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Webber SC, Thille P, Liu K, Wittmeier K, Cain P. Determining Associations Among Health Orientation, Fitness Orientation, and Attitudes Toward Fatness in Physiotherapists and Physiotherapy Students Using Structural Equation Modeling. Physiother Can 2024; 76:220-229. [PMID: 38725602 PMCID: PMC11078247 DOI: 10.3138/ptc-2022-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/30/2022] [Accepted: 09/06/2022] [Indexed: 05/12/2024]
Abstract
Purpose Research suggests physiotherapists hold negative attitudes and beliefs toward fatness and fat people. Physiotherapists are also health-conscious, and invested in healthy lifestyle behaviours including physical activity. Our purpose was to describe relationships between health orientation, fitness orientation, and fat attitudes. Methods Physiotherapists (n = 187) and physiotherapy students (n = 34) completed an online survey (Health Orientation Scale, Multidimensional Body-Self Relations Questionnaire, Fat Attitudes Assessment Toolkit). Structural equation modeling estimated associations between fat attitudes (dependent variable) and health and fitness orientation (independent variables). Results Participants scored high in orientation toward fitness and health. We found strong positive associations between fitness orientation and health orientation (p < 0.001). Health orientation was not significantly associated with fat attitudes (p = 0.075), whereas increased age was associated with more positive fat attitudes (p < 0.01). Although most participants acknowledged that factors outside an individual's control contribute to body weight, many also agreed with normative negative perspectives. Conclusions Physiotherapists are highly oriented toward fitness and health. This may underlie beliefs in the controllability of body weight and contribute to negative attitudes toward fatness and fat people. Further research, with greater sample sizes is necessary to further investigate associations between health orientation and fat attitudes.
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Affiliation(s)
- Sandra C. Webber
- From the:
Department of Physiotherapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Patricia Thille
- From the:
Department of Physiotherapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kun Liu
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kristy Wittmeier
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Patricia Cain
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
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Baldwin JN, He J, Oliveira JS, Bates A, Tiedemann A, Hassett L, Sherrington C, Pinheiro MB. Responsiveness of Patient-Reported and Device-Based Physical Activity Measures: Secondary Analysis of Four Randomized Trials. Med Sci Sports Exerc 2024; 56:663-672. [PMID: 37962224 DOI: 10.1249/mss.0000000000003338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
PURPOSE This study aimed to compare the responsiveness of patient-reported and device-based instruments within four physical activity trials. METHODS This was a secondary analysis of four randomized trials that used both a patient-reported outcome measure (the Incidental and Planned Exercise Questionnaire (IPEQ)) and a device-based instrument (ActiGraph or ActivPAL) to measure physical activity. The four trials included were (i) Activity and MObility UsiNg Technology (AMOUNT), digitally enabled exercises in those undertaking aged care and neurological rehabilitation; (ii) Balance Exercise Strength Training at Home, home-based balance and strength exercises in community-dwelling people 65 yr or older; (iii) Coaching for Healthy Ageing (CHAnGE), physical activity coaching and fall prevention intervention in community-dwelling people 60 yr or older; and (iv) Fitbit trial, fall prevention and physical activity promotion with health coaching and activity monitor in community-dwelling people 60 yr or older. We estimated treatment effects for all variables within each physical activity instrument using regression analyses and expressed results as effect sizes (ES). RESULTS Overall, device-based instruments were more responsive among healthy older adults (ES range, 0.01 to 0.32), whereas the IPEQ was more responsive among adults requiring rehabilitation (ES range, -0.06 to 0.35). Both the IPEQ and device-based instruments were more responsive in trials that promoted walking via coaching participants to increase their daily steps (AMOUNT (ES range, -0.06 to 0.35), CHAnGE (ES range, -0.24 to 0.22), and Fitbit trial (ES range, -0.23 to 0.32)). Individual variables within the IPEQ and device-based instruments varied in their responsiveness (ES range, -0.13 to 0.20). CONCLUSIONS Both the IPEQ and device-based instruments are able to detect small changes in physical activity levels. However, responsiveness varies across different interventions and populations. Our findings provide guidance for researchers and clinicians in selecting an appropriate instrument to measure changes in physical activity.
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Affiliation(s)
| | | | | | - Amanda Bates
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, AUSTRALIA
| | | | | | - Catherine Sherrington
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, AUSTRALIA
| | - Marina B Pinheiro
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, AUSTRALIA
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Yap B, Rajaram N, Ho WK, Khor GL, Teo SH. Perceptions, attitudes and beliefs towards soya among healthy Asian women participating in a soya randomised controlled trial. J Nutr Sci 2023; 12:e69. [PMID: 37457681 PMCID: PMC10345781 DOI: 10.1017/jns.2023.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/17/2023] [Accepted: 05/25/2023] [Indexed: 07/18/2023] Open
Abstract
The soya-breast cancer risk relationship remains controversial in Asia due to limited and inconsistent research findings and is exacerbated by difficulties in recruiting and retaining participants in intervention trials. Understanding public perceptions towards soya is important for designing effective intervention trials. Here, we administered a close-ended, quantitative survey to healthy, peri- and post-menopausal Asian women in the Malaysian Soy and Mammographic Density (MiSo) Study to assess perception towards soya and explore motivators and barriers that affect study adherence using the Capability, Opportunity, Motivation and Belief (COM-B) Model and Theoretical Domains Framework (TDF). Of 118 participants, the majority reported the belief that soya promotes good health (Supplement = 85⋅7 %, Diet = 90⋅0 %, Control = 87⋅9 %). Most participants reported obtaining information about soya from the internet (Supplement = 61⋅0 %, Diet = 55⋅3 %, Control = 35⋅9 %), while health professionals were least reported (Supplement = 9⋅8 %, Diet = 7⋅9 %, Control = 5⋅1 %). Stratified analyses by study completion and adherence status yielded comparable findings. By the end of the study, dietary arm participants reported a strong belief that soya has no impact on their health (Supplement = 7⋅1 % v. Diet = 20⋅0 % v. Control = 0⋅0 %, P = 0⋅012). Motivation and opportunity strongly facilitated soya consumption, while psychological capability was the most common barrier to consumption though less evident among dietary arm participants. While most Asian women have a positive perception towards soya, theory-based intervention trials are warranted to understand the perception-study adherence relationship and to accurately inform the public of the health effects of soya.
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Affiliation(s)
- Beverley Yap
- Cancer Research Malaysia, Subang Jaya, Selangor 47500, Malaysia
| | - Nadia Rajaram
- Cancer Research Malaysia, Subang Jaya, Selangor 47500, Malaysia
- School of Mathematical Sciences, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih, Selangor 43500, Malaysia
| | - Weang Kee Ho
- Cancer Research Malaysia, Subang Jaya, Selangor 47500, Malaysia
- School of Mathematical Sciences, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih, Selangor 43500, Malaysia
| | - Geok Lin Khor
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Soo Hwang Teo
- Cancer Research Malaysia, Subang Jaya, Selangor 47500, Malaysia
- Faculty of Medicine, University Malaya Cancer Research Institute, University of Malaya, Kuala Lumpur 50603, Malaysia
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4
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Western MJ, Standage M, Peacock OJ, Nightingale T, Thompson D. Supporting Behavior Change in Sedentary Adults via Real-time Multidimensional Physical Activity Feedback: Mixed Methods Randomized Controlled Trial. JMIR Form Res 2022; 6:e26525. [PMID: 35234658 PMCID: PMC8928046 DOI: 10.2196/26525] [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: 12/15/2020] [Revised: 03/18/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Increasing physical activity (PA) behavior remains a public health priority, and wearable technology is increasingly being used to support behavior change efforts. Using wearables to capture and provide comprehensive, visually persuasive, multidimensional feedback with real-time support may be a promising way of increasing PA in inactive individuals. OBJECTIVE This study aims to explore whether a 6-week self-monitoring intervention using composite web-based multidimensional PA feedback with real-time daily feedback supports increased PA in adults. METHODS A 6-week, mixed methods, 2-armed exploratory randomized controlled trial with 6-week follow-up was used, whereby low to moderately active (PA level [PAL] <2.0) adults (mean age 51.3 years, SD 8.4 years; women 28/51, 55%) were randomly assigned to receive the self-monitoring intervention (36/51, 71%) or waiting list control (15/51, 29%). Assessment of PA across multiple health-harnessing PA dimensions (eg, PAL, weekly moderate to vigorous intensity PA, sedentary time, and steps), psychosocial cognitions (eg, behavioral regulation, barrier self-efficacy, and habit strength), and health were made at the prerandomization baseline at 6 and 12 weeks. An exploratory analysis of the mean difference and CIs was conducted using the analysis of covariance model. After the 12-week assessment, intervention participants were interviewed to explore their views on the program. RESULTS There were no notable differences in any PA outcome immediately after the intervention; however, at 12 weeks, moderate-to-large effects were observed with a mean difference in PAL of 0.09 (95% CI 0.02-0.15; effect size [Hedges g] 0.8), daily moderate-intensity PA of 24 (95% CI 0-45; Hedges g=0.6) minutes, weekly moderate-to-vigorous intensity PA of 195 (95% CI 58-331; Hedges g=0.8) minutes, and steps of 1545 (95% CI 581-2553; Hedges g=0.7). Descriptive analyses suggested that the differences in PA at 12 weeks were more pronounced in women and participants with lower baseline PA levels. Immediately after the intervention, there were favorable differences in autonomous motivation, controlled motivation, perceived competence for PA, and barrier self-efficacy, with the latter sustained at follow-up. Qualitative data implied that the intervention was highly informative for participants and that the real-time feedback element was particularly useful in providing tangible, day-to-day behavioral support. CONCLUSIONS Using wearable trackers to capture and present sophisticated multidimensional PA feedback combined with discrete real-time support may be a useful way of facilitating changes in behavior. Further investigation into the ways of optimizing the use of wearables in inactive participants and testing the efficacy of this approach via a robust study design is warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT02432924; https://clinicaltrials.gov/ct2/show/NCT02432924.
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Affiliation(s)
| | - Martyn Standage
- Department for Health, University of Bath, Bath, United Kingdom
| | | | - Tom Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Dylan Thompson
- Department for Health, University of Bath, Bath, United Kingdom
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5
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Poveda-López S, Montilla-Herrador J, Gacto-Sánchez M, Romero-Galisteo RP, Lillo-Navarro C. Wishes and perceptions about exercise programs in exercising institutionalized older adults living in long-term care institutions: A qualitative study. Geriatr Nurs 2021; 43:167-174. [PMID: 34902751 DOI: 10.1016/j.gerinurse.2021.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 01/24/2023]
Abstract
The level of exercise among older adults is low, particularly among those living in health-care institutions. To gain insight into the perceptions of institutionalized older adults towards the exercise programs developed in long-term care institutions and to identify their wishes and needs regarding these programs, we conducted a qualitative study using focus group discussions. Thirty-six institutionalized participants (≥ 65 years) were recruited. Six common themes emerged: participants' attitudes and motivations towards the exercise programs, self-perceived health, knowledge of the concept of physical exercise, perceived effects of the exercise programs, and wishes or expectations for the exercise programs. The main wishes were to increase frequency of exercise sessions, to exercise outdoor and to increase walking times. The results suggest the need for changes in the development of exercise programs, including changes in the frequency, performance environment and types of exercises performed.
