Short term effects of a weight loss and healthy lifestyle programme for overweight and obese men delivered by German football clubs

How European Fans in Training (EuroFIT), a lifestyle change program for men delivered in football clubs, achieved its effect: a mixed methods process evaluation embedded in a randomised controlled trial

BACKGROUND

A randomised trial of European Fans in Training (EuroFIT), a 12-week healthy lifestyle program delivered in 15 professional football clubs in the Netherlands, Norway, Portugal, and the United Kingdom, successfully increased physical activity and improved diet but did not reduce sedentary time. To guide future implementation, this paper investigates how those effects were achieved. We ask: 1) how was EuroFIT implemented? 2) what were the processes through which outcomes were achieved?

METHODS

We analysed qualitative data implementation notes, observations of 29 of 180 weekly EuroFIT deliveries, semi-structured interviews with 16 coaches and 15 club representatives, and 30 focus group discussions with participants (15 post-program and 15 after 12 months). We descriptively analysed quantitative data on recruitment, attendance at sessions and logs of use of the technologies and survey data on the views of participants at baseline, post program and after 12 months. We used a triangulation protocol to investigate agreement between data from difference sources, organised around meeting 15 objectives within the two research questions.

RESULTS

We successfully recruited clubs, coaches and men to EuroFIT though the draw of the football club seemed stronger in the UK and Portugal. Advertising that emphasized getting fitter, club-based deliveries, and not 'standing out' worked and attendance and fidelity were good, so that coaches in all countries were able to deliver EuroFIT flexibly as intended. Coaches in all 15 clubs facilitated the use of behaviour change techniques and interaction between men, which together enhanced motivation. Participants found it harder to change sedentary time than physical activity and diet. Fitting changes into daily routines, planning for setbacks and recognising the personal benefit of behaviour change were important to maintain changes. Bespoke technologies were valued, but technological hitches frustrated participants.

CONCLUSION

EuroFIT was delivered as planned by trained club coaches working flexibly in all countries. It worked as expected to attract men and support initiation and maintenance of changes in physical activity and diet but the use of bespoke, unstable, technologies was frustrating. Future deliveries should eliminate the focus on sedentary time and should use only proven technologies to support self-monitoring and social interaction.

TRIAL REGISTRATION

ISRCTN81935608, registered 16/06/2015.

Football fans' emotional attachment to their clubs as a predictor of weight loss in a prevention programme for men with obesity

Data about which factors in lifestyle interventions facilitate weight loss (WL) success in men is still scarce. The Football Fans in Training (FFIT) programme in Germany attracts men with overweight and facilitates meaningful weight reduction. The goal of this study was to evaluate the possible impact of the fans' emotional attachment to their favourite football clubs on achieving at least 5% WL among the male-only participants. All 791 FFIT intervention participants of 2017 and 2018 were included in the study. We performed two separate logistic regression analyses: (a) baseline values of several participant characteristics as predictors of a 5% WL and (b) change scores of participants' health behaviour characteristics from the course start to end as predictors of the 5% WL. In addition, both models included the Emotional Attachment to a Sports Team (EAST). Analyses were based on the intention-to-treat principle. Higher EAST at baseline was associated with WL success, as was higher WL self-efficacy, lower score in vegetable intake and higher score in food high on carbohydrates. In the second analysis, EAST, an increase in fruit intake, vegetable intake, whole-grain intake and steps per day, as well as a reduction of fatty food intake, were associated with 5% WL success. The predictors are mostly explorative and limited to correlations. The results indicate that EAST was an independent predictor of WL success in the participating football fans. This understanding might be used for tailoring future interventions in sports or similar settings.

Effectiveness of Adult Health Promotion Interventions Delivered Through Professional Sport: Systematic Review and Meta-Analysis

BACKGROUND

Researchers are capitalising on the strong connections that sport fans have with their teams for health promotion programmes, yet no existing systematic reviews have evaluated the effectiveness of interventions delivered through professional sport.

OBJECTIVE

The aim of this study was to systematically collate, evaluate, and synthesise the evidence on health promotion interventions implemented in professional sport settings.

METHODS

Randomised controlled trials reporting on adult health promotion initiatives delivered in professional sport settings were identified through electronic database searches in CINAHL, MEDLINE, SPORTDiscus, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar. Data on health-related outcomes (e.g., weight, physical activity, dietary intake) were extracted and synthesised, and random effects meta-analyses were conducted to examine effects for weight and waist circumference. Risk of bias was examined using the Cochrane risk-of-bias tool for randomised controlled trials (RoB 2).

RESULTS

Six studies reporting on five unique interventions met the inclusion criteria, and all included studies were gender-sensitised and exclusively targeted men. Intervention effects were observed for several health outcomes, including physical activity, dietary intake, and psychosocial health. All studies aimed to reduce weight, and for most studies (n = 4), weight was a primary outcome, either of the included study or to inform a future definitive trial. Findings from the meta-analysis revealed an overall significant difference in change in weight of - 3.2 kg (95% confidence interval [CI] - 4.6 to - 1.8) and waist circumference of - 3.9 cm (95% CI - 4.9 to - 2.8), both in favour of the intervention group at 12 weeks. Intervention effects were also reported for several other health outcomes (e.g., physical activity, dietary intake, psychosocial health); however, they were not consistently measured across the studies and thus were not meta-analysed.

