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Timm A, van Hoye A, Sharp P, Andersen TH, Hansen L, Oestergaard JN, Krustrup P, Cortsen K, Iversen PB, Rod MH, Klinker CD. Promoting men's health through sports clubs: A systematic rapid realist review. JOURNAL OF SPORT AND HEALTH SCIENCE 2024:100969. [PMID: 39209022 DOI: 10.1016/j.jshs.2024.100969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/21/2024] [Accepted: 04/11/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Health promotion (HP) interventions delivered through sports clubs have demonstrated promising outcomes among men, but less is known about which aspects of the interventions work, for whom, and under what circumstances. This rapid realist review aims to understand the contexts, mechanisms, and outcomes of HP interventions for men delivered through sports clubs. METHODS A systematic literature search was conducted in February 2023 for studies published after 2013 in MEDLINE, Embase, and SPORTDiscus databases. INCLUDED STUDIES (a) were delivered by or in collaboration with sports clubs, (b) targeted men aged 18+ years, and (c) reported 1 or more HP outcome. A grey literature search was also performed. Studies were included in a realist synthesis based on richness and rigor. Hereafter, context-mechanisms-outcome (CMO) configurations were developed. RESULTS We identified and screened 3356 studies, finally including 60 studies describing 22 interventions. Most HP interventions were delivered in high income countries, included Caucasian men aged 35-65 years with overweight/obesity, and used professional sports clubs (mostly football) for recruitment and facilities. Quantitative HP outcomes were reported across 19 interventions. Of these 19 interventions, the majority reported on weight (n = 18), physical activity (n = 12), mental health (n = 10), and diet (n = 9). We identified 12 CMOs related to how HP interventions affected men's recruitment, engagement, and health behavior maintenance. CONCLUSION Our findings show that using sports clubs for HP interventions is effective for engaging men. Recruitment was facilitated by leveraging sports clubs' identity, addressing masculinity-related barriers, improving accessibility, and building trust. Engagement was enhanced through shared identity experiences, safe spaces, inclusive competition, and self-efficacy. However, there's limited evidence on behavior maintenance post-intervention, though involving community stakeholders seemed vital. In general, considerations should be made to avoid perpetuating traditional masculine norms, which may exclude some men and reinforce unhealthy behaviors. These findings can guide intervention development, emphasizing the need to harness men's perspectives in the process.
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Affiliation(s)
- Anne Timm
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Herlev, 2730, Denmark.
| | - Aurelie van Hoye
- UMR1319 Interdisciplinarité en Santé Publique, Intervention et Instruments de Mesures Complexes, University of Lorraine, Villers-les-Nancy, 54600, France; Physical Activity for Health research cluster, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, V94T9PX, Ireland
| | - Paul Sharp
- School of Nursing and Department of Psychiatry, University of British Columbia, Vancouver, V6T 2B5, Canada; School of Health Sciences, University of New South Wales, Sydney, 2052, Australia
| | - Tue Helms Andersen
- Department of Education, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Herlev, 2730, Denmark
| | - Louise Hansen
- Department of Education, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Herlev, 2730, Denmark
| | | | - Peter Krustrup
- Sport and Health Sciences Cluster (SHSC), Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark; Danish Institute for Advanced Study (DIAS), Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5230, Denmark
| | - Kenneth Cortsen
- University College of Northern Denmark, Hjoerring, 9800, Denmark
| | | | - Morten Hulvej Rod
- National Institute of Public Health, University of Southern Denmark, Copenhagen, 1455, Denmark
| | - Charlotte Demant Klinker
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Herlev, 2730, Denmark
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Thomson L, Keshavarz M, Sénéchal M, Bouchard DR. Online exercise program for men living with obesity: Experiences, barriers, and enablers. Contemp Clin Trials Commun 2023; 36:101226. [PMID: 38034839 PMCID: PMC10681938 DOI: 10.1016/j.conctc.2023.101226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 10/18/2023] [Accepted: 11/04/2023] [Indexed: 12/02/2023] Open
Abstract
The prevalence of obesity is increasing among men, and this population remains under-represented in lifestyle and weight management interventions. The current study aims to explore the experiences of men living with obesity (body fat ≥25 %) toward a 12-week supervised online exercise platform. Ten men were interviewed for this qualitative study. Semi-structured, open-ended phone interviews were conducted, and the transcripts were thematically coded using the qualitative data analysis Nvivo QSR software package. The research findings are illustrated using quotes from participants. The results were organized into two main themes: those that removed barriers to exercise and those that improved the enablers of exercise. Eliminating barriers included not purchasing specialized equipment or travelling to a gym facility. The enablers to their success with the program included the structured format of the circuit program and having supervised sessions. By removing barriers and enhancing enablers, the 12-week online exercise circuit program increased compliance to and success of the exercise program for men living with obesity. Future research should explore the long-term effects of an online program for men living with obesity and its appeal beyond COVID-19.
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Affiliation(s)
- Lisa Thomson
- University of New Brunswick, Department of Sociology Fredericton NB, Canada
| | - Mohammad Keshavarz
- University of New Brunswick, Faculty of Kinesiology Fredericton NB, Canada
- Cardiometabolic Exercise and Lifestyles Laboratory, Fredericton NB, Canada
| | - Martin Sénéchal
- University of New Brunswick, Faculty of Kinesiology Fredericton NB, Canada
- Cardiometabolic Exercise and Lifestyles Laboratory, Fredericton NB, Canada
| | - Danielle R. Bouchard
- University of New Brunswick, Faculty of Kinesiology Fredericton NB, Canada
- Cardiometabolic Exercise and Lifestyles Laboratory, Fredericton NB, Canada
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Lim ASX, Schweickle MJ, Liddelow C, Liddle SK, Vella SA. Process evaluations of health-promotion interventions in sports settings: a systematic review. Health Promot Int 2023; 38:daad114. [PMID: 37721373 PMCID: PMC10506172 DOI: 10.1093/heapro/daad114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Sports settings have been identified as an ideal place to conduct complex multi-level health-promotion interventions, with the potential to engage a broad audience. Whilst the benefits of delivering health-promotion interventions in sports settings are well documented, such interventions' real-world implementation and success must be better understood. Process evaluations can be conducted to provide information related to an intervention's fidelity, replication, scaling, adoption, and the underlying mechanisms driving outcomes. This systematic review summarizes how process evaluations of health-promotion interventions are conducted in sports settings and highlight facilitators and barriers to health-promotion intervention delivery using narrative synthesis. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, searches included original peer-reviewed articles from inception-January 2023. We searched eight electronic databases: Academic Search Complete; MEDLINE, PsycARTICLES; PsycINFO; SPORTSDiscus with Full Text; MEDLINE; SCOPUS; Pub Med, and Pro Quest Central. Thirty-two studies were included. Findings suggest that most process evaluations of health-promotion interventions have acknowledged the inherent complexity of sports settings, and investigated factors that explain their intervention's success (e.g. trust building, engagement). However, poor use of process evaluation frameworks or guidelines resulted in wide variations of how process evaluations are conducted and reported, which made findings difficult to integrate and standardize with consistency. Accordingly, this review provides a guide on how future process evaluations can be conducted to improve health-promotion interventions' transparency, replicability and reliability in real-world settings.
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Affiliation(s)
- Angie S X Lim
- Global Alliance for Mental Health and Sport, School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia
| | - Matthew J Schweickle
- Global Alliance for Mental Health and Sport, School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia
| | - Caitlin Liddelow
- Global Alliance for Mental Health and Sport, School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia
| | - Sarah K Liddle
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton, Victoria, 3800, Australia
| | - Stewart A Vella
- Global Alliance for Mental Health and Sport, School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, New South Wales, 2522, Australia
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McDonald MD, Hunt K, Moullin J, Kerr D, Ntoumanis N, Quested E. 'A Different Ball Game': Adaptation of a men's health program for implementation in rural Australia. BMC Public Health 2023; 23:1387. [PMID: 37468854 DOI: 10.1186/s12889-023-16247-w] [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: 11/13/2022] [Accepted: 07/05/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Men residing in rural areas are less likely to participate in weight management interventions than women, and few men-specific programs target rural areas. Aussie-Fans in Training (Aussie-FIT) is an evidence-based weight management intervention that uses professional Australian Football club affiliations and settings as a 'hook' to engage urban-residing men. The aim of this study is to report on how findings from rural stakeholder focus groups were used to inform the adaptation of Aussie-FIT for implementation in rural areas. METHODS Seven focus groups with stakeholders (n = 24) in three rural towns explored existing weight management and physical activity provisions, barriers and facilitators to engaging men, and considerations for adapting Aussie-FIT for implementation in rural contexts. Qualitative data were analysed using the framework approach. Adaptations made to the Aussie-FIT program and strategies to implement the program in rural contexts were reported using a structured framework. RESULTS Themes generated from our analysis include limited appealing services for men, Australian Football as a 'common language', the influence of the 'smaller fishpond'(population), considerations for program inclusivity, and the importance of local partner organisations for sustainability. We adapted the recruitment and marketing strategies, delivery settings, football program theme and partnerships for rural implementation. Stakeholders advised that an Australian Football program theme without specific local club affiliations would be important to avoid alienating men with differing club allegiances or non-sporting backgrounds. A multi-component recruitment strategy utilising local trusted sources, and program marketing that aligns with masculine ideals were considered important by stakeholders in small communities where 'people talk'. CONCLUSIONS Rural areas were described as 'a different ball game' due to limited local services and resources in comparison to metropolitan areas. Study findings have synergies with previous studies undertaken in rural contexts including in relation to the power of word of mouth, the importance of trust, and local partner organisations. Findings have implications for engaging rural men in health interventions in rural contexts where professional sporting contexts are not available. Assessing the extent to which the adapted Aussie-FIT program can reach and engage men in rural Australia, and exploring the barriers and facilitators to delivering the program in rural contexts is required.
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Affiliation(s)
- Matthew D McDonald
- Curtin School of Population Health, Curtin University, Perth, Australia.
- Physical Activity and Well-Being Research Group, enAble Institute, Curtin University, Perth, Australia.
| | - Kate Hunt
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Joanna Moullin
- Curtin School of Population Health, Curtin University, Perth, Australia
| | - Deborah Kerr
- Curtin School of Population Health, Curtin University, Perth, Australia
- Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
| | - Nikos Ntoumanis
- Danish Centre for Motivation and Behaviour Change, University of Southern Denmark, Odense, Denmark
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Eleanor Quested
- Curtin School of Population Health, Curtin University, Perth, Australia
- Physical Activity and Well-Being Research Group, enAble Institute, Curtin University, Perth, Australia
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Bunn C, Palmer V, Chng NR, Andersen E, Gray CM, Hunt K, Jelsma JGM, Morgan H, der Sanden MNV, Pereira HV, Philpott M, Roberts GC, Rooksby J, Røynesdal ØB, Silva MN, Sørensen M, Teixeira PJ, van Achterberg T, van de Glind I, van Mechelen W, van Nassau F, van der Ploeg HP, Wyke S. How European Fans in Training (EuroFIT), a lifestyle change program for men delivered in football clubs, achieved its effect: a mixed methods process evaluation embedded in a randomised controlled trial. BMC Public Health 2023; 23:526. [PMID: 36941552 PMCID: PMC10026416 DOI: 10.1186/s12889-023-15419-y] [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: 11/21/2022] [Accepted: 03/10/2023] [Indexed: 03/22/2023] Open
Abstract
BACKGROUND A randomised trial of European Fans in Training (EuroFIT), a 12-week healthy lifestyle program delivered in 15 professional football clubs in the Netherlands, Norway, Portugal, and the United Kingdom, successfully increased physical activity and improved diet but did not reduce sedentary time. To guide future implementation, this paper investigates how those effects were achieved. We ask: 1) how was EuroFIT implemented? 2) what were the processes through which outcomes were achieved? METHODS We analysed qualitative data implementation notes, observations of 29 of 180 weekly EuroFIT deliveries, semi-structured interviews with 16 coaches and 15 club representatives, and 30 focus group discussions with participants (15 post-program and 15 after 12 months). We descriptively analysed quantitative data on recruitment, attendance at sessions and logs of use of the technologies and survey data on the views of participants at baseline, post program and after 12 months. We used a triangulation protocol to investigate agreement between data from difference sources, organised around meeting 15 objectives within the two research questions. RESULTS We successfully recruited clubs, coaches and men to EuroFIT though the draw of the football club seemed stronger in the UK and Portugal. Advertising that emphasized getting fitter, club-based deliveries, and not 'standing out' worked and attendance and fidelity were good, so that coaches in all countries were able to deliver EuroFIT flexibly as intended. Coaches in all 15 clubs facilitated the use of behaviour change techniques and interaction between men, which together enhanced motivation. Participants found it harder to change sedentary time than physical activity and diet. Fitting changes into daily routines, planning for setbacks and recognising the personal benefit of behaviour change were important to maintain changes. Bespoke technologies were valued, but technological hitches frustrated participants. CONCLUSION EuroFIT was delivered as planned by trained club coaches working flexibly in all countries. It worked as expected to attract men and support initiation and maintenance of changes in physical activity and diet but the use of bespoke, unstable, technologies was frustrating. Future deliveries should eliminate the focus on sedentary time and should use only proven technologies to support self-monitoring and social interaction. TRIAL REGISTRATION ISRCTN81935608, registered 16/06/2015.
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Affiliation(s)
- Christopher Bunn
- School of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK.
| | - Victoria Palmer
- School of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK
| | - Nai Rui Chng
- School of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK
| | - Eivind Andersen
- Institute for Sport and Social Science, Norwegian School of Sport Science, Oslo, Norway
| | - Cindy M Gray
- School of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK
| | - Kate Hunt
- School of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK
- Institute for Social Marketing and Health, Faculty of Health and Sports Sciences, University of Stirling, Scotland, UK
| | - Judith G M Jelsma
- Amsterdam Public Health Research Institute, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
| | - Heather Morgan
- Institute of Applied Health Sciences, University of Aberdeen, Scotland, UK
| | - Maria Nijhuis-van der Sanden
- Radboud Institute for Health Sciences, Radboud University Medical Center, IQ Healthcare, Nijmegen, The Netherlands
| | - Hugo V Pereira
- CIDEFES - Centro de Investigação em Desporto, Faculdade de Educação Física e Desporto da Universidade Lusófona, Educação Física, Exercício e Saúde, Lisbon, Portugal
| | | | - Glyn C Roberts
- Institute for Sport and Social Science, Norwegian School of Sport Science, Oslo, Norway
| | - John Rooksby
- Computer and Information Sciences, Northumbria University, Newcastle Upon Tyne, UK
| | - Øystein B Røynesdal
- Institute for Sport and Social Science, Norwegian School of Sport Science, Oslo, Norway
- Department of Teacher Education, NLA University College, Bergen, Norway
| | - Marlene N Silva
- CIDEFES - Centro de Investigação em Desporto, Faculdade de Educação Física e Desporto da Universidade Lusófona, Educação Física, Exercício e Saúde, Lisbon, Portugal
- Direcção-Geral da Saúde, Programa Nacional Para a Promoção da Atividade Física, Lisbon, Portugal
| | - Marit Sørensen
- Institute for Sport and Social Science, Norwegian School of Sport Science, Oslo, Norway
| | - Pedro J Teixeira
- CIDEFES - Centro de Investigação em Desporto, Faculdade de Educação Física e Desporto da Universidade Lusófona, Educação Física, Exercício e Saúde, Lisbon, Portugal
| | - Theo van Achterberg
- Department of Public Health and Primary Care, KU Louvain, Academic Centre for Nursing and Midwifery, Louvain, Belgium
| | - Irene van de Glind
- FWG, Department of Researchesearch and Development, Utrecht, The Netherlands
| | - Willem van Mechelen
- Amsterdam Public Health Research Institute, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
| | - Femke van Nassau
- Amsterdam Public Health Research Institute, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
| | - Hidde P van der Ploeg
- Amsterdam Public Health Research Institute, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
| | - Sally Wyke
- School of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK
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Donnachie C, Sweeting H, Hunt K. A Qualitative Study on Young Men's Experiences of Intentional Weight-Gain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3320. [PMID: 36834015 PMCID: PMC9964095 DOI: 10.3390/ijerph20043320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
This qualitative study investigated how young men perceive their body image and experiences of purposively gaining weight, and what these reveal about broader sociocultural meanings around food, consumption and male body image. The participants in this study were a subsample of men participating in the 'GlasVEGAS' study which examined the effect of weight-gain and weight loss on metabolism, fitness and disease risk in young adult men. Twenty-three qualitative, semi-structured interviews were conducted with thirteen men (mean age 23 years) at GlasVEGAS baseline (n = 10) and weight-gain (6-week) follow-up assessment (n = 13). Data were analysed using the principles of framework analysis. The majority of men viewed the foods provided as part of the GlasVEGAS study as 'luxury' items despite their being of low nutritional value. The weight-gain process prompted men to reflect on how cultural norms and social environments may amplify overeating. Several described being surprised at how quickly they assimilated unhealthy eating habits and/or gained weight. Some valued changes in their appearance associated with weight-gain, including appearing larger or having increased muscle size. These factors are vital to consider when developing weight management initiatives targeting young men, including the valorisation of unhealthy foods, wider social influences on diet and male body image ideals.