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Affiliation(s)
- Salud Poveda-López
- Faculty of Health Sciences, UCAM Catholic University of Murcia, Murcia. Spain
| | - Joaquina Montilla-Herrador
- Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, Spain.
| | - Mariano Gacto-Sánchez
- Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, Spain
| | - Rita P Romero-Galisteo
- Departament of Physical therapy. Biomedical Research Institute of Málaga (IBIMA), University of Málaga. Málaga, Spain
| | - Carmen Lillo-Navarro
- Department of Pathology and Surgery and Center for Translational Research in Physical Therapy (CEIT). University Miguel Hernández, Sant Joan, Alicante, Spain
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Barriers and Motivators to Physical Activity Prior to Starting a Community-Based Walking Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010659. [PMID: 34682405 PMCID: PMC8535237 DOI: 10.3390/ijerph182010659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 11/17/2022]
Abstract
Despite the clear benefits of an active lifestyle, most American adults fail to meet physical activity (PA) guidelines. Because of its safety and ease, walking is a promising population-level strategy to increase PA. There is a need to further understand why adults do and do not participate in walking. This study provides a broader understanding of barriers and motivators of walking prior to starting a walking program. Four years of baseline data from a community-based walking program were analyzed (n = 1491). Descriptive statistics summarized participant characteristics, barriers, reinforcements, and current PA. Chi-square tests were used to assess differences in the barrier and reinforcement responses between participant’s PA level and age categories. Open-ended responses were analyzed using thematic analysis. On average, participants were white (96%), middle-aged (52 ± 13 years old) females (92%). Poor weather and time were frequently reported barriers to walking. Open-ended responses (n = 141) identified additional barriers of lack of motivation (n = 37), joint issues (n = 29), fatigue (n = 24), safety or lack of environmental supports (n = 17), family or work demands (n = 15), and lacking a walking partner (n = 9). Good weather, health, and weight loss were frequently reported motivators. Additional motivators (n = 282) identified included stress relief and mental health (n = 82), social time (n = 70), dog care (n = 41), other health benefits (n = 38), connect with nature (n = 19), enjoyment (14), occupation (n = 11), and environmental and community supports (n = 6). Findings highlight the importance of understanding participant barriers and motivators for PA before starting a program. Future research should examine how reported barriers and motivators are related to program completion and adherence. Tailoring community-based programs to address specific barriers and motivators may enable more participants to effectively change and maintain PA.
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7
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Leung KM, Ou KL, Chung PK, Thøgersen-Ntoumani C. Older Adults' Perceptions toward Walking: A Qualitative Study Using a Social-Ecological Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147686. [PMID: 34300136 PMCID: PMC8303868 DOI: 10.3390/ijerph18147686] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/06/2021] [Accepted: 07/14/2021] [Indexed: 01/10/2023]
Abstract
Objectives: In this study, we aimed to investigate older adults’ perceptions of their walking experiences, using the social-ecological model as a guiding framework and to propose future walking intervention content. Methods: Thirty-eight participants (19 women; 47% from private elderly centers; mean age = 72.8 (SD = 7.4 years) took part in semi-structured interviews. Qualitative data analysis software QSR-NVivo was used for thematic coding. Results: Thematic deductive analysis revealed pertinent themes at the individual level (health benefits and barriers, fall risk, perseverance, and walking as a suitable activity for older adults), social environment level (social support and social interaction), physical environment level (density, land-use mix, and connectivity; perceived safety, pedestrian facilities (benches, quality of walking paths and sidewalks, and aesthetics), other pedestrian behaviors, and weather, and policy level (lack of walking programs in the community, and supportive culture for an active lifestyle). Discussion: Our findings provide insights for the planning of future multilevel walking intervention programs for older adults in Hong Kong. It is suggested that future walking intervention should include professionals (e.g., physiotherapist or coach) in a group setting, practical walking recommendations such as proper walking posture, and additional fun activities for older adults.
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Affiliation(s)
- Ka-Man Leung
- Department of Health and Physical Education, Education University of Hong Kong, Hong Kong, China;
| | - Kai-Ling Ou
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China;
- Correspondence: ; Tel.: +852-3411-8035
| | - Pak-Kwong Chung
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China;
| | - Cecilie Thøgersen-Ntoumani
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5000 Odense, Denmark;
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8
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McKevitt S, Jinks C, Healey EL, Quicke JG. The attitudes towards, and beliefs about, physical activity in people with osteoarthritis and comorbidity: A qualitative investigation. Musculoskeletal Care 2021; 20:167-179. [PMID: 34245657 DOI: 10.1002/msc.1579] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/29/2021] [Accepted: 07/03/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the attitudes towards, and beliefs about, physical activity (PA) in older adults with osteoarthritis (OA) and comorbidity to understand experiences and seek ways to improve PA participation. METHODS Semi-structured interviews with adults aged ≥45, with self-reported OA and comorbidity (N = 17). Face-to-face interviews explored participant perspectives regarding; (1) attitudes and beliefs about PA in the context of OA and comorbidity and (2) how people with OA and comorbidity could be encouraged to improve and maintain PA levels. Data were transcribed verbatim and inductive thematic analysis was undertaken using a framework approach. RESULTS Participants did not conceptualise multiple long-term conditions (LTCs) together and instead self-prioritised OA over other LTCs. Barriers to PA included uncertainty about both the general management of individual LTCs and the effectiveness of PA for their LTCs; and, negative perceptions about their health, ageing and PA. Participants experienced dynamic and co-existing barriers to PA, and problematized this as a multi-level process, identifying a barrier, then a solution, followed by a new barrier. Facilitators of PA included social support and support from knowledgeable healthcare professionals (HCPs), together with PA adapted for OA and comorbidity and daily life. PA levels could be increased through targeted interventions to increase self-efficacy for managing OA alongside other LTCs and self-efficacy for PA. CONCLUSION People with OA and comorbidity experience complicated PA barriers. To increase PA levels, tailored PA interventions could include HCP and social support to anticipate and overcome multi-level PA barriers and target increased self-efficacy for LTC management and PA.
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Affiliation(s)
- Sarah McKevitt
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Clare Jinks
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Emma L Healey
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Jonathan G Quicke
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, UK.,Haywood Hospital, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
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9
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Mau M, Nielsen DS, Jakobsen IS, Klausen SH, Roessler KK. Mental movements: How long-distance walking influences reflection processes among middle-age and older adults. Scand J Psychol 2021; 62:365-373. [PMID: 33719040 DOI: 10.1111/sjop.12721] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/29/2021] [Indexed: 12/20/2022]
Abstract
By providing a distinctive room for reflection, long-distance walks can help people similar to professional counselling. To understand reflection processes' influence on mental health, a framework focusing on personal transformations, specifically through the concept of liminality, can be used. Through nine semi-structured interviews with middle-aged and older long-distance walkers, this study answers the following question: How do middle-aged and older adults experience long-distance walking, and how do their experiences influence their reflective process? Four themes emerged during the analysis: (1) overcoming strain and achieving a sense of capability; (2) simplicity in obligations and having the time to pursue emotionally difficult experiences; (3) solitariness and reflection on oneself; and (4) calmness and embracing thoughts. These findings illustrate how going on long-distance walks may be similar to entering a liminal, or transformational, space. The findings show how long-distance walks can be helpful, or perhaps even therapeutic, in situations where personal transformation is required.
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Affiliation(s)
- Martin Mau
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Health, Social Work and Welfare Research, UCL University College, Odense, Denmark.,Health Sciences Research Centre, UCL University College, Odense, Denmark
| | - Dorthe S Nielsen
- Migrant Health Clinic, Odense University Hospital, Odense, Denmark.,Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Ida Skytte Jakobsen
- Health, Social Work and Welfare Research, UCL University College, Odense, Denmark
| | - Søren H Klausen
- Department for the Study of Culture, University of Southern, Odense, Denmark
| | - Kirsten K Roessler
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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10
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Taylor AH, Taylor RS, Ingram WM, Anokye N, Dean S, Jolly K, Mutrie N, Lambert J, Yardley L, Greaves C, King J, McAdam C, Steele M, Price L, Streeter A, Charles N, Terry R, Webb D, Campbell J, Hughes L, Ainsworth B, Jones B, Jane B, Erwin J, Little P, Woolf A, Cavanagh C. Adding web-based behavioural support to exercise referral schemes for inactive adults with chronic health conditions: the e-coachER RCT. Health Technol Assess 2020; 24:1-106. [PMID: 33243368 PMCID: PMC7750864 DOI: 10.3310/hta24630] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND There is modest evidence that exercise referral schemes increase physical activity in inactive individuals with chronic health conditions. There is a need to identify additional ways to improve the effects of exercise referral schemes on long-term physical activity. OBJECTIVES To determine if adding the e-coachER intervention to exercise referral schemes is more clinically effective and cost-effective in increasing physical activity after 1 year than usual exercise referral schemes. DESIGN A pragmatic, multicentre, two-arm randomised controlled trial, with a mixed-methods process evaluation and health economic analysis. Participants were allocated in a 1 : 1 ratio to either exercise referral schemes plus e-coachER (intervention) or exercise referral schemes alone (control). SETTING Patients were referred to exercise referral schemes in Plymouth, Birmingham and Glasgow. PARTICIPANTS There were 450 participants aged 16-74 years, with a body mass index of 30-40 kg/m2, with hypertension, prediabetes, type 2 diabetes, lower limb osteoarthritis or a current/recent history of treatment for depression, who were also inactive, contactable via e-mail and internet users. INTERVENTION e-coachER was designed to augment exercise referral schemes. Participants received a pedometer and fridge magnet with physical activity recording sheets, and a user guide to access the web-based support in the form of seven 'steps to health'. e-coachER aimed to build the use of behavioural skills (e.g. self-monitoring) while strengthening favourable beliefs in the importance of physical activity, competence, autonomy in physical activity choices and relatedness. All participants were referred to a standard exercise referral scheme. PRIMARY OUTCOME MEASURE Minutes of moderate and vigorous physical activity in ≥ 10-minute bouts measured by an accelerometer over 1 week at 12 months, worn ≥ 16 hours per day for ≥ 4 days including ≥ 1 weekend day. SECONDARY OUTCOMES Other accelerometer-derived physical activity measures, self-reported physical activity, exercise referral scheme attendance and EuroQol-5 Dimensions, five-level version, and Hospital Anxiety and Depression Scale scores were collected at 4 and 12 months post randomisation. RESULTS Participants had a mean body mass index of 32.6 (standard deviation) 4.4 kg/m2, were referred primarily for weight loss and were mostly confident self-rated information technology users. Primary outcome analysis involving those with usable data showed a weak indicative effect in favour of the intervention group (n = 108) compared with the control group (n = 124); 11.8 weekly minutes of moderate and vigorous physical activity (95% confidence interval -2.1 to 26.0 minutes; p = 0.10). Sixty-four per cent of intervention participants logged on at least once; they gave generally positive feedback on the web-based support. The intervention had no effect on other physical activity outcomes, exercise referral scheme attendance (78% in the control group vs. 75% in the intervention group) or EuroQol-5 Dimensions, five-level version, or Hospital Anxiety and Depression Scale scores, but did enhance a number of process outcomes (i.e. confidence, importance and competence) compared with the control group at 4 months, but not at 12 months. At 12 months, the intervention group incurred an additional mean cost of £439 (95% confidence interval -£182 to £1060) compared with the control group, but generated more quality-adjusted life-years (mean 0.026, 95% confidence interval 0.013 to 0.040), with an incremental cost-effectiveness ratio of an additional £16,885 per quality-adjusted life-year. LIMITATIONS A significant proportion (46%) of participants were not included in the primary analysis because of study withdrawal and insufficient device wear-time, so the results must be interpreted with caution. The regression model fit for the primary outcome was poor because of the considerable proportion of participants [142/243 (58%)] who recorded no instances of ≥ 10-minute bouts of moderate and vigorous physical activity at 12 months post randomisation. FUTURE WORK The design and rigorous evaluation of cost-effective and scalable ways to increase exercise referral scheme uptake and maintenance of moderate and vigorous physical activity are needed among patients with chronic conditions. CONCLUSIONS Adding e-coachER to usual exercise referral schemes had only a weak indicative effect on long-term rigorously defined, objectively assessed moderate and vigorous physical activity. The provision of the e-coachER support package led to an additional cost and has a 63% probability of being cost-effective based on the UK threshold of £30,000 per quality-adjusted life-year. The intervention did improve some process outcomes as specified in our logic model. TRIAL REGISTRATION Current Controlled Trials ISRCTN15644451. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 63. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Adrian H Taylor
- Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Rod S Taylor
- University of Exeter Medical School, University of Exeter, Exeter, UK
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Wendy M Ingram
- Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Nana Anokye
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, London, UK
| | - Sarah Dean
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nanette Mutrie
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | - Jeffrey Lambert
- University of Exeter Medical School, University of Exeter, Exeter, UK
- Department for Health, University of Bath, Bath, UK
| | - Lucy Yardley
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Centre for Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Colin Greaves
- University of Exeter Medical School, University of Exeter, Exeter, UK
- School of Sport, Exercise and Rehabilitation, University of Birmingham, Birmingham, UK
| | - Jennie King
- Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Chloe McAdam
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | - Mary Steele
- Centre for Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Lisa Price
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Adam Streeter
- Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | | | - Rohini Terry
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Douglas Webb
- Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
- Bristol Medical School, University of Bristol, Bristol, UK
| | - John Campbell
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Lucy Hughes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ben Ainsworth
- Centre for Applications of Health Psychology, University of Southampton, Southampton, UK
- Department of Psychology, University of Bath, Bath, UK
| | - Ben Jones
- Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Ben Jane
- School of Sport, Health and Wellbeing, Plymouth Marjon University, Plymouth, UK
| | - Jo Erwin
- Bone and Joint Research Group, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Paul Little
- Centre for Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Anthony Woolf
- Bone and Joint Research Group, Royal Cornwall Hospitals NHS Trust, Truro, UK
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11
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Lewis ZH, Ottenbacher KJ, Fisher SR, Jennings K, Brown AF, Swartz MC, Martinez E, Lyons EJ. Effect of Electronic Activity Monitors and Pedometers on Health: Results from the TAME Health Pilot Randomized Pragmatic Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186800. [PMID: 32961834 PMCID: PMC7559399 DOI: 10.3390/ijerph17186800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 11/16/2022]
Abstract
Background: Brief counseling and self-monitoring with a pedometer are common practice within primary care for physical activity promotion. It is unknown how high-tech electronic activity monitors compare to pedometers within this setting. This study aimed to investigate the outcomes, through effect size estimation, of an electronic activity monitor-based intervention to increase physical activity and decrease cardiovascular disease risk. Method: The pilot randomized controlled trial was pre-registered online at clinicaltrials.gov (NCT02554435). Forty overweight, sedentary participants 55–74 years of age were randomized to wear a pedometer or an electronic activity monitor for 12 weeks. Physical activity was measured objectively for 7 days at baseline and follow-up by a SenseWear monitor and cardiovascular disease risk was estimated by the Framingham risk calculator. Results: Effect sizes for behavioral and health outcomes ranged from small to medium. While these effect sizes were favorable to the intervention group for physical activity (PA) (d = 0.78) and general health (d = 0.39), they were not favorable for measures. Conclusion: The results of this pilot trial show promise for this low-intensity intervention strategy, but large-scale trials are needed to test its efficacy.
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Affiliation(s)
- Zakkoyya H. Lewis
- College of Science, Department of Kinesiology and Health Promotion, California State Polytechnic University Pomona, 3801 West Temple Ave., Pomona, CA 91768, USA
- Correspondence:
| | - Kenneth J. Ottenbacher
- School of Health Professions, Division of Rehabilitation Sciences, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA;
| | - Steve R. Fisher
- School of Health Professions, Department of Physical Therapy, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA;
| | - Kristofer Jennings
- Department of Biostatistics, MD Anderson Cancer Center, 1400 Pressler St., Unit 1411, Houston, TX 77030-4008, USA;
| | - Arleen F. Brown
- School of Medicine, Division of General Internal Medicine and Health Services Research, University of California Los Angeles, 1100 Glendon, Ave., Los Angeles, CA 90095, USA;
| | - Maria C. Swartz
- Department of Pediatrics, Division of Pediatrics, MD Anderson Cancer Center, 7777 Knight Rd., Houston, TX 77054, USA;
| | - Eloisa Martinez
- Sealy Center on Aging, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA;
| | - Elizabeth J. Lyons
- School of Health Professions, Department of Nutrition and Metabolism, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA;
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12
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Craighead DH, Heinbockel TC, Hamilton MN, Bailey EF, MacDonald MJ, Gibala MJ, Seals DR. Time-efficient physical training for enhancing cardiovascular function in midlife and older adults: promise and current research gaps. J Appl Physiol (1985) 2019; 127:1427-1440. [PMID: 31556835 PMCID: PMC10205162 DOI: 10.1152/japplphysiol.00381.2019] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/28/2019] [Accepted: 09/18/2019] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular diseases (CVD) remain the leading cause of death in developed societies, and "midlife" (50-64 yr) and older (65+) men and women bear the great majority of the burden of CVD. Much of the increased risk of CVD in this population is attributable to CV dysfunction, including adverse changes in the structure and function of the heart, increased systolic blood pressure, and arterial dysfunction. The latter is characterized by increased arterial stiffness and vascular endothelial dysfunction. Conventional aerobic exercise training, as generally recommended in public health guidelines, is an effective strategy to preserve or improve CV function with aging. However, <40% of midlife and older adults meet aerobic exercise guidelines, due in part to time availability-related barriers. As such, there is a need to develop evidence-based time-efficient exercise interventions that promote adherence and optimize CV function in these groups. Two promising interventions that may meet these criteria are interval training and inspiratory muscle strength training (IMST). Limited research suggests these modes of training may improve CV function with time commitments of ≤60 min/wk. This review will summarize the current evidence for interval training and IMST to improve CV function in midlife/older adults and identify key research gaps and future directions.
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Affiliation(s)
- Daniel H Craighead
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Thomas C Heinbockel
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Makinzie N Hamilton
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - E Fiona Bailey
- Department of Physiology, University of Arizona College of Medicine, Tucson, Arizona
| | | | - Martin J Gibala
- Department of Kinesiology, McMaster University, Ontario, Canada
| | - Douglas R Seals
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
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13
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Wu ML, Tsai JC, Yu KH, Chen JJ. Effects of physical activity counselling in women with systemic lupus erythematosus: A randomized controlled trial. Int J Nurs Pract 2019; 25:e12770. [PMID: 31332914 DOI: 10.1111/ijn.12770] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 05/31/2019] [Accepted: 06/15/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Low physical activity is common in systemic lupus erythematosus populations. AIM To evaluate the effect of physical activity counselling on physical activity and the association between physical activity changes and changes in fatigue, quality of sleep, and quality of life in women with systemic lupus erythematosus. METHODS A randomized, controlled, single-blind trial was conducted from March 2015 to August 2016. Seventy-six women with systemic lupus erythematosus were randomly assigned to the intervention or control groups. The intervention group received three sessions of physical activity counselling at 1, 4, and 8 weeks and three telephone follow-ups over 13 weeks. Outcome measures, which include daily steps, fatigue, quality of sleep, and the quality of life, were collected at baseline and 8 and 12 weeks. RESULTS The study showed that daily steps, quality of sleep, and vitality in the intervention group were significantly improved compared with those in the control group at weeks 8 and 12. Mental health was significantly improved only at week 8 in the counselling group. A positive correlation between physical activity changes and changes in vitality and mental health was observed. CONCLUSIONS Physical activity counselling can improve physical activity. As physical activity increases, systemic lupus erythematosus women feel more energetic and happier.
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Affiliation(s)
- Mei-Ling Wu
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.,Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
| | - Jen-Chen Tsai
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Kuang-Hui Yu
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jin-Jong Chen
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan.,College of Well-Being Industry, Yuanpei University of Medical Technology, Hsinchu, Taiwan
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14
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Gomes GADO, Papini CB, Nakamura PM, Teixeira IP, Kokubun E. Barreiras para prática de atividade física entre mulheres atendidas na Atenção Básica de Saúde. REVISTA BRASILEIRA DE CIÊNCIAS DO ESPORTE 2019. [DOI: 10.1016/j.rbce.2018.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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15
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Vetrovsky T, Vetrovska K, Bunc V. A qualitative exploration of the experiences of primary care patients engaged in email counseling meant to increase physical activity. ACTA GYMNICA 2019. [DOI: 10.5507/ag.2019.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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16
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Harris T, Limb ES, Hosking F, Carey I, DeWilde S, Furness C, Wahlich C, Ahmad S, Kerry S, Whincup P, Victor C, Ussher M, Iliffe S, Ekelund U, Fox-Rushby J, Ibison J, Cook DG. Effect of pedometer-based walking interventions on long-term health outcomes: Prospective 4-year follow-up of two randomised controlled trials using routine primary care data. PLoS Med 2019; 16:e1002836. [PMID: 31237875 PMCID: PMC6592516 DOI: 10.1371/journal.pmed.1002836] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/21/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Data are lacking from physical activity (PA) trials with long-term follow-up of both objectively measured PA levels and robust health outcomes. Two primary care 12-week pedometer-based walking interventions in adults and older adults (PACE-UP and PACE-Lift) found sustained objectively measured PA increases at 3 and 4 years, respectively. We aimed to evaluate trial intervention effects on long-term health outcomes relevant to walking interventions, using routine primary care data. METHODS AND FINDINGS Randomisation was from October 2012 to November 2013 for PACE-UP participants from seven general (family) practices and October 2011 to October 2012 for PACE-Lift participants from three practices. We downloaded primary care data, masked to intervention or control status, for 1,001 PACE-UP participants aged 45-75 years, 36% (361) male, and 296 PACE-Lift participants, aged 60-75 years, 46% (138) male, who gave written informed consent, for 4-year periods following randomisation. The following new events were counted for all participants, including those with preexisting diseases (apart from diabetes, for which existing cases were excluded): nonfatal cardiovascular, total cardiovascular (including fatal), incident diabetes, depression, fractures, and falls. Intervention effects on time to first event post-randomisation were modelled using Cox regression for all outcomes, except for falls, which used negative binomial regression to allow for multiple events, adjusting for age, sex, and study. Absolute risk reductions (ARRs) and numbers needed to treat (NNTs) were estimated. Data were downloaded for 1,297 (98%) of 1,321 trial participants. Event rates were low (<20 per group) for outcomes, apart from fractures and falls. Cox hazard ratios for time to first event post-randomisation for interventions versus controls were nonfatal cardiovascular 0.24 (95% confidence interval [CI] 0.07-0.77, p = 0.02), total cardiovascular 0.34 (95% CI 0.12-0.91, p = 0.03), diabetes 0.75 (95% CI 0.42-1.36, p = 0.34), depression 0.98 (95% CI 0.46-2.07, p = 0.96), and fractures 0.56 (95% CI 0.35-0.90, p = 0.02). Negative binomial incident rate ratio for falls was 1.07 (95% CI 0.78-1.46, p = 0.67). ARR and NNT for cardiovascular events were nonfatal 1.7% (95% CI 0.5%-2.1%), NNT = 59 (95% CI 48-194); total 1.6% (95% CI 0.2%-2.2%), NNT = 61 (95% CI 46-472); and for fractures 3.6% (95% CI 0.8%-5.4%), NNT = 28 (95% CI 19-125). Main limitations were that event rates were low and only events recorded in primary care records were counted; however, any underrecording would not have differed by intervention status and so should not have led to bias. CONCLUSIONS Routine primary care data used to assess long-term trial outcomes demonstrated significantly fewer new cardiovascular events and fractures in intervention participants at 4 years. No statistically significant differences between intervention and control groups were demonstrated for other events. Short-term primary care pedometer-based walking interventions can produce long-term health benefits and should be more widely used to help address the public health inactivity challenge. TRIAL REGISTRATIONS PACE-UP isrctn.com ISRCTN98538934; PACE-Lift isrctn.com ISRCTN42122561.
