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Li Z, Lu Y, Xie B, Wu Y. Large-scale greenway exposure reduces sedentary behavior: A natural experiment in China. Health Place 2024; 89:103283. [PMID: 38850725 DOI: 10.1016/j.healthplace.2024.103283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/25/2024] [Accepted: 05/29/2024] [Indexed: 06/10/2024]
Abstract
As a global public health problem, sedentary behavior has attracted more and more attention. Although numerous studies have demonstrated many benefits of green spaces to health, causal evidence on how green spaces affect people's sedentary behavior is scarce. This study used a natural experiment to evaluate the impact of greenway intervention on sedentary behavior. Two waves of data were collected in 2016 and 2019 (before and after the intervention) at East Lake Greenway (102-km-long) in Wuhan, China, with 1020 participants in 52 neighborhoods. We adopted three major methods to evaluate the impact of greenway intervention on sedentary behavior, including Propensity Score Matching and difference-in-difference (PSM-DID) method (with both individual and neighborhood variables to match samples), continuous treatment DID method (with distance to the greenway as the continuous treatment), and mediation analysis (with moderate to vigorous physical activity or MVPA, and walking time as the mediator). The results revealed that the greenway intervention significantly reduced participants' sedentary time and the intervention has a distance decay effect. The closer to the greenway, the greater decrease in sedentary time after the greenway opening. Furthermore, we found that MVPA and walking time mediate the impact of the greenway intervention on the change in sedentary behavior. The effect of greenway intervention was more beneficial for those under the age of 60, those who were employed, or those who were married. Our findings provided robust evidence that exposure to urban greenways affects sedentary behavior and such green infrastructures help protect public health in high-density urban areas.
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Affiliation(s)
- Zhenhua Li
- Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong, China.
| | - Yi Lu
- Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong, China.
| | - Bo Xie
- School of Urban Design, Wuhan University, Wuhan, 430072, China.
| | - Yihao Wu
- Department of Architecture, University of Cambridge, Cambridgeshire, UK.
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Aulbach MB, Puukko S, Palsola M, Haukkala A, Sund R, Vasankari T, Hankonen N. How does a school-based intervention impact students' social cognitions on reducing sedentary behavior over 14 months? PSYCHOL HEALTH MED 2024; 29:1235-1249. [PMID: 38013166 DOI: 10.1080/13548506.2023.2285734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/15/2023] [Indexed: 11/29/2023]
Abstract
Despite sedentary behavior being ubiquitous in students and detrimental to health, interventions specifically targeting it are mostly restricted to leisure time screen time reduction. With six weekly sessions alongside a poster campaign and an additional teacher intervention, the Let's Move It trial delivered environmental and psychological strategies to increase physical activity (PA) and reduce sedentary behavior (SB) in vocational schools, an understudied environment for behavioral interventions. Participants in the intervention arm considerably reduced sedentary time post-intervention. To investigate how social cognitions about restricting SB, as defined by the Reasoned Action Approach, change in intervention and control arms, self-reported data on social cognitions was collected as part of a cluster-randomized controlled trial from 1166 students (59% female, mage = 18.7 years, range: 16-49) in six vocational schools before, post-intervention, and 14 months post-baseline. Data were analyzed using mixed between-within repeated measures ANOVA. We found greater improvements in intention (F(1, 833) = 9.69; η2p = 0.01; p = .018) and descriptive norms (F(1, 831) = 13.25; η2p = 0.016; p < .001) in the intervention than control arm, but these effects depended on the included control variables. Generally, intervention effects leveled off from post-intervention to follow-up. The Let's Move It intervention for SB reduction showed modest, short-lived effects on social cognitions, indicating that changes in behavior are likely due to other factors like changes to the classroom environment. Optimally, SB reduction interventions should not only change behavior but produce robust changes in conscious intentions to restrict one's sitting, so that positive effects generalize to other contexts.
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Affiliation(s)
- Matthias Burkard Aulbach
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- School of Science, Aalto University, Espoo, Finland
- Department of Psychology, Paris-Lodron-University of Salzburg, Salzburg, Austria
| | - Sarmite Puukko
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Minttu Palsola
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Ari Haukkala
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Helsinki Collegium of Advanced Studies, University of Helsinki, Helsinki, Finland
| | - Reijo Sund
- Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tommi Vasankari
- UKK Institute for Health Promotion Research, Tampere University, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Nelli Hankonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Faculty of Social Sciences, Tampere University, Tampere, Finland
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Teran-Escobar C, Duché S, Bouscasse H, Isoard-Gatheur S, Juen P, Lacoste L, Lyon-Caen S, Mathy S, Ployon E, Risch A, Sarrazin P, Slama R, Tabaka K, Treibich C, Chardonnel S, Chalabaev A. InterMob: a 24-month randomised controlled trial comparing the effectiveness of an intervention including behavioural change techniques and free transport versus an intervention including air pollution awareness-raising on car use reduction among regular car users living in Grenoble, France. BMC Public Health 2022; 22:1763. [PMID: 36114537 PMCID: PMC9482286 DOI: 10.1186/s12889-022-14099-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Frequent car use contributes to health and environmental issues such as air pollution, climate change and obesity. Active and sustainable mobility (bike, walk, public transport, car sharing) may address these issues. Different strategies have been implemented in past research, involving hard levers, aimed at modifying the economical or geographical context (e.g., free public transport), and soft levers, aimed at modifying psychological processes (e.g., personalised transport advice). However, few studies have combined both hard and soft levers. In addition, few have used robust methodologies (e.g., randomised controlled trials), followed behavioural changes in the long-term, and been anchored in behaviour change theories. InterMob aims to address these limits by implementing a 24-month randomised controlled trial including hard and soft levers. The objectives of InterMob are to a) evaluate the effectiveness of an experimental arm versus an active controlled arm, and b) identify the processes of mobility change. Methods Regular car users living in Grenoble (N = 300) will be recruited and randomised to one of the two arms. The experimental arm consists in a six-month intervention combining hard levers (free access to transport/bikes), and soft levers (e.g., personalised transport advice). The control arm consists in a six-month intervention aimed at raising awareness on air pollution and its health effects. Both arms will include eight evaluation weeks (spread out over 24 months) based on a GPS, an accelerometer, and a pollution sensor. Moreover, participants will complete mobility logbooks and surveys measuring psychological constructs, socio-economical, and socio-spatial characteristics. Discussion InterMob will assess the effectiveness of two interventions aimed at reducing car use within regular car users in the short-, mid- and long-term. Moreover, InterMob will allow to better understand the psychological processes of behaviour change, and the socio-economical and geographical conditions under which the intervention is efficient in reducing car use. Finally, the benefits of mobility change in terms of physical activity, quality of life, and exposure to pollution will be quantified. Trial registration ClinicalTrials.gov: NCT05096000 on 27/10/2021 (retrospectively registered). Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14099-4.
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Rampisheh Z, Ramezani M, Khalili N, Massahikhaleghi P, Hoveidamanesh S, Darroudi S, SoleimanvandiAzar N, Tayefi B. Physical Activity and Well-being Status among Employees of University of Medical Sciences. Med J Islam Repub Iran 2022; 36:97. [PMID: 36408338 PMCID: PMC9587180 DOI: 10.47176/mjiri.36.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Workplace physical activity plays an important role in employees' health. As university employees are a population at risk for a sedentary working pattern, this study aimed to investigate the physical activity status of employees of Iran University of Medical Sciences (IUMS) and its subsequent effects on their well-being. Methods: This cross-sectional study included 472 employees from different units of IUMS in Tehran. The participants were selected by a multistage sampling method. Interviews were conducted by using an international physical activity questionnaire, a questionnaire for stages of behavioral change, the World Health Organization Well-being Questionnaire, and a demographic checklist from July to October 2019. Analysis of variance, t test, and logistic regression analysis were used. Data were analyzed using IBM SPSS (Version 21.0). Results: Total physical activity in the study population was 6216.58 ± 5886.09 MET-minutes/week. The mean score of the well-being index was 54.72 ± 22.4; there was an association between sex and location of work with physical activity in domains (p<0.05). The highest prevalence rates for change of stage of physical activity were found in the maintenance stage for men and the contemplation stage for women. There was a significant difference between men and women's well-being index-men reported being more active and energetic than women (p<0.001). Results also revealed that having vigorous physical activity compared with a moderate level could increase the well-being index. Conclusion: Physical activity behavior at the workplace was associated with well-being level. It could, therefore, be postulated that enhancing physical activity may be beneficial to improving well-being in an academic environment.
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Affiliation(s)
- Zahra Rampisheh
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mozhdeh Ramezani
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Narjes Khalili
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Parissa Massahikhaleghi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Susan Darroudi
- Student Research Committee, International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Neda SoleimanvandiAzar
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Batool Tayefi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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D'Lima D, Soukup T, Hull L. Evaluating the Application of the RE-AIM Planning and Evaluation Framework: An Updated Systematic Review and Exploration of Pragmatic Application. Front Public Health 2022; 9:755738. [PMID: 35155336 PMCID: PMC8826088 DOI: 10.3389/fpubh.2021.755738] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background RE-AIM is one of the most widely applied frameworks to plan and evaluate the implementation of public health and health behavior change interventions. The objective of this review is to provide an updated synthesis of use of the RE-AIM (Reach Effectiveness Adoption Implementation and Maintenance) planning and evaluation framework and explore pragmatic use (i.e., partial application of the framework) and how this is reported. Methods Systematic review. MEDLINE (R) and PsycINFO were searched, via the Ovid interface, between January 2011 and December 2017. Studies that applied RE-AIM as a planning and/or evaluation framework were included. Results One hundred fifty-seven articles met inclusion criteria. One hundred forty-nine reported using RE-AIM for evaluation, three for planning and five for planning and evaluation. Reach was the most frequently reported dimension (92.9%), followed by implementation (90.3%), adoption (89.7%), effectiveness (84.5%), and maintenance (77.4%). One hundred forty-seven/one hundred fifty-seven articles originated from high-income economy countries. Within a sub-set analysis (10% of included articles), 9/15 articles evaluated all dimensions. Of the 6/15 articles that did not evaluate all dimensions, five provided no justification for pragmatic application. Conclusions RE-AIM has gained increased use in recent years and there is evidence that it is being applied pragmatically. However, the rationale for pragmatic use is often not reported. Systematic Review Registration PROSPERO (CRD42017054616).
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Affiliation(s)
- Danielle D'Lima
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, London, United Kingdom
| | - Tayana Soukup
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, United Kingdom
| | - Louise Hull
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, United Kingdom
- *Correspondence: Louise Hull
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Larsen RT, Wagner V, Korfitsen CB, Keller C, Juhl CB, Langberg H, Christensen J. Effectiveness of physical activity monitors in adults: systematic review and meta-analysis. BMJ 2022; 376:e068047. [PMID: 35082116 PMCID: PMC8791066 DOI: 10.1136/bmj-2021-068047] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To estimate the effectiveness of physical activity monitor (PAM) based interventions among adults and explore reasons for the heterogeneity. DESIGN Systematic review and meta-analysis. STUDY SELECTION The electronic databases MEDLINE, Embase, SPORTDiscus, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched on 4 June 2021. Eligible randomised controlled trials compared interventions in which adults received feedback from PAMs with control interventions in which no feedback was provided. No restrictions on type of outcome measurement, publication date, or language were applied. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data and assessed risk of bias. Random effects meta-analyses were used to synthesise the results. The certainty of evidence was rated by the Grading of Recommendations Assessment and Evaluation (GRADE) approach. MAIN OUTCOME MEASURES The three primary outcomes of interest were physical activity, moderate to vigorous physical activity, and sedentary time. RESULTS 121 randomised controlled trials with 141 study comparisons, including 16 743 participants, were included. The PAM based interventions showed a moderate effect (standardised mean difference 0.42, 95% confidence interval 0.28 to 0.55) on physical activity, equivalent to 1235 daily steps; a small effect (0.23, 0.16 to 0.30) on moderate to vigorous physical activity, equivalent to 48.5 weekly minutes; and a small insignificant effect (-0.12, -0.25 to 0.01) on sedentary time, equal to 9.9 daily minutes. All outcomes favoured the PAM interventions. CONCLUSIONS The certainty of evidence was low for the effect of PAM based interventions on physical activity and moderate for moderate to vigorous physical activity and sedentary time. PAM based interventions are safe and effectively increase physical activity and moderate to vigorous physical activity. The effect on physical activity and moderate to vigorous physical activity is well established but might be overestimated owing to publication bias. STUDY REGISTRATION PROSPERO CRD42018102719.