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Affiliation(s)
- Craig Donnachie
- School of Social and Political Sciences, University of Glasgow, Glasgow G12 8RS, UK
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow G1 1QE, UK
| | - Helen Sweeting
- Retired—Previously MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow G3 7HR, UK
| | - Kate Hunt
- Institute for Social Marketing and Health, University of Stirling, Stirling FK9 4LA, UK
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C McSweeney Z, McSweeney MD, Huang SH, G Hill S. Predictors of successful weight loss in children treated at a community hospital-based tertiary care pediatric weight management program. J Child Health Care 2022; 26:612-624. [PMID: 34372677 DOI: 10.1177/13674935211037535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Childhood obesity is a major public health concern. However, predictors of successful outcomes for patients treated at multidisciplinary community hospital-based pediatric weight management programs remain poorly understood. We conducted a retrospective analysis to evaluate 633 pediatric patients from ages 2 to 18 at a tertiary pediatric weight management program in 2018. Predictors were evaluated in univariate comparisons, and significant variables were included in a linear regression analysis to identify factors associated with improvements in body mass index relative to the age- and sex-specific 95th percentile body mass index (%BMIp95). We found that male sex and increased number of clinical visits were independently and significantly associated with reductions in %BMIp95. Baseline %BMIp95, age, preferred language, and insurance status were not significant predictors of outcomes. A total of 398 (63%) patients experienced a decrease in %BMIp95 from baseline to follow-up. One quarter (24.8%) of patients experienced a decrease in %BMIp95 of at least 5%, a threshold associated with cardiometabolic improvements. Further, we observed significant improvements in cholesterol, triglycerides, alanine aminotransferase, aspartate aminotransferase, HbA1c, and waist circumference. These findings support a potential need for sex- and gender-tailored care as well as the benefits of increased access to pediatric weight management programs.
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Affiliation(s)
- Zina C McSweeney
- Memorial Healthcare System, 23454Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | | | - Shirley H Huang
- Pediatric Weight Management Program, 10848WakeMed Health and Hospitals, Raleigh, NC, USA
- Campbell University School of Osteopathic Medicine, Lillington, NC, USA
| | - Samareh G Hill
- Pediatric Weight Management Program, 10848WakeMed Health and Hospitals, Raleigh, NC, USA
- Campbell University School of Osteopathic Medicine, Lillington, NC, USA
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The feasibility of a peer support intervention to encourage adoption and maintenance of a Mediterranean diet in established community groups at increased CVD risk: the TEAM-MED EXTEND study: a pilot cluster randomised controlled trial. Br J Nutr 2022; 128:1445-1458. [PMID: 34753522 PMCID: PMC9556267 DOI: 10.1017/s0007114521004050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This study aimed to evaluate the feasibility of a peer support intervention to encourage adoption and maintenance of a Mediterranean diet (MD) in established community groups where existing social support may assist the behaviour change process. Four established community groups with members at increased Cardiovascular Disease (CVD) risk and homogenous in gender were recruited and randomised to receive either a 12-month Peer Support (PS) intervention (PSG) (n 2) or a Minimal Support intervention (educational materials only) (MSG) (n 2). The feasibility of the intervention was assessed using recruitment and retention rates, assessing the variability of outcome measures (primary outcome: adoption of an MD at 6 months (using a Mediterranean Diet Score (MDS)) and process evaluation measures including qualitative interviews. Recruitment rates for community groups (n 4/8), participants (n 31/51) and peer supporters (n 6/14) were 50 %, 61 % and 43 %, respectively. The recruitment strategy faced several challenges with recruitment and retention of participants, leading to a smaller sample than intended. At 12 months, a 65 % and 76·5 % retention rate for PSG and MSG participants was observed, respectively. A > 2-point increase in MDS was observed in both the PSG and the MSG at 6 months, maintained at 12 months. An increase in MD adherence was evident in both groups during follow-up; however, the challenges faced in recruitment and retention suggest a definitive study of the peer support intervention using current methods is not feasible and refinement based on the current feasibility study should be incorporated. Lessons learned during the implementation of this intervention will help inform future interventions in this area.
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Robertson C, Aceves-Martins M, Cruickshank M, Imamura M, Avenell A. Does weight management research for adults with severe obesity represent them? Analysis of systematic review data. BMJ Open 2022; 12:e054459. [PMID: 35641006 PMCID: PMC9157335 DOI: 10.1136/bmjopen-2021-054459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Our objective was to determine the extent to which current evidence from long-term randomised controlled trials (RCTs) of weight management is generalisable and applicable to underserved adult groups with obesity (body mass index (BMI) ≥35 kg/m2). METHODS Descriptive analysis of 131 RCTs, published after 1990-May 2017 with ≥1 year of follow-up, included in a systematic review of long-term weight management interventions for adults with BMI ≥35 kg/m2 (the REBALANCE Project). Studies were identified from MEDLINE, EMBASE, PsychINFO, SCI, CENTRAL and from hand searching. Reporting of trial inclusion and exclusion criteria, trial recruitment strategies, baseline characteristics and outcomes were analysed using a predefined list of characteristics informed by the PROGRESS (Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status, Social capital)-Plus framework and the UK Equality Act 2010. RESULTS Few (6.1%) trials reported adapting recruitment to appeal to underserved groups. 10.0% reported culturally adapting their trial materials. Only 6.1% of trials gave any justification for their exclusion criteria, yet over half excluded participation for age or mental health reasons. Just over half (58%) of the trials reported participants' race or ethnicity, and one-fifth reported socioeconomic status. Where outcomes were reported for underserved groups, the most common analysis was by sex (47.3%), followed by race or ethnicity (16.8%). 3.1% of trials reported outcomes according to socioeconomic status. DISCUSSION Although we were limited by poor trial reporting, our results indicate inadequate representation of people most at risk of obesity. Guidance for considering underserved groups may improve the appropriateness of research and inform greater engagement with health and social care services. FUNDING National Institute for Health Research Health Technology Assessment Programme (project number: 15/09/04). PROSPERO REGISTRATION NUMBER CRD42016040190.
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Affiliation(s)
- Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - Mari Imamura
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Perruccio AV, Roos EM, Skou ST, Grønne DT, Davis AM. Factors Influencing Pain Response Following Patient Education and Supervised Exercise in Male and Female Subjects With Hip Osteoarthritis. Arthritis Care Res (Hoboken) 2022; 75:1140-1146. [PMID: 35587461 DOI: 10.1002/acr.24954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 04/20/2022] [Accepted: 05/10/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To understand factors associated with pain intensity responder status following nonsurgical hip osteoarthritis (OA) intervention, according to sex. METHODS Data were from individuals with hip OA participating in the Danish Good Life With Osteoarthritis in Denmark 8-week education and exercise program. The following factors were recorded at program entry: age; education; mental well-being; comorbidities; body mass index; symptoms in hip, knee, and low back; and program-specific factors including education sessions, former participant lectures, and supervised exercise sessions. Pain intensity was recorded at baseline and at month 3 (post-program) on a 0-100-mm visual analog scale. Response was defined as pain intensity improvement of ≥30% from baseline to post-program. Logistic regression was used and conducted separately in male and female subjects. RESULTS The sample included 791 men and 2,253 women. Female subjects had a mean baseline pain score of 47.2 of 100 (95% confidence interval [95% CI] 46.4-48.1) and male subjects had a score of 41.7 (95% CI 40.3-43.1). By post-program, the proportion of pain responders was 50.4% among women and 45.8% among men (difference P = 0.025). Among women, program-specific factors (attending former participant lectures and more supervised exercise sessions) were positively associated with pain response, as were better mental well-being and fewer comorbidities, while symptoms in other joints/sites were associated with a decreased likelihood of response. Among men, program-specific factors were not associated with response, while better mental well-being and fewer comorbidities were associated with being a responder. CONCLUSION Findings suggest that the influence of some factors on pain response differ for male and female subjects and point to a potential need for targeted approaches for men and women who may require different key messages/approaches from health care providers.
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Affiliation(s)
- Anthony V Perruccio
- University Health Network, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ewa M Roos
- University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- University of Southern Denmark, Odense, Denmark, and Naestved-Slagelse-Ringsted Hospital, Slagelse, Denmark
| | | | - Aileen M Davis
- University Health Network, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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MacLean A, Maycock M, Hunt K, Mailer C, Mason K, Gray CM. Fit for LIFE: the development and optimization of an intervention delivered through prison gymnasia to support incarcerated men in making positive lifestyle changes. BMC Public Health 2022; 22:783. [PMID: 35436873 PMCID: PMC9017016 DOI: 10.1186/s12889-022-13004-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/11/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Despite prison settings presenting opportunities for healthy eating and regular exercise, many incarcerated men supplement prison food with unhealthy snacks and drinks, and are less likely to achieve recommended physical activity guidelines than non-incarcerated men. This paper describes the co-development with prison staff of a healthy lifestyle intervention for delivery to incarcerated men, and feasibility testing of its delivery through prison physical education departments. METHODS The starting point for intervention development was Football Fans in Training (FFIT), an evidence-based intervention successful in engaging men and supporting them to lose weight, make positive lifestyle changes and maintain these long term. We iteratively tested and adapted FFIT for delivery in prison gym facilities through a four Phase pilot and optimisation study. Methods used to evaluate each phase included: observations of session deliveries; semi-structured interviews with participants; and a focus group/semi-structured interviews with prison Physical Education Instructors (PEIs) who delivered the programme. Data were analysed thematically using the Framework approach. Findings from each phase informed development of the optimised programme. RESULTS We iteratively co-developed a healthy lifestyle intervention (known as Fit for LIFE) tailored to the needs of incarcerated men and prison operational constraints. Fit for LIFE comprises elements specifically designed to address common barriers to a healthy lifestyle within prison, including: discussion of healthiest available food choices; trying out different physical activity options in the prison gym; and strategies (such as in-cell workouts) for dealing with prolonged time in cells at evenings/weekends. Weight loss was not always the most valued outcome. Instead, participants cited a wide range of behavioural, physical and mental health improvements as important to them, and were more motivated if they could focus on identifying and achieving personally relevant objectives. CONCLUSIONS Fit for LIFE is a 10-week, group-based healthy lifestyle programme tailored for delivery to incarcerated men in prison gymnasia. Weekly 90-min sessions include informative and interactive 'classroom' activities followed by a practical physical activity training session, often with group activities. Fit for LIFE aims to help incarcerated men to: increase physical activity; reduce sedentary time; eat more healthily; and start and maintain using prison gym facilities with confidence.
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Affiliation(s)
- Alice MacLean
- Institute of Social Marketing and Health, University of Stirling, Stirling, UK
| | - Matthew Maycock
- School of Education and Social Work, University of Dundee, Dundee, UK
| | - Kate Hunt
- Institute of Social Marketing and Health, University of Stirling and Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | | | - Cindy M. Gray
- Institute of Health and Wellbeing, School of Social and Political Sciences, University of Glasgow, Glasgow, UK
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Maycock M. Embodied masculinities and bodywork within two British prison gyms. NORMA : NORDISK TIDSSKRIFT FOR MASKULINITETSSTUDIER = NORDIC JOURNAL OF MASCULINITY STUDIES 2022; 18:47-64. [PMID: 38505103 PMCID: PMC10950071 DOI: 10.1080/18902138.2022.2037970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 02/01/2022] [Indexed: 03/21/2024]
Abstract
Prison masculinities are evolving in a plurality of ways that have profound implications for embodied masculinities within prison. However, previous literature has tended to overlook the importance of prison gyms as cites of particular kinds of bodywork within prison, something this paper seeks to address. Using interview data collected from two high-security men's prisons in Britain, this paper examines accounts of the sorts of bodies that prisoners aspire to achieve. This paper considers the ways in which the prison context shapes both the 'looking' and the 'doing' of male prisoners' bodies. It also considers the ways in which specific manifestations of bodywork and associated performances of certain embodied masculinities constitute agency and potential resistance to the prison regime. Finally, this paper examines the ways in which context-specific constructs of 'looking good' constitute an expression of agency and potentially a form of resistance and/or compliance with prison regimes. Ultimately, there emerge diverse sites of tension in the ways in which masculinities and bodies interact within the prisons and prison gyms in particular that are the focus of this study.
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Affiliation(s)
- Matthew Maycock
- Community Education Discipline, School of Education and Social Work, The University of Dundee, Dundee, UK
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13
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Hargreaves EA, Marsh S, Maddison R. Factors Influencing Men's Experiences and Engagement with the Rugby Fans in Training-New Zealand Pilot Trial: A Healthy Lifestyle Intervention for Men. Healthcare (Basel) 2021; 9:1737. [PMID: 34946463 PMCID: PMC8700970 DOI: 10.3390/healthcare9121737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022] Open
Abstract
Health promotion programs designed specifically to support men to improve their lifestyle behaviours are required to improve men's health. This study explored factors that influenced men's experiences of, and engagement with, the Rugby Fans in Training-New Zealand pilot trial, a professional sport-based healthy lifestyle intervention for overweight men. Thirty-five men (mean age = 45, SD = 10 years) who completed the 12-week intervention participated in one of eight semi-structured focus groups. Using inductive thematic analysis, five themes represented the meanings in the data. First, a group of like-minded men all in the same boat recognised the importance of being in similar life situations and having similar reasons for joining the programme. Second, the men described the importance of the support and motivation provided by the team atmosphere created through the programme. Third, the motivational coach recognised the characteristics, skills and knowledge of the coach delivering the programme which created engagement with it. Fourth, the education sessions were valued for the knowledge gained and underpinning philosophies that guided them. Finally, the involvement of the rugby franchise influenced commitment to the programme and created initial interest. These results provide evidence for the key components that should be incorporated into the future development of and improvement to healthy lifestyle interventions for men.
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Affiliation(s)
- Elaine Anne Hargreaves
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin 9016, New Zealand
| | - Samantha Marsh
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland 1010, New Zealand; (S.M.); (R.M.)
| | - Ralph Maddison
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland 1010, New Zealand; (S.M.); (R.M.)
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC 3125, Australia
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14
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Skagerström J, Hjertstedt M, Dannapfel P, Müssener U, Leijon M. Football and Ice Hockey Fans' Experience of a 12-Week Training and Weight-Loss Pilot Intervention (ViSiT) in Sweden-A Focus Group Study. Front Sports Act Living 2021; 3:616427. [PMID: 34485899 PMCID: PMC8416276 DOI: 10.3389/fspor.2021.616427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 07/21/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Excess weight is associated with an increased risk of poor health and premature mortality. This is more problematic for men than for women because men have a lower life expectancy and a higher prevalence of several lifestyle-related diseases. A concept whereby overweight male supporters of professional football clubs are recruited and offered a weight-loss intervention has been developed in Scotland. In the present study, we explore participants' experiences of a similar pilot intervention, called ViSiT, conducted with supporters in one ice hockey club and one football club in Sweden to assess the feasibility of using the intervention in a Swedish context. Methods: In this user centered evaluation, focus groups were conducted with 12 men who had completed the 12-week ViSiT intervention. Participants discussed reasons for participating in and completing the intervention, effects of the intervention, advantages, and areas of improvement of the intervention, and thoughts on the club's involvement. The material was analyzed using thematic analysis according to Braun and Clarke. Results: The analyses revealed four themes: reasons to participate, motivation and reinforcement, change of habit, and areas for improvement. The intervention was seen as an opportunity to change daily lifestyle behaviors. The group format, as well as the involvement of a prestigious sports club, was important for signing up to the intervention and for motivating continued involvement. The intervention had also resulted in increased knowledge on health and changed mindsets about being more attentive to regulating day-to-day behavior. Although the overall feedback on the intervention was positive, the participants suggested that possibilities to have more individual coaching should be added. Conclusions: The ViSiT weight loss and lifestyle intervention may be feasible in a Swedish context to reach overweight men at risk of poor health. The ice hockey and football club supporters expressed similar experiences from participating in the intervention. ViSiT seem to have a potential to be adopted by many sports clubs for a widespread reach to a group normally considered reluctant to participate in lifestyle change programs.