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Affiliation(s)
- Tess Harris
- Population Health Research Institute, St George’s University of London, Tooting, London, United Kingdom
| | - Elizabeth S. Limb
- Population Health Research Institute, St George’s University of London, Tooting, London, United Kingdom
| | - Fay Hosking
- Population Health Research Institute, St George’s University of London, Tooting, London, United Kingdom
| | - Iain Carey
- Population Health Research Institute, St George’s University of London, Tooting, London, United Kingdom
| | - Steve DeWilde
- Population Health Research Institute, St George’s University of London, Tooting, London, United Kingdom
| | - Cheryl Furness
- Population Health Research Institute, St George’s University of London, Tooting, London, United Kingdom
| | - Charlotte Wahlich
- Population Health Research Institute, St George’s University of London, Tooting, London, United Kingdom
| | - Shaleen Ahmad
- Population Health Research Institute, St George’s University of London, Tooting, London, United Kingdom
| | - Sally Kerry
- Pragmatic Clinical Trials Unit, Queen Mary’s University of London, London, United Kingdom
| | - Peter Whincup
- Population Health Research Institute, St George’s University of London, Tooting, London, United Kingdom
| | - Christina Victor
- Gerontology and Health Services Research Unit, Brunel University, London, United Kingdom
| | - Michael Ussher
- Population Health Research Institute, St George’s University of London, Tooting, London, United Kingdom
- Institute for Social Marketing and Public Health, University of Stirling, Stirling, Scotland, United Kingdom
| | - Steve Iliffe
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Ulf Ekelund
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Julia Fox-Rushby
- Department of Population Science, King’s College London, London, United Kingdom
| | - Judith Ibison
- Institute of Medical and Biomedical Education, St George’s University of London, Tooting, London, United Kingdom
| | - Derek G. Cook
- Population Health Research Institute, St George’s University of London, Tooting, London, United Kingdom
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17
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Harris T, Kerry S, Victor C, Iliffe S, Ussher M, Fox-Rushby J, Whincup P, Ekelund U, Furness C, Limb E, Anokye N, Ibison J, DeWilde S, David L, Howard E, Dale R, Smith J, Normansell R, Beighton C, Morgan K, Wahlich C, Sanghera S, Cook D. A pedometer-based walking intervention in 45- to 75-year-olds, with and without practice nurse support: the PACE-UP three-arm cluster RCT. Health Technol Assess 2019; 22:1-274. [PMID: 29961442 DOI: 10.3310/hta22370] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Guidelines recommend walking to increase moderate to vigorous physical activity (MVPA) for health benefits. OBJECTIVES To assess the effectiveness, cost-effectiveness and acceptability of a pedometer-based walking intervention in inactive adults, delivered postally or through dedicated practice nurse physical activity (PA) consultations. DESIGN Parallel three-arm trial, cluster randomised by household. SETTING Seven London-based general practices. PARTICIPANTS A total of 11,015 people without PA contraindications, aged 45-75 years, randomly selected from practices, were invited. A total of 6399 people were non-responders, and 548 people self-reporting achieving PA guidelines were excluded. A total of 1023 people from 922 households were randomised to usual care (n = 338), postal intervention (n = 339) or nurse support (n = 346). The recruitment rate was 10% (1023/10,467). A total of 956 participants (93%) provided outcome data. INTERVENTIONS Intervention groups received pedometers, 12-week walking programmes advising participants to gradually add '3000 steps in 30 minutes' most days weekly and PA diaries. The nurse group was offered three dedicated PA consultations. MAIN OUTCOME MEASURES The primary and main secondary outcomes were changes from baseline to 12 months in average daily step counts and time in MVPA (in ≥ 10-minute bouts), respectively, from 7-day accelerometry. Individual resource-use data informed the within-trial economic evaluation and the Markov model for simulating long-term cost-effectiveness. Qualitative evaluations assessed nurse and participant views. A 3-year follow-up was conducted. RESULTS Baseline average daily step count was 7479 [standard deviation (SD) 2671], average minutes per week in MVPA bouts was 94 minutes (SD 102 minutes) for those randomised. PA increased significantly at 12 months in both intervention groups compared with the control group, with no difference between interventions; additional steps per day were 642 steps [95% confidence interval (CI) 329 to 955 steps] for the postal group and 677 steps (95% CI 365 to 989 steps) for nurse support, and additional MVPA in bouts (minutes per week) was 33 minutes per week (95% CI 17 to 49 minutes per week) for the postal group and 35 minutes per week (95% CI 19 to 51 minutes per week) for nurse support. Intervention groups showed no increase in adverse events. Incremental cost per step was 19p and £3.61 per minute in a ≥ 10-minute MVPA bout for nurse support, whereas the postal group took more steps and cost less than the control group. The postal group had a 50% chance of being cost-effective at a £20,000 per quality-adjusted life-year (QALY) threshold within 1 year and had both lower costs [-£11M (95% CI -£12M to -£10M) per 100,000 population] and more QALYs [759 QALYs gained (95% CI 400 to 1247 QALYs)] than the nurse support and control groups in the long term. Participants and nurses found the interventions acceptable and enjoyable. Three-year follow-up data showed persistent intervention effects (nurse support plus postal vs. control) on steps per day [648 steps (95% CI 272 to 1024 steps)] and MVPA bouts [26 minutes per week (95% CI 8 to 44 minutes per week)]. LIMITATIONS The 10% recruitment level, with lower levels in Asian and socioeconomically deprived participants, limits the generalisability of the findings. Assessors were unmasked to the group. CONCLUSIONS A primary care pedometer-based walking intervention in 45- to 75-year-olds increased 12-month step counts by around one-tenth, and time in MVPA bouts by around one-third, with similar effects for the nurse support and postal groups, and persistent 3-year effects. The postal intervention provides cost-effective, long-term quality-of-life benefits. A primary care pedometer intervention delivered by post could help address the public health physical inactivity challenge. FUTURE WORK Exploring different recruitment strategies to increase uptake. Integrating the Pedometer And Consultation Evaluation-UP (PACE-UP) trial with evolving PA monitoring technologies. TRIAL REGISTRATION Current Controlled Trials ISRCTN98538934. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 37. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Tess Harris
- Population Health Research Institute, St George's, University of London, London, UK
| | - Sally Kerry
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Christina Victor
- Gerontology and Health Services Research Unit, Brunel University London, London, UK
| | - Steve Iliffe
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Michael Ussher
- Population Health Research Institute, St George's, University of London, London, UK
| | - Julia Fox-Rushby
- Health Economics Research Group, Brunel University London, London, UK
| | - Peter Whincup
- Population Health Research Institute, St George's, University of London, London, UK
| | - Ulf Ekelund
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.,Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Cheryl Furness
- Population Health Research Institute, St George's, University of London, London, UK
| | - Elizabeth Limb
- Population Health Research Institute, St George's, University of London, London, UK
| | - Nana Anokye
- Health Economics Research Group, Brunel University London, London, UK
| | - Judith Ibison
- Population Health Research Institute, St George's, University of London, London, UK
| | - Stephen DeWilde
- Population Health Research Institute, St George's, University of London, London, UK
| | - Lee David
- 10 Minute CBT, Devonshire Business Centre, Letchworth Garden City, UK
| | - Emma Howard
- Population Health Research Institute, St George's, University of London, London, UK
| | - Rebecca Dale
- Population Health Research Institute, St George's, University of London, London, UK
| | - Jaime Smith
- Population Health Research Institute, St George's, University of London, London, UK
| | - Rebecca Normansell
- Population Health Research Institute, St George's, University of London, London, UK
| | - Carole Beighton
- Population Health Research Institute, St George's, University of London, London, UK
| | - Katy Morgan
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Charlotte Wahlich
- Population Health Research Institute, St George's, University of London, London, UK
| | - Sabina Sanghera
- Health Economics Research Group, Brunel University London, London, UK
| | - Derek Cook
- Population Health Research Institute, St George's, University of London, London, UK
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18
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Grindell C, Mawson S, Gerrish K, Parker S, Bissell P. Exploring the acceptability and usability of a novel social innovation to encourage physical activity: The iStep prototype. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:383-391. [PMID: 30255638 DOI: 10.1111/hsc.12656] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/02/2018] [Accepted: 08/06/2018] [Indexed: 06/08/2023]
Abstract
This study explored the acceptability and usability of the iStep prototype a novel social innovation to encourage intergenerational physical activity (PA) to help reduce obesity levels in older age. Obesity is a major public health issue and physical inactivity is one of the many factors that influence this, especially in childhood and later life. iStep (a pedometer and interactive website) sought to increase PA levels across the life course through intergenerational partnerships participating in walking challenges together. This was a qualitative mixed methods study involving 130 participants from two different settings. Pupils and teachers from a local secondary school (n = 120) tested the iStep prototype over two separate 2-week periods. Pupil and teacher partnerships engaged in a walking challenge using pedometers and the website platform. In addition, 10 retirement age women were involved in a modified co-operative evaluation of the prototype. Two focus groups with pupils (n = 9 and 20), semistructured interviews with teachers (n = 5), and one dyadic interview (pupil/teacher) were undertaken. Data were analysed using an iterative thematic approach. Five themes were identified: perceptions of the technology, attitudes towards the walking challenge, attitudes to the intergenerational partnership, competition versus collaboration and promoting PA. The pedometer was a useful motivational tool which raised awareness of PA levels. The website was thought to be simple and easy to use. Walking was deemed inclusive and accessible to all age groups and setting a target goal was considered beneficial. Engaging in PA with a partner was regarded as a good way to provide support and encouragement. Overall, this early prototype evaluation showed that iStep has potential to be an innovative and engaging way to encourage increased PA across generations. It may positively contribute towards reducing obesity levels in older age but outcomes that effectively measure this need to be incorporated in any future iStep testing.
