Physical activity trends in Queensland (2002 to 2008): are women becoming more active than men?

Depression, anxiety, stress, and physical activity of Australian adults during COVID-19: A combined longitudinal and repeated cross-sectional study

Background

The COVID-19 pandemic has led to a worsening of mental health and health behaviors. While physical activity is positively associated mental health, there is limited understanding of how mental health and physical activity evolve throughout the COVID-19 pandemic. This study aimed to examine changes in depression, anxiety and stress and physical activity, and associations between depression, anxiety, and stress with physical activity in Australian adults across three-time points during the COVID-19 pandemic.

Materials and methods

This study collected both longitudinal and cross-sectional data at three-time points during the COVID-19 pandemic in Australia (i.e., April, July/August, and December 2020). Australians aged 18 years and over were invited to complete online surveys hosted on Qualtrics survey platform. Linear mixed models with random subject effect and general linear models were used to analyze the longitudinal and repeated cross-sectional data respectively.

Results

The number of participants in cross-sectional surveys and longitudinal surveys was 1,877 and 849, respectively. There was an overall reduction between time 2 vs. time 3 in depression (d = 1.03, 95% CI = 0.20, 1.85), anxiety (d = 0.57, 95% CI = 0.02, 1.12), and stress (d = 1.13, 95% CI = 0.21, 2.04) scores but no significant differences in physical activity across three-time points. On average, participants who met the physical activity guidelines had lower depression (d = −2.08, 95% CI = −2.90, −1.26), anxiety (d = −0.88, 95% CI = −1.41, −0.34), and stress (d = −1.35, 95% CI = −2.13, −0.56) scores compared to those not meeting the guidelines.

Conclusion

In the context of the ongoing COVID-19 pandemic, both governments and service providers should continue to provide the public with timely mental health support and promote the benefits of physical activity, as a cost-effective strategy to improve mental health and wellbeing.

Trends in Total Physical Activity Time, Walking, and Vigorous Physical Activity Time in Queensland Adults From 2004-2018

BACKGROUND

Health benefits of physical activity (PA) accrue with small increases in PA, with the greatest benefits for those transitioning from inactivity to any level of PA. This study examined whether self-reported PA time in Queensland adults changed between 2004 and 2018.

METHODS

The Queensland government conducts regular cross-sectional telephone surveys. Between 2004 and 2018, adults aged 18-75 years answered identical questions about their weekly minutes of walking, moderate PA, and vigorous PA. Hurdle regression estimated the average annual change in weekly minutes of PA overall and by activity type, focusing on sociodemographic differences in trends.

RESULTS

The sample size averaged 1764 (2004-2008) and 10,188 (2009-2018), totaling 107,171 participants aged 18-75 years. Unadjusted PA increased by 10 minutes per week per year (95% confidence interval [CI], 8.8-11.1) overall, with increases for most subgroups. Adjusted PA increased by 10.5 minutes per week per year (95% CI, 9.4-11.7). Trends differed by employment-employed adults and those not in the labor force increased by 14.3 (95% CI, 12.8-15.8) and 2.2 minutes per week per year (95% CI, 0.4-4.0), respectively, with no increase for unemployed adults. The increases were due to both an increased prevalence of doing any activity and an increased average duration among active adults.

CONCLUSIONS

Since 2004, PA time has increased for Queensland adults, with substantial variability by employment status.

Validity and responsiveness to change of the Active Australia Survey according to gender, age, BMI, education, and physical activity level and awareness

BACKGROUND

This study aimed to investigate the validity of the Active Australia Survey across different subgroups and its responsiveness to change, as few previous studies have examined this.

METHODS

The Active Australia Survey was validated against the ActiGraph as an objective measure of physical activity. Participants (n = 465) wore the ActiGraph for 7 days and subsequently completed the Active Australia Survey. Moderate activity, vigorous activity and total moderate and vigorous physical activity were compared using Spearman rank-order correlations. Changes in physical activity between baseline and 3-month assessments were correlated to examine responsiveness to change. The data were stratified to assess outcomes according to different subgroups (e.g., gender, age, weight, activity levels).