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Affiliation(s)
- Janna Skagerström
- Unit for Research and Development, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Magdalena Hjertstedt
- Unit for Human Resources, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Petra Dannapfel
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ulrika Müssener
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Matti Leijon
- Department of Medical and Health Sciences, Centre for Organizational Support and Development, Linköping University, Linköping, Sweden
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Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, Boyd KA, Craig N, French DP, McIntosh E, Petticrew M, Rycroft-Malone J, White M, Moore L. Framework for the development and evaluation of complex interventions: gap analysis, workshop and consultation-informed update. Health Technol Assess 2021; 25:1-132. [PMID: 34590577 PMCID: PMC7614019 DOI: 10.3310/hta25570] [Citation(s) in RCA: 169] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The Medical Research Council published the second edition of its framework in 2006 on developing and evaluating complex interventions. Since then, there have been considerable developments in the field of complex intervention research. The objective of this project was to update the framework in the light of these developments. The framework aims to help research teams prioritise research questions and design, and conduct research with an appropriate choice of methods, rather than to provide detailed guidance on the use of specific methods. METHODS There were four stages to the update: (1) gap analysis to identify developments in the methods and practice since the previous framework was published; (2) an expert workshop of 36 participants to discuss the topics identified in the gap analysis; (3) an open consultation process to seek comments on a first draft of the new framework; and (4) findings from the previous stages were used to redraft the framework, and final expert review was obtained. The process was overseen by a Scientific Advisory Group representing the range of relevant National Institute for Health Research and Medical Research Council research investments. RESULTS Key changes to the previous framework include (1) an updated definition of complex interventions, highlighting the dynamic relationship between the intervention and its context; (2) an emphasis on the use of diverse research perspectives: efficacy, effectiveness, theory-based and systems perspectives; (3) a focus on the usefulness of evidence as the basis for determining research perspective and questions; (4) an increased focus on interventions developed outside research teams, for example changes in policy or health services delivery; and (5) the identification of six 'core elements' that should guide all phases of complex intervention research: consider context; develop, refine and test programme theory; engage stakeholders; identify key uncertainties; refine the intervention; and economic considerations. We divide the research process into four phases: development, feasibility, evaluation and implementation. For each phase we provide a concise summary of recent developments, key points to address and signposts to further reading. We also present case studies to illustrate the points being made throughout. LIMITATIONS The framework aims to help research teams prioritise research questions and design and conduct research with an appropriate choice of methods, rather than to provide detailed guidance on the use of specific methods. In many of the areas of innovation that we highlight, such as the use of systems approaches, there are still only a few practical examples. We refer to more specific and detailed guidance where available and note where promising approaches require further development. CONCLUSIONS This new framework incorporates developments in complex intervention research published since the previous edition was written in 2006. As well as taking account of established practice and recent refinements, we draw attention to new approaches and place greater emphasis on economic considerations in complex intervention research. We have introduced a new emphasis on the importance of context and the value of understanding interventions as 'events in systems' that produce effects through interactions with features of the contexts in which they are implemented. The framework adopts a pluralist approach, encouraging researchers and research funders to adopt diverse research perspectives and to select research questions and methods pragmatically, with the aim of providing evidence that is useful to decision-makers. FUTURE WORK We call for further work to develop relevant methods and provide examples in practice. The use of this framework should be monitored and the move should be made to a more fluid resource in the future, for example a web-based format that can be frequently updated to incorporate new material and links to emerging resources. FUNDING This project was jointly funded by the Medical Research Council (MRC) and the National Institute for Health Research (Department of Health and Social Care 73514).
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Affiliation(s)
- Kathryn Skivington
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lynsay Matthews
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sharon Anne Simpson
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Peter Craig
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Jane M Blazeby
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research and Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Kathleen Anne Boyd
- Health Economics and Health Technology Assessment Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - David P French
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mark Petticrew
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Martin White
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Laurence Moore
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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16
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Bergin N, Richardson N. 'Sheds for Life': getting the balance right in delivering health promotion through Sheds in Ireland. Health Promot Int 2021; 36:605-615. [PMID: 32830228 DOI: 10.1093/heapro/daaa082] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Men with the poorest health outcomes are, paradoxically, the least likely to access health services or to engage with health promotion interventions. This has focused attention on developing gender-sensitive and strengths-based approaches to engage so-called 'hard-to-reach' men. Men's Sheds ('Sheds') are recognized as an alternative space in which to engage older and more marginalized groups of men in health. The aim of this study was to establish key principles that could align the ethos of Sheds with a national health promotion initiative ('Sheds for Life'; SFL) in terms of methods of engagement, programme content and models of delivery. Qualitative methods incorporating semi-structured interviews, focus groups and observations were conducted with men in Sheds ('Shedders'; n = 38), oversight/advisory groups (n = 11) and partner organizations (n = 8). The principles of grounded theory were used to inform data collection and analysis. Findings revealed a range of mediating factors in terms of how Shedders engage with or 'do' health that were grounded in a recognition of the health-enhancing 'essence' of Sheds and in 'making men's health men's business'. Key learnings arising from the process of engaging with Shedders included the importance of investing in relationships, establishing credibility and tailoring SFL programme content and delivery to individual Sheds. In terms of conceptualizing SFL, attention was drawn to the need for a coherent and formalized SFL strategy and 'rules of engagement', as well as a robust and sustainable system for implementation. This is the first study that informs a more systematic and formal approach to health promotion in Sheds.
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Affiliation(s)
- Niamh Bergin
- National Centre for Men's Health, Institute of Technology Carlow, Ireland
| | - Noel Richardson
- National Centre for Men's Health, Institute of Technology Carlow, Ireland
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17
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Lozano-Sufrategui L, Pringle A, Zwolinsky S, Drew KJ. Professional football clubs' involvement in health promotion in Spain: an audit of current practices. Health Promot Int 2021; 35:994-1004. [PMID: 31539049 DOI: 10.1093/heapro/daz097] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The implementation of effective community-based health interventions within Spanish football clubs has the potential to positively influence the public health agenda and enable the healthcare system in Spain to be more successful and sustainable. This paper aims to explore the involvement of Spanish football clubs in health promotion activities, their potential for future involvement and what that would require. A mixed methods explanatory sequential design, with a purposive sample of La Liga clubs. Data collection included online questionnaires and phone interviews. Quantitative methods enabled us to describe the number and types of programmes the clubs are currently involved in. Qualitative data was useful to further unpick the processes followed by the clubs in planning and developing health promotion programmes, while identifying any determinants to change. Seventeen clubs completed questionnaires and 11 participated in interviews. Clubs generally support inclusive programmes that target disadvantaged groups. Health-related programmes focus on healthy eating, physical activity and blood donation. Thematic analysis of interviews with 11 representatives of La Liga clubs resulted in three-key themes. These related to: (i) Diversity of programmes; (ii) (Lack of) evidence-based approaches to intervention design and evaluation and (iii) Contrasting views about a club's role in health promotion interventions. Spanish football clubs have potential to reach into communities that are currently underserved. However, there is limited infrastructure and understanding within the clubs to do this. Nevertheless, there is huge opportunity for organizations with public health responsibility in Spain to implement translational approaches within football-based settings.
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Affiliation(s)
| | - Andy Pringle
- Active Lifestyles, Carnegie School of Sport, Leeds Beckett University, Leeds LS6 3QS, UK
| | - Stephen Zwolinsky
- Active Lifestyles, Carnegie School of Sport, Leeds Beckett University, Leeds LS6 3QS, UK
| | - Kevin J Drew
- Active Lifestyles, Carnegie School of Sport, Leeds Beckett University, Leeds LS6 3QS, UK
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Müssig K, Adamek HE. Fußball – neue Wege in der Prävention und Behandlung des Typ-2-Diabetes. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1310-2685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungÜber die Hälfte der Bevölkerung in westlichen Ländern ist übergewichtig, und nahezu jeder Vierte ist adipös. In den nächsten Jahren wird es deshalb zu einem enormen Anstieg der Zahl an nicht übertragbaren Erkrankungen wie Diabetes, kardiovaskuläre Erkrankungen und Krebs kommen. Eine ausgewogene Ernährung, begleitet von regelmäßiger Bewegung, ist entscheidend bei der Prävention der Entwicklung und des Fortschreitens nicht übertragbarer Erkrankungen. Gesundheitsfördernde Programme besitzen eine große Bedeutung bei der langfristigen Verbesserung des Gesundheitsstatus unserer Bevölkerung, jedoch nehmen insbesondere Männer selten an gesundheitsfördernden Programmen teil. Deshalb gilt es nach neuen Wegen zu suchen, um effizienter Menschen mit einem erhöhten Risiko zu erreichen. Fußball verfügt über ein großes Potenzial, Menschen und vor allem Männer mit einem erhöhten Risiko für nicht übertragbare Erkrankungen, die üblichen gesundheitsfördernden Maßnahmen ablehnend gegenüberstehen, für die Teilnahme an Gesundheitsprogrammen zu gewinnen. Für ältere Spieler ist Walking Football eine neue Fußball-Variante mit einem geringeren Risiko für Verletzungen und eine körperliche Überlastung. Die vorliegende Arbeit gibt einen Überblick über die metabolischen Auswirkungen von Freizeitfußball und insbesondere Walking Football sowie Maßnahmen zur Gesundheitsförderung, die von professionellen Fußballvereinen angeboten werden, bei Menschen mit einem erhöhten Risiko für oder mit bereits bestehenden nicht übertragbaren Erkrankungen, wie insbesondere Typ-2-Diabetes.
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Affiliation(s)
- Karsten Müssig
- Klinik für Innere Medizin und Gastroenterologie, Franziskus-Hospital Harderberg, Georgsmarienhütte, Germany
| | - Henning E. Adamek
- Medizinische Klinik 2 (Gastroenterologie, Hepatologie, Diabetologie), Klinikum Leverkusen gGmbH, Leverkusen, Germany
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19
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Müssig K, Adamek HE. Football - Novel Approaches to Tackle Diabetes. Exp Clin Endocrinol Diabetes 2020; 130:190-197. [PMID: 33027833 DOI: 10.1055/a-1262-6352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Balanced diet and regular physical activity are of key importance to the prevention of the development and progression of non-communicable diseases. In 2050, 50% of the European population is expected to be obese. Cardiovascular diseases, diabetes mellitus, cancer, as well as joint impairments, will further increase. Therefore, programmes are critical to the improvement of the population's health status in the long run. New ways have to be found that allow addressing more people than with the current approaches. Football has a great potential to attract people at risk for or with already existing non-communicable diseases, such as type 2 diabetes, to participate in health-promoting programmes. The novel football version, walking football was developed for elderly players, aiming at avoiding injuries and physical overload. The present article gives a brief overview on the metabolic effects of recreational football, particularly walking football, as well as health-promoting programmes offered by professional football clubs in humans at risk for or with already existing non-communicable diseases.
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Affiliation(s)
- Karsten Müssig
- Department of Internal Medicine, Niels-Stensen-Kliniken, Franziskus-Hospital Harderberg, Georgsmarienhütte
| | - Henning E Adamek
- Second Department of Internal Medicine (Gastroenterology, Hepatology, Diabetology), Klinikum Leverkusen, Leverkusen
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20
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McDonald MD, Dombrowski SU, Skinner R, Calveley E, Carroll P, Elders A, Gray CM, Grindle M, Harris FM, Jones C, Hoddinott P. Recruiting men from across the socioeconomic spectrum via GP registers and community outreach to a weight management feasibility randomised controlled trial. BMC Med Res Methodol 2020; 20:249. [PMID: 33023501 PMCID: PMC7542377 DOI: 10.1186/s12874-020-01136-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/25/2020] [Indexed: 11/17/2022] Open
Abstract
Background Men, particularly those living in disadvantaged areas, are less likely to participate in weight management programmes than women despite similar levels of excess weight. Little is known about how best to recruit men to weight management interventions. This paper describes patient and public involvement in pre-trial decisions relevant to recruitment and aims to report on recruitment to the subsequent men-only weight management feasibility trial, including the: i) acceptability and feasibility of recruitment; and ii) baseline sample characteristics by recruitment strategy. Methods Men with BMI ≥30 kg/m2 and/or waist circumference ≥ 40 in. were recruited to the feasibility trial via two strategies; community outreach (venue information stands and word of mouth) and GP letters, targeting disadvantaged areas. Recruitment activities (e.g. letters sent, researcher venue hours) were recorded systematically, and baseline characteristics questionnaire data collated. Qualitative interviews (n = 50) were conducted three months post-recruitment. Analyses and reporting followed a complementary mixed methods approach. Results 105 men were recruited within four months (community n = 60, GP letter n = 45). Community outreach took 2.3 recruiter hours per participant and GP letters had an opt-in rate of 10.2% (n = 90/879). More men were interested than could be accommodated. Most participants (60%) lived in more disadvantaged areas. Compared to community outreach, men recruited via GP letters were older (mean = 57 vs 48 years); more likely to report an obesity-related co-morbidity (87% vs 44%); and less educated (no formal qualifications, 32% vs 10%, degree educated 11% vs 41%). Recruitment strategies were acceptable, a sensitive approach and trusting relationships with recruiters valued, and the ‘catchy’ study name drew attention. Conclusions Targeted community outreach and GP letters were acceptable strategies that successfully recruited participants to a men-only weight management feasibility trial. Both strategies engaged men from disadvantaged areas, a typically underserved population. Using two recruitment strategies produced samples with different health risk profiles, which could add value to research where either primary or secondary prevention is of interest. Further work is required to examine how these strategies could be implemented and sustained in practice. Trial registration ClinicalTrials.gov: NCT03040518, 2nd February 2017.
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Affiliation(s)
- Matthew D McDonald
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK. .,Physical Activity and Wellbeing Research Group, Curtin University, Perth, Australia. .,School of Psychology, Curtin University, Perth, Australia.
| | - Stephan U Dombrowski
- Faculty of Kinesiology, University of New Brunswick, Fredericton, New Brunswick, Canada.,Division of Psychology, University of Stirling, Stirling, UK
| | - Rebecca Skinner
- Division of Psychology, University of Stirling, Stirling, UK
| | - Eileen Calveley
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | | | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Cindy M Gray
- School of Social and Political Sciences, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Mark Grindle
- Institute for Health Research and Innovation, University of the Highlands and Islands, Inverness, UK
| | - Fiona M Harris
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Claire Jones
- Health Informatics Centre, University of Dundee, Dundee, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
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21
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Kwasnicka D, Ntoumanis N, Hunt K, Gray CM, Newton RU, Gucciardi DF, Thøgersen-Ntoumani C, Olson JL, McVeigh J, Kerr DA, Wyke S, Morgan PJ, Robinson S, Makate M, Quested E. A gender-sensitised weight-loss and healthy living program for men with overweight and obesity in Australian Football League settings (Aussie-FIT): A pilot randomised controlled trial. PLoS Med 2020; 17:e1003136. [PMID: 32760144 PMCID: PMC7410214 DOI: 10.1371/journal.pmed.1003136] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 06/16/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Recent evidence shows that sport settings can act as a powerful draw to engage men in weight loss. The primary objective of this pilot study was to test the feasibility of delivering and to evaluate preliminary efficacy of Aussie-FIT, a weight-loss program for men with overweight/obesity delivered in Australian Football League (AFL) settings, in preparation for a future definitive trial. METHODS AND FINDINGS This 6-month pilot trial took place in Perth, Australia. Participants were overweight/obese (Body Mass Index [BMI] ≥ 28 kg/m2), middle-aged (35-65 years old) men. Participants were recruited in May 2018, and the intervention took place between June and December 2018. The intervention involved 12 weekly 90-min face-to-face sessions, incorporating physical activity, nutrition, and behaviour change information and practical activities delivered by coaches at 2 clubs. Data were collected at baseline and immediately postintervention. For trial feasibility purposes, 6-month follow-ups were completed. Outcomes were differences in weight loss (primary outcome) and recruitment and retention rates, self-reported measures (for example, psychological well-being), device-measured physical activity, waist size, and blood pressure at 3 months. Within 3 days of advertising at each club, 426 men registered interest; 306 (72%) were eligible. Men were selected on a first-come first-served basis (n = 130; M age = 45.8, SD = 8; M BMI = 34.48 kg/m2, SD = 4.87) and randomised by a blinded researcher. Trial retention was 86% and 63% at 3- and 6-month follow-ups (respectively). No adverse events were reported. At 3 months, mean difference in weight between groups, adjusted for baseline weight and group, was 3.3 kg (95% CI 1.9, 4.8) in favour of the intervention group (p < 0.001). The intervention group's moderate-to-vigorous physical activity (MVPA) was higher than the control group by 8.54 min/day (95% CI 1.37, 15.71, p = 0.02). MVPA among men attracted to Aussie-FIT was high at baseline (intervention arm 35.61 min/day, control arm 38.38 min/day), which may have limited the scope for improvement. CONCLUSIONS Aussie-FIT was feasible to deliver; participants increased physical activity, decreased weight, and reported improvements in other outcomes. Issues with retention were a limitation of this trial. In a future, fully powered randomised controlled trial (RCT), retention could be improved by conducting assessments outside of holiday seasons. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12617000515392.
