Why do people sit? A framework for targeted behavior change

A behaviour change intervention to reduce sedentary behaviour in chronic obstructive pulmonary disease: a qualitative study

OBJECTIVES

To document the experiences of people with chronic obstructive pulmonary disease (COPD) who underwent a behaviour change intervention to reduce sedentary behaviour (SB) in a clinical trial.

DESIGN AND PARTICIPANTS

Qualitative study using semi-structured interviews to explore perspectives of the behaviour change intervention and specific intervention components in people with stable COPD on the waitlist for pulmonary rehabilitation.

SETTING

Three outpatient pulmonary rehabilitation programmes in Sydney, Australia.

INTERVENTIONS

The six-week behaviour change intervention with once weekly contact with a physiotherapist aimed to reduce SB by replacing it with light-intensity physical activity (PA) and by breaking up prolonged SB.

MAIN OUTCOME MEASURES

Of 30 participants who completed the behaviour change intervention, interviews were conducted with 13 participants and analysed using the 'capability, opportunity, motivation, behaviour (COM-B)' framework of behaviour change.

RESULTS

Intervention components regarded as most helpful by participants were verbal education on health consequences on SB, goal setting, and self-monitoring of, and feedback on, step count using activity trackers. There was a clear preference during goal setting to increase PA rather than to reduce SB. Physical limitations and enjoyment of SB were the most reported barriers to reducing SB.

CONCLUSIONS

Goal setting, verbal education, and self-monitoring of, and feedback on step count, were viewed positively by people with COPD and may show promise for reducing SB and increasing PA based on individual preference. CONTRIBUTION OF THE PAPER.

Workplace Productivity, Health and Wellbeing: Findings From a Cluster Randomised Controlled Trial of a Workplace Intervention to Reduce Sitting in Office Workers

OBJECTIVE

The aim of the study was to evaluate the feasibility and potential effects of a workplace intervention to reduce and break up sitting.

METHODS

Office workers were randomized in clusters to intervention ( n = 22) or control ( n = 22). The intervention included a height-adjustable workstation, education, computer prompt software, and line manager support. Outcomes included device-measured workplace sitting and ecological momentary assessed workplace productivity. Recruitment, retention, and data completion rates were assessed.

RESULTS

Recruitment ( N = 44), retention (91%), and workplace sitting measurement rates demonstrated study feasibility. At 8 weeks, workplace sitting was 11% lower (95% CI: -20.71, -1.30) in the intervention group compared with control participants. Intervention participants were also more engaged, motivated, and productive while sitting ( P ≤ 0.016).

CONCLUSIONS

It was feasible to implement and evaluate this office workplace intervention, with potential benefits on workplace sitting and ecological momentary assessed productivity.

Associations of lifestyle with burnout risk and recovery need in Flemish secondary schoolteachers: a cross-sectional study

Teacher burnout and high recovery need are a topic of concern for educational institutions. This cross-sectional study assesses the association between lifestyle (including physical activity (PA), sedentary behavior (SB), dietary behavior and sleep), burnout risk and recovery need in 1878 secondary schoolteachers in Flanders. In September-October 2019, an online-questionnaire assessing burnout (i.e., emotional exhaustion, depersonalization, personal accomplishment), recovery need, PA-domains, SB-domains, dietary behavior (including fruit and vegetable intake and diet quality) and sleep during the week and the weekend was completed. Multiple linear regression models were applied. More emotional exhaustion was associated with more domestic and garden PA, work-related SB and sleep during the weekend, whereas higher scores of emotional exhaustion were associated with lower fruit intake, diet quality and less sleep during the week. More depersonalization was associated with more leisure-time PA and work-related SB and with lower fruit intake. Teachers showing more recovery need, showed more domestic and garden PA and work-related SB, but less leisure-time PA and sleep during the week. Future research should use longitudinal or experimental designs to get more insight into causality. Despite the low effect sizes, education networks and schools might benefit from promoting and facilitating a healthy lifestyle in secondary schoolteachers.

Breaking the Habit? Identifying Discrete Dimensions of Sitting Automaticity and Their Responsiveness to a Sitting-Reduction Intervention

BACKGROUND

Growing evidence suggests that sitting is activated automatically on exposure to associated environments, yet no study has yet sought to identify in what ways sitting may be automatic.

METHOD

This study used data from a 12-month sitting-reduction intervention trial to explore discrete dimensions of sitting automaticity, and how these dimensions may be affected by an intervention. One hundred ninety-four office workers reported sitting automaticity at baseline, and 3 months, 6 months, 9 months and 12 months after receiving one of two sitting-reduction intervention variants.