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Affiliation(s)
| | - Sue Mawson
- Section HSR, ScHARR, The University of Sheffield, Sheffield, UK
| | - Kate Gerrish
- University of Sheffield/Sheffield Teaching Hospitals NHS FT, Sheffield, UK
| | - Stuart Parker
- Institute of Health and Society, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Paul Bissell
- Dean of the School of Human and Health Sciences, Huddersfield University, Huddersfield, UK
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19
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Andersen P, Lendahls L, Holmberg S, Nilsen P. Patients' experiences of physical activity on prescription with access to counsellors in routine care: a qualitative study in Sweden. BMC Public Health 2019; 19:210. [PMID: 30786907 PMCID: PMC6381718 DOI: 10.1186/s12889-019-6535-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 02/12/2019] [Indexed: 11/25/2022] Open
Abstract
Background Physical activity on prescription (PAP) has been implemented in several countries, including Sweden, to support patients who might benefit from increased physical activity. This study explores the experiences of recipients of PAP in routine health care in Sweden that offers the recipients support from physical activity counsellors. The aim was to explore influences on engagement in physical activity by PAP recipients’ from a long-term perspective. Methods We conducted individual semi-structured interviews using a topic guide with a purposively selected sample of 13 adult PAP recipients 1.5 to 2.5 years after PAP. Interviews were recorded, transcribed verbatim and analysed through inductive and deductive content analysis. The questions were informed by Capability-Opportunity-Motivation-Behaviour (COM-B), which was also used as a framework to analyse the data by means of categorizing the factors (influences on the behaviour). Results Ten factors (i.e. sub-categories) that influenced the participants’ engagement in physical activity were identified. PAP recipients’ capability to engage in physical activity was associated with adapting the PAP to the individual’s physical capacity and taking into account the individual’s previous experiences of physical activity. PAP recipients’ opportunity to engage in physical activity was related to receiving a prescription, receiving professional counselling and follow-up from a physical activity counsellor, collaboration between prescriber and counsellor, having access to appropriate activities, having a balanced life situation and having support from someone who encouraged continued physical activity. PAP recipients’ motivation to engage in physical activity was associated with the desire to improve his or her health condition and finding activities that encouraged continuation. Conclusions PAP recipients’ engagement in physical activity was influenced by their capability, opportunity and motivation to undertake this behaviour. Numerous extraneous factors influence capability and motivation. Physical activity counsellors were found to be important for sustained activity because they use an individual approach to counselling and flexible follow-up adapted to each individual’s need of support. Electronic supplementary material The online version of this article (10.1186/s12889-019-6535-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pia Andersen
- Department of Research and Development, Region Kronoberg, Växjö, Sweden. .,Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, Linköping, Sweden.
| | - Lena Lendahls
- Department of Research and Development, Region Kronoberg, Växjö, Sweden.,Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | - Sara Holmberg
- Department of Research and Development, Region Kronoberg, Växjö, Sweden.,Division of Occupational and Environmental Medicine, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Per Nilsen
- Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, Linköping, Sweden
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20
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Westland H, Sluiter J, te Dorsthorst S, Schröder CD, Trappenburg JCA, Vervoort SCJM, Schuurmans MJ. Patients' experiences with a behaviour change intervention to enhance physical activity in primary care: A mixed methods study. PLoS One 2019; 14:e0212169. [PMID: 30753213 PMCID: PMC6372184 DOI: 10.1371/journal.pone.0212169] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 01/29/2019] [Indexed: 12/17/2022] Open
Abstract
Objective To explore the experiences of patients at risk for cardiovascular disease in primary care with the Activate intervention in relation to their success in increasing their physical activity. Methods A convergent mixed methods study was conducted, parallel to a cluster-randomised controlled trial in primary care, using a questionnaire and semi-structured interviews. Questionnaires from 67 patients were analysed, and semi-structured interviews of 22 patients were thematically analysed. Experiences of patients who had objectively increased their physical activity (responders) were compared to those who had not (non-responders). Objective success was analysed in relation to self-perceived success. Results The questionnaire and interview data corresponded, and no substantial differences among responders and non-responders emerged. Participating in the intervention increased patients’ awareness of their physical activity and their physical activity level. Key components of the intervention were the subsequent support of nurses with whom patients’ have a trustful relationship and the use of self-monitoring tools. Patients highly valued jointly setting goals, planning actions, receiving feedback and review on their goal attainment and jointly solving problems. Nurses’ support, the use of self-monitoring tools, and involving others incentivised patients to increase their physical activity. Internal circumstances and external circumstances challenged patients’ engagement in increasing and maintaining their physical activity. Conclusion Patients experienced the Activate intervention as valuable to increase and maintain their physical activity, irrespective of their objective change in physical activity. The findings enable the understanding of the effectiveness of the intervention and implementation in primary care. Trial registration ClinicalTrials.gov NCT02725203.
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Affiliation(s)
- Heleen Westland
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- * E-mail:
| | - Jill Sluiter
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sophie te Dorsthorst
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Carin D. Schröder
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht University Utrecht, Utrecht, the Netherlands
- De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Jaap C. A. Trappenburg
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Marieke J. Schuurmans
- Education Center, UMC Utrecht Academy, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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The impact of multidimensional physical activity feedback on healthcare practitioners and patients. BJGP Open 2019; 3:bjgpopen18X101628. [PMID: 31049409 PMCID: PMC6480860 DOI: 10.3399/bjgpopen18x101628] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/20/2018] [Indexed: 12/18/2022] Open
Abstract
Background Promotion of physical activity in primary care has had limited success. Wearable technology presents an opportunity to support healthcare practitioners (HCPs) in providing personalised feedback to their patients. Aim To explore the differing thoughts and feelings of both HCPs and at-risk patients provided with personalised multidimensional physical activity feedback. Design & setting Qualitative study with HCPs (n = 15) and patients at risk of cardiovascular disease or type 2 diabetes (n = 29), recruited from primary care. Method HCPs and patients wore a physical activity monitor for 7 days and were subsequently shown their personalised multidimensional feedback, including sedentary time, calorie burn, short (1-minute) or long (>10-minute) bouts of moderate-to-vigorous activity during semi-structured interviews. Transcripts were analysed thematically with comparisons made between individuals of high (n = 21) and low (n = 23) physical activity levels as to their cognitive–affective responses to their data. Results Personalised feedback elicited positive emotional responses for highly active participants and negative emotional responses for those with low activity. However, individuals with low activity demonstrated largely positive coping mechanisms. Some low active participants were in denial over feedback, but the majority valued it as an opportunity to think of ways to improve physical activity (cognitive reappraisal) and started forming action plans (problem-focused coping). Around half of all participants also sought to validate their feedback against peers. Conclusion Personalised, visual feedback elicits immediate emotional and coping responses in participants of high and low physical activity levels. Further studies should explore whether multidimensional feedback could help practitioners explore diverse ways for lifestyle change with patients.
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Vetrovsky T, Cupka J, Dudek M, Kuthanova B, Vetrovska K, Capek V, Bunc V. A pedometer-based walking intervention with and without email counseling in general practice: a pilot randomized controlled trial. BMC Public Health 2018; 18:635. [PMID: 29769107 PMCID: PMC5956962 DOI: 10.1186/s12889-018-5520-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/26/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND General practitioners play a fundamental role in combatting the current epidemic of physical inactivity, and pedometer-based walking interventions are able to increase physical activity levels of their patients. Supplementing these interventions with email counseling driven by feedback from the pedometer has the potential to further improve their effectiveness but it has to be yet confirmed in clinical trials. Therefore, the aim of our pilot randomized controlled trial is to evaluate the feasibility and potential efficacy of future trials designed to assess the additional benefit of email counseling added to a pedometer-based intervention in a primary care setting. METHODS Physically inactive patients were opportunistically recruited from four general practices and randomized to a 12-week pedometer-based intervention with or without email counseling. To explore the feasibility of future trials, we assessed the speed and efficiency of recruitment, adherence to wearing the pedometer, and engagement with email counseling. To evaluate the potential efficacy, daily step-count was the primary outcome and blood pressure, waist and hip circumference, and body mass were the secondary outcomes. Additionally, we conducted a qualitative analysis of structured interviews with the participating general practitioners. RESULTS The opportunistic recruitment has been shown to be feasible and acceptable, but relatively slow and inefficient; moreover, general practitioners selectively recruited overweight and obese patients. Patients manifested high adherence, wearing the pedometer on 83% (± 20) of days. All patients from the counseling group actively participated in email communication and responded to 46% (± 22) of the emails they received. Both groups significantly increased their daily step-count (pedometer-plus-email, + 2119, p = 0.002; pedometer-alone, + 1336, p = 0.03), but the difference between groups was not significant (p = 0.18). When analyzing both groups combined, there was a significant decrease in body mass (- 0.68 kg, p = 0.04), waist circumference (- 1.73 cm, p = 0.03), and systolic blood pressure (- 3.48 mmHg, p = 0.045). CONCLUSIONS This study demonstrates that adding email counseling to a pedometer-based intervention in a primary care setting is feasible and might have the potential to increase the efficacy of such an intervention in increasing physical activity levels. TRIAL REGISTRATION The trial was retrospectively registered at ClinicalTrials.gov (ID: NCT03135561 , date: April 26, 2017).
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Affiliation(s)
- Tomas Vetrovsky
- Faculty of Physical Education and Sport, Charles University, Jose Martiho 31, 162 52, Prague 6, Czech Republic.
| | - Jozef Cupka
- Mediciman s.r.o, Maxovska 1019/6, 155 00, Prague 5, Czech Republic
| | - Martin Dudek
- Laureus s.r.o, Palackeho 541, 252 29, Dobrichovice, Czech Republic
| | - Blanka Kuthanova
- Praktici Praha 6, s.r.o, Vitezne namesti 817/9, 160 00, Prague 6, Czech Republic
| | | | - Vaclav Capek
- Second Faculty of Medicine, Charles University, V Uvalu 84, 150 06, Prague 5, Czech Republic
| | - Vaclav Bunc
- Faculty of Physical Education and Sport, Charles University, Jose Martiho 31, 162 52, Prague 6, Czech Republic
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Cooke AB, Pace R, Chan D, Rosenberg E, Dasgupta K, Daskalopoulou SS. A qualitative evaluation of a physician-delivered pedometer-based step count prescription strategy with insight from participants and treating physicians. Diabetes Res Clin Pract 2018. [PMID: 29530385 DOI: 10.1016/j.diabres.2018.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AIMS The integration of pedometers into clinical practice has the potential to enhance physical activity levels in patients with chronic disease. Our SMARTER randomized controlled trial demonstrated that a physician-delivered step count prescription strategy has measurable effects on daily steps, glycemic control, and insulin resistance in patients with type 2 diabetes and/or hypertension. In this study, we aimed to understand perceived barriers and facilitators influencing successful uptake and sustainability of the strategy, from patient and physician perspectives. METHODS Qualitative in-depth interviews were conducted in a purposive sample of physicians (n = 10) and participants (n = 20), including successful and less successful cases in terms of pedometer-assessed step count improvements. Themes that achieved saturation in either group through thematic analysis are presented. RESULTS All participants appreciated the pedometer-based monitoring combined with step count prescriptions. Accountability to physicians and support offered by the trial coordinator influenced participant motivation. Those who increased step counts adopted strategies to integrate more steps into their routines and were able to overcome weather-related barriers by finding indoor alternative options to outdoor steps. Those who decreased step counts reported difficulty in overcoming weather-related challenges, health limitations and work constraints. Physicians indicated the strategy provided a framework for discussing physical activity and motivating patients, but emphasized the need for support from allied professionals to help deliver the strategy in busy clinical settings. CONCLUSION A physician-delivered step count prescription strategy was feasibly integrated into clinical practice and successful in engaging most patients; however, continual support is needed for maximal engagement and sustained use.