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Affiliation(s)
- Rasmus Tolstrup Larsen
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet Copenhagen, Denmark
| | - Vibeke Wagner
- Department of Brain Injury Rehabilitation, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Christoffer Bruun Korfitsen
- Parker Institute, Bispebjerg and Frederiksberg Hospital, Capital Region, Frederiksberg, Denmark
- Danish Health Authority, Copenhagen, Denmark
| | - Camilla Keller
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet Copenhagen, Denmark
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Carsten Bogh Juhl
- Research Unit of Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - Henning Langberg
- Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark
| | - Jan Christensen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet Copenhagen, Denmark
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Hallam KT, Peeters A, Gupta A, Bilsborough S. Moving minds: Mental health and wellbeing benefits of a 50-day workplace physical activity program. CURRENT PSYCHOLOGY 2022; 42:1-12. [PMID: 35035189 PMCID: PMC8743094 DOI: 10.1007/s12144-021-02525-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2021] [Indexed: 01/02/2023]
Abstract
The aim of this study was to assess changes in mental health and wellbeing measures across a 50-day physical activity workplace program. The secondary aims assessed the relationship between demographic and pre-program physical activity self-reported variables, mental health, wellbeing and program engagement measures. The study utilized a naturalistic longitudinal design with a study population of 2903 people. Participants were engaged in the 10,000 step daily physical activity program for 50-days and measures of engagement were tracked. 1320 participants provided full pre/post-program data across a range of standardized mental health and wellbeing measures alongside demographic and program engagement measures. For individuals providing pre and post program data there was a significant reduction in anxiety (18.2%, p = .008), stress (13.0%, p = .014) and sleep related impairment (6.9%, p < .001) alongside a significant improvement in overall wellbeing (6.7%, p = .001). The data further showed no significant mental health differences were identified between individuals who recorded below versus equal to or above 10,000 steps. Regression analyses indicated numerous group and personal variables impacted mental health, wellbeing and program engagement. The study highlights improvements in a range of mental health and wellbeing scores occurred over the 50-day activity program for people who complete the program. Finally, the study identified a range of protective and risk factors for mental health benefits of these programs and level of engagement. Whilst there were similarities in the pre-program mental health and wellbeing scores of those who completed and those lost to follow-up, further research is required to better characterize and understand this group.
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Affiliation(s)
- Karen T. Hallam
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, PO Box 281, Geelong, Vic 3220 Australia
- Moving Mindz Pty Ltd, Melbourne, Australia
| | - Anna Peeters
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia
| | - A. Gupta
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia
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Ramezani M, Tayefi B, Zandian E, SoleimanvandiAzar N, Khalili N, Hoveidamanesh S, Massahikhaleghi P, Rampisheh Z. Workplace interventions for increasing physical activity in employees: A systematic review. J Occup Health 2022; 64:e12358. [PMID: 36085590 PMCID: PMC9463462 DOI: 10.1002/1348-9585.12358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 07/30/2022] [Accepted: 08/26/2022] [Indexed: 11/26/2022] Open
Abstract
Background There is scattered evidence of the impact of workplace interventions in improving employees' physical activity. This systematic review was performed to evaluate the strategies of workplace interventions and their effectiveness, as reported in primary studies. Method Primary experimental trials, both randomized controlled trials (RCTs) and non‐RCTs, which examined interventions to increase healthy adult employees' physical activity were included in this review. Studies in English or Persian published between 2009 and 2019 with access to full text of resources were considered. Google Scholar, PubMed, Web of Science, Scopus and Cochrane Library, ProQuest (Thesis) and World Health Organization Clinical Trial Registration Databases and Persian databases such as SID, Magiran, IranMedex, Irandoc were searched. All the stages of review were conducted based on PRISMA. RoB and ROBINS‐I were used to assess the risk of bias of the primary studies. Results Thirty‐nine studies, with a total of 18 494 participants, met the inclusion criteria. Of these, 22 were RCTs, 17 were non‐RCTs. Effective interventions were reported in 15 RCTs and 14 non‐RCTs. Four main strategies of interventions were identified, consisting of motivation and support; monitoring and feedback; information and education; and activity. Thirteen different behavior change techniques (BCT) were identified with self‐determination theory (SDT) being the most frequent behavior change theory used. Conclusion It seems that a multi‐strategy intervention that one of the strategies of which is physical activity in the workplace (Activity), the use of behavioral change theories, especially SDT, may be indicative of a more effective intervention. It is recommended that BCTs be considered when designing physical activity interventions.
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Affiliation(s)
- Mozhdeh Ramezani
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Community and Family Medicine Department, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Batool Tayefi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Community and Family Medicine Department, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Zandian
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Neda SoleimanvandiAzar
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Narjes Khalili
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Community and Family Medicine Department, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Parissa Massahikhaleghi
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Community and Family Medicine Department, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Rampisheh
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Community and Family Medicine Department, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Western MJ, Armstrong MEG, Islam I, Morgan K, Jones UF, Kelson MJ. The effectiveness of digital interventions for increasing physical activity in individuals of low socioeconomic status: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2021; 18:148. [PMID: 34753490 PMCID: PMC8576797 DOI: 10.1186/s12966-021-01218-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 10/20/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Digital technologies such as wearables, websites and mobile applications are increasingly used in interventions targeting physical activity (PA). Increasing access to such technologies makes an attractive prospect for helping individuals of low socioeconomic status (SES) in becoming more active and healthier. However, little is known about their effectiveness in such populations. The aim of this systematic review was to explore whether digital interventions were effective in promoting PA in low SES populations, whether interventions are of equal benefit to higher SES individuals and whether the number or type of behaviour change techniques (BCTs) used in digital PA interventions was associated with intervention effects. METHODS A systematic search strategy was used to identify eligible studies from MEDLINE, Embase, PsycINFO, Web of Science, Scopus and The Cochrane Library, published between January 1990 and March 2020. Randomised controlled trials, using digital technology as the primary intervention tool, and a control group that did not receive any digital technology-based intervention were included, provided they had a measure of PA as an outcome. Lastly, studies that did not have any measure of SES were excluded from the review. Risk of Bias was assessed using the Cochrane Risk of Bias tool version 2. RESULTS Of the 14,589 records initially identified, 19 studies were included in the final meta-analysis. Using random-effects models, in low SES there was a standardised mean difference (SMD (95%CI)) in PA between intervention and control groups of 0.06 (- 0.08,0.20). In high SES the SMD was 0.34 (0.22,0.45). Heterogeneity was modest in both low (I2 = 0.18) and high (I2 = 0) SES groups. The studies used a range of digital technologies and BCTs in their interventions, but the main findings were consistent across all of the sub-group analyses (digital interventions with a PA only focus, country, chronic disease, and duration of intervention) and there was no association with the number or type of BCTs. DISCUSSION Digital interventions targeting PA do not show equivalent efficacy for people of low and high SES. For people of low SES, there is no evidence that digital PA interventions are effective, irrespective of the behaviour change techniques used. In contrast, the same interventions in high SES participants do indicate effectiveness. To reduce inequalities and improve effectiveness, future development of digital interventions aimed at improving PA must make more effort to meet the needs of low SES people within the target population.
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Affiliation(s)
- Max J. Western
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY UK
| | - Miranda E. G. Armstrong
- Centre for Exercise, Nutrition and Health Science, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK
| | - Ishrat Islam
- PRIME Centre Wales, School of Medicine, Cardiff University, Cardiff, CF14 4YS UK
| | - Kelly Morgan
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, CF10 3BD UK
| | - Una F. Jones
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, CF14 4XN UK
| | - Mark J. Kelson
- Department of Mathematics/Institute of Data Science and Artificial Intelligence, University of Exeter, Laver Building, Exeter, EX4 4QE UK
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Haverinen EH, Elonheimo HM, Tolonen HK, Jousilahti PJ, Wennman HJC. The effects of long-term physical activity interventions in communities: Scoping review in the Nordic countries. Scand J Public Health 2021; 50:272-286. [PMID: 34176347 PMCID: PMC8873971 DOI: 10.1177/14034948211020599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Aims: Physical activity (PA) is an important part of maintaining good overall health. Currently, the number of insufficiently physically active adults and children is alarmingly high worldwide. To tackle the challenge, several interventions have been conducted, however, current knowledge on intervention effectiveness is still inconclusive. This scoping review aimed to summarize the effects of long-term PA interventions across all age groups in the Nordic countries. Methods: A scoping review was conducted by including all age groups and interventions lasting more than 12 months. The aims of the interventions had to focus on increasing PA and/or fitness. The Behaviour Change Wheel framework was used to describe components of the intervention functions. Results: Initially, 1937 studies were identified. Twelve intervention studies fulfilled the inclusion criteria and were included in the analysis. From the included studies, seven focused on children and/or their parents and five on working-age adult populations. Most of the studies built on theoretical backgrounds and included several behaviour change functions. A hindering factor for synthesis was variation in measurement methods: both subjective and objective outcome measures were reported. Among all age groups, intervention effects on PA were modest. Conclusions: There was no clear evidence of increased PA or fitness from long-term interventions in communities. However, even small improvements in PA are important for increasing PA at a population level and enhancing public health. More research is required for evidence-based community and public health planning.