RESULTS

With regards to the validity, a significant correlation of ρ = 0.19 was found for moderate physical activity, ρ = 0.33 for vigorous physical activity and ρ = 0.23 for moderate and vigorous physical activity combined. For vigorous physical activity correlations were higher than 0.3 for most subgroups, whereas they were only higher than 0.3 in those with a healthy weight for the other activity outcomes. With regards to responsiveness to change, a correlation of ρ = 0.32 was found for moderate physical activity, ρ = 0.19 for vigorous physical activity and ρ = 0.35 for moderate and vigorous physical activity combined. For moderate and vigorous activity combined correlations were higher than 0.4 for several subgroups, but never for vigorous physical activity.

CONCLUSIONS

Little evidence for the validity of Active Australia Survey was found, although the responsiveness to change was acceptable for several subgroups. Findings from studies using the Active Australia Survey should be interpreted with caution.

TRIAL REGISTRATION

World Health Organisation Universal Trial Number: U111-1119-1755. Australian New Zealand Clinical Trials Registry, ACTRN12611000157976 . Registration date: 8 March 2011.

The Effectiveness of a Web-Based Computer-Tailored Physical Activity Intervention Using Fitbit Activity Trackers: Randomized Trial

BACKGROUND

Web-based interventions that provide personalized physical activity advice have demonstrated good effectiveness but rely on self-reported measures of physical activity, which are prone to overreporting, potentially reducing the accuracy and effectiveness of the advice provided.

OBJECTIVE

This study aimed to examine whether the effectiveness of a Web-based computer-tailored intervention could be improved by integrating Fitbit activity trackers.

METHODS

Participants received the 3-month TaylorActive intervention, which included 8 modules of theory-based, personally tailored physical activity advice and action planning. Participants were randomized to receive the same intervention either with or without Fitbit tracker integration. All intervention materials were delivered on the Web, and there was no face-to-face contact at any time point. Changes in physical activity (Active Australia Survey), sitting time (Workforce Sitting Questionnaire), and body mass index (BMI) were assessed 1 and 3 months post baseline. Advice acceptability, website usability, and module completion were also assessed.

RESULTS

A total of 243 Australian adults participated. Linear mixed model analyses showed a significant increase in total weekly physical activity (adjusted mean increase=163.2; 95% CI 52.0-274.5; P=.004) and moderate-to-vigorous physical activity (adjusted mean increase=78.6; 95% CI 24.4-131.9; P=.004) in the Fitbit group compared with the non-Fitbit group at the 3-month follow-up. The sitting time and BMI decreased more in the Fitbit group, but no significant group × time interaction effects were found. The physical activity advice acceptability and the website usability were consistently rated higher by participants in the Fitbit group. Non-Fitbit group participants completed 2.9 (SD 2.5) modules, and Fitbit group participants completed 4.4 (SD 3.1) modules.

CONCLUSIONS

Integrating physical activity trackers into a Web-based computer-tailored intervention significantly increased intervention effectiveness.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12616001555448; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371793 (Archived by WebCite at http://www.webcitation.org/73ioTxQX2).

Generational differences in patterns of physical activities over time in the Canadian population: an age-period-cohort analysis

Background

Using longitudinal panel data, the aim of this study was to examine the contribution of age, period, and cohort effects on changes in physical activity over time in a population-based sample of Canadians. We focused on three domains of physical activities: leisure time, commuting (i.e. walking and cycling), and daily activities (i.e. sedentary behavior). We also examined whether changes in sedentary behavior related to changes in participation in leisure time and commuting activities.

Methods

We used data from the Longitudinal National Population Health Survey (1994–2011): 10050 participants born between 1935 and 1984 grouped in five 10-years birth cohorts. We examined three outcomes: moderate-to-vigorous leisure time physical activity, active commuting, and sedentary behavior. We also included education, income, and body mass index as covariates. We used hierarchical age-period-cohort analysis to examine the contribution of age, period, and cohort effects to changes over time for each outcome.

Results

We found that recent cohorts were more likely to report sedentary behavior and greater participation in leisure time physical activities and active commuting. We also found a significant trend of increasing participation in active leisure time physical activity and active commuting among Canadians from 1994/95 to 2010/11 and, at the same time, an increase in sedentary behavior. The greater participation in leisure time physical activities and active commuting in each succeeding recent cohort was partially related to the secular trend of increasing participation in physical activities over time in the population. Furthermore, those with sedentary behavior were less likely to report participation in physical activities. Overall, obese individuals were less likely to be physically active and more likely to be sedentary, while the effect of socio-economic status varied by outcome.