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Affiliation(s)
- Dominika Kwasnicka
- Physical Activity and Well-being Research Group, Curtin University, Perth, Australia
- School of Psychology, Curtin University, Perth, Australia
- SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Nikos Ntoumanis
- Physical Activity and Well-being Research Group, Curtin University, Perth, Australia
- School of Psychology, Curtin University, Perth, Australia
| | - Kate Hunt
- Physical Activity and Well-being Research Group, Curtin University, Perth, Australia
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Cindy M. Gray
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Robert U. Newton
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
| | - Daniel F. Gucciardi
- Physical Activity and Well-being Research Group, Curtin University, Perth, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Cecilie Thøgersen-Ntoumani
- Physical Activity and Well-being Research Group, Curtin University, Perth, Australia
- School of Psychology, Curtin University, Perth, Australia
| | - Jenny L. Olson
- Physical Activity and Well-being Research Group, Curtin University, Perth, Australia
- School of Psychology, Curtin University, Perth, Australia
| | - Joanne McVeigh
- Physical Activity and Well-being Research Group, Curtin University, Perth, Australia
- School of Occupational Therapy, Speech Therapy & Social Work, Curtin University, Perth, Australia
- Movement Physiology Laboratory, School of Physiology, University of Witwatersrand, Johannesburg, South Africa
| | - Deborah A. Kerr
- School of Public Health, Curtin University, Perth, Australia
| | - Sally Wyke
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Philip J. Morgan
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Newcastle, Australia
| | | | - Marshall Makate
- School of Public Health, Curtin University, Perth, Australia
| | - Eleanor Quested
- Physical Activity and Well-being Research Group, Curtin University, Perth, Australia
- School of Psychology, Curtin University, Perth, Australia
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Harper LD, Field A, Corr LD, Naughton RJ. The Physiological, Physical, and Biomechanical Demands of Walking Football: Implications for Exercise Prescription and Future Research in Older Adults. J Aging Phys Act 2020; 28:478-488. [PMID: 31825890 DOI: 10.1123/japa.2019-0330] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/07/2019] [Accepted: 10/07/2019] [Indexed: 10/27/2023]
Abstract
The aim of this investigation was to profile the physiological, physical, and biomechanical responses during walking football. A total of 17 male participants (aged 66 ± 6 years) participated. Heart rate; blood lactate; accelerometer variables (biomechanical load [PlayerLoad™], changes of direction); and rating of perceived exertion were measured. Participants mean percentage of maximum heart rate was 76 ± 6% during the sessions, with rating of perceived exertion across all sessions at 13 ± 2. Blood lactate increased by ∼157% from presession (1.24 ± 0.4 mmol/L) to postsession (3.19 ± 1.7 mmol/L; p ≤ .0005). PlayerLoad™ values of 353 ± 67 arbitrary units were observed, as well as ∼100 changes of direction per session. In conclusion, walking football is a moderate- to vigorous-intensity activity. The longitudinal health benefits of walking football remain to be elucidated, particularly on bone health, cardiovascular fitness, and social and mental well-being.
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Responsiveness of Device-Based and Self-Report Measures of Physical Activity to Detect Behavior Change in Men Taking Part in the Football Fans in Training (FFIT) Program. ACTA ACUST UNITED AC 2020; 3:67-77. [PMID: 32395706 DOI: 10.1123/jmpb.2019-0018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The capacity of physical activity (PA) measures to detect changes in PA within interventions is crucial. This is the first study to examine the responsiveness of activPAL3™ and the International Physical Activity Questionnaire (IPAQ; Short Form) in detecting PA change during a 12-week group-based, men-only weight management program-Football Fans in Training (FFIT). Participants wore an activPAL3™ and completed the IPAQ pre- and post-program (n = 30). Relationships between change scores were assessed by Spearman's correlations. Mean or median changes in PA were measured using paired samples t-tests and Wilcoxon signed-rank tests. Responsiveness to change was assessed utilizing Standardized Response Mean (SRM). Both device-based and self-report measures demonstrated significant changes pre-post intervention, although these changes were not significantly correlated. The SRM values for changes in activPAL3™ metrics were: 0.54 (MET-mins/day); 0.53 (step counts/day); and 0.44 (MVPA/day), indicating a small to medium responsiveness to change. SRM values for changes in IPAQ scores were: 0.59 (for total PA mins/day); 0.54 (for total MET-mins/day); 0.59 (for walking MET-mins/day); 0.38 (for vigorous MET-mins/day); and 0.38 (for moderate MET-mins/day), revealing a small to medium responsiveness to change. These findings reveal that two commonly used device-based and self-report measures demonstrated responsiveness to changes in PA. While inclusion of both device-based and self-report measures is desirable within interventions it is not always feasible. The results from this study support that self-reported measures can detect PA change within behavioral interventions, although may have a tendency to overestimate changes compared with device-based measures on absolute values, but not standardized response values.
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Maddison R, Hargreaves EA, Jiang Y, Calder AJ, Wyke S, Gray CM, Hunt K, Lubans D, Eyles H, Draper N, Heke I, Kara S, Sundborn G, Arandjus C, Jenkins M, Marsh S. Rugby Fans in Training New Zealand (RUFIT-NZ): protocol for a randomized controlled trial to assess the effectiveness and cost-effectiveness of a healthy lifestyle program for overweight men delivered through professional rugby clubs in New Zealand. Trials 2020; 21:139. [PMID: 32019609 PMCID: PMC7001306 DOI: 10.1186/s13063-019-4038-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/29/2019] [Indexed: 11/18/2022] Open
Abstract
Background A healthy lifestyle program that appeals to, and supports, obese New Zealand (NZ) European, Māori (indigenous) and Pasifika men to achieve weight loss is urgently needed. In Scotland, Football Fans in Training (FFIT), a weight management and healthy lifestyle program for overweight and obese men aged 35–65 years , delivered by community coaching staff at professional football clubs, has been shown to be beneficial and cost-effective. A pilot program inspired by FFIT but delivered by professional rugby clubs in NZ (n = 96) was shown to be effective in weight loss, improved physiological outcomes, and adherence to healthy lifestyle behaviors in overweight and obese men. The objective of this trial is to determine the effectiveness and cost-effectiveness of the Rugby Fans in Training New Zealand (RUFIT-NZ) program. Methods A pragmatic, two-arm, multi-center, randomized controlled trial involving 308 overweight and obese men aged 30–65 years, randomized to either an intervention group (n = 154) or a wait-list control group (n = 154). The intervention-group participated in the 12-week RUFIT-NZ program, a gender-sensitized, healthy lifestyle intervention adapted to the environment and cultural diversity of NZ and delivered through professional rugby clubs. Participants in the intervention group undergo physical training sessions, in addition to workshop-based sessions to learn about nutrition, physical activity, sleep, sedentary behavior, and a range of behavior-change strategies for sustaining a healthier lifestyle. The control group receives the program after 52 weeks. The primary outcome is change in body weight from baseline to 52 weeks. Secondary outcomes include change in body weight at 12 weeks; waist circumference, blood pressure, fitness, and lifestyle behaviors at 12 and 52 weeks; and cost-effectiveness. A process evaluation informed by the RE-AIM framework will evaluate potential implementation of RUFIT-NZ as an ongoing program in NZ after the trial. Discussion This trial will investigate the effectiveness and cost-effectiveness of the RUFIT-NZ program in overweight and obese NZ men. Trial registration Australia New Zealand Clinical Trials Registry, ACTRN12619000069156. Registered on 18 January 2019, according to the World Health Organization Trial Registration Data Set. Universal Trial Number, U1111-1245-0645.
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Affiliation(s)
- Ralph Maddison
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand. .,Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, Australia.
| | - Elaine Anne Hargreaves
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Yannan Jiang
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Amanda Jane Calder
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Sally Wyke
- Institute for Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, Scotland
| | - Cindy M Gray
- Institute for Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, Scotland
| | - Kate Hunt
- Institute for Social Marketing, Faculty of Health and Sports Sciences, University of Stirling, Stirling, UK
| | - David Lubans
- School of Education, Priority Research Centre for Physical Activity and Nutrition University of Newcastle, Newcastle, NSW, Australia
| | - Helen Eyles
- National Institute for Health Innovation and Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Nick Draper
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | | | - Stephen Kara
- Axis Sport Medicine Clinic, Auckland, New Zealand
| | - Gerhard Sundborn
- Department of Pacific Health, University of Auckland, Auckland, New Zealand
| | - Claire Arandjus
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Matthew Jenkins
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Samantha Marsh
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
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Harcourt KA, Appleton J, Clegg ME, Hunter L. The Influence of Social Relationships on Men's Weight. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:106-113. [PMID: 31611050 DOI: 10.1016/j.jneb.2019.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 08/16/2019] [Accepted: 08/18/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To explore how men's social relationships influence their dietary, physical activity, and weight loss intentions and behaviors. DESIGN Qualitative study using semistructured interviews. SETTING One county in the southwest of England. PARTICIPANTS Men (n = 19) aged 18-60 years with a body mass index ≥24 kg/m2 who were otherwise healthy. PHENOMENON OF INTEREST Men's perceptions of dieting, physical activity and weight loss, and how social relationships influence these behaviors. ANALYSIS Interviews were audiorecorded and transcribed verbatim. Transcripts were coded line by line using NVivo software. Themes and subthemes were inductively generated using thematic analysis. RESULTS Four themes were derived: (1) how experiences shape beliefs, (2) being a proper bloke, (3) adapting to family life, and (4) support from outside the home. Men discussed how partners were a greater influence on diet than physical activity. Attitudes toward diet and physical activity were influenced by life events such as becoming a father. It was framed as acceptable for men to talk to their friends about exercise and food intake in general, but they emphasized that this was not for "support." CONCLUSIONS AND IMPLICATIONS Family members were key influences on men's behaviors. Future qualitative research could include interviews with men's families. Findings may inform family weight loss interventions.
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Affiliation(s)
| | - Jane Appleton
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, England
| | - Miriam E Clegg
- Department of Food and Nutritional Sciences, University of Reading, Reading, United Kingdom.
| | - Louise Hunter
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, England
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Hunt K, Wyke S, Bunn C, Donnachie C, Reid N, Gray CM. Scale-Up and Scale-Out of a Gender-Sensitized Weight Management and Healthy Living Program Delivered to Overweight Men via Professional Sports Clubs: The Wider Implementation of Football Fans in Training (FFIT). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E584. [PMID: 31963224 PMCID: PMC7014345 DOI: 10.3390/ijerph17020584] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/11/2022]
Abstract
Increasing prevalence of obesity poses challenges for public health. Men have been under-served by weight management programs, highlighting a need for gender-sensitized programs that can be embedded into routine practice or adapted for new settings/populations, to accelerate the process of implementing programs that are successful and cost-effective under research conditions. To address gaps in examples of how to bridge the research to practice gap, we describe the scale-up and scale-out of Football Fans in Training (FFIT), a weight management and healthy living program in relation to two implementation frameworks. The paper presents: the development, evaluation and scale-up of FFIT, mapped onto the PRACTIS guide; outcomes in scale-up deliveries; and the scale-out of FFIT through programs delivered in other contexts (other countries, professional sports, target groups, public health focus). FFIT has been scaled-up through a single-license franchise model in over 40 UK professional football clubs to 2019 (and 30 more from 2020) and scaled-out into football and other sporting contexts in Australia, Canada, New Zealand, England and other European countries. The successful scale-up and scale-out of FFIT demonstrates that, with attention to cultural constructions of masculinity, public health interventions can appeal to men and support them in sustainable lifestyle change.
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Affiliation(s)
- Kate Hunt
- Institute for Social Marketing, University of Stirling, Stirling FK9 4LA, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8QQ, UK; (S.W.); (C.B.); (C.D.); (C.M.G.)
- Department of Psychology, Curtin University, Bentley, WA 6102, Australia
| | - Sally Wyke
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8QQ, UK; (S.W.); (C.B.); (C.D.); (C.M.G.)
| | - Christopher Bunn
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8QQ, UK; (S.W.); (C.B.); (C.D.); (C.M.G.)
| | - Craig Donnachie
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8QQ, UK; (S.W.); (C.B.); (C.D.); (C.M.G.)
| | - Nicky Reid
- Scottish Professional League Trust (SPFL-T), Glasgow G42 9DE, UK;
| | - Cindy M. Gray
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8QQ, UK; (S.W.); (C.B.); (C.D.); (C.M.G.)
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Skea ZC, Aceves-Martins M, Robertson C, De Bruin M, Avenell A. Acceptability and feasibility of weight management programmes for adults with severe obesity: a qualitative systematic review. BMJ Open 2019; 9:e029473. [PMID: 31511284 PMCID: PMC6738728 DOI: 10.1136/bmjopen-2019-029473] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To improve our understanding of the acceptability of behavioural weight management programmes (WMPs) for adults with severe obesity. DESIGN A systematic review of qualitative evidence. DATA SOURCES Medline, Embase, PsycINFO, CINAHL, SCI, SSCI and CAB abstracts were searched from 1964 to May 2017. ELIGIBILITY CRITERIA Papers that contained qualitative data from adults with body mass index (BMI) ≥35 kg/m2 (and/or the views of providers involved in their care) and considered issues about weight management. DATA EXTRACTION AND SYNTHESIS Two reviewers read and systematically extracted data from the included papers which were compared, and contrasted according to emerging issues and themes. Papers were appraised for methodological rigour and theoretical relevance using Toye's proposed criteria for quality in relation to meta-ethnography. RESULTS 33 papers met our inclusion criteria from seven countries published 2007-2017. Findings were presented from a total of 644 participants and 153 programme providers. Participants described being attracted to programmes that were perceived to be novel or exciting, as well as being endorsed by their healthcare provider. The sense of belonging to a group who shared similar issues, and who had similar physiques and personalities, was particularly important and seemed to foster a strong group identity and related accountability. Group-based activities were enjoyed by many and participants preferred WMPs with more intensive support. However, some described struggling with physical activities (due to a range of physical comorbidities) and not everyone enjoyed group interaction with others (sometimes due to various mental health comorbidities). Although the mean BMI reported across the papers ranged from 36.8 to 44.7 kg/m2, no quotes from participants in any of the included papers were linked to specific detail regarding BMI status. CONCLUSIONS Although group-based interventions were favoured, people with severe obesity might be especially vulnerable to physical and mental comorbidities which could inhibit engagement with certain intervention components.