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Affiliation(s)
- Elsi H Haverinen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna M Elonheimo
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna K Tolonen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Pekka J Jousilahti
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Heini J C Wennman
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
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Mönninghoff A, Kramer JN, Hess AJ, Ismailova K, Teepe GW, Tudor Car L, Müller-Riemenschneider F, Kowatsch T. Long-term Effectiveness of mHealth Physical Activity Interventions: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res 2021; 23:e26699. [PMID: 33811021 PMCID: PMC8122296 DOI: 10.2196/26699] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/24/2021] [Accepted: 04/02/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) interventions can increase physical activity (PA); however, their long-term impact is not well understood. OBJECTIVE The primary aim of this study is to understand the immediate and long-term effects of mHealth interventions on PA. The secondary aim is to explore potential effect moderators. METHODS We performed this study according to the Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched PubMed, the Cochrane Library, SCOPUS, and PsycINFO in July 2020. Eligible studies included randomized controlled trials of mHealth interventions targeting PA as a primary outcome in adults. Eligible outcome measures were walking, moderate-to-vigorous physical activity (MVPA), total physical activity (TPA), and energy expenditure. Where reported, we extracted data for 3 time points (ie, end of intervention, follow-up ≤6 months, and follow-up >6 months). To explore effect moderators, we performed subgroup analyses by population, intervention design, and control group type. Results were summarized using random effects meta-analysis. Risk of bias was assessed using the Cochrane Collaboration tool. RESULTS Of the 2828 identified studies, 117 were included. These studies reported on 21,118 participants with a mean age of 52.03 (SD 14.14) years, of whom 58.99% (n=12,459) were female. mHealth interventions significantly increased PA across all the 4 outcome measures at the end of intervention (walking standardized mean difference [SMD] 0.46, 95% CI 0.36-0.55; P<.001; MVPA SMD 0.28, 95% CI 0.21-0.35; P<.001; TPA SMD 0.34, 95% CI 0.20-0.47; P<.001; energy expenditure SMD 0.44, 95% CI 0.13-0.75; P=.01). Only 33 studies reported short-term follow-up measurements, and 8 studies reported long-term follow-up measurements in addition to end-of-intervention results. In the short term, effects were sustained for walking (SMD 0.26, 95% CI 0.09-0.42; P=.002), MVPA (SMD 0.20, 95% CI 0.05-0.35; P=.008), and TPA (SMD 0.53, 95% CI 0.13-0.93; P=.009). In the long term, effects were also sustained for walking (SMD 0.25, 95% CI 0.10-0.39; P=.001) and MVPA (SMD 0.19, 95% CI 0.11-0.27; P<.001). We found the study population to be an effect moderator, with higher effect scores in sick and at-risk populations. PA was increased both in scalable and nonscalable mHealth intervention designs and regardless of the control group type. The risk of bias was rated high in 80.3% (94/117) of the studies. Heterogeneity was significant, resulting in low to very low quality of evidence. CONCLUSIONS mHealth interventions can foster small to moderate increases in PA. The effects are maintained long term; however, the effect size decreases over time. The results encourage using mHealth interventions in at-risk and sick populations and support the use of scalable mHealth intervention designs to affordably reach large populations. However, given the low evidence quality, further methodologically rigorous studies are warranted to evaluate the long-term effects.
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Affiliation(s)
- Annette Mönninghoff
- Institute for Customer Insight, University of St. Gallen, St. Gallen, Switzerland
- Institute for Mobility, University of St. Gallen, St. Gallen, Switzerland
| | - Jan Niklas Kramer
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
- CSS Insurance, Lucerne, Switzerland
| | - Alexander Jan Hess
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Kamila Ismailova
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Gisbert W Teepe
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- School of Public Health, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | | | - Tobias Kowatsch
- Centre for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore-ETH Centre, Singapore, Singapore
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12
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Moulin MS, Truelove S, Burke SM, Irwin JD. Sedentary time among undergraduate students: A systematic review. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:237-244. [PMID: 31518211 DOI: 10.1080/07448481.2019.1661422] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/10/2019] [Accepted: 08/15/2019] [Indexed: 06/10/2023]
Abstract
To systematically review and synthesize all relevant literature to assess the range of average daily sedentary time (ST) of undergraduate students enrolled in university and college programs across the world. Methods: Published, peer-reviewed articles were included if they: (a) were in English; (b) had a study population that consisted entirely of undergraduate students; (c) reported a daily or weekly ST for undergraduate students; and (d) included a measure of ST using a valid sedentary behavior questionnaire or accelerometers. Results: Twenty-three studies were included in the review. A wide range of ST (0.75 to 14.35 hours per day) was reported. Mean ST as measured by domain-specific questionnaires and accelerometers was 11.10 hours per day and 10.69 hours per day, respectively. Conclusion: Findings suggest that some undergraduate students participate in high levels of ST. Additional research, as well as interventions focused on reducing ST among postsecondary students, are needed.
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Affiliation(s)
- Marc S Moulin
- Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada
| | - Stephanie Truelove
- Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada
| | - Shauna M Burke
- Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada
| | - Jennifer D Irwin
- Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada
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13
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Freak-Poli RLA, Cumpston M, Albarqouni L, Clemes SA, Peeters A. Workplace pedometer interventions for increasing physical activity. Cochrane Database Syst Rev 2020; 7:CD009209. [PMID: 32700325 PMCID: PMC7389933 DOI: 10.1002/14651858.cd009209.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The World Health Organization (WHO) recommends undertaking 150 minutes of moderate-intensity physical activity per week, but most people do not. Workplaces present opportunities to influence behaviour and encourage physical activity, as well as other aspects of a healthy lifestyle. A pedometer is an inexpensive device that encourages physical activity by providing feedback on daily steps, although pedometers are now being largely replaced by more sophisticated devices such as accelerometers and Smartphone apps. For this reason, this is the final update of this review. OBJECTIVES To assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving long-term health outcomes. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Occupational Safety and Health (OSH) UPDATE, Web of Science, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform from the earliest record to December 2016. We also consulted the reference lists of included studies and contacted study authors to identify additional records. We updated this search in May 2019, but these results have not yet been incorporated. One more study, previously identified as an ongoing study, was placed in 'Studies awaiting classification'. SELECTION CRITERIA We included randomised controlled trials (RCTs) of workplace interventions with a pedometer component for employed adults, compared to no or minimal interventions, or to alternative physical activity interventions. We excluded athletes and interventions using accelerometers. The primary outcome was physical activity. Studies were excluded if physical activity was not measured. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. When studies presented more than one physical activity measure, we used a pre-specified list of preferred measures to select one measure and up to three time points for analysis. When possible, follow-up measures were taken after completion of the intervention to identify lasting effects once the intervention had ceased. Given the diversity of measures found, we used ratios of means (RoMs) as standardised effect measures for physical activity. MAIN RESULTS We included 14 studies, recruiting a total of 4762 participants. These studies were conducted in various high-income countries and in diverse workplaces (from offices to physical workplaces). Participants included both healthy populations and those at risk of chronic disease (e.g. through inactivity or overweight), with a mean age of 41 years. All studies used multi-component health promotion interventions. Eleven studies used minimal intervention controls, and four used alternative physical activity interventions. Intervention duration ranged from one week to two years, and follow-up after completion of the intervention ranged from three to ten months. Most studies and outcomes were rated at overall unclear or high risk of bias, and only one study was rated at low risk of bias. The most frequent concerns were absence of blinding and high rates of attrition. When pedometer interventions are compared to minimal interventions at follow-up points at least one month after completion of the intervention, pedometers may have no effect on physical activity (6 studies; very low-certainty evidence; no meta-analysis due to very high heterogeneity), but the effect is very uncertain. Pedometers may have effects on sedentary behaviour and on quality of life (mental health component), but these effects were very uncertain (1 study; very low-certainty evidence). Pedometer interventions may slightly reduce anthropometry (body mass index (BMI) -0.64, 95% confidence interval (CI) -1.45 to 0.18; 3 studies; low-certainty evidence). Pedometer interventions probably had little to no effect on blood pressure (systolic: -0.08 mmHg, 95% CI -3.26 to 3.11; 2 studies; moderate-certainty evidence) and may have reduced adverse effects (such as injuries; from 24 to 10 per 100 people in populations experiencing relatively frequent events; odds ratio (OR) 0.50, 95% CI 0.30 to 0.84; low-certainty evidence). No studies compared biochemical measures or disease risk scores at follow-up after completion of the intervention versus a minimal intervention. Comparison of pedometer interventions to alternative physical activity interventions at follow-up points at least one month after completion of the intervention revealed that pedometers may have an effect on physical activity, but the effect is very uncertain (1 study; very low-certainty evidence). Sedentary behaviour, anthropometry (BMI or waist circumference), blood pressure (systolic or diastolic), biochemistry (low-density lipoprotein (LDL) cholesterol, total cholesterol, or triglycerides), disease risk scores, quality of life (mental or physical health components), and adverse effects at follow-up after completion of the intervention were not compared to an alternative physical activity intervention. Some positive effects were observed immediately at completion of the intervention periods, but these effects were not consistent, and overall certainty of evidence was insufficient to assess the effectiveness of workplace pedometer interventions. AUTHORS' CONCLUSIONS Exercise interventions can have positive effects on employee physical activity and health, although current evidence is insufficient to suggest that a pedometer-based intervention would be more effective than other options. It is important to note that over the past decade, technological advancement in accelerometers as commercial products, often freely available in Smartphones, has in many ways rendered the use of pedometers outdated. Future studies aiming to test the impact of either pedometers or accelerometers would likely find any control arm highly contaminated. Decision-makers considering allocating resources to large-scale programmes of this kind should be cautious about the expected benefits of incorporating a pedometer and should note that these effects may not be sustained over the longer term. Future studies should be designed to identify the effective components of multi-component interventions, although pedometers may not be given the highest priority (especially considering the increased availability of accelerometers). Approaches to increase the sustainability of intervention effects and behaviours over a longer term should be considered, as should more consistent measures of physical activity and health outcomes.
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Affiliation(s)
- Rosanne LA Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Miranda Cumpston
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Loai Albarqouni
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Stacy A Clemes
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Anna Peeters
- Institute for Health Transformation, Deakin University, Geelong, Australia
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Mathew V, Akkilagunta S, Kumar D, Lakshminarayanan S, Kar SS. Effectiveness of Pedometer-Based Walking Program to Improve Physical Activity of Workers in a Software Industry: An Experimental Study. Int J Prev Med 2019; 10:49. [PMID: 31143423 PMCID: PMC6528552 DOI: 10.4103/ijpvm.ijpvm_378_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 01/22/2018] [Indexed: 11/17/2022] Open
Abstract
Background: Workplace acts as an efficient target for health promotion activities. Pedometer can act as a motivator and monitor of physical activity. Aims: The aim of the study was to assess the effect of pedometer usage in increasing physical activity and the level of adherence among employees of a software company in Puducherry. Methods: An interventional study was conducted with a prepost design. A single group of software company employees (n = 46), age ≥30 years selected by simple random sampling, was included in the study. Intervention consisted of health education program on physical activity, goal setting, and instructions regarding the use of pedometers for 1 week. Physical activity levels were measured at baseline and endline using global physical activity questionnaire. Results: Out of the 46 participants, 93% of the participants used the pedometer for at least 6 days. The difference between maximum observed step count during the week (median 9834 steps) and at baseline (6963 steps) was significant. Overall, 93.5% found pedometers to be useful for improving physical activity. Proportion of individuals with adequate physical activity based on Metabolic equivalents (MET) minutes increased from 41.3% (n = 19) at baseline to 69.6% at endline (n = 32) (P = 0.004). Conclusions: This study shows that a pedometer-driven walking intervention in the workplace setting is feasible and effective in increasing physical activity over a short term. Further research is required to test the effect of supportive strategies and long-term effectiveness of pedometer use.
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Affiliation(s)
- Varna Mathew
- Department of Preventive and Social Medicine, JIPMER, Puducherry, India
| | - Sujiv Akkilagunta
- Department of Preventive and Social Medicine, JIPMER, Puducherry, India
| | - Dinesh Kumar
- Department of Preventive and Social Medicine, JIPMER, Puducherry, India
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15
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Howlett N, Trivedi D, Troop NA, Chater AM. Are physical activity interventions for healthy inactive adults effective in promoting behavior change and maintenance, and which behavior change techniques are effective? A systematic review and meta-analysis. Transl Behav Med 2019; 9:147-157. [PMID: 29506209 PMCID: PMC6305562 DOI: 10.1093/tbm/iby010] [Citation(s) in RCA: 231] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Physical inactivity and sedentary behavior relate to poor health outcomes independently. Healthy inactive adults are a key target population for prevention. This systematic review and meta-analysis aimed to evaluate the effectiveness of physical activity and/or sedentary behavior interventions, measured postintervention (behavior change) and at follow-up (behavior change maintenance), to identify behavior change techniques (BCT) within, and report on fidelity. Included studies were randomized controlled trials, targeting healthy inactive adults, aiming to change physical activity and/or sedentary behavior, with a minimum postintervention follow-up of 6 months, using 16 databases from 1990. Two reviewers independently coded risk of bias, the "Template for Intervention Description and Replication" (TIDieR) checklist, and BCTs. Twenty-six studies were included; 16 pooled for meta-analysis. Physical activity interventions were effective at changing behavior (d = 0.32, 95% confidence intervals = 0.16-0.48, n = 2,346) and maintaining behavior change after 6 months or more (d = 0.21, 95% confidence intervals = 0.12-0.30, n = 2,190). Sedentary behavior interventions (n = 2) were not effective. At postintervention, physical activity intervention effectiveness was associated with the BCTs "Biofeedback," "Demonstration of the behavior," "Behavior practice/rehearsal," and "Graded tasks." At follow-up, effectiveness was associated with using "Action planning," "Instruction on how to perform the behavior," "Prompts/cues," "Behavior practice/rehearsal," "Graded tasks," and "Self-reward." Fidelity was only documented in one study. Good evidence was found for behavior change maintenance effects in healthy inactive adults, and underlying BCTs. This review provides translational evidence to improve research, intervention design, and service delivery in physical activity interventions, while highlighting the lack of fidelity measurement.