Conclusions

The greater participation in physical activities (leisure time and commuting) in recent cohorts is encouraging and was substantially explained by period effects, which reflect broad social and environmental factors affecting the whole population. The large cohort effect of increasing sedentary behavior and the inverse relationship between sedentary behavior and physical activity is concerning, and identifies a target group for future interventions.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5189-z) contains supplementary material, which is available to authorized users.

8-year trends in physical activity, nutrition, TV viewing time, smoking, alcohol and BMI: A comparison of younger and older Queensland adults

Lifestyle behaviours significantly contribute to high levels of chronic disease in older adults. The aims of the study were to compare the prevalence and the prevalence trends of health behaviours (physical activity, fruit and vegetable consumption, fast food consumption, TV viewing, smoking and alcohol consumption), BMI and a summary health behaviour indicator score in older (65+ years) versus younger adults (18-65 years). The self-report outcomes were assessed through the Queensland Social Survey annually between 2007-2014 (n = 12,552). Regression analyses were conducted to compare the proportion of older versus younger adults engaging in health behaviours and of healthy weight in all years combined and examine trends in the proportion of younger and older adults engaging in health behaviours and of healthy weight over time. Older adults were more likely to meet recommended intakes of fruit and vegetable (OR = 1.43, 95%CI = 1.23-1.67), not consume fast food (OR = 2.54, 95%CI = 2.25-2.86) and be non-smokers (OR = 3.02, 95%CI = 2.53-3.60) in comparison to younger adults. Conversely, older adults were less likely to meet the physical activity recommendations (OR = 0.86, 95%CI = 0.78-0.95) and watch less than 14 hours of TV per week (OR = 0.65, 95%CI = 0.58-0.74). Overall, older adults were more likely to report engaging in 3, or at least 4 out of 5 healthy behaviours. The proportion of both older and younger adults meeting the physical activity recommendations (OR = 0.97, 95%CI = 0.95-0.98 and OR = 0.94, 95%CI = 0.91-0.97 respectively), watching less than 14 hours of TV per week (OR = 0.96, 95%CI = 0.94-0.99 and OR = 0.94, 95%CI = 0.90-0.99 respectively) and who were a healthy weight (OR = 0.95, 95%CI = 0.92-0.99 and OR = 0.96, 95%CI = 0.94-0.98 respectively) decreased over time. The proportion of older adults meeting the fruit and vegetable recommendations (OR = 0.90, 95%CI = 0.84-0.96) and not consuming fast food (OR = 0.94, 95%CI = 0.88-0.99) decreased over time. Although older adults meet more health behaviours than younger adults, the decreasing prevalence of healthy nutrition behaviours in this age group needs to be addressed.

TaylorActive--Examining the effectiveness of web-based personally-tailored videos to increase physical activity: a randomised controlled trial protocol

BACKGROUND

Physical inactivity levels are unacceptably high and effective interventions that can increase physical activity in large populations at low cost are urgently needed. Web-based interventions that use computer-tailoring have shown to be effective, though people tend to 'skim' and 'scan' text on the Internet rather than thoroughly read it. The use of online videos is, however, popular and engaging. Therefore, the aim of this 3-group randomised controlled trial is to examine whether a web-based physical activity intervention that provides personally-tailored videos is more effective when compared with traditional personally-tailored text-based intervention and a control group.

METHODS/DESIGN

In total 510 Australians will be recruited through social media advertisements, e-mail and third party databases. Participants will be randomised to one of three groups: text-tailored, video-tailored, or control. All groups will gain access to the same web-based platform and a library containing brief physical activity articles. The text-tailored group will additionally have access to 8 sessions of personalised physical activity advice that is instantaneously generated based on responses to brief online surveys. The theory-based advice will be provided over a period of 3 months and address constructs such as self-efficacy, motivation, goal setting, intentions, social support, attitudes, barriers, outcome expectancies, relapse prevention and feedback on performance. Text-tailored participants will also be able to complete 7 action plans to help them plan what, when, where, who with, and how they will become more active. Participants in the video-tailored group will gain access to the same intervention content as those in the text-tailored group, however all sessions will be provided as personalised videos rather than text on a webpage. The control group will only gain access to the library with generic physical activity articles. The primary outcome is objectively measured physical activity. Secondary outcomes include website engagement and retention, quality of life, depression, anxiety, stress, sitting time, sleep and psychosocial correlates of physical activity. Outcomes will be measured at baseline, 3, and 9 months.