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Affiliation(s)
- Zoë C Skea
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - M De Bruin
- Health Psychology Department, University of Aberdeen, Aberdeen, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Pietsch B, Weisser B, Hanewinkel R, Gray C, Hunt K, Wyke S, Morgenstern M. Short term effects of a weight loss and healthy lifestyle programme for overweight and obese men delivered by German football clubs. Eur J Sport Sci 2019; 20:703-712. [PMID: 31456489 DOI: 10.1080/17461391.2019.1660809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Numbers of obese and overweight people continue to grow in Germany as they do worldwide. Men are affected more often but do less about it and few weight loss services attract men in particular. To evaluate the effectiveness of a men-only weight loss programme, Football Fans in Training (FFIT), delivered by football clubs in the German Bundesliga, we did a non-randomized trial with a waiting list control group. Participants' data were collected between January 2017 and July 2018. FFIT is a 12-week, group-based, weight loss programme and was delivered in stadia and facilities of 15 professional German Bundesliga clubs. Inclusion criteria were age 35-65 years, BMI ≥ 28 and waist circumference ≥100 cm. Clubs recruited participants through Social Media, E-Mail and match day advertisement. 477 German male football fans were allocated to the intervention group by order of registration date at their respective clubs. 84 participants on the waiting list were allocated to the control group. Primary outcome was mean difference in weight loss with treatment condition over time as independent variable. We performed a multilevel mixed-effects linear regression analysis. Results were based on Intention-to-treat (ITT) analysis with Multiple Imputation. After 12 weeks, the mean weight loss of the intervention group adjusted for club, course and participants' age was 6.24 kg (95% CI 5.82-6.66) against 0.50 kg (-0.47-1.49) in the comparison group (p < 0.001). The results indicate that Football Fans in Training effectively helped German men to reduce their weight and waist circumference.
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Affiliation(s)
| | - Burkhard Weisser
- Department of Sports Medicine, Christian-Albrechts-University, Kiel, Germany
| | | | - Cindy Gray
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Kate Hunt
- Institute for Social Marketing, University of Stirling, Stirling, UK
| | - Sally Wyke
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
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Draper CE, Tomaz SA, Zihindula G, Bunn C, Gray CM, Hunt K, Micklesfield LK, Wyke S. Development, feasibility, acceptability and potential effectiveness of a healthy lifestyle programme delivered in churches in urban and rural South Africa. PLoS One 2019; 14:e0219787. [PMID: 31365557 PMCID: PMC6668772 DOI: 10.1371/journal.pone.0219787] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/01/2019] [Indexed: 11/19/2022] Open
Abstract
Rising levels of obesity in South Africa require innovation in community-level lifestyle change programmes. Our aim was to co-develop Impilo neZenkolo ('Health through Faith'), a healthy lifestyle programme for low-income, black South Africans delivered through churches, and evaluate its feasibility, acceptability and potential effectiveness. In the first phase we developed programme materials with church members. In the second phase we trained lay leaders to deliver the programme and assessed feasibility, acceptability (observation, focus groups and interviews) and potential effectiveness (pre and post measurement of weight, hip and waist circumferences, blood pressure, self-reported physical activity, dietary habits, health status, self-esteem, psychological distress). The study was conducted in four churches in urban and rural South Africa. The development workshops led to increased focus on positive benefits of participation, widening inclusion criteria to all adults and greater emphasis on Christian ethos. Challenges to feasibility included: recruitment of churches; scheduling of programme sessions (leading to one church not delivering the programme); attendance at the programme (63% attended more than half of the 12 weekly sessions); and poor programme fidelity (in particular in teaching behaviour change techniques). Aspects of the programme were acceptable, particularly the way in which the programme was aligned with a Christian ethos. There was some indication that amongst the 42/68 (62%) for whom we were obtained pre- and post-programme measurements the programme has potential to support weight loss. We conclude that a healthy lifestyle programme for low-income, black South Africans, delivered through churches, may be viable with extensive re-development of delivery strategies. These include finding external funding for the programme, endorsement from national level denominational organisations and the professionalization of programme leadership, including paid rather than volunteer leaders to ensure sufficient time can be spent in training.
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Affiliation(s)
- Catherine Elizabeth Draper
- Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Simone Annabella Tomaz
- Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Ganzamungu Zihindula
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- University of KwaZulu-Natal, Durban, South Africa
| | - Christopher Bunn
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Cindy M. Gray
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Kate Hunt
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Institute for Social Marketing, Faculty of Health and Sports Sciences, University of Stirling, Stirling, United Kingdom
| | - Lisa Kim Micklesfield
- Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sally Wyke
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
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30
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Maddison R, Hargreaves EA, Wyke S, Gray CM, Hunt K, Heke JI, Kara S, Ni Mhurchu C, Jull A, Jiang Y, Sundborn G, Marsh S. Rugby Fans in Training New Zealand (RUFIT-NZ): a pilot randomized controlled trial of a healthy lifestyle program for overweight men delivered through professional rugby clubs in New Zealand. BMC Public Health 2019; 19:166. [PMID: 30736781 PMCID: PMC6368698 DOI: 10.1186/s12889-019-6472-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 01/23/2019] [Indexed: 12/05/2022] Open
Abstract
Background Healthy lifestyle programs that are designed specifically to appeal to and support men to improve lifestyle behaviors and lose weight are needed. The Rugby Fans in Training-New Zealand (RUFIT-NZ) program is delivered by professional rugby clubs and inspired by the successful Football Fans In Training program (FFIT), a gender sensitized weight loss program for obese middle-aged men delivered by professional football clubs in Scotland. RUFIT-NZ required development and evaluation for feasibility. Methods To develop the intervention we reviewed content from the FFIT program and evidence-based physical activity, dietary and weight management guidelines, and undertook a series of focus groups and key informant interviews. We then evaluated the feasibility of the intervention in a two-arm, parallel, pilot randomized controlled trial in New Zealand. Ninety-six participants were randomized to either the 12-week RUFIT-NZ intervention (N = 49) or a control group (N = 47). The intervention was delivered through professional rugby clubs and involved physical activity training and classroom sessions on healthy lifestyle behaviors. Pilot trial outcomes included body weight, heart rate, blood pressure, cardiorespiratory fitness, and lifestyle behaviors. Feasibility was assessed by recruitment and retention rates, and acceptability of the intervention. Results At 12 weeks the mean difference in body weight was 2.5 kg (95% CI -0.4 to 5.4), which favored the intervention. Statistically significant differences in favor of the intervention group were also observed for waist circumference, resting heart rate, diastolic blood pressure, cardiorespiratory fitness, and the proportion of participants that were adherent to 3 or more healthy lifestyle behaviors. The intervention was considered feasible to test in a full trial given the good recruitment and retention rates, and positive feedback from participants. Conclusions A pilot study of a healthy lifestyle intervention delivered via professional rugby clubs in New Zealand demonstrated positive effects on weight and physiological outcomes, as well as adherence to lifestyle behaviors. Feasibility issues in terms of recruitment, retention, and participant acceptability were assessed and findings will be used to inform the design of a definitive trial. Trial registration The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry ACTRN12616000137493, 05/12/2016.
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Affiliation(s)
- Ralph Maddison
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Melbourne, Vic, 3125, Australia.
| | - Elaine Anne Hargreaves
- School of Physical Education, Sport & Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Sally Wyke
- Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Cindy M Gray
- Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Kate Hunt
- Institute for Social Marketing, Faculty of Health and Sports Sciences, University of Stirling, Stirling, UK
| | | | - Stephen Kara
- Axis Sports Medicine Clinic, Auckland, New Zealand
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Andrew Jull
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Gerhard Sundborn
- Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Samantha Marsh
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
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Wyke S, Bunn C, Andersen E, Silva MN, van Nassau F, McSkimming P, Kolovos S, Gill JMR, Gray CM, Hunt K, Anderson AS, Bosmans J, Jelsma JGM, Kean S, Lemyre N, Loudon DW, Macaulay L, Maxwell DJ, McConnachie A, Mutrie N, Nijhuis-van der Sanden M, Pereira HV, Philpott M, Roberts GC, Rooksby J, Røynesdal ØB, Sattar N, Sørensen M, Teixeira PJ, Treweek S, van Achterberg T, van de Glind I, van Mechelen W, van der Ploeg HP. The effect of a programme to improve men's sedentary time and physical activity: The European Fans in Training (EuroFIT) randomised controlled trial. PLoS Med 2019; 16:e1002736. [PMID: 30721231 PMCID: PMC6363143 DOI: 10.1371/journal.pmed.1002736] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 12/24/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Reducing sitting time as well as increasing physical activity in inactive people is beneficial for their health. This paper investigates the effectiveness of the European Fans in Training (EuroFIT) programme to improve physical activity and sedentary time in male football fans, delivered through the professional football setting. METHODS AND FINDINGS A total of 1,113 men aged 30-65 with self-reported body mass index (BMI) ≥27 kg/m2 took part in a randomised controlled trial in 15 professional football clubs in England, the Netherlands, Norway, and Portugal. Recruitment was between September 19, 2015, and February 2, 2016. Participants consented to study procedures and provided usable activity monitor baseline data. They were randomised, stratified by club, to either the EuroFIT intervention or a 12-month waiting list comparison group. Follow-up measurement was post-programme and 12 months after baseline. EuroFIT is a 12-week, group-based programme delivered by coaches in football club stadia in 12 weekly 90-minute sessions. Weekly sessions aimed to improve physical activity, sedentary time, and diet and maintain changes long term. A pocket-worn device (SitFIT) allowed self-monitoring of sedentary time and daily steps, and a game-based app (MatchFIT) encouraged between-session social support. Primary outcome (objectively measured sedentary time and physical activity) measurements were obtained for 83% and 85% of intervention and comparison participants. Intention-to-treat analyses showed a baseline-adjusted mean difference in sedentary time at 12 months of -1.6 minutes/day (97.5% confidence interval [CI], -14.3-11.0; p = 0.77) and in step counts of 678 steps/day (97.5% CI, 309-1.048; p < 0.001) in favor of the intervention. There were significant improvements in diet, weight, well-being, self-esteem, vitality, and biomarkers of cardiometabolic health in favor of the intervention group, but not in quality of life. There was a 0.95 probability of EuroFIT being cost-effective compared with the comparison group if society is willing to pay £1.50 per extra step/day, a maximum probability of 0.61 if society is willing to pay £1,800 per minute less sedentary time/day, and 0.13 probability if society is willing to pay £30,000 per quality-adjusted life-year (QALY). It was not possible to blind participants to group allocation. Men attracted to the programme already had quite high levels of physical activity at baseline (8,372 steps/day), which may have limited room for improvement. Although participants came from across the socioeconomic spectrum, a majority were well educated and in paid work. There was an increase in recent injuries and in upper and lower joint pain scores post-programme. In addition, although the five-level EuroQoL questionnaire (EQ-5D-5L) is now the preferred measure for cost-effectiveness analyses across Europe, baseline scores were high (0.93), suggesting a ceiling effect for QALYs. CONCLUSION Participation in EuroFIT led to improvements in physical activity, diet, body weight, and biomarkers of cardiometabolic health, but not in sedentary time at 12 months. Within-trial analysis suggests it is not cost-effective in the short term for QALYs due to a ceiling effect in quality of life. Nevertheless, decision-makers may consider the incremental cost for increase in steps worth the investment. TRIAL REGISTRATION International Standard Randomised Controlled Trials, ISRCTN-81935608.
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Affiliation(s)
- Sally Wyke
- Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Christopher Bunn
- Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Eivind Andersen
- Department of Coaching and Psychology, Norwegian School of Sport Science, Oslo, Norway
| | - Marlene N Silva
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - Femke van Nassau
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Paula McSkimming
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Spyros Kolovos
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jason M R Gill
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Cindy M Gray
- Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Kate Hunt
- Institute for Social Marketing, University of Stirling, Stirling, United Kingdom
| | - Annie S Anderson
- Centre for Public Health Nutrition Research, University of Dundee, Dundee, United Kingdom
| | - Judith Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Judith G M Jelsma
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Sharon Kean
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Nicolas Lemyre
- Department of Coaching and Psychology, Norwegian School of Sport Science, Oslo, Norway
| | | | - Lisa Macaulay
- Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, United Kingdom
| | | | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Nanette Mutrie
- Physical Activity for Health Research Centre, the University of Edinburgh, Edinburgh, United Kingdom
| | - Maria Nijhuis-van der Sanden
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, the Netherlands
| | - Hugo V Pereira
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - Matthew Philpott
- European Healthy Stadia Network CIC Ltd., Liverpool, United Kingdom
| | - Glyn C Roberts
- Department of Coaching and Psychology, Norwegian School of Sport Science, Oslo, Norway
| | - John Rooksby
- Computer and Information Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Øystein B Røynesdal
- Department of Coaching and Psychology, Norwegian School of Sport Science, Oslo, Norway
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Marit Sørensen
- Department of Coaching and Psychology, Norwegian School of Sport Science, Oslo, Norway
| | - Pedro J Teixeira
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | | | - Irene van de Glind
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, the Netherlands
| | - Willem van Mechelen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Hidde P van der Ploeg
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Leijon M, Åsberg K, Karlsson N, Skagerström J, Dannapfel P, Arvidsson D. A Weight-Loss and Healthy Living Program for Men Delivered in Swedish Football and Ice-Hockey Clubs (ViSiT): Results from the ViSiT Feasibility Study. Health (London) 2019. [DOI: 10.4236/health.2019.1110110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Avenell A, Robertson C, Skea Z, Jacobsen E, Boyers D, Cooper D, Aceves-Martins M, Retat L, Fraser C, Aveyard P, Stewart F, MacLennan G, Webber L, Corbould E, Xu B, Jaccard A, Boyle B, Duncan E, Shimonovich M, Bruin MD. Bariatric surgery, lifestyle interventions and orlistat for severe obesity: the REBALANCE mixed-methods systematic review and economic evaluation. Health Technol Assess 2018; 22:1-246. [PMID: 30511918 PMCID: PMC6296173 DOI: 10.3310/hta22680] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Adults with severe obesity [body mass index (BMI) of ≥ 35 kg/m2] have an increased risk of comorbidities and psychological, social and economic consequences. OBJECTIVES Systematically review bariatric surgery, weight-management programmes (WMPs) and orlistat pharmacotherapy for adults with severe obesity, and evaluate the feasibility, acceptability, clinical effectiveness and cost-effectiveness of treatment. DATA SOURCES Electronic databases including MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials and the NHS Economic Evaluation Database were searched (last searched in May 2017). REVIEW METHODS Four systematic reviews evaluated clinical effectiveness, cost-effectiveness and qualitative evidence for adults with a BMI of ≥ 35 kg/m2. Data from meta-analyses populated a microsimulation model predicting costs, outcomes and cost-effectiveness of Roux-en-Y gastric bypass (RYGB) surgery and the most effective lifestyle WMPs over a 30-year time horizon from a NHS perspective, compared with current UK population obesity trends. Interventions were cost-effective if the additional cost of achieving a quality-adjusted life-year is < £20,000-30,000. RESULTS A total of 131 randomised controlled trials (RCTs), 26 UK studies, 33 qualitative studies and 46 cost-effectiveness studies were included. From RCTs, RYGB produced the greatest long-term weight change [-20.23 kg, 95% confidence interval (CI) -23.75 to -16.71 kg, at 60 months]. WMPs with very low-calorie diets (VLCDs) produced the greatest weight loss at 12 months compared with no WMPs. Adding a VLCD to a WMP gave an additional mean weight change of -4.41 kg (95% CI -5.93 to -2.88 kg) at 12 months. The intensive Look AHEAD WMP produced mean long-term weight loss of 6% in people with type 2 diabetes mellitus (at a median of 9.6 years). The microsimulation model found that WMPs were generally cost-effective compared with population obesity trends. Long-term WMP weight regain was very uncertain, apart from Look AHEAD. The addition of a VLCD to a WMP was not cost-effective compared with a WMP alone. RYGB was cost-effective compared with no surgery and WMPs, but the model did not replicate long-term cost savings found in previous studies. Qualitative data suggested that participants could be attracted to take part in WMPs through endorsement by their health-care provider or through perceiving innovative activities, with WMPs being delivered to groups. Features improving long-term weight loss included having group support, additional behavioural support, a physical activity programme to attend, a prescribed calorie diet or a calorie deficit. LIMITATIONS Reviewed studies often lacked generalisability to UK settings in terms of participants and resources for implementation, and usually lacked long-term follow-up (particularly for complications for surgery), leading to unrealistic weight regain assumptions. The views of potential and actual users of services were rarely reported to contribute to service design. This study may have failed to identify unpublished UK evaluations. Dual, blinded numerical data extraction was not undertaken. CONCLUSIONS Roux-en-Y gastric bypass was costly to deliver, but it was the most cost-effective intervention. Adding a VLCD to a WMP was not cost-effective compared with a WMP alone. Most WMPs were cost-effective compared with current population obesity trends. FUTURE WORK Improved reporting of WMPs is needed to allow replication, translation and further research. Qualitative research is needed with adults who are potential users of, or who fail to engage with or drop out from, WMPs. RCTs and economic evaluations in UK settings (e.g. Tier 3, commercial programmes or primary care) should evaluate VLCDs with long-term follow-up (≥ 5 years). Decision models should incorporate relevant costs, disease states and evidence-based weight regain assumptions. STUDY REGISTRATION This study is registered as PROSPERO CRD42016040190. FUNDING The National Institute for Health Research Health Technology Assessment programme. The Health Services Research Unit and Health Economics Research Unit are core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorate.