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Affiliation(s)
- Neil Howlett
- Department of Psychology and Sport Sciences, University of Hertfordshire, Herts AL, UK
| | - Daksha Trivedi
- Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield, Herts AL, UK
| | - Nicholas A Troop
- Department of Psychology and Sport Sciences, University of Hertfordshire, Herts AL, UK
| | - Angel Marie Chater
- Department of Psychology and Sport Sciences, University of Hertfordshire, Herts AL, UK
- Institute for Sport and Physical Activity Research (ISPAR), School of Sport Science and Physical Activity, Faculty of Education and Sport, University of Bedfordshire, Bedford, UK
- UCL School of Pharmacy, Centre for Behavioural Medicine, Research Department of Practice and Policy, University College London, London, UK
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16
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Wolfenden L, Goldman S, Stacey FG, Grady A, Kingsland M, Williams CM, Wiggers J, Milat A, Rissel C, Bauman A, Farrell MM, Légaré F, Ben Charif A, Zomahoun HTV, Hodder RK, Jones J, Booth D, Parmenter B, Regan T, Yoong SL. Strategies to improve the implementation of workplace-based policies or practices targeting tobacco, alcohol, diet, physical activity and obesity. Cochrane Database Syst Rev 2018; 11:CD012439. [PMID: 30480770 PMCID: PMC6362433 DOI: 10.1002/14651858.cd012439.pub2] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Given the substantial period of time adults spend in their workplaces each day, these provide an opportune setting for interventions addressing modifiable behavioural risk factors for chronic disease. Previous reviews of trials of workplace-based interventions suggest they can be effective in modifying a range of risk factors including diet, physical activity, obesity, risky alcohol use and tobacco use. However, such interventions are often poorly implemented in workplaces, limiting their impact on employee health. Identifying strategies that are effective in improving the implementation of workplace-based interventions has the potential to improve their effects on health outcomes. OBJECTIVES To assess the effects of strategies for improving the implementation of workplace-based policies or practices targeting diet, physical activity, obesity, tobacco use and alcohol use.Secondary objectives were to assess the impact of such strategies on employee health behaviours, including dietary intake, physical activity, weight status, and alcohol and tobacco use; evaluate their cost-effectiveness; and identify any unintended adverse effects of implementation strategies on workplaces or workplace staff. SEARCH METHODS We searched the following electronic databases on 31 August 2017: CENTRAL; MEDLINE; MEDLINE In Process; the Campbell Library; PsycINFO; Education Resource Information Center (ERIC); Cumulative Index to Nursing and Allied Health Literature (CINAHL); and Scopus. We also handsearched all publications between August 2012 and September 2017 in two speciality journals: Implementation Science and Journal of Translational Behavioral Medicine. We conducted searches up to September 2017 in Dissertations and Theses, the WHO International Clinical Trials Registry Platform, and the US National Institutes of Health Registry. We screened the reference lists of included trials and contacted authors to identify other potentially relevant trials. We also consulted experts in the field to identify other relevant research. SELECTION CRITERIA Implementation strategies were defined as strategies specifically employed to improve the implementation of health interventions into routine practice within specific settings. We included any trial with a parallel control group (randomised or non-randomised) and conducted at any scale that compared strategies to support implementation of workplace policies or practices targeting diet, physical activity, obesity, risky alcohol use or tobacco use versus no intervention (i.e. wait-list, usual practice or minimal support control) or another implementation strategy. Implementation strategies could include those identified by the Effective Practice and Organisation of Care (EPOC) taxonomy such as quality improvement initiatives and education and training, as well as other strategies. Implementation interventions could target policies or practices directly instituted in the workplace environment, as well as workplace-instituted efforts encouraging the use of external health promotion services (e.g. gym membership subsidies). DATA COLLECTION AND ANALYSIS Review authors working in pairs independently performed citation screening, data extraction and 'Risk of bias' assessment, resolving disagreements via consensus or a third reviewer. We narratively synthesised findings for all included trials by first describing trial characteristics, participants, interventions and outcomes. We then described the effect size of the outcome measure for policy or practice implementation. We performed meta-analysis of implementation outcomes for trials of comparable design and outcome. MAIN RESULTS We included six trials, four of which took place in the USA. Four trials employed randomised controlled trial (RCT) designs. Trials were conducted in workplaces from the manufacturing, industrial and services-based sectors. The sample sizes of workplaces ranged from 12 to 114. Workplace policies and practices targeted included: healthy catering policies; point-of-purchase nutrition labelling; environmental supports for healthy eating and physical activity; tobacco control policies; weight management programmes; and adherence to guidelines for staff health promotion. All implementation interventions utilised multiple implementation strategies, the most common of which were educational meetings, tailored interventions and local consensus processes. Four trials compared an implementation strategy intervention with a no intervention control, one trial compared different implementation interventions, and one three-arm trial compared two implementation strategies with each other and a control. Four trials reported a single implementation outcome, whilst the other two reported multiple outcomes. Investigators assessed outcomes using surveys, audits and environmental observations. We judged most trials to be at high risk of performance and detection bias and at unclear risk of reporting and attrition bias.Of the five trials comparing implementation strategies with a no intervention control, pooled analysis was possible for three RCTs reporting continuous score-based measures of implementation outcomes. The meta-analysis found no difference in standardised effects (standardised mean difference (SMD) -0.01, 95% CI -0.32 to 0.30; 164 participants; 3 studies; low certainty evidence), suggesting no benefit of implementation support in improving policy or practice implementation, relative to control. Findings for other continuous or dichotomous implementation outcomes reported across these five trials were mixed. For the two non-randomised trials examining comparative effectiveness, both reported improvements in implementation, favouring the more intensive implementation group (very low certainty evidence). Three trials examined the impact of implementation strategies on employee health behaviours, reporting mixed effects for diet and weight status (very low certainty evidence) and no effect for physical activity (very low certainty evidence) or tobacco use (low certainty evidence). One trial reported an increase in absolute workplace costs for health promotion in the implementation group (low certainty evidence). None of the included trials assessed adverse consequences. Limitations of the review included the small number of trials identified and the lack of consistent terminology applied in the implementation science field, which may have resulted in us overlooking potentially relevant trials in the search. AUTHORS' CONCLUSIONS Available evidence regarding the effectiveness of implementation strategies for improving implementation of health-promoting policies and practices in the workplace setting is sparse and inconsistent. Low certainty evidence suggests that such strategies may make little or no difference on measures of implementation fidelity or different employee health behaviour outcomes. It is also unclear if such strategies are cost-effective or have potential unintended adverse consequences. The limited number of trials identified suggests implementation research in the workplace setting is in its infancy, warranting further research to guide evidence translation in this setting.
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Affiliation(s)
- Luke Wolfenden
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Sharni Goldman
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
| | - Fiona G Stacey
- University of Newcastle, Hunter Medical Research Institute, Priority Research Centre in Health Behaviour, and Priority Research Centre in Physical Activity and NutritionSchool of Medicine and Public HealthCallaghanNSWAustralia2287
| | - Alice Grady
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Melanie Kingsland
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
| | - Christopher M Williams
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - John Wiggers
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Andrew Milat
- NSW Ministry of HealthCentre for Epidemiology and EvidenceNorth SydneyNSWAustralia2060
- The University of SydneySchool of Public HealthSydneyAustralia
| | - Chris Rissel
- Sydney South West Local Health DistrictOffice of Preventive HealthLiverpoolNSWAustralia2170
| | - Adrian Bauman
- The University of SydneySchool of Public HealthSydneyAustralia
- Sax InstituteThe Australian Prevention Partnership CentreSydneyAustralia
| | - Margaret M Farrell
- US National Cancer InstituteDivision of Cancer Control and Population Sciences/Implementation Sciences Team9609 Medical Center DriveBethesdaMarylandUSA20892
| | - France Légaré
- Université LavalCentre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL‐UL)2525, Chemin de la CanardièreQuebecQuébecCanadaG1J 0A4
| | - Ali Ben Charif
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL‐UL)Université Laval2525, Chemin de la CanardièreQuebecQuebecCanadaG1J 0A4
| | - Hervé Tchala Vignon Zomahoun
- Centre de recherche sur les soins et les services de première ligne ‐ Université LavalHealth and Social Services Systems, Knowledge Translation and Implementation Component of the SPOR‐SUPPORT Unit of Québec2525, Chemin de la CanardièreQuebecQCCanadaG1J 0A4
| | - Rebecca K Hodder
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Jannah Jones
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Debbie Booth
- University of NewcastleAuchmuty LibraryUniversity DriveCallaghanNSWAustralia2308
| | - Benjamin Parmenter
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
| | - Tim Regan
- University of NewcastleThe School of PsychologyCallaghanAustralia
| | - Sze Lin Yoong
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
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Poppe L, Crombez G, De Bourdeaudhuij I, Van der Mispel C, Shadid S, Verloigne M. Experiences and Opinions of Adults with Type 2 Diabetes Regarding a Self-Regulation-Based eHealth Intervention Targeting Physical Activity and Sedentary Behaviour. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15050954. [PMID: 29748460 PMCID: PMC5981993 DOI: 10.3390/ijerph15050954] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/07/2018] [Accepted: 05/07/2018] [Indexed: 11/18/2022]
Abstract
Background: Online interventions targeting a healthy lifestyle in adults with type 2 diabetes are more effective when informed by behaviour change theories. Although these theories provide guidance in developing the content of an intervention, information regarding how to present this content in an engaging way is often lacking. Consequently, incorporating users’ views in the creation of eHealth interventions has become an important target. Methods: Via a qualitative interview study with 21 adults with type 2 diabetes who had completed an online self-regulation-based intervention (‘MyPlan 2.0’), we assessed participants’ opinions regarding the usefulness of the implemented self-regulation techniques, the design of the programme as well as their knowledge regarding physical activity and sedentary behaviour. A directed content analysis was performed to synthesize the interview data. Results: Participants experienced difficulties completing the coping planning component. The simple design of the website was considered helpful, and most participants were aware of the beneficial effects of an active lifestyle. Conclusions: ‘MyPlan 2.0’ was well-accepted by the majority of participants. However, the coping planning component will need to be adapted. Based on these findings, recommendations on how to tailor eHealth interventions to the population of adults with type 2 diabetes have been formulated.
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Affiliation(s)
- Louise Poppe
- Department of Movement and Sports Sciences, Ghent University, 9000 Gent, Belgium.
- Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium.
| | - Geert Crombez
- Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium.
| | | | - Celien Van der Mispel
- Department of Movement and Sports Sciences, Ghent University, 9000 Gent, Belgium.
- Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium.
| | - Samyah Shadid
- Department of Endocrinology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Maïté Verloigne
- Department of Movement and Sports Sciences, Ghent University, 9000 Gent, Belgium.
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Guitar NA, MacDougall A, Connelly DM, Knight E. Fitbit Activity Trackers Interrupt Workplace Sedentary Behavior: A New Application. Workplace Health Saf 2017; 66:218-222. [DOI: 10.1177/2165079917738264] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study investigated whether Fitbit devices can reduce sedentary behavior among employees in the workplace. Participants were asked to wear Fitbits during 8-hour work shifts, 5 days per week, for 8 weeks. They were instructed to stand at least once every 30 minutes throughout the workday. The goal of the study was to determine whether standing once every 30 minutes was a feasible strategy for reducing sedentary workplace behavior. On average, participants completed 36 of 40 workdays using Fitbits. The number of times participants stood during an 8-hour workday averaged 12 stands per day (maximum 16 stands per day). These results indicate that Fitbit technology is effective for recording and tracking interruptions in sitting time; however, to reduce sitting behavior, alternate approaches are required to motivate larger numbers of workers to participate.
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Lambert JD, Greaves CJ, Farrand P, Cross R, Haase AM, Taylor AH. Assessment of fidelity in individual level behaviour change interventions promoting physical activity among adults: a systematic review. BMC Public Health 2017; 17:765. [PMID: 28969669 PMCID: PMC5625828 DOI: 10.1186/s12889-017-4778-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 09/20/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Behaviour change interventions that promote physical activity have major implications for health and well-being. Measuring intervention fidelity is crucial in determining the extent to which an intervention is delivered as intended, therefore increasing scientific confidence about effectiveness. However, we lack a clear overview of how well intervention fidelity is typically assessed in physical activity trials. METHODS A systematic literature search was conducted to identify peer - reviewed physical activity promotion trials that explicitly measured intervention fidelity. Methods used to assess intervention fidelity were categorised, narratively synthesised and critiqued using assessment criteria from NIH Behaviour Change Consortium (BCC) Treatment Fidelity Framework (design, training, delivery, receipt and enactment). RESULTS Twenty eight articles reporting of twenty one studies used a wide variety of approaches to measure intervention fidelity. Delivery was the most common domain of intervention fidelity measured. Approaches used to measure fidelity across all domains varied from researcher coding of observational data (using checklists or scales) to participant self-report measures. There was considerable heterogeneity of methodological approaches to data collection with respect to instruments used, attention to psychometric properties, rater-selection, observational method and sampling strategies. CONCLUSIONS In the field of physical activity interventions, fidelity measurement is highly heterogeneous both conceptually and methodologically. Clearer articulation of the core domains of intervention fidelity, along with appropriate measurement approaches for each domain are needed to improve the methodological quality of fidelity assessment in physical activity interventions. Recommendations are provided on how this situation can be improved.
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Affiliation(s)
- Jeffrey D. Lambert
- University of Exeter Medical School, St Luke’s Campus, Magdalen Road, Exeter, EX1 2LU UK
| | - Colin J. Greaves
- University of Exeter Medical School, St Luke’s Campus, Magdalen Road, Exeter, EX1 2LU UK
| | - Paul Farrand
- Clinical Education, Development and Research (CEDAR); Psychology, University of Exeter, Exeter, EX4 4QG UK
| | - Rosina Cross
- Department for Health, University of Bath, Wessex House 6.9, Claverton, Bath, BA2 7AY UK
| | - Anne M. Haase
- Centre for Exercise, Nutrition and Health Sciences, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK
| | - Adrian H. Taylor
- Plymouth University, N6, ITTC, Tamar Science Park, Plymouth, Devon PL6 8BX UK
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Jirathananuwat A, Pongpirul K. Promoting physical activity in the workplace: A systematic meta-review. J Occup Health 2017; 59:385-393. [PMID: 28740029 PMCID: PMC5635147 DOI: 10.1539/joh.16-0245-ra] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Physically active (PA) people have a lower risk of various diseases, compared to those with sedentary lifestyles. Evidence on the effects of PA promoting programs in the workplace is large, and several systematic reviews (SR) and/or meta-analyses (MA) have been published. However, they have failed to consider factors that could influence interventions. This paper aimed to classify and describe interventions to promote PA in the workplace based on evidence from SR/MA. METHOD A literature search for SR/MA was done using PubMed, Web of Science, and Science Direct (January 2006-February 2015). Quality assessment of SR/MA was performed using AMSTAR. The PRECEDE-PROCEED model was used for classifying the interventions into predisposing, enabling, reinforcing, environment, and policy domains of focus. RESULTS Eleven SR/MA included 220 primary studies, of which 139 (63%) were randomized controlled trials. Of 48 interventions identified, 22 (46%) and 17 (35%) focused on predisposing or enabling employees to have more PA, respectively. Of the 22 predisposing factors, 6 were information delivery, 5 were self-motivation, and 11 were program training. The enabling approaches were 12 instrument resources and 5 health service facilities. The reinforcing approaches were 4 incentive and 3 social support. The remaining interventions focused on the environmental development and policy regulation. CONCLUSIONS This systematic meta-review classified interventions using appropriate framework and described the intervention pattern.
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Affiliation(s)
- Areeya Jirathananuwat
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University.,Community Health Unit, Faculty of Medicine Vajira Hospital, Navamindradhiraj University
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University.,Department of International Health, Johns Hopkins Bloomberg School of Public Health.,Thailand Research Center for Health Services System (TRC-HS), Faculty of Medicine, Chulalongkorn University
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21
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Lydell M, Hildingh C, Söderbom A, Ziegert K. Future challenges for occupational health services can be prevented by proactive collaboration with the companies using the services: a participatory and reflection project. J Multidiscip Healthc 2017; 10:217-225. [PMID: 28579793 PMCID: PMC5449106 DOI: 10.2147/jmdh.s131382] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background There is clearly a need for research in the field of occupational health service (OHS) for applying new perspectives. Proactive collaboration is needed between the OHSs and the companies. The customers of the companies using the services should be able to safeguard themselves from the health problems caused by the work environment through proactive collaboration with the OHSs. Objective The main purpose of this interdisciplinary study was to explore how the stakeholders reflected to create and agree on core values for future challenges in OHS, as seen from the perspectives of OHS professionals and customer companies. Methodology An action research process was conducted. This study was divided into three phases. In phase I, the data were collected from interviews and diaries of interdisciplinary occupational health professionals (n=12). A focus group that sampled the eight managers of the customer companies was also included. In phase II, a questionnaire was developed with 24 questions focusing on examining the future challenges for OHS. The questionnaire was sent to customer companies (n=116). In phase III, a scoping review was undertaken. Results Three categories emerged from the analysis: “Balancing complex situations” clarified the complexity regarding senior employees; “Working with a proactive approach” indicated the need for working with a new proactive approach supporting sustainable health; and “Collaborate internally and externally” showed good relationships between the customer and the OHS, which is a mutual responsibility to both the partners. Conclusion The results outlined that it is necessary to take action to apply new proactive health promotions, with a focus on workplace health promotion. The results also indicated that interventions for senior employees are of importance. This study was done in collaboration with the stakeholders from the occupational health care service center and the managers from the customer companies. The use of a participatory research design, including close collaboration with the participants, allows the researchers to see the challenges.
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Affiliation(s)
- Marie Lydell
- Center of Research on Welfare, Health and Sport (CVHI), School of Social and Health Sciences
| | - Cathrine Hildingh
- Center of Research on Welfare, Health and Sport (CVHI), School of Social and Health Sciences
| | - Arne Söderbom
- Center for Innovation, Entrepreneurship and Learning Research (CIEL), School of Economics, Technology and Science, Halmstad University, Halmstad, Sweden
| | - Kristina Ziegert
- Center of Research on Welfare, Health and Sport (CVHI), School of Social and Health Sciences
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22
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Curbelo Rodríguez R, Zarco Montejo P, Almodóvar González R, Flórez García M, Carmona Ortells L. Barreras y facilitadores para la práctica del ejercicio físico en pacientes con espondiloartritis: estudio cualitativo de grupos focales (EJES-3D). ACTA ACUST UNITED AC 2017; 13:91-96. [DOI: 10.1016/j.reuma.2016.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/26/2016] [Accepted: 03/04/2016] [Indexed: 11/25/2022]
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23
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Reed JL, Prince SA, Elliott CG, Mullen KA, Tulloch HE, Hiremath S, Cotie LM, Pipe AL, Reid RD. Impact of Workplace Physical Activity Interventions on Physical Activity and Cardiometabolic Health Among Working-Age Women: A Systematic Review and Meta-Analysis. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.003516. [PMID: 28228457 DOI: 10.1161/circoutcomes.116.003516] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 01/23/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of death among women in high-income Organization for Economic Co-operation and Development countries. Physical activity is protective for cardiovascular disease. The realities of modern life require working-age women to address work-related, family, and social demands. Few working-age women meet current moderate-to-vigorous-intensity physical activity (MVPA) recommendations. Given that working-age women spend a substantial proportion of their waking hours at work, places of employment may be an opportune and a controlled setting to implement programs, improving MVPA levels and enhancing cardiometabolic health. METHODS AND RESULTS Eight electronic databases were searched to identify all prospective cohort and experimental studies reporting an MVPA outcome of workplace interventions for working-age women (mean age, 18-65 years) in high-income Organization for Economic Co-operation and Development countries. Risk of bias was assessed using the Cochrane risk of bias tool; quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. A qualitative synthesis was performed for all studies, and meta-analyses were conducted where possible. Twenty-four studies met the inclusion criteria; 20 studies were included in the meta-analyses. Workplace interventions significantly increased minutes per week of metabolic equivalents (4 studies; standardized mean differences, 2.07; 95% confidence interval [CI], 1.44 to 2.69), but not minutes per week of MVPA (13 studies; standardized mean differences, 0.38; 95% CI, -0.15 to 0.92) or metabolic equivalents per week (3 studies; standardized mean differences, 0.11; 95% CI, -0.48 to 0.71). Workplace interventions also significantly decreased body mass (7 studies; mean differences, -0.83 kg; 95% CI, -1.64 to -0.02), body mass index (6 studies; mean differences, -0.35 kg/m2; 95% CI, -0.62 to -0.07), low-density lipoprotein (4 studies; mean differences, -0.11 mmol/L; 95% CI, -0.17 to -0.04), and blood glucose (2 studies; mean differences, -0.18 mmol/L; 95% CI, -0.29 to -0.07). These workplace interventions targeting MVPA levels and known beneficial cardiometabolic health sequelae were of lower quality evidence. CONCLUSIONS Workplace interventions variably improve MVPA levels and related cardiometabolic health sequelae of working-age women in high-income Organization for Economic Co-operation and Development countries. Our findings underscore the need for ongoing research in this area but also increased dissemination of the existing programs and knowledge.