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Affiliation(s)
- Alexandra B Cooke
- Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Romina Pace
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Deborah Chan
- Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Ellen Rosenberg
- Department of Family Medicine, St. Mary's Hospital, McGill University, Montreal, Quebec, Canada
| | - Kaberi Dasgupta
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada.
| | - Stella S Daskalopoulou
- Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada; Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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Relating process evaluation measures to complex intervention outcomes: findings from the PACE-UP primary care pedometer-based walking trial. Trials 2018; 19:58. [PMID: 29357921 PMCID: PMC5778651 DOI: 10.1186/s13063-017-2428-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 12/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The PACE-UP trial demonstrated positive effects of a pedometer-based walking intervention on objective physical activity (PA) outcomes at three and 12 months in 45-75-year-old primary care patients, in postal and nurse-supported trial arms compared with controls. We explored associations between process evaluation measures and change in PA outcomes. METHODS The MRC framework guided process evaluation. Three quantitative measures (nurse session attendance [dose delivered], PA diary completion [fidelity] and pedometer use [fidelity]) were selected as independent variables in multi-level models estimating intervention effectiveness on PA outcomes (changes in step-counts and time in moderate-to-vigorous PA [MVPA] levels in ≥ 10-min bouts). RESULTS Dose: attending all three nurse sessions compared with 0-2 sessions was associated with an increase in steps/day at three and 12 months of 1197 (95% confidence interval [CI] = 627-1766) and 605 (95% CI = 74-1137), respectively; and MVPA in bouts (min/week) at three and 12 months by 74 (95% CI = 45-103) and 30 (95% CI = 3-57), respectively. Fidelity: postal and nurse groups showed strong positive associations of diary return with steps/day at three months: postal 1458 (95% CI = 854-2061), nurse 873 (95% CI = 190-1555). MVPA in bouts (min/week): postal 64 (95% CI = 33-94), nurse 50 (95% CI = 15-85). At 12 months, only the postal group effects remained statistically significant: steps/day 1114 (95% CI = 538-1689), MVPA 47 (95% CI = 18-75). Regular pedometer use in the postal group only was associated with higher three-month and 12-month steps/day: 1029 (95% CI = 383-1675) and 606 (95% CI = 22-1190), respectively, and with MVPA in bouts at three months: 40 (95% CI = 6-73). CONCLUSION Process evaluation measures demonstrated significant associations with PA outcomes at three and 12 months. We cannot infer causality, but the associations between the process measures and PA outcomes suggest that they were important in enabling the trial changes observed and should be considered core components of the PACE-UP nurse and postal interventions. We have shown the MRC framework to be a useful tool for process evaluation of intervention implementation. TRIAL REGISTRATION ISRCTN Registry, ISRCTN98538934 . Registered on 2 March 2012.
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Meteorologic and Geographic Barriers to Physical Activity in a Workplace Wellness Program. J Phys Act Health 2017; 15:108-116. [PMID: 28872399 DOI: 10.1123/jpah.2016-0731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Inclement weather and home environment can act as barriers to physical activity. However, it is unclear if they reduce the activity of persons participating in activity-promoting programs. METHODS Data from a 6-month workplace financial incentives program were used to establish the association between meteorologic (temperature, rain, snow, and wind) and geographic factors (urban/nonurban home location and distance between home and work) and moderate to vigorous physical activity (MVPA). Multivariable models were built to estimate mean weekly minutes of MVPA adjusting for demographic factors, clinical factors, and impulsivity. RESULTS The 292 participants had a mean age of 38 (SD = 11) years. Eighty-three percent were female and 62% were white. Twenty-nine percent lived within 3 miles of work, and 35% lived in urban areas. Participants who lived more than 3 miles from work averaged 75 [95% confidence interval (CI), 65-84] minutes of weekly MVPA compared with 105 (95% CI, 88-122) minutes for those who lived within 3 miles of work. Urban participants averaged 70 (95% CI, 57-83) minutes of MVPA compared with 91 (95% CI, 80-102) minutes for nonurban participants. Colder temperatures were associated with decreased MVPA, and impulsivity modified the effect. CONCLUSIONS Colder temperatures, greater distance from work, and an urban residence are associated with fewer minutes of MVPA.
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Mental health and quality of life benefits of a pedometer-based walking intervention delivered in a primary care setting. ACTA GYMNICA 2017. [DOI: 10.5507/ag.2017.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
The rise in life expectancy requires strategies to enable healthy ageing and the promotion of a high quality of life in old age. Poor mental health including depression and social isolation can blight older people's lives. Despite the positive benefits of physical activity for both mental and physical health, only a minority of those over 65 years are attaining the recommended levels of physical activity. The evidence relating to the benefits of pet dogs as promoters of wellbeing is set out in this article, although meeting their care needs may place an additional strain on an older person and/or their carer who has limited resources and physical capabilities.
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Affiliation(s)
- Alison While
- Emeritus Professor of Community Nursing, King's College London, Florence Nightingale Faculty of Nursing and Midwifery and Fellow of the QNI
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28
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‘You started something … then I continued by myself’: a qualitative study of physical activity maintenance. Prim Health Care Res Dev 2017; 18:574-590. [DOI: 10.1017/s1463423617000433] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background
Most mid-life and older adults are not achieving recommended physical activity (PA) targets and effective interventions are needed to increase and maintain PA long-term for health benefits. The Pedometer And Consultation Evaluation (PACE-UP) trial, a three-armed primary care pedometer-based walking intervention in those aged 45–75 years, demonstrated increased PA levels at 12 months. A three-year follow-up was conducted to evaluate long-term PA maintenance, including a qualitative component.
Aim
To examine facilitators and barriers to PA maintenance in mid-life and older adults previously involved in a PA trial.
Method
Semi-structured telephone interviews were conducted with 60 PACE-UP participants across all study arms. Interviews were audio-recorded, transcribed verbatim and coded independently by researchers, prior to thematic analysis.
Findings
Two-thirds of participants felt since the PACE-UP trial they had an awareness of PA, with the pedometer reported as ‘kick-starting’ regular activity, and then helped them to maintain regular activity. PA facilitators included: maintaining good health, self-motivation, social support and good weather. Lack of time was the most frequently cited barrier. Other barriers were often the inverse of the facilitators; for example, poor health and bad weather. Participants described the type of ‘top-up’ intervention they would find beneficial to aid PA maintenance (eg, text messages, online resources and walking groups).
Conclusion
A challenge for future PA interventions is to transform barriers into facilitators; for example, educating trial participants about the value of PA for many chronic health conditions to change this from inhibiting to promoting PA. Participants provided ideas for encouraging PA maintenance which could be incorporated into future interventions.
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del Río Carral M, Roux P, Bruchez C, Santiago-Delefosse M. Santé digitale : promesses, défis et craintes. Une revue de la littérature. PRAT PSYCHOL 2017. [DOI: 10.1016/j.prps.2016.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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30
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Schrager JD, Shayne P, Wolf S, Das S, Patzer RE, White M, Heron S. Assessing the Influence of a Fitbit Physical Activity Monitor on the Exercise Practices of Emergency Medicine Residents: A Pilot Study. JMIR Mhealth Uhealth 2017; 5:e2. [PMID: 28143805 PMCID: PMC5309436 DOI: 10.2196/mhealth.6239] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/07/2016] [Accepted: 12/17/2016] [Indexed: 11/13/2022] Open
Abstract
Background Targeted interventions have improved physical activity and wellness of medical residents. However, no exercise interventions have focused on emergency medicine residents. Objective This study aimed to measure the effectiveness of a wearable device for tracking physical activity on the exercise habits and wellness of this population, while also measuring barriers to adoption and continued use. Methods This pre-post cohort study enrolled 30 emergency medicine residents. Study duration was 6 months. Statistical comparisons were conducted for the primary end point and secondary exercise end points with nonparametric tests. Descriptive statistics were provided for subjective responses. Results The physical activity tracker did not increase the overall self-reported median number of days of physical activity per week within this population: baseline 2.5 days (interquartile range, IQR, 1.9) versus 2.8 days (IQR 1.5) at 1 month (P=.36). There was a significant increase in physical activity from baseline to 1 month among residents with median weekly physical activity level below that recommended by the Centers for Disease Control and Prevention at study start, that is, 1.5 days (IQR 0.9) versus 2.4 days (IQR 1.2; P=.04), to 2.0 days (IQR 2.0; P=.04) at 6 months. More than half (60%, 18/30) of participants reported a benefit to their overall wellness, and 53% (16/30) reported a benefit to their physical activity. Overall continued use of the device was 67% (20/30) at 1 month and 33% (10/30) at 6 months. Conclusions The wearable physical activity tracker did not change the overall physical activity levels among this population of emergency medicine residents. However, there was an improvement in physical activity among the residents with the lowest preintervention physical activity. Subjective improvements in overall wellness and physical activity were noted among the entire study population.