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Affiliation(s)
- Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Zoë Skea
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Elisabet Jacobsen
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - David Cooper
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | | | | | - Bonnie Boyle
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Eilidh Duncan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Sharp P, Bottorff JL, Hunt K, Oliffe JL, Johnson ST, Dudley L, Caperchione CM. Men's Perspectives of a Gender-Sensitized Health Promotion Program Targeting Healthy Eating, Active Living, and Social Connectedness. Am J Mens Health 2018; 12:2157-2166. [PMID: 30234419 PMCID: PMC6199449 DOI: 10.1177/1557988318799159] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/25/2018] [Accepted: 08/13/2018] [Indexed: 01/08/2023] Open
Abstract
Men in high income countries have poorer dietary habits and higher rates of overweight and obesity than women. A major challenge with engaging men in health promotion is the perception that attention to one's health runs counter to masculine identities. Contemporary health promotion programs are believed to hold little "manly" appeal and often fail to engage and retain men. The HAT TRICK program was designed to engage men with their health by delivering an intervention in collaboration with a semi-professional ice hockey team. The program included 12 weekly sessions promoting healthy eating, active living, and social connectedness among men. Gender-sensitized elements were reflected in the program design, setting, content, and delivery. Semistructured telephone interviews were conducted with 23 men to explore perspectives of their participation in the gender-sensitized intervention. Participants were white (100%) with a mean age of 53 years ( SD ± 9.9), Body Mass Index (BMI) of 37 kg/m2 ( SD ± 6.8), and waist circumference of 127 centimeters ( SD ± 14.5). Inductive thematic analysis revealed three overarching themes, including: (a) Harnessing nostalgia for past masculinities: "Closet athletes from 30 years ago," (2) Offsetting resistance to change with sensible health advice: "Don't give up drinking beer, just have less," and (3) Gendered social spaces for doing health: "A night out with the guys," The findings support the value of gender-sensitized approaches to men's health promotion. Further research is needed to identify which gender-sensitized elements are critical to engaging men in healthy lifestyle changes.
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Affiliation(s)
- Paul Sharp
- Human Performance Research Centre, University of Technology Sydney, Sydney, NSW, Australia
| | - Joan L. Bottorff
- Institute for Healthy Living and Chronic Disease Prevention, University of British Columbia, Kelowna, BC, Canada
- School of Nursing, University of British Columbia, Kelowna, BC, Canada
| | - Kate Hunt
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - John L. Oliffe
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Steven T. Johnson
- Faculty of Health Disciplines, Athabasca University, Edmonton, AB, Canada
| | - Lauren Dudley
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - Cristina M. Caperchione
- Human Performance Research Centre, University of Technology Sydney, Sydney, NSW, Australia
- Institute for Healthy Living and Chronic Disease Prevention, University of British Columbia, Kelowna, BC, Canada
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35
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Quested E, Kwasnicka D, Thøgersen-Ntoumani C, Gucciardi DF, Kerr DA, Hunt K, Robinson S, Morgan PJ, Newton RU, Gray C, Wyke S, McVeigh J, Malacova E, Ntoumanis N. Protocol for a gender-sensitised weight loss and healthy living programme for overweight and obese men delivered in Australian football league settings (Aussie-FIT): A feasibility and pilot randomised controlled trial. BMJ Open 2018; 8:e022663. [PMID: 30337315 PMCID: PMC6196804 DOI: 10.1136/bmjopen-2018-022663] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/28/2018] [Accepted: 08/21/2018] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Overweight and obesity are highly prevalent among Australian men. Professional sports settings can act as a powerful 'hook' to engage men in weight loss programmes; the Football Fans in Training programme delivered in professional UK soccer clubs was successful and cost-effective in helping men lose weight. The Australian Football League (AFL) is a potentially attractive setting to engage men in a weight loss programme. We aim to develop, pilot and evaluate the feasibility of a weight loss intervention for overweight/obese middle-aged men, delivered in AFL settings, to promote weight loss and healthier lifestyles and determine its suitability for a future randomised control trial. METHODS AND ANALYSIS 120 overweight/obese male fans will complete baseline physical and psychological health measures and objective measures of physical activity (PA), weight, waist size and blood pressure prior to randomisation into the intervention or waitlist comparison group. The intervention group will receive 12 weekly 90 min workshops incorporating PA, nutrition education, behaviour change techniques and principles of effective motivation. Four community coaches will be trained to deliver Aussie-FIT at two AFL clubs in Western Australia. Measurements will be repeated in both groups at 3 months (post-intervention) and 6 months (follow-up). Outcomes will include programme uptake, attendance, changes in lifestyle and weight variables to inform power calculations for a future definitive trial, fidelity of programme delivery, acceptability, satisfaction with the programme and perceptions of effectiveness. We will also determine trial feasibility and potential to gather cost-effectiveness data. ETHICS AND DISSEMINATION Ethics approval was granted by Curtin University's Human Research Ethics Committee (HREC2017-0458). Results will be disseminated via peer-reviewed publications, conference presentations and reports. A multicomponent dissemination strategy will include targeted translation and stakeholder engagement events to establish strategies for sustainability and policy change. TRIAL REGISTRATION NUMBER ACTRN12617000515392; Pre-results.
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Affiliation(s)
- Eleanor Quested
- Health Psychology & Behavioural Medicine Research Group, School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Dominika Kwasnicka
- Health Psychology & Behavioural Medicine Research Group, School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Cecilie Thøgersen-Ntoumani
- Health Psychology & Behavioural Medicine Research Group, School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Daniel F Gucciardi
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Deborah A Kerr
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Kate Hunt
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
- Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Suzanne Robinson
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Philip J Morgan
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan, New South Wales, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Cindy Gray
- Institute of Health and Well-being, University of Glasgow, Glasgow, UK
| | - Sally Wyke
- Institute of Health and Well-being, University of Glasgow, Glasgow, UK
| | - Joanne McVeigh
- Movement Physiology Laboratory, School of Physiology, University of Witwatersrand, Witwatersrand, South Africa
- School of Occupational Therapy & Social Work, Curtin University, Perth, Western Australia, Australia
| | - Eva Malacova
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Nikos Ntoumanis
- Health Psychology & Behavioural Medicine Research Group, School of Psychology, Curtin University, Perth, Western Australia, Australia
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Coupe N, Cotterill S, Peters S. Tailoring lifestyle interventions to low socio-economic populations: a qualitative study. BMC Public Health 2018; 18:967. [PMID: 30075716 PMCID: PMC6076398 DOI: 10.1186/s12889-018-5877-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 07/24/2018] [Indexed: 11/18/2022] Open
Abstract
Background People living in deprived areas are more likely to be overweight or obese, have poorer health outcomes, and tend to benefit less from interventions than those from more affluent backgrounds. One approach to address such health inequalities is to tailor existing interventions to low socio-economic populations, yet there is limited evidence to inform their design. This study aims to identify how best to tailor lifestyle interventions to low socio-economic populations to improve outcomes. Methods Following direct observations of community-run weight loss groups, we interviewed 11 group facilitators and 14 service users from a health improvement service in a low socio-economic area in the North West of England. Audio-recorded interviews were transcribed verbatim and analysed thematically. Results We identified two overarching themes within the data. The first theme, managing diversity, included challenges faced in delivering a generic intervention to a diverse population in terms of knowledge, language and literacy skills, and cultural diversity. The second theme incorporated all issues relating to the environment, such as cost, access and availability of food and leisure facilities, and ‘life gets in the way’. Conclusions Tailoring interventions for this population is necessary, and more attention is needed to develop ways to ensure service providers and users engage with behaviour change techniques such as goal setting, rather than focusing on information provision alone. Interventions should also be mindful of cost, cultural diversity, and language and literacy barriers, as well as potential for disengaging this hard to reach population.
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Affiliation(s)
- Nia Coupe
- Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, Manchester, UK.
| | - Sarah Cotterill
- Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Sarah Peters
- Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, Manchester, UK
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Gray CM, Wyke S, Zhang R, Anderson AS, Barry S, Brennan G, Briggs A, Boyer N, Bunn C, Donnachie C, Grieve E, Kohli-Lynch C, Lloyd S, McConnachie A, McCowan C, McLean A, Mutrie N, Hunt K. Long-term weight loss following a randomised controlled trial of a weight management programme for men delivered through professional football clubs: the Football Fans in Training follow-up study. PUBLIC HEALTH RESEARCH 2018. [DOI: 10.3310/phr06090] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background
Rising levels of obesity require interventions that support people in long-term weight loss. The Football Fans in Training (FFIT) programme uses loyalty to football teams to engage men in weight loss. In 2011/12, a randomised controlled trial (RCT) found that the FFIT programme was effective in helping men lose weight up to 12 months.
Objectives
To investigate the long-term weight, and other physical, behavioural and psychological outcomes up to 3.5 years after the start of the RCT; the predictors, mediators and men’s qualitative experiences of long-term weight loss; cost-effectiveness; and the potential for long-term follow-up via men’s medical records.
Design
A mixed-methods, longitudinal cohort study.
Setting
Thirteen professional Scottish football clubs from the RCT and 16 additional Scottish football clubs that delivered the FFIT programme in 2015/16.
Participants
A total of 665 men who were aged 35–65 years at the RCT baseline measures and who consented to follow-up after the RCT (intervention group, n = 316; comparison group, n = 349), and 511 men who took part in the 2015/16 deliveries of the FFIT programme.
Interventions
None as part of this study.
Main outcome measures
Objectively measured weight change from the RCT baseline to 3.5 years.
Results
In total, 488 out of 665 men (73.4%) attended 3.5-year measurements. Participants in the FFIT follow-up intervention group sustained a mean weight loss from baseline of 2.90 kg [95% confidence interval (CI) 1.78 to 4.02 kg; p < 0.001], and 32.2% (75/233) weighed ≥ 5% less than at baseline. Participants in the FFIT follow-up comparison group (who participated in routine deliveries of the FFIT programme after the RCT) lost a mean of 2.71 kg (95% CI 1.65 to 3.77 kg; p < 0.001), and 31.8% (81/255) achieved ≥ 5% weight loss. Both groups showed long-term improvements in body mass index, waist circumference, percentage body fat, blood pressure, self-reported physical activity (PA) (including walking), the consumption of fatty and sugary foods, fruit and vegetables and alcohol, portion sizes, self-esteem, positive and negative affect, and physical and mental health-related quality of life (HRQoL). Mediators included self-reported PA (including walking) and sitting time, the consumption of fatty and sugary foods and fruit and vegetables, portion sizes, self-esteem, positive affect, physical HRQoL, self-monitoring of weight, autonomous regulation, internal locus of control, perceived competence, and relatedness to other FFIT programme participants and family members. In qualitative interviews, men described continuing to self-monitor weight and PA. Many felt that PA was important for weight control, and walking remained popular; most were still aware of portion sizes and tried to eat fewer snacks. The FFIT programme was associated with an incremental cost-effectiveness of £10,700–15,300 per quality-adjusted life-year (QALY) gained at 3.5 years, and around £2000 per QALY gained in the lifetime analysis. Medical record linkage provided rich information about the clinical health outcomes of the FFIT RCT participants, and 90% of men (459/511) who took part in the 2015/16 FFIT programme gave permission for future linkage.
Conclusions
Participation in the FFIT programme under both research (during the FFIT RCT) and routine (after the FFIT RCT) delivery conditions led to significant long-term weight loss. Further research should investigate (1) how to design programmes to improve long-term weight loss maintenance, (2) longer-term follow-up of FFIT RCT participants and (3) very long-term follow-up via medical record linkage.
Trial registration
Current Controlled Trials ISRCTN32677491.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 6, No. 9. See the NIHR Journals Library website for further project information. The Scottish Executive Health Department Chief Scientist Office (CSO) funded the feasibility pilot that preceded the FFIT RCT (CZG/2/504). The Medical Research Council (MRC) funded Kate Hunt and additional developmental research through the MRC/CSO Social and Public Health Sciences Unit Gender and Health programme (5TK50/25605200-68094).
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Affiliation(s)
- Cindy M Gray
- School of Social and Political Sciences, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sally Wyke
- School of Social and Political Sciences, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Rachel Zhang
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Annie S Anderson
- Centre for Public Health Nutrition Research, Ninewells Medical School, University of Dundee, Dundee, UK
| | - Sarah Barry
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Graham Brennan
- School of Social and Political Sciences, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Andrew Briggs
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicki Boyer
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Christopher Bunn
- School of Social and Political Sciences, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Craig Donnachie
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Eleanor Grieve
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ciaran Kohli-Lynch
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Suzanne Lloyd
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Colin McCowan
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alice McLean
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Nanette Mutrie
- Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Kate Hunt
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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Gray CM, Wyke S, Zhang R, Anderson AS, Barry S, Boyer N, Brennan G, Briggs A, Bunn C, Donnachie C, Grieve E, Kohli-Lynch C, Lloyd SM, McConnachie A, McCowan C, MacLean A, Mutrie N, Hunt K. Long-term weight loss trajectories following participation in a randomised controlled trial of a weight management programme for men delivered through professional football clubs: a longitudinal cohort study and economic evaluation. Int J Behav Nutr Phys Act 2018; 15:60. [PMID: 29954449 PMCID: PMC6022303 DOI: 10.1186/s12966-018-0683-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 05/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity is a major public health concern requiring innovative interventions that support people to lose weight and keep it off long term. However, weight loss maintenance remains a challenge and is under-researched, particularly in men. The Football Fans in Training (FFIT) programme engages men in weight management through their interest in football, and encourages them to incorporate small, incremental physical activity and dietary changes into daily life to support long-term weight loss maintenance. In 2011/12, a randomised controlled trial (RCT) of FFIT demonstrated effectiveness and cost-effectiveness at 12 months. The current study aimed to investigate long-term maintenance of weight loss, behavioural outcomes and lifetime cost-effectiveness following FFIT. METHODS A longitudinal cohort study comprised 3.5-year follow-up of the 747 FFIT RCT participants. Men aged 35-65 years, BMI ≥ 28 kg/m2 at RCT baseline who consented to long-term follow-up (n = 665) were invited to participate: those in the FFIT Follow Up Intervention group (FFIT-FU-I) undertook FFIT in 2011 during the RCT; the FFIT Follow Up Comparison group (FFIT-FU-C) undertook FFIT in 2012 under routine (non-research) conditions. The primary outcome was objectively-measured weight loss (from baseline) at 3.5 years. Secondary outcomes included changes in self-reported physical activity and diet at 3.5 years. Cost-effectiveness was estimated at 3.5 years and over participants' lifetime. RESULTS Of 665 men invited, 488 (73%; 65% of the 747 RCT participants) attended 3.5-year measurements. The FFIT-FU-I group sustained a mean weight loss of 2.90 kg (95% CI 1.78, 4.02; p < 0.001) 3.5 years after starting FFIT; 32.2% (75/233) weighed ≥5% less than baseline. The FFIT-FU-C group had lost 2.71 kg (1.65, 3.77; p < 0.001) at the 3.5-year measurements (2.5 years after starting FFIT); 31.8% (81/255) weighed ≥5% less than baseline. There were significant sustained improvements in self-reported physical activity and diet in both groups. The estimated incremental cost-effectiveness of FFIT was £10,700-£15,300 per QALY gained at 3.5 years, and £1790-£2200 over participants' lifetime. CONCLUSIONS Participation in FFIT under research and routine conditions leads to long-term weight loss and improvements in physical activity and diet. Investment in FFIT is likely to be cost-effective as part of obesity management strategies in countries where football is popular. TRIAL REGISTRATION ISRCTN32677491 , 20 October 2011.