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Affiliation(s)
- Jennifer L Reed
- From the Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ontario, Canada (J.L.R., S.A.P., C.G.E., K.-A.M., H.E.T., L.M.C., A.L.P., R.D.R.); and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada (S.H.).
| | - Stephanie A Prince
- From the Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ontario, Canada (J.L.R., S.A.P., C.G.E., K.-A.M., H.E.T., L.M.C., A.L.P., R.D.R.); and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada (S.H.)
| | - Cara G Elliott
- From the Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ontario, Canada (J.L.R., S.A.P., C.G.E., K.-A.M., H.E.T., L.M.C., A.L.P., R.D.R.); and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada (S.H.)
| | - Kerri-Anne Mullen
- From the Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ontario, Canada (J.L.R., S.A.P., C.G.E., K.-A.M., H.E.T., L.M.C., A.L.P., R.D.R.); and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada (S.H.)
| | - Heather E Tulloch
- From the Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ontario, Canada (J.L.R., S.A.P., C.G.E., K.-A.M., H.E.T., L.M.C., A.L.P., R.D.R.); and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada (S.H.)
| | - Swapnil Hiremath
- From the Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ontario, Canada (J.L.R., S.A.P., C.G.E., K.-A.M., H.E.T., L.M.C., A.L.P., R.D.R.); and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada (S.H.)
| | - Lisa M Cotie
- From the Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ontario, Canada (J.L.R., S.A.P., C.G.E., K.-A.M., H.E.T., L.M.C., A.L.P., R.D.R.); and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada (S.H.)
| | - Andrew L Pipe
- From the Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ontario, Canada (J.L.R., S.A.P., C.G.E., K.-A.M., H.E.T., L.M.C., A.L.P., R.D.R.); and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada (S.H.)
| | - Robert D Reid
- From the Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ontario, Canada (J.L.R., S.A.P., C.G.E., K.-A.M., H.E.T., L.M.C., A.L.P., R.D.R.); and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada (S.H.)
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24
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Puhkala J, Kukkonen-Harjula K, Aittasalo M, Mansikkamäki K, Partinen M, Hublin C, Kärmeniemi P, Sallinen M, Olkkonen S, Tokola K, Ojala A, Nygård CH, Fogelholm M. Lifestyle counseling in overweight truck and bus drivers - Effects on dietary patterns and physical activity. Prev Med Rep 2016; 4:435-40. [PMID: 27583202 PMCID: PMC4995529 DOI: 10.1016/j.pmedr.2016.08.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 08/10/2016] [Accepted: 08/12/2016] [Indexed: 11/17/2022] Open
Abstract
UNLABELLED We studied dietary patterns, physical activity (PA), and monthly goal setting in a weight reduction intervention in long-distance professional drivers. The study was conducted in Finland in 2009-2012. Male drivers with waist circumference > 100 cm were randomized to a lifestyle counseling (LIFE, N = 55) and a reference (REF, N = 58) group. During 12 months, LIFE participated in 6 face-to-face and 7 telephone counseling sessions on diet and PA. Dietary patterns were assessed using an index combining food diary and counselor interview, and PA with the number of daily steps using a pedometer. Monthly lifestyle goals, perceived facilitators and barriers, and adverse effects of PA in the LIFE participants were monitored using counselors' log books. Forty-seven (85%) LIFE participants completed the 12-month program. After 12 months, the mean dietary index score improved by 12% (p = 0.002, N = 24), and the number of daily steps increased by 1811 steps (median; p = 0.01, N = 22). The most frequent dietary goals dealt with meal frequency, plate model, and intake of vegetables, fruits, and berries. The most common PA mode was walking. Typical facilitators to reach monthly lifestyle goals were support from family and friends and ailment prevention; typical barriers were working schedules and ailments. Adverse effects, most commonly musculoskeletal pain, occurred among 83% of the LIFE participants. Positive changes in lifestyle habits were observed during counseling. Monthly lifestyle counseling combining face-to-face and phone contacts seemed appropriate to long-distance drivers. Barriers for reaching lifestyle changes, and adverse effects of PA were common and need to be addressed when planning counseling. TRIAL REGISTRATION Clinical Trials NCT00893646.
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Affiliation(s)
- Jatta Puhkala
- UKK Institute for Health Promotion Research, Tampere, Finland
| | | | - Minna Aittasalo
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Kirsi Mansikkamäki
- UKK Institute for Health Promotion Research, Tampere, Finland
- Tampere University of Applied Sciences, Tampere, Finland
| | - Markku Partinen
- Vitalmed Sleep Clinic and Research Centre, Helsinki, Finland
| | | | - Paula Kärmeniemi
- Rehabilitation, South Karelia, Social and Health Care District, Lappeenranta, Finland
| | - Mikael Sallinen
- Finnish Institute of Occupational Health, Helsinki, Finland
- Agora Center, University of Jyväskylä, Jyväskylä, Finland
| | - Seppo Olkkonen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Kari Tokola
- UKK Institute for Health Promotion Research, Tampere, Finland
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Anna Ojala
- UKK Institute for Health Promotion Research, Tampere, Finland
| | | | - Mikael Fogelholm
- Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland
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25
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Brakenridge CL, Fjeldsoe BS, Young DC, Winkler EAH, Dunstan DW, Straker LM, Healy GN. Evaluating the effectiveness of organisational-level strategies with or without an activity tracker to reduce office workers' sitting time: a cluster-randomised trial. Int J Behav Nutr Phys Act 2016; 13:115. [PMID: 27814738 PMCID: PMC5097432 DOI: 10.1186/s12966-016-0441-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 10/26/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Office workers engage in high levels of sitting time. Effective, context-specific, and scalable strategies are needed to support widespread sitting reduction. This study aimed to evaluate organisational-support strategies alone or in combination with an activity tracker to reduce sitting in office workers. METHODS From one organisation, 153 desk-based office workers were cluster-randomised (by team) to organisational support only (e.g., manager support, emails; 'Group ORG', 9 teams, 87 participants), or organisational support plus LUMOback activity tracker ('Group ORG + Tracker', 9 teams, 66 participants). The waist-worn tracker provided real-time feedback and prompts on sitting and posture. ActivPAL3 monitors were used to ascertain primary outcomes (sitting time during work- and overall hours) and other activity outcomes: prolonged sitting time (≥30 min bouts), time between sitting bouts, standing time, stepping time, and number of steps. Health and work outcomes were assessed by questionnaire. Changes within each group (three- and 12 months) and differences between groups were analysed by linear mixed models. Missing data were multiply imputed. RESULTS At baseline, participants (46 % women, 23-58 years) spent (mean ± SD) 74.3 ± 9.7 % of their workday sitting, 17.5 ± 8.3 % standing and 8.1 ± 2.7 % stepping. Significant (p < 0.05) reductions in sitting time (both work and overall) were observed within both groups, but only at 12 months. For secondary activity outcomes, Group ORG significantly improved in work prolonged sitting, time between sitting bouts and standing time, and overall prolonged sitting time (12 months), and in overall standing time (three- and 12 months); while Group ORG + Tracker, significantly improved in work prolonged sitting, standing, stepping and overall standing time (12 months). Adjusted for confounders, the only significant between-group differences were a greater stepping time and step count for Group ORG + Tracker relative to Group ORG (+20.6 min/16 h day, 95 % CI: 3.1, 38.1, p = 0.021; +846.5steps/16 h day, 95 % CI: 67.8, 1625.2, p = 0.033) at 12 months. Observed changes in health and work outcomes were small and not statistically significant. CONCLUSIONS Organisational-support strategies with or without an activity tracker resulted in improvements in sitting, prolonged sitting and standing; adding a tracker enhanced stepping changes. Improvements were most evident at 12 months, suggesting the organisational-support strategies may have taken time to embed within the organisation. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry: ACTRN12614000252617 . Registered 10 March 2014.
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Affiliation(s)
- C. L. Brakenridge
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - B. S. Fjeldsoe
- School of Public Health, The University of Queensland, Brisbane, Australia
| | | | - E. A. H. Winkler
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - D. W. Dunstan
- School of Public Health, The University of Queensland, Brisbane, Australia
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
- Department of Medicine, Monash University, Melbourne, Australia
- School of Sport Science, Exercise and Health, The University of Western Australia, Perth, Australia
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - L. M. Straker
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - G. N. Healy
- School of Public Health, The University of Queensland, Brisbane, Australia
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
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Chu AHY, Ng SHX, Tan CS, Win AM, Koh D, Müller-Riemenschneider F. A systematic review and meta-analysis of workplace intervention strategies to reduce sedentary time in white-collar workers. Obes Rev 2016; 17:467-81. [PMID: 26990220 DOI: 10.1111/obr.12388] [Citation(s) in RCA: 155] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/28/2015] [Accepted: 01/14/2016] [Indexed: 12/31/2022]
Abstract
Prolonged sedentary behaviour has been associated with various detrimental health risks. Workplace sitting is particularly important, providing it occupies majority of total daily sedentary behaviour among desk-based employees. The aim of this systematic review and meta-analysis was to examine the effectiveness of workplace interventions overall, and according to different intervention strategies (educational/behavioural, environmental and multi-component interventions) for reducing sitting among white-collar working adults. Articles published through December 2015 were identified in five online databases and manual searches. Twenty-six controlled intervention studies published between 2003 and 2015 of 4568 working adults were included. All 26 studies were presented qualitatively, and 21 studies with a control group without any intervention were included in the meta-analysis. The pooled intervention effect showed a significant workplace sitting reduction of -39.6 min/8-h workday (95% confidence interval [CI]: -51.7, -27.5), favouring the intervention group. Multi-component interventions reported the greatest workplace sitting reduction (-88.8 min/8-h workday; 95% CI: -132.7, -44.9), followed by environmental (-72.8 min/8-h workday; 95% CI: -104.9, -40.6) and educational/behavioural strategies -15.5 min/8-h workday (95% CI:-22.9,-8.2). Our study found consistent evidence for intervention effectiveness in reducing workplace sitting, particularly for multi-component and environmental strategies. Methodologically rigorous studies using standardized and objectively determined outcomes are warranted. © 2016 World Obesity.
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Affiliation(s)
- A H Y Chu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - S H X Ng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - C S Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - A M Win
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - D Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei
| | - F Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany
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McEwan D, Harden SM, Zumbo BD, Sylvester BD, Kaulius M, Ruissen GR, Dowd AJ, Beauchamp MR. The effectiveness of multi-component goal setting interventions for changing physical activity behaviour: a systematic review and meta-analysis. Health Psychol Rev 2015; 10:67-88. [DOI: 10.1080/17437199.2015.1104258] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Burke LE, Ma J, Azar KMJ, Bennett GG, Peterson ED, Zheng Y, Riley W, Stephens J, Shah SH, Suffoletto B, Turan TN, Spring B, Steinberger J, Quinn CC. Current Science on Consumer Use of Mobile Health for Cardiovascular Disease Prevention: A Scientific Statement From the American Heart Association. Circulation 2015; 132:1157-213. [PMID: 26271892 PMCID: PMC7313380 DOI: 10.1161/cir.0000000000000232] [Citation(s) in RCA: 372] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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29
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Qiu S, Cai X, Ju C, Sun Z, Yin H, Zügel M, Otto S, Steinacker JM, Schumann U. Step Counter Use and Sedentary Time in Adults: A Meta-Analysis. Medicine (Baltimore) 2015; 94:e1412. [PMID: 26334900 PMCID: PMC4616497 DOI: 10.1097/md.0000000000001412] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Although step counters are increasingly being used in walking programmes to promote sedentary behavior changes in adults, their effectiveness remains unknown. The aim of this meta-analysis of randomized controlled trials (RCTs) was to assess the effectiveness of step counter use in reducing sedentary time among adults.English-language RCTs from 3 databases were searched up to December 2014. Studies were included if they evaluated the effects of step counter use in adult populations and reported outcomes in sedentary time. Summary estimates (Cohen d with 95% confidence intervals [CIs]) were pooled using a random-effects model. Subgroup analyses and random-effects meta-regression analyses based on the characteristics of participants or interventions were conducted to explore their associations with sedentary time changes.Fifteen RCTs with a total sample size of 3262 adults were included. Step counter use was associated with a small but significant overall effect in reducing sedentary time (d = -0.20, 95% CI -0.33 to -0.07), equating to a reduction in sedentary time of ~23 min/d compared with controls. Subgroup analyses showed that step counter use with a step goal was associated with significantly reduced sedentary time (d =- 0.32, 95% CI -0.53 to -0.11), whereas without, it had only a trend. A greater reduction in sedentary time was observed among step counter users employing objective methods than those employing subjective methods for measurement (P = 0.03). Effects of covariates on sedentary time changes were generally unclear.Step counter use is associated with reduced sedentary time among adults. Future studies are required to specify the step goal use and to employ objective as well as subjective methods for measuring both total and domain-specific sedentary time.