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Affiliation(s)
- Justin David Schrager
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Philip Shayne
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Sarah Wolf
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Shamie Das
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | | | - Melissa White
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Sheryl Heron
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
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Harris T, Kerry SM, Limb ES, Victor CR, Iliffe S, Ussher M, Whincup PH, Ekelund U, Fox-Rushby J, Furness C, Anokye N, Ibison J, DeWilde S, David L, Howard E, Dale R, Smith J, Cook DG. Effect of a Primary Care Walking Intervention with and without Nurse Support on Physical Activity Levels in 45- to 75-Year-Olds: The Pedometer And Consultation Evaluation (PACE-UP) Cluster Randomised Clinical Trial. PLoS Med 2017; 14:e1002210. [PMID: 28045890 PMCID: PMC5207642 DOI: 10.1371/journal.pmed.1002210] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/23/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Pedometers can increase walking and moderate-to-vigorous physical activity (MVPA) levels, but their effectiveness with or without support has not been rigorously evaluated. We assessed the effectiveness of a pedometer-based walking intervention in predominantly inactive adults, delivered by post or through primary care nurse-supported physical activity (PA) consultations. METHODS AND FINDINGS A parallel three-arm cluster randomised trial was randomised by household, with 12-mo follow-up, in seven London, United Kingdom, primary care practices. Eleven thousand fifteen randomly selected patients aged 45-75 y without PA contraindications were invited. Five hundred forty-eight self-reporting achieving PA guidelines were excluded. One thousand twenty-three people from 922 households were randomised between 2012-2013 to one of the following groups: usual care (n = 338); postal pedometer intervention (n = 339); and nurse-supported pedometer intervention (n = 346). Of these, 956 participants (93%) provided outcome data (usual care n = 323, postal n = 312, nurse-supported n = 321). Both intervention groups received pedometers, 12-wk walking programmes, and PA diaries. The nurse group was offered three PA consultations. Primary and main secondary outcomes were changes from baseline to 12 mo in average daily step-counts and time in MVPA (in ≥10-min bouts), respectively, measured objectively by accelerometry. Only statisticians were masked to group. Analysis was by intention-to-treat. Average baseline daily step-count was 7,479 (standard deviation [s.d.] 2,671), and average time in MVPA bouts was 94 (s.d. 102) min/wk. At 12 mo, mean steps/d, with s.d. in parentheses, were as follows: control 7,246 (2,671); postal 8,010 (2,922); and nurse support 8,131 (3,228). PA increased in both intervention groups compared with the control group; additional steps/d were 642 for postal (95% CI 329-955) and 677 for nurse support (95% CI 365-989); additional MVPA in bouts (min/wk) were 33 for postal (95% CI 17-49) and 35 for nurse support (95% CI 19-51). There were no significant differences between the two interventions at 12 mo. The 10% (1,023/10,467) recruitment rate was a study limitation. CONCLUSIONS A primary care pedometer-based walking intervention in predominantly inactive 45- to 75-y-olds increased step-counts by about one-tenth and time in MVPA in bouts by about one-third. Nurse and postal delivery achieved similar 12-mo PA outcomes. A primary care pedometer intervention delivered by post or with minimal support could help address the public health physical inactivity challenge. CLINICAL TRIAL REGISTRATION isrctn.com ISRCTN98538934.
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Affiliation(s)
- Tess Harris
- Population Health Research Institute, St George’s University of London, London, United Kingdom
| | - Sally M. Kerry
- Pragmatic Clinical Trials Unit, Queen Mary’s University of London, London, United Kingdom
| | - Elizabeth S. Limb
- Population Health Research Institute, St George’s University of London, London, United Kingdom
| | - Christina R. Victor
- Gerontology and Health Services Research Unit, Brunel University, London, United Kingdom
| | - Steve Iliffe
- Research Department of Primary Care & Population Health, University College, London, United Kingdom
| | - Michael Ussher
- Population Health Research Institute, St George’s University of London, London, United Kingdom
| | - Peter H. Whincup
- Population Health Research Institute, St George’s University of London, London, United Kingdom
| | - Ulf Ekelund
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Julia Fox-Rushby
- Health Economics Research Group, Brunel, University of London, London, United Kingdom
| | - Cheryl Furness
- Population Health Research Institute, St George’s University of London, London, United Kingdom
| | - Nana Anokye
- Health Economics Research Group, Brunel, University of London, London, United Kingdom
| | - Judith Ibison
- Population Health Research Institute, St George’s University of London, London, United Kingdom
| | - Steve DeWilde
- Population Health Research Institute, St George’s University of London, London, United Kingdom
| | - Lee David
- 10 Minute CBT, Devonshire Business Centre, Letchworth Garden City, United Kingdom
| | - Emma Howard
- Population Health Research Institute, St George’s University of London, London, United Kingdom
| | - Rebecca Dale
- Population Health Research Institute, St George’s University of London, London, United Kingdom
| | - Jaime Smith
- Population Health Research Institute, St George’s University of London, London, United Kingdom
| | - Derek G. Cook
- Population Health Research Institute, St George’s University of London, London, United Kingdom
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Mitchell F, Stalker K, Matthews L, Mutrie N, Melling C, McConnachie A, Murray H, Melville CA. A qualitative exploration of participants’ experiences of taking part in a walking programme: Perceived benefits, barriers, choices and use of intervention resources. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 31 Suppl 1:110-121. [DOI: 10.1111/jar.12326] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Fiona Mitchell
- Physical Activity and Health Research Group; University of Strathclyde; Glasgow UK
| | - Kirsten Stalker
- Glasgow School of Social Work; University of Strathclyde; Glasgow UK
| | - Lynsay Matthews
- MRC/CSO Social and Public Health Sciences Unit; Institute of Health and Wellbeing; University of Glasgow; Glasgow UK
| | - Nanette Mutrie
- Institute for Sport, Physical Education and Health Sciences; Moray House School of Education; University of Edinburgh; Edinburgh UK
| | - Chris Melling
- Head of Learning Disability Services; West CHCP Glasgow; Glasgow UK
| | - Alex McConnachie
- Institute of Health and Wellbeing; Robertson Centre for Biostatistics; University of Glasgow; Glasgow UK
| | - Heather Murray
- Institute of Health and Wellbeing; Robertson Centre for Biostatistics; University of Glasgow; Glasgow UK
| | - Craig A. Melville
- Institute of Health and Wellbeing; Robertson Centre for Biostatistics; University of Glasgow; Glasgow UK
- Institute of Health and Wellbeing; Mental Health and Wellbeing; University of Glasgow; Glasgow UK
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Thorup CB, Grønkjær M, Spindler H, Andreasen JJ, Hansen J, Dinesen BI, Nielsen G, Sørensen EE. Pedometer use and self-determined motivation for walking in a cardiac telerehabilitation program: a qualitative study. BMC Sports Sci Med Rehabil 2016; 8:24. [PMID: 27547404 PMCID: PMC4991060 DOI: 10.1186/s13102-016-0048-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 08/04/2016] [Indexed: 12/26/2022]
Abstract
Background Exercise-based cardiac rehabilitation reduces morbidity and mortality. Walking is a convenient activity suitable for people with cardiac disease. Pedometers count steps, measure walking activity and motivate people to increase physical activity. In this study, patients participating in cardiac telerehabilitation were provided with a pedometer to support motivation for physical activity with the purpose of exploring pedometer use and self-determined motivation for walking experienced by patients and health professionals during a cardiac telerehabilitation program. Methods A qualitative research design consisting of observations, individual interviews and patient documents made the basis for a content analysis. Data was analysed deductively using Self Determination Theory as a frame for analysis and discussion, focusing on the psychological needs of autonomy, competence and relatedness. Twelve cardiac patients, 11 health professionals, 6 physiotherapists and 5 registered nurses were included. Results The pedometer offered independence from standardised rehabilitation since the pedometer supported tailoring, individualised walking activity based on the patient’s choice. This led to an increased autonomy. The patients felt consciously aware of health benefits of walking, and the pedometer provided feedback on walking activity leading to an increased competence to achieve goals for steps. Finally, the pedometer supported relatedness with others. The health professionals’ surveillance of patients’ steps, made the patients feel observed, yet supported, furthermore, their next of kin appeared to be supportive as walking partners. Conclusion Cardiac patients’ motivation for walking was evident due to pedometer use. Even though not all aspects of motivation were autonomous and self determined, the patients felt motivated for walking. The visible steps and continuous monitoring of own walking activity made it possible for each individual patient to choose their desired kind of activity and perform ongoing adjustments of walking activity. The immediate feedback on step activity and the expectations of health benefits resulted in motivation for walking. Finally, pedometer supported walking made surveillance possible, giving the patients a feeling of being looked after and supported. Trial registration Current study is a part of The Teledi@log project.
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Affiliation(s)
- Charlotte Brun Thorup
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Hobrovej 18-22, DK-9000 Aalborg, Denmark ; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, DK-9000 Aalborg, Denmark ; Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Frederik Bajers Vej 7D, DK-9220 Aalborg, Denmark
| | - Mette Grønkjær
- Clinical Nursing Research Unit, Aalborg University Hospital, Søndre Skovvej 15, DK-9000 Aalborg, Denmark
| | - Helle Spindler
- Department of Psychology and Behavioural Science, Aarhus University, Bartholins Allé 9, DK-8000 Aarhus C, Denmark
| | - Jan Jesper Andreasen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Hobrovej 18-22, DK-9000 Aalborg, Denmark ; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, DK-9000 Aalborg, Denmark
| | - John Hansen
- Laboratory for Cardio technology, Medical Informatics Group, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Frederik Bajers Vej 7D, DK-9220 Aalborg, Denmark
| | - Birthe Irene Dinesen
- Laboratory of Assistive Technologies - Telehealth and Telerehabilitation, SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Gitte Nielsen
- Department of Cardiology, Vendsyssel Hospital, Bispensgade 37, DK-9800 Hjoerring, Denmark
| | - Erik Elgaard Sørensen
- Clinical Nursing Research Unit, Aalborg University Hospital, Søndre Skovvej 15, DK-9000 Aalborg, Denmark ; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, DK-9000 Aalborg, Denmark
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Attwood S, Morton KL, Mitchell J, Van Emmenis M, Sutton S. Reasons for non-participation in a primary care-based physical activity trial: a qualitative study. BMJ Open 2016; 6:e011577. [PMID: 27217288 PMCID: PMC4885436 DOI: 10.1136/bmjopen-2016-011577] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore reasons for non-participation in a primary care-based physical activity trial and understand how these may contribute to recruitment of non-representative research samples. We also aimed to elicit non-participants' own recommendations for enhancing trial uptake in primary care. DESIGN Semistructured telephone interviews with non-participants to a randomised controlled trial of a very brief intervention for promoting physical activity conducted in primary care (the Very Brief Interventions trial), with thematic analysis of interview transcripts. SETTING 5 general practice (GP) surgeries in the East of England, UK. PARTICIPANTS Interviews were completed with 10 female and 6 male non-participants of white ethnicity and aged between 40 and 71 years. 13 of the 16 interviewees were either active or moderately active according to the GP Physical Activity Questionnaire (GPPAQ). RESULTS Interviewees discussed a range of reasons for non-participation. These included beliefs surrounding the personal relevance of the trial based on preconceptions of intervention content. Many interviewees considered themselves either sufficiently active or too functionally limited to increase activity levels further, so rendering participation pointless in their view. Other identified barriers included a lack of free time, for trial participation and for increasing physical activity, and dissatisfaction with appointment scheduling systems in place at GP surgeries. Interviewees questioned the appropriateness of primary care as a context for delivering interventions to promote physical activity. In general, interviewees were positively disposed towards the idea of trial participation, especially if personal benefits are made salient, but suggested that interventions could be delivered in a different setting such as the internet. CONCLUSIONS To increase participation in physical activity promotion trials conducted in primary care, the content of invitation materials and procedures for contacting potential participants require reconsideration. Specific recommendations include streamlining intervention materials and enhancing their relevance to the health concerns of invitees. TRIAL REGISTRATION NUMBER ISRCTN72691150; Pre-results.