CONCLUSION

Health promotion interventions delivered through professional sporting organisations can significantly improve weight- and lifestyle-related health outcomes. Representation across the socioeconomic spectrum and across culturally and linguistically diverse groups was limited. As only a limited number of studies met the inclusion criteria for this review, a need exists for rigorously designed interventions, standardised intervention approaches, with long-term follow-up, and the potential for scalability.

PROSPERO REGISTRATION NUMBER

CRD42019123295.

Exploring the provision and motives behind the adoption of health-promotion programmes in professional football clubs across four European countries

This study mapped existing health-promotion provisions targeting adults in professional football clubs across England, the Netherlands, Norway, and Portugal, and explored motives behind the clubs’ adoption of the European Fans in Training (EuroFIT) programme. We surveyed top-tier football clubs in the four countries and interviewed representatives from football clubs and the clubs’ charitable foundation who delivered EuroFIT. The findings showed large between-country differences, with football clubs in England reporting far greater healthy lifestyle provision than other countries. Relatively few health-promotion programmes targeted adults, particularly in the Netherlands, Portugal, and Norway. Club representatives reported that the motives for adopting the EuroFIT programme often involved adhering to both the social objectives of the football club or club’s foundation and business-related objectives. They viewed the scientific evidence and evaluation underpinning EuroFIT as helpful in demonstrating the value and potential future impact of both the programme and the clubs’ wider corporate social responsibility provision.

Fußball – neue Wege in der Prävention und Behandlung des Typ-2-Diabetes

Über die Hälfte der Bevölkerung in westlichen Ländern ist übergewichtig, und nahezu jeder Vierte ist adipös. In den nächsten Jahren wird es deshalb zu einem enormen Anstieg der Zahl an nicht übertragbaren Erkrankungen wie Diabetes, kardiovaskuläre Erkrankungen und Krebs kommen. Eine ausgewogene Ernährung, begleitet von regelmäßiger Bewegung, ist entscheidend bei der Prävention der Entwicklung und des Fortschreitens nicht übertragbarer Erkrankungen. Gesundheitsfördernde Programme besitzen eine große Bedeutung bei der langfristigen Verbesserung des Gesundheitsstatus unserer Bevölkerung, jedoch nehmen insbesondere Männer selten an gesundheitsfördernden Programmen teil. Deshalb gilt es nach neuen Wegen zu suchen, um effizienter Menschen mit einem erhöhten Risiko zu erreichen. Fußball verfügt über ein großes Potenzial, Menschen und vor allem Männer mit einem erhöhten Risiko für nicht übertragbare Erkrankungen, die üblichen gesundheitsfördernden Maßnahmen ablehnend gegenüberstehen, für die Teilnahme an Gesundheitsprogrammen zu gewinnen. Für ältere Spieler ist Walking Football eine neue Fußball-Variante mit einem geringeren Risiko für Verletzungen und eine körperliche Überlastung. Die vorliegende Arbeit gibt einen Überblick über die metabolischen Auswirkungen von Freizeitfußball und insbesondere Walking Football sowie Maßnahmen zur Gesundheitsförderung, die von professionellen Fußballvereinen angeboten werden, bei Menschen mit einem erhöhten Risiko für oder mit bereits bestehenden nicht übertragbaren Erkrankungen, wie insbesondere Typ-2-Diabetes.

Scale-Up and Scale-Out of a Gender-Sensitized Weight Management and Healthy Living Program Delivered to Overweight Men via Professional Sports Clubs: The Wider Implementation of Football Fans in Training (FFIT)

Increasing prevalence of obesity poses challenges for public health. Men have been under-served by weight management programs, highlighting a need for gender-sensitized programs that can be embedded into routine practice or adapted for new settings/populations, to accelerate the process of implementing programs that are successful and cost-effective under research conditions. To address gaps in examples of how to bridge the research to practice gap, we describe the scale-up and scale-out of Football Fans in Training (FFIT), a weight management and healthy living program in relation to two implementation frameworks. The paper presents: the development, evaluation and scale-up of FFIT, mapped onto the PRACTIS guide; outcomes in scale-up deliveries; and the scale-out of FFIT through programs delivered in other contexts (other countries, professional sports, target groups, public health focus). FFIT has been scaled-up through a single-license franchise model in over 40 UK professional football clubs to 2019 (and 30 more from 2020) and scaled-out into football and other sporting contexts in Australia, Canada, New Zealand, England and other European countries. The successful scale-up and scale-out of FFIT demonstrates that, with attention to cultural constructions of masculinity, public health interventions can appeal to men and support them in sustainable lifestyle change.