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Affiliation(s)
- Shanhu Qiu
- From the Department of Endocrinology (SQ, XC, CJ, ZS, HY), Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, P.R. China; and Department of Internal Medicine II (HY, MZ, SO, JMS, US), Division of Sports and Rehabilitation Medicine, Ulm University, Ulm, Germany
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Mansi S, Milosavljevic S, Tumilty S, Hendrick P, Higgs C, Baxter DG. 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. BMC Public Health 2015; 15:410. [PMID: 25895747 PMCID: PMC4431031 DOI: 10.1186/s12889-015-1736-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 04/07/2015] [Indexed: 12/16/2022] Open
Abstract
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.
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Affiliation(s)
- Suliman Mansi
- School of Physiotherapy, University of Otago, Dunedin, New Zealand.
| | - Stephan Milosavljevic
- School of Physiotherapy, University of Saskatchewan, 1121 College Drive, Saskatoon, SK, S7N 0W3, Canada.
| | - Steve Tumilty
- School of Physiotherapy, University of Otago, Dunedin, New Zealand.
| | - Paul Hendrick
- Division of Physiotherapy Education, The University of Nottingham, Nottingham, NG5, UK.
| | - Chris Higgs
- School of Physiotherapy, University of Otago, Dunedin, New Zealand.
| | - David G Baxter
- School of Physiotherapy, University of Otago, Dunedin, New Zealand.
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Anthony D, Dyson PA, Lv J, Thankappan KR, Fernández MT, Matthews DR. Reducing Health Risk Factors in Workplaces of Low and Middle-Income Countries. Public Health Nurs 2015; 32:478-87. [PMID: 25801204 DOI: 10.1111/phn.12189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To reduce risk factors in workplace settings in low- and middle-income countries. DESIGN AND SAMPLE Workplace interventions were utilized as part of the Community Interventions for Health program, a nonrandomized, controlled study undertaken in three communities in China, India, and Mexico. Exactly, 45 industrial, 82 health and 101 school workplace settings with a target population of 15,726. Two independent cross-sectional surveys of workers were conducted at baseline and follow-up, after 18-24 months of intervention activities. MEASURES Culturally appropriate interventions to reduce tobacco use, increase physical activity, and improve dietary intake were delivered in the intervention areas. RESULTS Exactly, 12,136 adults completed surveys at baseline, and 9,786 at follow-up. In the intervention group, the prevalence of tobacco use reduced significantly in men (-6.0%, p < .001) and the proportion eating five portions of fruit and vegetables daily increased (+6.9%, p < .001) compared with the control group. There were no significant differences between the groups for changes in physical activity or prevalence of overweight. CONCLUSIONS Workplace interventions improved risk factors in China, India, and Mexico.
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Affiliation(s)
| | - Pamela A Dyson
- Oxford Centre for Diabetes, Endocrinology & Metabolism, University of Oxford, Oxford, UK
| | - Jun Lv
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Kavumpurathu R Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | - David R Matthews
- Harris Manchester College, University of Oxford, Oxford, UK.,Oxford NIHR Biomedical Research Centre, Oxford, UK
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Folta SC, Lichtenstein AH, Seguin RA, Goldberg JP, Corbin MA, Wiker N, Gauker J, Chui K, Nelson ME. The StrongWomen-Healthy Hearts program in Pennsylvania: RE-AIM analysis. Transl Behav Med 2015; 5:94-102. [PMID: 25729458 PMCID: PMC4332910 DOI: 10.1007/s13142-014-0286-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Dissemination of evidence-based programs is needed to reduce CVD risk among midlife and older women. The aim of this study is to examine the public health impact of StrongWomen-Healthy Hearts in Pennsylvania using the RE-AIM framework. Reach, adoption, implementation, and maintenance were assessed using qualitative and quantitative measures; effectiveness was assessed using a pretest-posttest within-participants design. Reach into the target population was 5 in 100,000. Compared to the target population, a greater percentage of participants were white, married, middle-class, and had a graduate degree. Effectiveness was demonstrated (weight loss -2.0 kg, p < 0.001). Adoption among trained leaders was high (83.3 %), as was fidelity in implementation (average score 9.3 of 10). No leaders maintained the program. To increase impact of the StrongWomen-Healthy Hearts Program, it will be important to lower the costs and modify the recruitment and training strategies to better reach low-income and minority women. Such strategies may also improve program maintenance.
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Affiliation(s)
- Sara C Folta
- />John Hancock Research Center on Physical Activity, Nutrition, and Obesity Prevention, Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA USA
| | | | - Rebecca A Seguin
- />Division of Nutritional Sciences, Cornell University, Ithaca, NY USA
| | - Jeanne P Goldberg
- />John Hancock Research Center on Physical Activity, Nutrition, and Obesity Prevention, Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA USA
| | | | - Nancy Wiker
- />Penn State Cooperative Extension, University Park, PA USA
| | - Jodi Gauker
- />Chester County Economic Development Council, Exton, PA USA
| | - Kenneth Chui
- />Department of Public Health and Community Medicine, School of Medicine, Tufts University, Medford, MA USA
| | - Miriam E Nelson
- />John Hancock Research Center on Physical Activity, Nutrition, and Obesity Prevention, Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA USA
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Arnott B, Rehackova L, Errington L, Sniehotta FF, Roberts J, Araujo-Soares V. Efficacy of behavioural interventions for transport behaviour change: systematic review, meta-analysis and intervention coding. Int J Behav Nutr Phys Act 2014; 11:133. [PMID: 25429846 PMCID: PMC4267710 DOI: 10.1186/s12966-014-0133-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 10/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reducing reliance on motorised transport and increasing use of more physically active modes of travel may offer an opportunity to address physical inactivity. This review evaluates the evidence for the effects of behavioural interventions to reduce car use for journeys made by adults and codes intervention development and content. METHODS The review follows the procedure stated in the registration protocol published in the PROSPERO database (registration number CRD42011001797). Controlled studies evaluating behavioural interventions to reduce car use compared with no interventions or alternative interventions on outcome measures of transport behaviours taken in adult participants are included in this review. Searches were conducted on all records in Applied Social Sciences Index and Abstracts (ASSIA), Ovid Embase, Ovid Medline, Ovid PsycInfo, Scopus, Sociological Abstracts, Transportation Research Information Service (TRIS), Transportation Research International Documentation (TRID), and Web of Science databases. Peer reviewed publications in English language meeting the inclusion criteria are eligible. Methodological quality is assessed using the Cochrane Risk of Bias Tool. Interventions are categorised in terms of behavioural frameworks, theories and techniques. RESULTS 15 full text articles are included, representing 13 unique studies, with 4895 participants and 27 intervention arms. Risk of bias across the review is appraised as considerable due to the unclear methodological quality of individual studies. Heterogeneity of included studies is considerable. Meta-analyses reveal no significant effect on reduction of frequency of car use or on increasing the proportion of journeys by alternative, more active modes of transport. There is insufficient data relating to alternative outcomes such as distance and duration which may have important health implications. Interventions were top-down but could not be described as theory-based. Intervention efficacy was associated with the use of a combination of information provision and behavioural regulation techniques. There was a lack of consideration of opportunity for change and behaviour in context. CONCLUSIONS There is no evidence for the efficacy of existing behavioural interventions to reduce car trips included in this review. The evidence for efficacy of behavioural interventions to decrease distance and duration of car journeys is limited and inconclusive. Overall the evidence is highly heterogeneous and is at considerable risk of bias. Future research should investigate alternative behavioural interventions in high quality, controlled studies informed by existing evidence, theory, and viewers of potential users. Future intervention studies should increase scientific rigour, include objective outcome measures, and incorporate thorough evaluations as standard.
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Affiliation(s)
- Bronia Arnott
- Institute of Health and Society, Newcastle University, Newcastle-Upon-Tyne, UK.
| | - Lucia Rehackova
- Institute of Health and Society, Newcastle University, Newcastle-Upon-Tyne, UK.
| | - Linda Errington
- Institute of Health and Society, Newcastle University, Newcastle-Upon-Tyne, UK.
| | - Falko F Sniehotta
- Institute of Health and Society, Newcastle University, Newcastle-Upon-Tyne, UK.
| | - Jennifer Roberts
- Department of Economics, University of Sheffield, Sheffield, UK.
| | - Vera Araujo-Soares
- Institute of Health and Society, Newcastle University, Newcastle-Upon-Tyne, UK.
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Prince SA, Saunders TJ, Gresty K, Reid RD. A comparison of the effectiveness of physical activity and sedentary behaviour interventions in reducing sedentary time in adults: a systematic review and meta-analysis of controlled trials. Obes Rev 2014; 15:905-19. [PMID: 25112481 PMCID: PMC4233995 DOI: 10.1111/obr.12215] [Citation(s) in RCA: 244] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/23/2014] [Accepted: 06/23/2014] [Indexed: 12/16/2022]
Abstract
UNLABELLED The objective of this study was to systematically review the literature and compare the effectiveness of controlled interventions with a focus on physical activity (PA) and/or sedentary behaviours (SBs) for reducing sedentary time in adults. Six electronic databases were searched to identify all studies that examined the effects of interventions that targeted PA and/or SBs and that reported on changes in SBs (sedentary, sitting or television time). A qualitative synthesis was performed for all studies, and meta-analyses conducted among studies with mean differences (min/d) of sedentary time. PROSPERO CRD42014006535. Sixty-five controlled studies met inclusion criteria; 33 were used in the meta-analyses. Interventions with a focus on PA or that included a PA and SB component produced less consistent findings and generally resulted in modest reductions in sedentary time (PA: standardized mean differences [SMD] = -0.22 [95% confidence interval {CI}: -0.35, -0.10], PA+SB: SMD= -0.37 [95% CI: -0.69, -0.05]). Moderate quality evidence from the randomized controlled trial meta-analysis coupled with the qualitative synthesis provides consistent evidence that large and clinically meaningful reductions in sedentary time can be expected from interventions with a focus on reducing SBs (SMD= -1.28 [95% CI: -1.68, -0.87] ). There is evidence to support the need for interventions to include a component focused on reducing SBs in order to generate clinically meaningful reductions in sedentary time.
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Affiliation(s)
- S A Prince
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
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Bopp M, Behrens TK, Velecina R. Associations of Weight Status, Social Factors, and Active Travel Among College Students. AMERICAN JOURNAL OF HEALTH EDUCATION 2014. [DOI: 10.1080/19325037.2014.948652] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Promoting physical activity and healthy dietary behavior: the role of the occupational health services: a scoping review. J Occup Environ Med 2014; 56:35-46. [PMID: 24351888 DOI: 10.1097/jom.0000000000000012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Conduct a scoping review to identify and map the literature that has evaluated the effects of health promotion interventions aimed at physical activity and/or dietary behavior, implemented by the occupational health services. METHODS A search for peer-reviewed articles was conducted (up to February 2013) through electronic databases, hand searching of key journals, and reference lists. A methodological quality assessment was performed. RESULTS Fourteen studies were included, describing 10 interventions. The main component was counseling of individuals with known cardiovascular disease risk factors. Intervention effects were reported for dietary behavior, physical activity, sedentary behavior, and biological risk factors. CONCLUSIONS Results are promising, especially with regard to interventions containing counseling targeting individuals at risk. High-quality studies using objective measures to assess behavioral outcomes and the (cost)-effectiveness of interventions containing counseling, PA on prescription, and multilevel interventions are needed.