RESULTS

Principal component analysis extracted two automaticity components, corresponding to a lack of awareness and a lack of control. Scores on both automaticity scales decreased over time post-intervention, indicating that sitting became more mindful, though lack of awareness scores were consistently higher than lack of control scores.

CONCLUSION

Attempts to break office workers' sitting habits should seek to enhance conscious awareness of alternatives to sitting and afford office workers a greater sense of control over whether they sit or stand.

An intervention to promote positive homeworker health and wellbeing through effective home-working practices: a feasibility and acceptability study

BACKGROUND

In the wake of Covid-19, the prevalence of working from home ('home-working') is expected to rise. Yet, working from home can have negative health and wellbeing impacts. Interventions are needed to promote effective ways of working that also protect workers' health and wellbeing. This study explored the feasibility and acceptability of an intervention intended to promote home-working practices that would protect and promote health behaviour and wellbeing.

METHODS

An uncontrolled, single-arm mixed-methods trial design was employed. Forty-two normally-office-based UK workers, working from home between January-February 2021 (during the Covid pandemic), consented to receive the intervention. The intervention: a digital document offering evidence-based recommendations for home-working in ways conducive to health behaviour and wellbeing. Feasibility and acceptability were quantitatively indexed by: expressions of interest within 1 week (target threshold ≥ 35); attrition across the one-week study period (threshold ≤ 20%); and the absence of any apparent detriments in self-reported physical activity, sedentary behaviour, snacking, and work-related wellbeing prior to and one week after receiving the intervention. Qualitative think-aloud data, obtained while participants read through the intervention, and analysed using reflexive thematic analysis, explored acceptability. Semi-structured interviews conducted one week after intervention exposure were content-analysed to identify whether and which behaviour changes were adopted.

RESULTS

Two feasibility criteria were met: 85 expressions of interest indicated satisfactory intervention demand, and no detriments were observed in health behaviours or wellbeing. Forty-two participants (i.e., maximum capacity for the study; 26 females, 16 males, aged 22-63) consented to take part. 31% dropped out over the one-week study period leaving a final sample of 29 (18 females, 11 males, aged 22-63), exceeding identified attrition thresholds. Think-aloud data showed that participants concurred with intervention guidance, but felt it lacked novelty and practicality. Follow-up interviews produced 18 (62%) participant reports of intervention adherence, where nine recommendations reportedly prompted behaviour change in at least one participant.

CONCLUSIONS

Mixed evidence was found for intervention feasibility and acceptability. Whilst the information was deemed relevant and of value, further development is required to increase its novelty. It may also be more fruitful to provide this information via employers, to encourage and emphasise employer endorsement.

mHealth intervention delivered in general practice to increase physical activity and reduce sedentary behaviour of patients with prediabetes and type 2 diabetes (ENERGISED): rationale and study protocol for a pragmatic randomised controlled trial

BACKGROUND

The growing number of patients with type 2 diabetes and prediabetes is a major public health concern. Physical activity is a cornerstone of diabetes management and may prevent its onset in prediabetes patients. Despite this, many patients with (pre)diabetes remain physically inactive. Primary care physicians are well-situated to deliver interventions to increase their patients' physical activity levels. However, effective and sustainable physical activity interventions for (pre)diabetes patients that can be translated into routine primary care are lacking.

METHODS

We describe the rationale and protocol for a 12-month pragmatic, multicentre, randomised, controlled trial assessing the effectiveness of an mHealth intervention delivered in general practice to increase physical activity and reduce sedentary behaviour of patients with prediabetes and type 2 diabetes (ENERGISED). Twenty-one general practices will recruit 340 patients with (pre)diabetes during routine health check-ups. Patients allocated to the active control arm will receive a Fitbit activity tracker to self-monitor their daily steps and try to achieve the recommended step goal. Patients allocated to the intervention arm will additionally receive the mHealth intervention, including the delivery of several text messages per week, with some of them delivered just in time, based on data continuously collected by the Fitbit tracker. The trial consists of two phases, each lasting six months: the lead-in phase, when the mHealth intervention will be supported with human phone counselling, and the maintenance phase, when the intervention will be fully automated. The primary outcome, average ambulatory activity (steps/day) measured by a wrist-worn accelerometer, will be assessed at the end of the maintenance phase at 12 months.

DISCUSSION

The trial has several strengths, such as the choice of active control to isolate the net effect of the intervention beyond simple self-monitoring with an activity tracker, broad eligibility criteria allowing for the inclusion of patients without a smartphone, procedures to minimise selection bias, and involvement of a relatively large number of general practices. These design choices contribute to the trial's pragmatic character and ensure that the intervention, if effective, can be translated into routine primary care practice, allowing important public health benefits.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT05351359, 28/04/2022).