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Affiliation(s)
- Cindy M. Gray
- School of Social and Political Sciences, Institute of Health and Wellbeing, 25-29 Bute Gardens, University of Glasgow, Glasgow, G12 8RS UK
| | - Sally Wyke
- School of Social and Political Sciences, Institute of Health and Wellbeing, 25-29 Bute Gardens, University of Glasgow, Glasgow, G12 8RS UK
| | - Ruiqi Zhang
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, Boyd Orr Building, University Avenue, University of Glasgow, Glasgow, G12 8QQ UK
| | - Annie S. Anderson
- Centre for Public Health Nutrition Research, Mailbox 7, Level 7, Ninewells Medical School, University of Dundee, Dundee, DD1 9SY UK
| | - Sarah Barry
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, Boyd Orr Building, University Avenue, University of Glasgow, Glasgow, G12 8QQ UK
| | - Nicki Boyer
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, 1 Lilybank Gardens, University of Glasgow, Glasgow, G12 8RZ UK
| | - Graham Brennan
- Institute of Health and Wellbeing, 25-29 Bute Gardens, University of Glasgow, Glasgow, G12 8RS UK
| | - Andrew Briggs
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, 1 Lilybank Gardens, University of Glasgow, Glasgow, G12 8RZ UK
| | - Christopher Bunn
- Institute of Health and Wellbeing, 25-29 Bute Gardens, University of Glasgow, Glasgow, G12 8RS UK
| | - Craig Donnachie
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Glasgow, FK9 4LA UK
| | - Eleanor Grieve
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, 1 Lilybank Gardens, University of Glasgow, Glasgow, G12 8RZ UK
| | - Ciaran Kohli-Lynch
- Health Economics and Health Technology Assessment, Institute of Health & Wellbeing, 1 Lilybank Gardens, University of Glasgow, Glasgow, G12 8RZ UK
| | - Suzanne M. Lloyd
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, Boyd Orr Building, University Avenue, University of Glasgow, Glasgow, G12 8QQ UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, Boyd Orr Building, University Avenue, University of Glasgow, Glasgow, G12 8QQ UK
| | - Colin McCowan
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, Boyd Orr Building, University Avenue, University of Glasgow, Glasgow, G12 8QQ UK
| | - Alice MacLean
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB UK
| | - Nanette Mutrie
- Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, 2.27 St Leonard’s Land, Holyrood Road, Edinburgh, EH8 8AQ UK
| | - Kate Hunt
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Glasgow, FK9 4LA UK
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Sutcliffe K, Melendez-Torres GJ, Burchett HED, Richardson M, Rees R, Thomas J. The importance of service-users' perspectives: A systematic review of qualitative evidence reveals overlooked critical features of weight management programmes. Health Expect 2018. [PMID: 29537117 PMCID: PMC5980498 DOI: 10.1111/hex.12657] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Extensive research effort shows that weight management programmes (WMPs) targeting both diet and exercise are broadly effective. However, the critical features of WMPs remain unclear. Objective To develop a deeper understanding of WMPs critical features, we undertook a systematic review of qualitative evidence. We sought to understand from a service‐user perspective how programmes are experienced, and may be effective, on the ground. Search strategy We identified qualitative studies from existing reviews and updated the searches of one review. Inclusion criteria We included UK studies capturing the views of adult WMP users. Data extraction and synthesis Thematic analysis was used inductively to code and synthesize the evidence. Main results Service users were emphatic that supportive relationships, with service providers or WMP peers, are the most critical aspect of WMPs. Supportive relationships were described as providing an extrinsic motivator or “hook” which helped to overcome barriers such as scepticism about dietary advice or a lack confidence to engage in physical activity. Discussion and conclusions The evidence revealed that service‐users’ understandings of the critical features of WMPs differ from the focus of health promotion guidance or descriptions of evaluated programmes which largely emphasize educational or goal setting aspects of WMPs. Existing programme guidance may not therefore fully address the needs of service users. The study illustrates that the perspectives of service users can reveal unanticipated intervention mechanisms or underemphasized critical features and underscores the value of a holistic understanding about “what happens” in complex psychosocial interventions such as WMPs.
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Affiliation(s)
- Katy Sutcliffe
- EPPI-Centre, UCL Institute of Education, University College London, London, UK
| | - G J Melendez-Torres
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Helen E D Burchett
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Michelle Richardson
- EPPI-Centre, UCL Institute of Education, University College London, London, UK
| | - Rebecca Rees
- EPPI-Centre, UCL Institute of Education, University College London, London, UK
| | - James Thomas
- EPPI-Centre, UCL Institute of Education, University College London, London, UK
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Grace B, Richardson N, Carroll P. ". . . If You're Not Part of the Institution You Fall by the Wayside": Service Providers' Perspectives on Moving Young Men From Disconnection and Isolation to Connection and Belonging. Am J Mens Health 2018; 12:252-264. [PMID: 26921002 PMCID: PMC5818107 DOI: 10.1177/1557988316634088] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
There have been increasing calls for more gender-specific service provision to support young men's (20-29 years) mental health and well-being. In Ireland, young men are the demographic group that are most likely to die by suicide but among the least likely to seek help. This study sought to investigate service providers' perspectives on the factors that support or inhibit young men from engaging in services targeted at supporting their mental/emotional well-being. Qualitative methodologies (focus groups, n = 9; interviews, n = 7) were used for this study. Disconnection from family and community was identified as a key indicator of "at-risk" groups of young men who, more typically, had experienced significant disruption in their lives. The discord between demands and expectations facing young men on one hand, and insufficient life-management and coping skills on the other, left many young men vulnerable and bereft. The desire to save face and preserve one's masculine identity was linked to young men's reluctance to seek help when feeling down. There was a strong consensus that there could be no shortcuts to [re]connecting with young men. While sport, technology, and social media were cited as appropriate media in which to engage young men, the essence of sustained connection revolved around creating safety, trust, rapport, and meaningful relationships. The findings from this study have informed the development of a Train the Trainer program ("Connecting with Young Men"), which is currently being delivered to service providers in Ireland and which may have implications for service provision elsewhere.
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Affiliation(s)
- Billy Grace
- Institute of Technology Carlow, Carlow, Ireland
| | | | - Paula Carroll
- Waterford Institute of Technology, Waterford, Ireland
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Donnachie C, Wyke S, Hunt K. Men's reactions to receiving objective feedback on their weight, BMI and other health risk indicators. BMC Public Health 2018; 18:291. [PMID: 29486743 PMCID: PMC5830073 DOI: 10.1186/s12889-018-5179-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 02/16/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Receiving information about one's weight, Body Mass Index (BMI) and other indicators of health risk may prompt behaviour change. This study investigated men's reactions to receiving information on indicators of health risk prior to taking part in a men-only weight management programme, Football Fans in Training (FFIT). It also investigated the extent to which the information was reported as influencing lifestyle change and having adverse consequences. METHODS We undertook a qualitative, semi-structured, telephone interview study with 28 men who took part in FFIT. We sought to interview approximately equal numbers of men who had and had not lost 5% or more of their pre-programme body weight by the end of the 12-week programme. Data were analysed thematically utilising principles of framework analysis. RESULTS Some men were apprehensive about receiving information which confirmed their overweight/obese status, particularly those less familiar with having similar information fed back to them. The professional football setting and the people present (including other men on the programme whom they perceived to be 'like them' and the fieldwork staff) were important factors in making the men feel comfortable in an otherwise potentially threatening situation. Men who achieved greater weight loss were more likely to report being motivated by this pre-programme feedback and to perceive themselves as responsible for their current weight and health status. However, for others the information only reaffirmed what they suspected about their relatively poor health status and was insufficient to prompt behaviour change. CONCLUSION Undertaking measurements and receiving information on health risk indicators, such as weight or BMI, within the context of behaviour change programmes can enhance motivation for behaviour change when communicated in an empathic and non-stigmatising way, and therefore should be considered as an integral part of interventions. However, providing feedback on health risk may be insufficient to prompt behaviour change in some people and may be detrimental to those with poor body image and/or lacking personal agency to adopt lifestyle changes. It is therefore imperative that adequate support and opportunities are made available when information on weight and disease risk are fed back within research or other settings.
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Affiliation(s)
- Craig Donnachie
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB UK
| | - Sally Wyke
- Institute of Health and Wellbeing, College of Social Science, University of Glasgow, 25-29 Bute Gardens, Glasgow, G12 8RS UK
| | - Kate Hunt
- Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA UK
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Pietsch B, Hanewinkel R, Weisser B, Morgenstern M. Fußballfans im Training. PRÄVENTION UND GESUNDHEITSFÖRDERUNG 2018. [DOI: 10.1007/s11553-018-0637-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Blunt W, Gill DP, Sibbald SL, Riggin B, Pulford RW, Scott R, Danylchuk K, Gray CM, Wyke S, Bunn C, Petrella RJ. Optimization of the Hockey Fans in Training (Hockey FIT) weight loss and healthy lifestyle program for male hockey fans. BMC Public Health 2017; 17:916. [PMID: 29183291 PMCID: PMC5706169 DOI: 10.1186/s12889-017-4926-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/19/2017] [Indexed: 11/15/2022] Open
Abstract
Background The health outcomes of men continue to be poorer than women globally. Challenges in addressing this problem include difficulties engaging men in weight loss programs as they tend to view these programs as contrary to the masculine narrative of independence and self-reliance. Researchers have been turning towards sports fans to engage men in health promotion programs as sports fans are typically male, and tend to have poor health habits. Methods Developed from the highly successful gender-sensitized Football Fans in Training program, Hockey Fans in Training (Hockey FIT) recruited 80 male hockey fans of the London Knights and Sarnia Sting who were overweight or obese into a weekly, 90-minute classroom education and group exercise program held over 12 weeks; a 40-week minimally-supported phase followed. A process evaluation of the Hockey FIT program was completed alongside a pragmatic randomized controlled trial and outcome evaluation in order to fully explore the acceptability of the Hockey FIT program from the perspectives of coaches delivering and participants engaged in the program. Data sources included attendance records, participant focus groups, coach interviews, assessment of fidelity (program observations and post-session coach reflections), and 12-month participant interviews. Results Coaches enjoyed delivering the program and found it simple to deliver. Men valued being among others of similar body shape and similar weight loss goals, and found the knowledge they gained through the program helped them to make and maintain health behaviour changes. Suggested improvements include having more hockey-related information and activities, greater flexibility with timing of program delivery, and greater promotion of technology support tools. Conclusions We confirmed Hockey FIT was an acceptable “gender-sensitized” health promotion program for male hockey fans who were overweight or obese. Minor changes were required for optimization, which will be evaluated in a future definitive trial. Trial registration NCT02396524 (Clinicaltrials.gov). Date of registration: Feb 26, 2015.
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Affiliation(s)
- Wendy Blunt
- Department of Family Medicine, Centre for Studies in Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Dawn P Gill
- Department of Family Medicine, Centre for Studies in Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,School of Health Studies, Faculty of Health Sciences, Western University, London, Ontario, Canada.,Graduate Program in Health & Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Shannon L Sibbald
- Department of Family Medicine, Centre for Studies in Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,School of Health Studies, Faculty of Health Sciences, Western University, London, Ontario, Canada.,Graduate Program in Health & Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada.,The Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Brendan Riggin
- School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Roseanne W Pulford
- Department of Family Medicine, Centre for Studies in Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Ryan Scott
- School of Health Studies, Faculty of Health Sciences, Western University, London, Ontario, Canada.,Graduate Program in Health & Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Karen Danylchuk
- School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Cindy M Gray
- Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Sally Wyke
- Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Christopher Bunn
- Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Robert J Petrella
- Department of Family Medicine, Centre for Studies in Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. .,Lawson Health Research Institute, London, Ontario, Canada. .,Graduate Program in Health & Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada. .,School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada. .,Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, 2nd Floor, Western University, 1465 Richmond St, London, ON, N6G 2M1, Canada.
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van de Glind I, Bunn C, Gray CM, Hunt K, Andersen E, Jelsma J, Morgan H, Pereira H, Roberts G, Rooksby J, Røynesdal Ø, Silva M, Sorensen M, Treweek S, van Achterberg T, van der Ploeg H, van Nassau F, Nijhuis-van der Sanden M, Wyke S. The intervention process in the European Fans in Training (EuroFIT) trial: a mixed method protocol for evaluation. Trials 2017; 18:356. [PMID: 28750673 PMCID: PMC5531072 DOI: 10.1186/s13063-017-2095-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 07/11/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND EuroFIT is a gender-sensitised, health and lifestyle program targeting physical activity, sedentary time and dietary behaviours in men. The delivery of the program in football clubs, led by the clubs' community coaches, is designed to both attract and engage men in lifestyle change through an interest in football or loyalty to the club they support. The EuroFIT program will be evaluated in a multicentre pragmatic randomised controlled trial (RCT), for which ~1000 overweight men, aged 30-65 years, will be recruited in 15 top professional football clubs in the Netherlands, Norway, Portugal and the UK. The process evaluation is designed to investigate how implementation within the RCT is achieved in the various football clubs and countries and the processes through which EuroFIT affects outcomes. METHODS This mixed methods evaluation is guided by the Medical Research Council (MRC) guidance for conducting process evaluations of complex interventions. Data will be collected in the intervention arm of the EuroFIT trial through: participant questionnaires (n = 500); attendance sheets and coach logs (n = 360); observations of sessions (n = 30); coach questionnaires (n = 30); usage logs from a novel device for self-monitoring physical activity and non-sedentary behaviour (SitFIT); an app-based game to promote social support for physical activity outside program sessions (MatchFIT); interviews with coaches (n = 15); football club representatives (n = 15); and focus groups with participants (n = 30). Written standard operating procedures are used to ensure quality and consistency in data collection and analysis across the participating countries. Data will be analysed thematically within datasets and overall synthesis of findings will address the processes through which the program is implemented in various countries and clubs and through which it affects outcomes, with careful attention to the context of the football club. DISCUSSION The process evaluation will provide a comprehensive account of what was necessary to implement the EuroFIT program in professional football clubs within a trial setting and how outcomes were affected by the program. This will allow us to re-appraise the program's conceptual base, optimise the program for post-trial implementation and roll out, and offer suggestions for the development and implementation of future initiatives to promote health and wellbeing through professional sports clubs. TRIAL REGISTRATION ISRCTN81935608 . Registered on 16 June 2015.
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Affiliation(s)
- I van de Glind
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - C Bunn
- Institute of Health and Wellbeing, College of Social Sciences, 27 Bute Gardens, University of Glasgow, Glasgow, G12 8RS, UK.
| | - C M Gray
- Institute of Health and Wellbeing, College of Social Sciences, 27 Bute Gardens, University of Glasgow, Glasgow, G12 8RS, UK
| | - K Hunt
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, 200 Renfield St, University of Glasgow, Glasgow, G2 3QB, UK
| | - E Andersen
- Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo, Norway
| | - J Jelsma
- Department of Public and Occupational Health, and EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands
| | - H Morgan
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - H Pereira
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculty of Human Kinetics, University of Lisbon, Estrada da Costa, 1495-688, Cruz Quebrada, Portugal
| | - G Roberts
- Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo, Norway
| | - J Rooksby
- School of Computing Science, University of Glasgow, Glasgow, G12 8RZ, UK
| | - Ø Røynesdal
- Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo, Norway
| | - M Silva
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculty of Human Kinetics, University of Lisbon, Estrada da Costa, 1495-688, Cruz Quebrada, Portugal
| | - M Sorensen
- Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo, Norway
| | - S Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - T van Achterberg
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
| | - H van der Ploeg
- Department of Public and Occupational Health, and EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands
| | - F van Nassau
- Department of Public and Occupational Health, and EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands
| | - M Nijhuis-van der Sanden
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - S Wyke
- Institute of Health and Wellbeing, College of Social Sciences, 27 Bute Gardens, University of Glasgow, Glasgow, G12 8RS, UK
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Ashton LM, Morgan PJ, Hutchesson MJ, Rollo ME, Collins CE. Young Men's Preferences for Design and Delivery of Physical Activity and Nutrition Interventions: A Mixed-Methods Study. Am J Mens Health 2017; 11:1588-1599. [PMID: 28675118 PMCID: PMC5675188 DOI: 10.1177/1557988317714141] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Young adult men are under-represented in health research, and little is known about how to reach and engage them in lifestyle interventions. This mixed-methods study aimed to explore young males' preferences for recruitment strategies, content, format (delivery mode and program duration and frequency), and facilitator characteristics for future physical activity and nutrition interventions. Ten focus groups involving 61 men (aged 18-25 years) in the Hunter region, New South Wales, Australia and an online survey distributed within Australia were completed by 282 males (aged 18-25 years). Key focus group themes included a preference for recruitment via multiple sources, ensuring images and recruiters were relatable; intervention facilitators to be engaging and refrain from discussing negative consequences of being unhealthy. Key program content preferences included skill development and individualized goals and feedback. Focus groups and the survey confirmed a preference for multiple delivery modes, including; face-to-face (group and individual), with support using eHealth technologies. Survey results confirmed the most favored program content as: "healthy eating on a budget," "quick and easy meals," and "resistance training." Focus group responses suggested a program duration of ≥6 months, with 2-3 combined face-to-face and supportive eHealth sessions per week. Survey intervention duration preference was 3 months with 4 face-to-face sessions per month. Findings can guide the design, conduct, and evaluation of relevant contemporary physical activity and or nutrition interventions for young men. There is a need to identify the most effective ways to address young men's individual preferences in intervention research.