DISCUSSION

This study presents an ideal opportunity to study the effectiveness of an isolated feature within a web-based physical activity intervention and the knowledge generated from this study will help to increase intervention effectiveness.

TRIAL REGISTRATION

Australian New-Zealand Clinical Trial Registry: ACTRN12615000057583 . Registered 22 January 2015. CQUniversity Ethics Project Number: H14/07-163.

Lack of exercise of "moderate to vigorous" intensity in people with low levels of physical activity is a major discriminant for sociodemographic factors and morbidity

INTRODUCTION

The aim is to examine the differences between participation at low and zero moderate to vigorous physical activity (MVPA) in relation to their trends and associations with known socio-demographic and health factors. We hypothesised that the number of people at zero MVPA level could be rising despite a parallel increase in the population meeting the recommended MVPA level. We also hypothesised that graded associations of sociodemographic and health factors exist across MVPA levels.

METHODS

Two independent population-based samples (n = 4320 [2004] and n = 2176 [1997]), were recruited with a stratified and random sampling procedure and interviewed at home by professional interviewers. The MVPA was assessed by validated questionnaire. The participants were classified into three MVPA levels: zero, low and recommended MVPA. The trend of each MVPA level was analysed with the standardized prevalence ratios. Correlates of low and zero MVPA levels were examined using multinomial logistic regression.

RESULTS

The population at zero and recommended MVPA levels rose between 1997-2004 by 12% (95% CI, 5-20%) and 7% (95% CI,-4-19%) respectively, while the population at low MVPA level decreased. At zero MVPA level, associative patterns were observed with sociodemographic and health factors which were different when compared to the population at low MVPA level.

CONCLUSIONS

Despite the slight increase of population meeting the recommended MVPA level, a higher trend of increase was observed at zero MVPA level. Both recommended and low MPVA levels increased their participation by absorbing participants from the low MVPA level. The sociodemographic profile of those with low MVPA was more similar to the population at recommended MVPA than at zero MVPA level. Methodological implications about the combination of light and moderate-intensity PA could be derived. The prevention of decline in actual low MVPA could change the trend of increase in the population at zero MVPA level, particularly among young adults.

Using online computer tailoring to promote physical activity: a randomized trial of text, video, and combined intervention delivery modes

Website-delivered interventions are increasingly used to deliver physical activity interventions, yet problems with engagement and retention result in reduced effectiveness. Hence, alternative modes of online intervention delivery need to be explored. Therefore, this study aimed to evaluate the acceptability and effectiveness of a computer-tailored physical activity intervention delivered on the Internet in 3 delivery modes: video, text, or both. Australian adults (N = 803), recruited through e-mail, were randomized into the three delivery modes and received personal physical activity advice. Intervention content was identical across groups. Repeated measures analyses of variance were used to compare the three groups regarding acceptability, website usability, and physical activity. Participants in the video group accepted the content of the physical activity advice significantly better (F = 5.59; p < .01), and spent significantly more time on the website (F = 21.19; p < .001) compared with the text and combination groups. Total physical activity improved significantly over time in all groups (F = 3.95; p < .01). Although the combination group increased physical activity the most, few significant differences between groups were observed. Providing video-tailored feedback has advantages over the conventional text-tailored interventions; however, this study revealed few behavioral differences. More studies, examining alternative delivery modes, that can overcome the limitations of the present study, are needed.

Effectiveness of a web- and mobile phone-based intervention to promote physical activity and healthy eating in middle-aged males: randomized controlled trial of the ManUp study

BACKGROUND

The high number of adult males engaging in low levels of physical activity and poor dietary practices, and the health risks posed by these behaviors, necessitate broad-reaching intervention strategies. Information technology (IT)-based (Web and mobile phone) interventions can be accessed by large numbers of people, yet there are few reported IT-based interventions targeting males' physical activity and dietary practices.