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De Leon E, Fuentes LW, Cohen JE. Characterizing periodic messaging interventions across health behaviors and media: systematic review. J Med Internet Res 2014; 16:e93. [PMID: 24667840 PMCID: PMC3978550 DOI: 10.2196/jmir.2837] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 11/01/2013] [Accepted: 01/23/2014] [Indexed: 12/12/2022] Open
Abstract
Background Periodic prompts serve as tools for health behavior interventions to encourage and maintain behavior changes. Past literature reviews have examined periodic messages targeting specific behaviors (smoking, physical activity, diet, etc) or media (telephone, email, face-to-face, newsletter, etc) and have found them to be effective in impacting health behavior in the short term. Objective Our goal was to review the literature related to periodic messaging and prompts in order to explore typical characteristics, assess the role of prompt timing, identify common theoretical models used, and identify characteristics associated with the effectiveness of periodic prompts. Methods Electronic searches of PubMed, PsycINFO, CINAHL, and Web of Science were conducted in October 2012 and May 2013. Database search terms included variant terms for periods, prompts, interventions, media, and health behaviors. Results Forty-two of the 55 included research articles found that prompts resulted in significant positive behavioral outcomes for participants. Prompts were delivered via text messages, email, mailed communications, and in a few instances via phone. Generally, the provision of feedback and specific strategies to accomplish behavior change appears to be important for the success of periodic prompts. Rationale for prompt timing was rarely provided, although some studies did organize message content around days of the week or times perceived to be high risk for particular behaviors. Smoking cessation interventions tended to be organized around quit date. Among studies using theoretical models to inform their interventions, the transtheoretical model was most common. Conclusions Periodic messaging interventions yield positive results for short-term health behavior changes. Interventions including feedback and prompts that included strategies were more likely to report significantly positive outcomes. Work remains to better understand elements that make periodic prompts successful and whether they are effective in producing long-term outcomes.
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Affiliation(s)
- Elaine De Leon
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
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Aneni EC, Roberson LL, Maziak W, Agatston AS, Feldman T, Rouseff M, Tran TH, Blumenthal RS, Blaha MJ, Blankstein R, Al-Mallah MH, Budoff MJ, Nasir K. A systematic review of internet-based worksite wellness approaches for cardiovascular disease risk management: outcomes, challenges & opportunities. PLoS One 2014; 9:e83594. [PMID: 24421894 PMCID: PMC3885454 DOI: 10.1371/journal.pone.0083594] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 11/14/2013] [Indexed: 11/18/2022] Open
Abstract
Context The internet is gaining popularity as a means of delivering employee-based cardiovascular (CV) wellness interventions though little is known about the cardiovascular health outcomes of these programs. In this review, we examined the effectiveness of internet-based employee cardiovascular wellness and prevention programs. Evidence Acquisition We conducted a systematic review by searching PubMed, Web of Science and Cochrane library for all published studies on internet-based programs aimed at improving CV health among employees up to November 2012. We grouped the outcomes according to the American Heart Association (AHA) indicators of cardiovascular wellbeing – weight, BP, lipids, smoking, physical activity, diet, and blood glucose. Evidence Synthesis A total of 18 randomized trials and 11 follow-up studies met our inclusion/exclusion criteria. Follow-up duration ranged from 6 – 24 months. There were significant differences in intervention types and number of components in each intervention. Modest improvements were observed in more than half of the studies with weight related outcomes while no improvement was seen in virtually all the studies with physical activity outcome. In general, internet-based programs were more successful if the interventions also included some physical contact and environmental modification, and if they were targeted at specific disease entities such as hypertension. Only a few of the studies were conducted in persons at-risk for CVD, none in blue-collar workers or low-income earners. Conclusion Internet based programs hold promise for improving the cardiovascular wellness among employees however much work is required to fully understand its utility and long term impact especially in special/at-risk populations.
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Affiliation(s)
- Ehimen C. Aneni
- Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida, United States of America
| | - Lara L. Roberson
- Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida, United States of America
| | - Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida, United States of America
| | - Arthur S. Agatston
- Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida, United States of America
| | - Theodore Feldman
- Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida, United States of America
| | - Maribeth Rouseff
- Baptist Health South Florida, Miami, Florida, United States of America
| | - Thinh H. Tran
- Baptist Health South Florida, Miami, Florida, United States of America
| | - Roger S. Blumenthal
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, United States of America
| | - Michael J. Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, United States of America
| | - Ron Blankstein
- Brigham and Women's Hospital, Harvard School of Medicine, Boston, Massachusetts, United States of America
| | | | - Matthew J. Budoff
- Los Angeles Biomedical Research Institute, Torrance, California, United States of America
| | - Khurram Nasir
- Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida, United States of America
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida, United States of America
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, United States of America
- Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
- * E-mail:
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Harris JR, Hannon PA, Beresford SAA, Linnan LA, McLellan DL. Health promotion in smaller workplaces in the United States. Annu Rev Public Health 2014; 35:327-42. [PMID: 24387086 PMCID: PMC10378509 DOI: 10.1146/annurev-publhealth-032013-182416] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Most American workplaces are smaller, with fewer than 1,000 employees. Many of these employees are low-wage earners and at increased risk for chronic diseases. Owing to the challenges smaller workplaces face to offering health-promotion programs, their employees often lack access to health-promotion opportunities available at larger workplaces. Many smaller employers do not offer health insurance, which is currently the major funding vehicle for health-promotion services. They also have few health-promotion vendors to serve them and low internal capacity for, and commitment to, delivery of on-site programs. The programs they offer, whether aimed at health promotion alone or integrated with health protection, are rarely comprehensive and are understudied. Research priorities for health promotion in smaller workplaces include developing programs feasible for the smallest workplaces with fewer than 20 employees. Policy priorities include incentives for smaller workplaces to implement comprehensive programs and an ongoing system for monitoring and evaluation.
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Affiliation(s)
- Jeffrey R Harris
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington 98105; , ,
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Lane A, Murphy N, Bauman A. An effort to ‘leverage’ the effect of participation in a mass event on physical activity. Health Promot Int 2013; 30:542-51. [DOI: 10.1093/heapro/dat077] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Freak-Poli RLA, Cumpston M, Peeters A, Clemes SA. Workplace pedometer interventions for increasing physical activity. Cochrane Database Syst Rev 2013:CD009209. [PMID: 23633368 DOI: 10.1002/14651858.cd009209.pub2] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The World Health Organization and the World Economic Forum have recommended further research to strengthen current knowledge of workplace health programmes, particularly on effectiveness and using simple instruments. A pedometer is one such simple instrument that can be incorporated in workplace interventions. OBJECTIVES To assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving subsequent health outcomes. SEARCH METHODS Electronic searches of the Cochrane Central Register of Controlled Trials (671 potential papers), MEDLINE (1001), Embase (965), CINAHL (1262), OSH UPDATE databases (75) and Web of Science (1154) from the earliest record to between 30th January and 6th February 2012 yielded 3248 unique records. Reference lists of articles yielded an additional 34 papers. Contact with individuals and organisations did not produce any further records. SELECTION CRITERIA We included individual and cluster-randomised controlled trials of workplace health promotion interventions with a pedometer component in employed adults. The primary outcome was physical activity and was part of the eligibility criteria. We considered subsequent health outcomes, including adverse effects, as secondary outcomes. DATA COLLECTION AND ANALYSIS Two review authors undertook the screening of titles and abstracts and the full-text papers independently. Two review authors (RFP and MC) independently completed data extraction and risk of bias assessment. We contacted authors to obtain additional data and clarification. MAIN RESULTS We found four relevant studies providing data for 1809 employees, 60% of whom were allocated to the intervention group. All studies assessed outcomes immediately after the intervention had finished and the intervention duration varied between three to six months. All studies had usual treatment control conditions; however one study's usual treatment was an alternative physical activity programme while the other three had minimally active controls. In general, there was high risk of bias mainly due to lack of blinding, self reported outcome measurement, incomplete outcome data due to attrition, and most of the studies had not published protocols, which increases the likelihood of selective reporting.Three studies compared the pedometer programme to a minimally active control group, but the results for physical activity could not be combined because each study used a different measure of activity. One study observed an increase in physical activity under a pedometer programme, but the other two did not find a significant difference. For secondary outcomes we found improvements in body mass index, waist circumference, fasting plasma glucose, the quality of life mental component and worksite injury associated with the pedometer programmes, but these results were based on limited data from one or two small studies. There were no differences between the pedometer programme and the control group for blood pressure, a number of biochemical outcomes and the quality of life physical component. Sedentary behaviour and disease risk scores were not measured by any of the included studies.One study compared a pedometer programme and an alternative physical activity programme, but baseline imbalances made it difficult to distinguish the true improvements associated with either programme.Overall, there was insufficient evidence to assess the effectiveness of pedometer interventions in the workplace.There is a need for more high quality randomised controlled trials to assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving subsequent health outcomes. To improve the quality of the evidence available, future studies should be registered in an online trials register, publish a protocol, allocate time and financial support to reducing attrition, and try to blind personnel (especially those who undertake measurement). To better identify the effects of pedometer interventions, future studies should report a core set of outcomes (total physical activity in METs, total time sitting in hours and minutes, objectively measured cardiovascular disease and type II diabetes risk factors, quality of life and injury), assess outcomes in the long term and undertake subgroup analyses based upon demographic subgroups (e.g. age, gender, educational status). Future studies should also compare different types of active intervention to test specific intervention components (eligibility, duration, step goal, step diary, settings), and settings (occupation, intervention provider). AUTHORS' CONCLUSIONS There was limited and low quality data providing insufficient evidence to assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving subsequent health outcomes.
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Affiliation(s)
- Rosanne L A Freak-Poli
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne,Australia.
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Allicock M, Johnson LS, Leone L, Carr C, Walsh J, Ni A, Resnicow K, Pignone M, Campbell M. Promoting fruit and vegetable consumption among members of black churches, Michigan and North Carolina, 2008-2010. Prev Chronic Dis 2013; 10:E33. [PMID: 23489638 PMCID: PMC3600872 DOI: 10.5888/pcd10.120161] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Evidence-based health promotion programs that are disseminated in community settings can improve population health. However, little is known about how effective such programs are when they are implemented in communities. We examined community implementation of an evidence-based program, Body and Soul, to promote consumption of fruits and vegetables. METHODS We randomly assigned 19 churches to 1 of 2 arms, a colon cancer screening intervention or Body and Soul. We conducted our study from 2008 through 2010. We used the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to evaluate the program and collected data via participant surveys, on-site observations, and interviews with church coordinators and pastors. RESULTS Members of 8 churches in Michigan and North Carolina participated in the Body and Soul program. Mean fruit and vegetable consumption increased from baseline (3.9 servings/d) to follow-up (+0.35, P = .04). The program reached 41.4% of the eligible congregation. Six of the 8 churches partially or fully completed at least 3 of the 4 program components. Six churches expressed intention to maintain the program. Church coordinators reported limited time and help to plan and implement activities, competing church events, and lack of motivation among congregation members as barriers to implementation. CONCLUSIONS The RE-AIM framework provided an effective approach to evaluating the dissemination of an evidence-based program to promote health. Stronger emphasis should be placed on providing technical assistance as a way to improve other community-based translational efforts.
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Affiliation(s)
- Marlyn Allicock
- The University of Texas, School of Public Health, Division of Health Promotion and Behavioral Sciences, 5323 Harry Hines, V8.112, Dallas, TX 75390-9128, USA.
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