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Affiliation(s)
- S Attwood
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Behavioural Science Group, Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - K L Morton
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - J Mitchell
- Behavioural Science Group, Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - M Van Emmenis
- Behavioural Science Group, Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - S Sutton
- Behavioural Science Group, Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
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Lewis ZH, Ottenbacher KJ, Fisher SR, Jennings K, Brown AF, Swartz MC, Lyons EJ. Testing Activity Monitors' Effect on Health: Study Protocol for a Randomized Controlled Trial Among Older Primary Care Patients. JMIR Res Protoc 2016; 5:e59. [PMID: 27129602 PMCID: PMC4867768 DOI: 10.2196/resprot.5454] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 01/19/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cardiovascular disease is the leading cause of mortality in the United States. Maintaining healthy levels of physical activity is critical to cardiovascular health, but many older adults are inactive. There is a growing body of evidence linking low motivation and inactivity. Standard behavioral counseling techniques used within the primary care setting strive to increase motivation, but often do not emphasize the key component of self-control. The addition of electronic activity monitors (EAMs) to counseling protocols may provide more effective behavior change and increase overall motivation for exercise through interactive self-monitoring, feedback, and social support from other users. OBJECTIVE The objective of the study is to conduct a three month intervention trial that will test the feasibility of adding an EAM system to brief counseling within a primary care setting. Participants (n=40) will be randomized to receive evidence-based brief counseling plus either an EAM or a pedometer. METHODS Throughout the intervention, we will test its feasibility and acceptability, the change in primary outcomes (cardiovascular risk and physical activity), and the change in secondary outcomes (adherence, weight and body composition, health status, motivation, physical function, psychological feelings, and self-regulation). Upon completion of the intervention, we will also conduct focus groups with the participants and with primary care stakeholders. RESULTS The study started recruitment in October 2015 and is scheduled to be completed by October 2016. CONCLUSIONS This project will lay the groundwork and establish the infrastructure for intervention refinement and ultimately translation within the primary care setting in order to prevent cardiovascular disease on a population level. TRIAL REGISTRATION ClinicalTrials.gov NCT02554435; https://clinicaltrials.gov/ct2/show/NCT02554435 (Archived by WebCite at http://www.webcitation/6fUlW5tdT).
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Affiliation(s)
- Zakkoyya H Lewis
- University of Texas Medical Branch, Division of Rehabilitation Sciences, Galveston, TX, United States.
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Normansell R, Holmes R, Victor C, Cook DG, Kerry S, Iliffe S, Ussher M, Fox-Rushby J, Whincup P, Harris T. Exploring non-participation in primary care physical activity interventions: PACE-UP trial interview findings. Trials 2016; 17:178. [PMID: 27039181 PMCID: PMC4818945 DOI: 10.1186/s13063-016-1299-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 03/17/2016] [Indexed: 11/10/2022] Open
Abstract
Background Trials in primary care to increase physical activity (PA) typically experience poor recruitment rates and may not recruit those with lower PA levels and who are most in need of the intervention. Despite the well-publicised benefits of physical activity, the majority of adults in the UK remain inactive and, therefore, at greater risk of many health problems. Our aim was to investigate the reasons for non-participation in the PACE-UP trial, which is a primary care pedometer-based walking intervention. This is important for successful recruitment and retention in future PA trials and programmes. Method We conducted semi-structured audio-recorded telephone interviews with 30 participants, aged 45–75 years, purposively sampled from those declining participation in the PACE-UP trial. Recruitment continued until data saturation and a demographically balanced sample was achieved. Interviews were transcribed verbatim, coded and subjected to thematic analysis. Results Interviewees supported walking as suitable exercise for most people in this age group, recognised the importance of this type of research and general practice as an appropriate setting. Key reasons for declining were: the perception of being already ‘too active’; existing medical conditions; work; travel and other commitments. Less frequently cited reasons included reluctance to be randomised, the intervention’s duration, wearing a pedometer, perceived inappropriateness of trial literature and a preference for a different kind of PA or for a group activity. Conclusions Whilst most interviewees perceived themselves to be sufficiently active, an important minority did not participate due to existing medical conditions and other commitments. Recruitment to future PA trials might be improved by tailoring activity to compensate for medical problems, and adapting PA interventions to fit around work and travel commitments. Ensuring that patient-targeted literature is succinct and inclusive and that equipment is user-friendly are also important. Primary care is seen as an appropriate setting for PA trials and programmes. Trial registration ISRCTN98538934.
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Affiliation(s)
- Rebecca Normansell
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 ORE, UK.
| | - Rebecca Holmes
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 ORE, UK
| | - Christina Victor
- Gerontology and Health Services Research Unit, Brunel University, London, UB8 3PH, UK
| | - Derek G Cook
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 ORE, UK
| | - Sally Kerry
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, E1 2AT, UK
| | - Steve Iliffe
- Research Department of Primary Care and Population Health, University College, London, NW3 2PF, UK
| | - Michael Ussher
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 ORE, UK
| | - Julia Fox-Rushby
- Health Economics Research Group, Brunel University, London, UB8 3PH, UK
| | - Peter Whincup
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 ORE, UK
| | - Tess Harris
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 ORE, UK
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Beighton C, Victor C, Normansell R, Cook D, Kerry S, Iliffe S, Ussher M, Whincup P, Fox-Rushby J, Woodcock A, Harris T. "It's not just about walking.....it's the practice nurse that makes it work": a qualitative exploration of the views of practice nurses delivering complex physical activity interventions in primary care. BMC Public Health 2015; 15:1236. [PMID: 26654223 PMCID: PMC4677041 DOI: 10.1186/s12889-015-2568-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 12/04/2015] [Indexed: 11/22/2022] Open
Abstract
Background Physical activity (PA) is important for physical and mental health in adults and older adults. Interventions incorporating theory-based behaviour change techniques (BCTs) can be useful in helping people to increase their PA levels and can be delivered by practice nurses in primary care. We undertook two primary care based complex walking interventions among adults and older adults. Both interventions were underpinned by BCTs and delivered by practice nurses and we sought their views and experiences of delivering over 1400 complex PA consultations. Methods Semi structured interviews with two practice nurse groups (n = 4 and n = 5) and two individual interviews (total n = 11) were conducted by independent facilitators; audio-recorded, transcribed verbatim and analysed using thematic analysis. Results Five key themes emerged as enablers and/or barriers to delivering the intervention: preparation and training; initial and ongoing support; adherence to the protocol; the use of materials and equipment; and engagement of participants. The themes were organised into a framework of ‘pre-trial’ and ‘delivery of the intervention’. Two additional ‘post-trial’ themes were identified; changed practice and the future feasibility of the intervention. Nurses believed that taking part in the trial, especially the BCT training, enhanced the quality and delivery of advice and support they provided within routine consultations, although the lack of time available routinely makes this challenging. Conclusion Delivering an effective behaviour change intervention in primary care requires adequate training and support for practice nurses both initially and throughout the trial as well as adequate consultation time. Enhanced skills from participating in such trials can lead to long-term changes, including more patient-centred consulting. Trial registration PACE-Lift ISRCTN 42122561, PACE-UP ISRCTN 98538934.
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Affiliation(s)
- Carole Beighton
- Faculty of Health, Social Care & Education, Kingston & St George's University of London, London, SW17 ORE, UK.
| | - Christina Victor
- College of Health and Life Sciences, Brunel University London, Middlesex, UB8 3PH, UK.
| | - Rebecca Normansell
- Population Health Research Institute, St Georges University of London, London, SW17 ORE, UK.
| | - Derek Cook
- Population Health Research Institute, St Georges University of London, London, SW17 ORE, UK.
| | - Sally Kerry
- Pragmatic Clinical Trials Unit, Queen Mary's University of London, London, E1 2AT, UK.
| | - Steve Iliffe
- Research Department of Primary Care & Population Health, University College, London, NW3 2PF, UK.
| | - Michael Ussher
- Population Health Research Institute, St Georges University of London, London, SW17 ORE, UK.
| | - Peter Whincup
- Population Health Research Institute, St Georges University of London, London, SW17 ORE, UK.
| | - Julia Fox-Rushby
- Health Economics Research Group, Brunel University, Uxbridge, UB8 3PH, UK.
| | - Alison Woodcock
- Independent Psychology Research Consultant, Southampton, UK.
| | - Tess Harris
- Population Health Research Institute, St Georges University of London, London, SW17 ORE, UK.
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Rossen J, Yngve A, Hagströmer M, Brismar K, Ainsworth BE, Iskull C, Möller P, Johansson UB. Physical activity promotion in the primary care setting in pre- and type 2 diabetes - the Sophia step study, an RCT. BMC Public Health 2015; 15:647. [PMID: 26164092 PMCID: PMC4499440 DOI: 10.1186/s12889-015-1941-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 06/15/2015] [Indexed: 11/23/2022] Open
Abstract
Background Physical activity prevents or delays progression of impaired glucose tolerance in high-risk individuals. Physical activity promotion should serve as a basis in diabetes care. It is necessary to develop and evaluate health-promoting methods that are feasible as well as cost-effective within diabetes care. The aim of Sophia Step Study is to evaluate the impact of a multi-component and a single component physical activity intervention aiming at improving HbA1c (primary outcome) and other metabolic and cardiovascular risk factors, physical activity levels and overall health in patients with pre- and type 2 diabetes. Methods/design Sophia Step Study is a randomized controlled trial and participants are randomly assigned to either a multi-component intervention group (A), a pedometer group (B) or a control group (C). In total, 310 patients will be included and followed for 24 months. Group A participants are offered pedometers and a website to register steps, physical activity on prescription with yearly follow-ups, motivational interviewing (10 occasions) and group consultations (including walks, 12 occasions). Group B participants are offered pedometers and a website to register steps. Group C are offered usual care. The theoretical framework underpinning the interventions is the Health Belief Model, the Stages of Change Model, and the Social Cognitive Theory. Both the multi-component intervention (group A) and the pedometer intervention (group B) are using several techniques for behavior change such as self-monitoring, goal setting, feedback and relapse prevention. Measurements are made at week 0, 8, 12, 16, month 6, 9, 12, 18 and 24, including metabolic and cardiovascular biomarkers (HbA1c as primary health outcome), accelerometry and daily steps. Furthermore, questionnaires were used to evaluate dietary intake, physical activity, perceived ability to perform physical activity, perceived support for being active, quality of life, anxiety, depression, well-being, perceived treatment, perceived stress and diabetes self- efficacy. Discussion This study will show if a multi-component intervention using pedometers with group- and individual consultations is more effective than a single- component intervention using pedometers alone, in increasing physical activity and improving HbA1c, other metabolic and cardiovascular risk factors, physical activity levels and overall health in patients with pre- and type 2 diabetes. Trial registration ClinicalTrials.gov Identifier: NCT02374788. Registered 28 January 2015.
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Affiliation(s)
- Jenny Rossen
- Sophiahemmet University, Stockholm, Sweden. .,Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
| | - Agneta Yngve
- Sophiahemmet University, Stockholm, Sweden. .,School of Hospitality, Culinary Arts and Meal Sciences, Örebro University, Örebro, Sweden.
| | - Maria Hagströmer
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, and Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden.
| | - Kerstin Brismar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Rolf Luft Research Center for Diabetes and Endocrinology, Karolinska University Hospital, Stockholm, Sweden.
| | - Barbara E Ainsworth
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, USA.
| | | | | | - Unn-Britt Johansson
- Sophiahemmet University, Stockholm, Sweden. .,Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
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