OBJECTIVE

This study examines the effectiveness of a 9-month IT-based intervention (ManUp) to improve the physical activity, dietary behaviors, and health literacy in middle-aged males compared to a print-based intervention.

METHODS

Participants, recruited offline (eg, newspaper ads), were randomized into either an IT-based or print-based intervention arm on a 2:1 basis in favor of the fully automated IT-based arm. Participants were adult males aged 35-54 years living in 2 regional cities in Queensland, Australia, who could access the Internet, owned a mobile phone, and were able to increase their activity level. The intervention, ManUp, was based on social cognitive and self-regulation theories and specifically designed to target males. Educational materials were provided and self-monitoring of physical activity and nutrition behaviors was promoted. Intervention content was the same in both intervention arms; only the delivery mode differed. Content could be accessed throughout the 9-month study period. Participants' physical activity, dietary behaviors, and health literacy were measured using online surveys at baseline, 3 months, and 9 months.

RESULTS

A total of 301 participants completed baseline assessments, 205 in the IT-based arm and 96 in the print-based arm. A total of 124 participants completed all 3 assessments. There were no significant between-group differences in physical activity and dietary behaviors (P≥.05). Participants reported an increased number of minutes and sessions of physical activity at 3 months (exp(β)=1.45, 95% CI 1.09-1.95; exp(β)=1.61, 95% CI 1.17-2.22) and 9 months (exp(β)=1.55, 95% CI 1.14-2.10; exp(β)=1.51, 95% CI 1.15-2.00). Overall dietary behaviors improved at 3 months (exp(β)=1.07, 95% CI 1.03-1.11) and 9 months (exp(β)=1.10, 95% CI 1.05-1.13). The proportion of participants in both groups eating higher-fiber bread and low-fat milk increased at 3 months (exp(β)=2.25, 95% CI 1.29-3.92; exp(β)=1.65, 95% CI 1.07-2.55). Participants in the IT-based arm were less likely to report that 30 minutes of physical activity per day improves health (exp(β)=0.48, 95% CI 0.26-0.90) and more likely to report that vigorous intensity physical activity 3 times per week is essential (exp(β)=1.70, 95% CI 1.02-2.82). The average number of log-ins to the IT platform at 3 and 9 months was 6.99 (SE 0.86) and 9.22 (SE 1.47), respectively. The average number of self-monitoring entries at 3 and 9 months was 16.69 (SE 2.38) and 22.51 (SE 3.79), respectively.

CONCLUSIONS

The ManUp intervention was effective in improving physical activity and dietary behaviors in middle-aged males with no significant differences between IT- and print-based delivery modes.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12611000081910; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000081910 (Archived by WebCite at http://www.webcitation.org/6QHIWad63).

What kinds of website and mobile phone-delivered physical activity and nutrition interventions do middle-aged men want?

Within a health context, men in Western societies are a hard-to-reach population who experience higher rates of chronic disease compared with women. Innovative technology-based interventions that specifically target men are needed; however, little is known about how these should be developed for this group. This study aimed to examine opinions and perceptions regarding the use of Internet and mobile phones to improve physical activity and nutrition behaviors for middle-aged men. The authors conducted 6 focus groups (n = 30) in Queensland, Australia. Their analyses identified 6 themes: (a) Internet experience, (b) website characteristics, (c) Web 2.0 applications, (d) website features, (e) self-monitoring, and (f) mobile phones as delivery method. The outcomes indicate that men support the use of the Internet to improve and self-monitor physical activity and dietary behaviors on the condition that the website-delivered interventions are quick and easy to use, because commitment levels to engage in online tasks are low. Participants also indicated that they were reluctant to use normal mobile phones to change health behaviors, although smartphones were perceived to be more acceptable. This pilot study suggests that there are viable avenues to engage middle-aged men in Internet- or in mobile-delivered health interventions. This study also suggests that to be successful, these interventions need to be tailor-made especially for men, with an emphasis on usability and convenience. A wider quantitative study would bring further support to these findings.

Physical activity in older people: a systematic review

BACKGROUND

Physical activity (PA) in older people is critically important in the prevention of disease, maintenance of independence and improvement of quality of life. Little is known about the physical activity of the older adults or their compliance with current physical activity guidelines.

