic review of the literature 2003-2010

Internationally, mass media campaigns to promote regular moderate-intensity physical activity have increased recently. Evidence of mass media campaign effectiveness exists in other health areas, however the evidence for physical activity is limited. The purpose was to systematically review the literature on physical activity mass media campaigns, 2003-2010. A focus was on reviewing evaluation designs, theory used, formative evaluation, campaign effects and outcomes. Literature was searched resulting in 18 individual adult mass media campaigns, mostly in high-income regions and two in middle-income regions. Designs included: quasi experimental (n = 5); non experimental (n = 12); a mixed methods design (n = 1). One half used formative research. Awareness levels ranged from 17 to 95%. Seven campaigns reported significant increases in physical activity levels. The review found that beyond awareness raising, changes in other outcomes were measured, assessed but reported in varying ways. It highlighted improvements in evaluation, although limited evidence of campaign effects remain. It provides an update on the evaluation methodologies used in the adult literature. We recommend optimal evaluation design should include: (1) formative research to inform theories/frameworks, campaign content and evaluation design; (2) cohort study design with multiple data collection points; (3) sufficient duration; (4) use of validated measures; (5) sufficient evaluation resources.