METHODS

A systematic literature search of the published literature was conducted. Included were published reports of original research that independently reported: the PA level of non-institutional older adults (aged 60 years and over); and the proportion of older adults in the different samples who met PA recommendations or guidelines. The review was restricted to studies published since 2000 to provide a current picture of older adults' PA levels.

RESULTS

Fifty three papers were included in the review. The percentage of older adults meeting recommended physical activity ranged from 2.4 - 83.0% across the studies. Definitions of "recommended" physical activity in older adults varied across the studies as did approaches to measurement which posed methodological challenges to data analysis. Older age groups were less likely than the reference group to be regularly active, and women were less likely than men to achieve regular physical activity, especially leisure time physical activity, when measured by both subjective and objective criteria.

CONCLUSION

The review highlights the need for studies which recruit representative random samples of community based older people and employ validated measurement methods consistently to enable comparison of PA levels over time and between countries.

Temporal trends in and relationships between screen time, physical activity, overweight and obesity

Background

The aims of this study were to examine temporal trends in the prevalence of sufficient moderate-to-vigorous intensity physical activity (MVPA), high levels of screen time, combined measures of these behaviors and overweight or obesity in Australian adults during the period 2002–2008. Trends over this time period in overweight or obesity within each behavior group (sufficient/insufficient MVPA, high/low screen time and combined behaviors) were also examined.

Methods

Data were collected via annually conducted cross-sectional computer-assisted-telephone-interviews (CATI) of adults (n=7908) living in Central Queensland, Australia (2002–2008). Self-reported MVPA, screen time (TV viewing and computer use), and BMI were used to create dichotomous classifications of physical activity (Sufficient MVPA (S-MVPA), Insufficient Physical Activity (I-MVPA)), screen time (High Screen Time (HST), Low Screen Time (LST)), combined behavior categories (S-MVPA/LST, I-MVPA/LST, S-MVPA/HST, I-MVPA/HST) and BMI (Overweight or Obese, Healthy Weight) respectively.

Results

The prevalence of S-MVPA, HST, and overweight or obesity increased at approximately the same rate over the study period in the overall sample and females (p≤0.05). In the overall sample and in females, the prevalence of overweight and obesity increased over the study period in those individuals classified as I-MVPA/HST (p≤0.05).

Conclusion

Results provide evidence that while the prevalence of S-MVPA appears to be modestly increasing, the proportion of the population engaging in HST and classified as overweight or obese are increasing at approximately the same rate. These observations highlight the need to increase levels of total physical activity (including light intensity physical activity) and decrease sedentary behavior including screen time.

Can a website-delivered computer-tailored physical activity intervention be acceptable, usable, and effective for older people?

Despite the numerous health benefits, population physical activity levels are low and declining with age. A continued increase of Internet access allows for website-delivered interventions to be implemented across age-groups, though older people have typically not been considered for this type of intervention. Therefore, the purpose of this study was to evaluate a website-delivered computer-tailored physical activity intervention, with a specific focus on differences in tailored advice acceptability, website usability, and physical activity change between three age-groups. To mimic "real-life" conditions, the intervention, which provided personalized physical activity feedback delivered via the Internet, was implemented and evaluated without any personal contact for the entire duration of the study. Data were collected online at baseline, 1-week, and 1-month follow-up and analyzed for three age-groups (≤44, 45-59, and ≥60 years) using linear mixed models. Overall, 803 adults received the intervention and 288 completed all measures. The oldest age-group increased physical activity more than the other two groups, spent the most time on the website, though had significantly lower perceived Internet self-confidence scores when compared with the youngest age-group. No differences were found in terms of website usability and tailored advice acceptability. These results suggest that website-delivered physical activity interventions can be suitable and effective for older aged adults.

Effectiveness of a website and mobile phone based physical activity and nutrition intervention for middle-aged males: trial protocol and baseline findings of the ManUp Study

BACKGROUND

Compared to females, males experience higher rates of chronic disease and mortality, yet few health promotion initiatives are specifically aimed at men. Therefore, the aim of the ManUp Study is to examine the effectiveness of an IT-based intervention to increase the physical activity and nutrition behaviour and literacy in middle-aged males (aged 35-54 years).

METHOD/DESIGN

The study design was a two-arm randomised controlled trial, having an IT-based (applying website and mobile phones) and a print-based intervention arm, to deliver intervention materials and to promote self-monitoring of physical activity and nutrition behaviours. Participants (n = 317) were randomised on a 2:1 ratio in favour of the IT-based intervention arm. Both intervention arms completed assessments at baseline, 3, and 9 months. All participants completed self-report assessments of physical activity, sitting time, nutrition behaviours, physical activity and nutrition literacy, perceived health status and socio-demographic characteristics. A randomly selected sub-sample in the IT-based (n = 61) and print-based (n = 30) intervention arms completed objective measures of height, weight, waist circumference, and physical activity as measured by accelerometer (Actigraph GT3X). The average age of participants in the IT-based and print-based intervention arm was 44.2 and 43.8 years respectively. The majority of participants were employed in professional occupations (IT-based 57.6%, Print-based 54.2%) and were overweight or obese (IT-based 90.8%, Print-based 87.3%). At baseline a lower proportion of participants in the IT-based (70.2%) group agreed that 30 minutes of physical activity each day is enough to improve health compared to the print-based (82.3%) group (p = .026). The IT-based group consumed a significantly lower number of serves of red meat in the previous week, compared to the print-based group (p = .017). No other significant between-group differences were observed at baseline.

DISCUSSION

The ManUp Study will examine the effectiveness of an IT-based approach to improve physical activity and nutrition behaviour and literacy. Study outcomes will provide much needed information on the efficacy of this approach in middle aged males, which is important due to the large proportions of males at risk, and the potential reach of IT-based interventions.

TRIAL REGISTRATION

ACTRN12611000081910.

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.

Do participants' preferences for mode of delivery (text, video, or both) influence the effectiveness of a Web-based physical activity intervention?

Background

In randomized controlled trials, participants cannot choose their preferred intervention delivery mode and thus might refuse to participate or not engage fully if assigned to a nonpreferred group. This might underestimate the true effectiveness of behavior-change interventions.

Objective

To examine whether receiving interventions either matched or mismatched with participants’ preferred delivery mode would influence effectiveness of a Web-based physical activity intervention.

Methods

Adults (n = 863), recruited via email, were randomly assigned to one of three intervention delivery modes (text based, video based, or combined) and received fully automated, Internet-delivered personal advice about physical activity. Personalized intervention content, based on the theory of planned behavior and stages of change concept, was identical across groups. Online, self-assessed questionnaires measuring physical activity were completed at baseline, 1 week, and 1 month. Physical activity advice acceptability and website usability were assessed at 1 week. Before randomization, participants were asked which delivery mode they preferred, to categorize them as matched or mismatched. Time spent on the website was measured throughout the intervention. We applied intention-to-treat, repeated-measures analyses of covariance to assess group differences.

Results

Attrition was high (575/863, 66.6%), though equal between groups (t₈₆₃ =1.31, P =.19). At 1-month follow-up, 93 participants were categorized as matched and 195 as mismatched. They preferred text mode (493/803, 61.4%) over combined (216/803, 26.9%) and video modes (94/803, 11.7%). After the intervention, 20% (26/132) of matched-group participants and 34% (96/282) in the mismatched group changed their delivery mode preference. Time effects were significant for all physical activity outcomes (total physical activity: F_2,801 = 5.07, P = .009; number of activity sessions: F_2,801 = 7.52, P < .001; walking: F_2,801 = 8.32, P < .001; moderate physical activity: F_2,801 = 9.53, P < .001; and vigorous physical activity: F_2,801 = 6.04, P = .002), indicating that physical activity increased over time for both matched and mismatched groups. Matched-group participants improved physical activity outcomes slightly more than those in the mismatched group, but interaction effects were not significant. Physical activity advice acceptability (content scale: t₃₆₈ = .10, P = .92; layout scale: t₃₆₈ = 1.53, P = .12) and website usability (layout scale: t₄₂₆ = .05, P = .96; ease of use scale: t₄₂₆ = .21, P = .83) were generally high and did not differ between the matched and mismatched groups. The only significant difference (t₆₂₁ = 2.16, P = .03) was in relation to total time spent on the website: the mismatched group spent significantly more time on the website (14.4 minutes) than the matched group (12.1 minutes).

Conclusion

Participants’ preference regarding delivery mode may not significantly influence intervention outcomes. Consequently, allowing participants to choose their preferred delivery mode may not increase effectiveness of Web-based interventions.

Living with diabetes: rationale, study design and baseline characteristics for an Australian prospective cohort study

Background

Diabetes mellitus is a major global public health threat. In Australia, as elsewhere, it is responsible for a sizeable portion of the overall burden of disease, and significant costs. The psychological and social impact of diabetes on individuals with the disease can be severe, and if not adequately addressed, can lead to the worsening of the overall disease picture. The Living With Diabetes Study aims to contribute to a holistic understanding of the psychological and social aspects of diabetes mellitus.

Methods/Design

The Living With Diabetes Study is a 5-year prospective cohort study, based in Queensland, Australia. The first wave of data, which was collected via a mailed self-report survey, was gathered in 2008, with annual collections thereafter. Measurements include: demographic, lifestyle, health and disease characteristics; quality of life (EQ-5D, ADDQoL); emotional well-being (CES-D, LOT-R, ESSI); disease self-management (PAM); and health-care utilisation and patient-assessed quality of care (PACIC). 29% of the 14,439 adults who were invited to participate in the study agreed to do so, yielding a sample size of 3,951 people.

Discussion

The data collected by the Living With Diabetes Study provides a good representation of Australians with diabetes to follow over time in order to better understand the natural course of the illness. The study has potential to further illuminate, and give a comprehensive picture of the psychosocial implications of living with diabetes. Data collection is ongoing.

Qualitative and quantitative research into the development and feasibility of a video-tailored physical activity intervention

Background

Continued low adherence to physical activity recommendations illustrates the need to refine intervention strategies and increase their effectiveness. The purpose of this study was to conduct formative research related to the development of a next generation of computer-tailored interventions that use online tailored video-messages to increase physical activity.

Methods

Five focus groups (n = 30), aimed at males and females, aged between 35 and 60 years, that do not meet the physical activity recommendation, were conducted to allow in-depth discussion of various elements related to the development of an online video-tailored intervention. In addition, a series of questions were delivered to a random sample (n = 1261) of Australians, using CATI survey technology, to gain more information and add a quantitative assessment of feasibility related to the development of the intervention. Focus group data was transcribed, and summarised using Nvivo software. Descriptive and frequency data of the survey was obtained using SPSS 18.0.

Results

Nearly all of the focus group participants supported the concept of a video-tailored intervention and 35.8% of survey participants indicated that they would prefer a video-based over a text-based intervention. Participants with a slow internet-connection displayed a lower preference for video-based advice (31.9%); however less than 20% of the survey sample indicated that downloading videos would be slow. The majority of focus group and survey participants did not support the idea of using mobile phones to receive this kind of intervention and indicated that video-tailored messages should be shorter than 5 minutes. Video-delivery of content is very rich in information, which increases the challenge to appropriately tailor content to participant characteristics; focus-group outcomes indicated a large diversity in participant preferences. 52.4% of survey participants indicated that the videos should be convincing and motivating.

Conclusions

These results provide valuable information to develop an innovative video-tailored physical activity intervention. The results support the feasibility of such intervention, both in terms of users being ready to participate in it, as well as from a point of view whereby current internet infrastructure is able to cope with the demands of downloading videos. Though promising, a number of specific challenges in the development of these interventions were identified (e.g. the videos need to be short, made professionally, and tailor to a larger number of variables) and will need to be overcome in the development and evaluation of this new type of physical activity intervention.

Identifying population subgroups at risk for underestimating weight health risks and overestimating physical activity health benefits

People may incorrectly perceive that their body weight or Physical Activity (PA) meets health recommendations; this provides an obstacle for change. In this study self-reported BMI and PA were assessed in relation to questions regarding perception of meeting weight and PA recommendations. Signal detection analysis was used to identify population subgroups. Study outcomes showed that 34.4 per cent of the 2535 adult participants underestimated weight health risks; low income, male participants who believed they were sufficiently active underestimated weight health risks the most (52.6%). A total of 23.7 per cent of participants overestimated PA health benefits; older age, low educated participants who did not believe their body weight was a health risk overestimated PA health benefits the most (58.3%). In conclusion, as weight and PA misperceptions are high, efforts are needed to reduce these misperceptions, so that behaviour change initiatives can be more effective.