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Affiliation(s)
- Lee M Ashton
- 1 School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Philip J Morgan
- 2 School of Education, Faculty of Education and Arts, Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Melinda J Hutchesson
- 1 School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Megan E Rollo
- 1 School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Clare E Collins
- 1 School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
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Ahern AL, Wheeler GM, Aveyard P, Boyland EJ, Halford JCG, Mander AP, Woolston J, Thomson AM, Tsiountsioura M, Cole D, Mead BR, Irvine L, Turner D, Suhrcke M, Pimpin L, Retat L, Jaccard A, Webber L, Cohn SR, Jebb SA. Extended and standard duration weight-loss programme referrals for adults in primary care (WRAP): a randomised controlled trial. Lancet 2017; 389:2214-2225. [PMID: 28478041 PMCID: PMC5459752 DOI: 10.1016/s0140-6736(17)30647-5] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 01/12/2017] [Accepted: 01/17/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Evidence exist that primary care referral to an open-group behavioural programme is an effective strategy for management of obesity, but little evidence on optimal intervention duration is available. We aimed to establish whether 52-week referral to an open-group weight-management programme would achieve greater weight loss and improvements in a range of health outcomes and be more cost-effective than the current practice of 12-week referrals. METHODS In this non-blinded, parallel-group, randomised controlled trial, we recruited participants who were aged 18 years or older and had body-mass index (BMI) of 28 kg/m2 or higher from 23 primary care practices in England. Participants were randomly assigned (2:5:5) to brief advice and self-help materials, a weight-management programme (Weight Watchers) for 12 weeks, or the same weight-management programme for 52 weeks. We followed-up participants over 2 years. The primary outcome was weight at 1 year of follow-up, analysed with mixed-effects models according to intention-to-treat principles and adjusted for centre and baseline weight. In a hierarchical closed-testing procedure, we compared combined behavioural programme arms with brief intervention, then compared the 12-week programme and 52-week programme. We did a within-trial cost-effectiveness analysis using person-level data and modelled outcomes over a 25-year time horizon using microsimulation. This study is registered with Current Controlled Trials, number ISRCTN82857232. FINDINGS Between Oct 18, 2012, and Feb 10, 2014, we enrolled 1269 participants. 1267 eligible participants were randomly assigned to the brief intervention (n=211), the 12-week programme (n=528), and the 52-week programme (n=528). Two participants in the 12-week programme had been found to be ineligible shortly after randomisation and were excluded from the analysis. 823 (65%) of 1267 participants completed an assessment at 1 year and 856 (68%) participants at 2 years. All eligible participants were included in the analyses. At 1 year, mean weight changes in the groups were -3·26 kg (brief intervention), -4·75 kg (12-week programme), and -6·76 kg (52-week programme). Participants in the behavioural programme lost more weight than those in the brief intervention (adjusted difference -2·71 kg, 95% CI -3·86 to -1·55; p<0·0001). The 52-week programme was more effective than the 12-week programme (-2·14 kg, -3·05 to -1·22; p<0·0001). Differences between groups were still significant at 2 years. No adverse events related to the intervention were reported. Over 2 years, the incremental cost-effectiveness ratio (ICER; compared with brief intervention) was £159 per kg lost for the 52-week programme and £91 per kg for the 12-week programme. Modelled over 25 years after baseline, the ICER for the 12-week programme was dominant compared with the brief intervention. The ICER for the 52-week programme was cost-effective compared with the brief intervention (£2394 per quality-adjusted life-year [QALY]) and the 12-week programme (£3804 per QALY). INTERPRETATION For adults with overweight or obesity, referral to this open-group behavioural weight-loss programme for at least 12 weeks is more effective than brief advice and self-help materials. A 52-week programme produces greater weight loss and other clinical benefits than a 12-week programme and, although it costs more, modelling suggests that the 52-week programme is cost-effective in the longer term. FUNDING National Prevention Research Initiative, Weight Watchers International (as part of an UK Medical Research Council Industrial Collaboration Award).
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Affiliation(s)
- Amy L Ahern
- MRC Human Nutrition Research, Cambridge, UK; MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
| | - Graham M Wheeler
- MRC Biostatistics Hub for Trials Methodology Research, University of Cambridge, Cambridge, UK; Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Emma J Boyland
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Jason C G Halford
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Adrian P Mander
- MRC Biostatistics Hub for Trials Methodology Research, University of Cambridge, Cambridge, UK
| | | | | | | | | | - Bethan R Mead
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Lisa Irvine
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - David Turner
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Marc Suhrcke
- Norwich Medical School, University of East Anglia, Norwich, UK; Centre for Health Economics, University of York, York, UK
| | | | | | | | | | - Simon R Cohn
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Susan A Jebb
- MRC Human Nutrition Research, Cambridge, UK; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Donnachie C, Wyke S, Mutrie N, Hunt K. 'It's like a personal motivator that you carried around wi' you': utilising self-determination theory to understand men's experiences of using pedometers to increase physical activity in a weight management programme. Int J Behav Nutr Phys Act 2017; 14:61. [PMID: 28476118 PMCID: PMC5420087 DOI: 10.1186/s12966-017-0505-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 04/07/2017] [Indexed: 12/01/2022] Open
Abstract
Background Self-monitoring using pedometers is an effective behaviour change technique to support increased physical activity (PA). However, the ways in which pedometers operate as motivational tools in adoption and maintenance of PA is not well understood. This paper investigates men’s experiences of pedometers as motivational tools both during and after their participation in a 12-week group-based, weight management programme for overweight/obese men, Football Fans in Training (FFIT). Methods Semi-structured telephone interviews were conducted with 28 men, purposively sampled to include men who did and did not achieve 5% weight loss during the programme. Data were analysed thematically utilising the framework approach, using Self-Determination Theory (SDT) - namely concepts of behavioural regulation and the basic needs of relatedness, competence and autonomy - as an analytical lens. Results During the programme, FFIT’s context and fellow participants supported relatedness and encouraged use of the pedometer. The pedometer was seen to provide tangible proof of progress, thus increasing competence for change, whilst the ability to monitor one’s own progress and take remedial action supported autonomy; these men portrayed the pedometer as an ‘ally’. However, a minority found the pedometer ‘dispiriting’ or controlling when it evidenced their inability to meet their PA targets. After the programme, some men no longer used the device as they had fully internalised their motivations for increased PA. In contrast, others continued to use pedometers or progressed to other self-monitoring technologies because it was enjoyable and facilitated maintenance of their increased PA. However, the minority of men who experienced the pedometer as controlling no longer used it. They were less successful in achieving 5% weight loss and appeared reliant on external factors, including support from coach and group members, to maintain motivation. Conclusion These findings show how self-monitoring using pedometers and associated goal setting supported the development of autonomous motivation for PA, during and after participation in a group-based programme. They also suggest that programmes could focus on early identification of participants who remain motivated by extrinsic factors or express negative experiences of self-monitoring tools, to offer greater support to identify the benefits of PA based on a person’s own values. Electronic supplementary material The online version of this article (doi:10.1186/s12966-017-0505-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Craig Donnachie
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK.
| | - Sally Wyke
- School of Social and Political Sciences, Institute of Health and Wellbeing, University of Glasgow, 25-29 Bute Gardens, Glasgow, G12 8RS, UK
| | - Nanette Mutrie
- Moray House School of Education, Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, 2.27 St Leonard's Land, Edinburgh, EH8 8AQ, UK
| | - Kate Hunt
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK
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Lackinger C, Wilfinger J, Mayerhofer J, Strehn A, Dick D, Dorner TE. Adherence to and effects on physical function parameters of a community-based standardised exercise programme for overweight or obese patients carried out by local sports clubs. Public Health 2017; 147:109-118. [PMID: 28404486 DOI: 10.1016/j.puhe.2017.01.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 01/27/2017] [Accepted: 01/30/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To evaluate the adherence to a sports-club-based standardised real-life exercise programme for overweight or obese patients. The effects on physical function parameters, anthropometry and quality of life were also assessed. STUDY DESIGN Within this prospective cohort study data from patients in Austrian sports-club-based programmes were analysed. METHODS Sports-club-based programmes were held twice a week and carried out by local trainers. The target group was overweight or obese patients. Adherence was determined after 2 and 6 months, and physical function parameters were evaluated at baseline and after 2 months. RESULTS A total of 71 patients (age: 52.0; standard deviation [SD: 12.1] years; body mass index [BMI]: 37.3 [SD: 8.2] kg/m2) took part in the study. Within the first 2 months the adherence rate was 62%, while 20% (14/71) participated in ≥75% of all offered sessions. After 6 months, 49% (17/35) of the retained sample still participated regularly in an exercise class. At baseline, muscle strength represented only 70% of the age- and sex-specific reference values and could be increased in a range from +4.0% (1.3 [SD: 3.0] kg; muscular endurance for the pectoral muscles) to +22.5% (16.1 [SD: 17.5] kg) (muscular endurance for the lower limb muscles). Concerning endurance capacity, the heart rate for a constant submaximal workload decreased from 126.4 (SD: 21.7) beats per minute at baseline to 120.9 (SD: 21.1) after 2 months (P < 0.001). CONCLUSIONS Sports clubs, as a non-clinical setting, can offer attractive standardised exercise programmes for a minority of overweight or obese patients. Long term changes in life-style, that result in sufficient levels of health enhancing physical activity still remain a huge public health challenge.
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Affiliation(s)
- C Lackinger
- Department of Health Promotion and Prevention, SPORTUNION Österreich, Falkestrasse 1, 1010 Vienna, Austria.
| | - J Wilfinger
- Department of Health Promotion and Prevention, SPORTUNION Österreich, Falkestrasse 1, 1010 Vienna, Austria
| | - J Mayerhofer
- Department of Health Promotion and Prevention, SPORTUNION Österreich, Falkestrasse 1, 1010 Vienna, Austria
| | - A Strehn
- Competence Center Health Promotion, Social Insurance Authority for Business, Osterwiese 2, 7000 Eisenstadt, Austria
| | - D Dick
- Department of Health Care, Social Insurance Authority for Business, Wiedner Hauptstrasse 84-86, 1051 Vienna, Austria
| | - T E Dorner
- Institute of Social Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090 Vienna, Austria
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Gill DP, Blunt W, De Cruz A, Riggin B, Hunt K, Zou G, Sibbald S, Danylchuk K, Zwarenstein M, Gray CM, Wyke S, Bunn C, Petrella RJ. Hockey Fans in Training (Hockey FIT) pilot study protocol: a gender-sensitized weight loss and healthy lifestyle program for overweight and obese male hockey fans. BMC Public Health 2016; 16:1096. [PMID: 27756351 PMCID: PMC5070306 DOI: 10.1186/s12889-016-3730-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 09/28/2016] [Indexed: 11/18/2022] Open
Abstract
Background Effective approaches that engage men in weight loss and lifestyle change are important because of worldwide increases, including in Canada, in obesity and chronic diseases. Football Fans in Training (FFIT), developed in Scotland, successfully tackled these problems by engaging overweight/obese male football fans in sustained weight loss and positive health behaviours, through program deliveries at professional football stadia. Methods Aims: 1) Adapt FFIT to hockey within the Canadian context and integrate with HealtheSteps™ (evidence-based lifestyle program) to develop Hockey Fans in Training (Hockey FIT); 2) Explore potential for Hockey FIT to help overweight/obese men lose weight and improve other outcomes by 12 weeks, and retain these improvements to 12 months; 3) Evaluate feasibility of recruiting and retaining overweight/obese men; 4) Evaluate acceptability of Hockey FIT; and 5) Conduct program optimization via a process evaluation. We conducted a two-arm pilot pragmatic randomized controlled trial (pRCT) whereby 80 overweight/obese male hockey fans (35–65 years; body-mass index ≥28 kg/m2) were recruited through their connection to two junior A hockey teams (London and Sarnia, ON) and randomized to Intervention (Hockey FIT) or Comparator (Wait-List Control). Hockey FIT includes a 12-week Active Phase (classroom instruction and exercise sessions delivered weekly by trained coaches) and a 40-week Maintenance Phase. Data collected at baseline and 12 weeks (both groups), and 12 months (Intervention only), will inform evaluation of the potential of Hockey FIT to help men lose weight and improve other health outcomes. Feasibility and acceptability will be assessed using data from self-reports at screening and baseline, program fidelity (program observations and coach reflections), participant focus group discussions, coach interviews, as well as program questionnaires and interviews with participants. This information will be analyzed to inform program optimization. Discussion Hockey FIT is a gender-sensitive program designed to engage overweight/obese male hockey fans to improve physical activity and healthy eating choices, thereby leading to weight loss and other positive changes in health outcomes. We expect this study to provide evidence for a full-scale confirmatory pRCT. Trial registration NCT02396524 (Clinicaltrials.gov). Date of registration: Feb 26, 2015.
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Affiliation(s)
- Dawn P Gill
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,School of Health Studies, Faculty of Health Sciences, Western University, London, Canada
| | - Wendy Blunt
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ashleigh De Cruz
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Brendan Riggin
- School of Kinesiology, Faculty of Health Sciences, Western University, London, Canada
| | - Kate Hunt
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Guangyong Zou
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada.,Robarts Clinical Trials, Robarts Research Institute, Western University, London, Canada
| | - Shannon Sibbald
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,School of Health Studies, Faculty of Health Sciences, Western University, London, Canada.,The Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Karen Danylchuk
- School of Kinesiology, Faculty of Health Sciences, Western University, London, Canada
| | - Merrick Zwarenstein
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Cindy M Gray
- Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK
| | - Sally Wyke
- Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK
| | - Christopher Bunn
- Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK
| | - Robert J Petrella
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. .,School of Kinesiology, Faculty of Health Sciences, Western University, London, Canada.
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Everyday tactics in local moral worlds: E-cigarette practices in a working-class area of the UK. Soc Sci Med 2016; 170:106-113. [PMID: 27788410 PMCID: PMC5115649 DOI: 10.1016/j.socscimed.2016.10.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 10/11/2016] [Accepted: 10/14/2016] [Indexed: 02/04/2023]
Abstract
Research into e-cigarette use has largely focused on their health effects and efficacy for smoking cessation, with little attention given to their potential effect on health inequalities. Drawing on three years of ethnographic research between 2012 and 2015, I investigate the emerging e-cigarette practices of adult smokers and quitters in a working-class area of the UK. I first use de Certeau's notion of ‘tactics’ to describe the informal economy of local e-cigarette use. Low-priced products were purchased through personal networks and informal sources for financial reasons, but also as a solution to the moral problems of addiction and expenditure on the self, particularly for older smokers. E-cigarette practices were produced in local moral worlds where smoking and cessation had a complex status mediated through norms of age and gender. For younger men, smoking cessation conflicted with an ethic of working-class hedonism but e-cigarette use allowed cessation to be incorporated into male sociality. Continued addiction had moral implications which older men addressed by constructing e-cigarette use as functional rather than pleasurable, drawing on a narrative of family responsibility. The low priority which older women with a relational sense of identity gave to their own health led to a lower tolerance for e-cigarette unreliability. I draw on Kleinman's local moral worlds to make sense of these findings, arguing that smoking cessation can be a risk to moral identity in violating local norms of age and gender performance. I conclude that e-cigarettes did have some potential to overcome normative barriers to smoking cessation and therefore to reduce health inequalities, at least in relation to male smoking. Further research which attends to local meanings of cessation in relation to age and gender will establish whether e-cigarettes have similar potential elsewhere. Smokers and e-cigarette users bought cheap products for moral and financial reasons. Smoking cessation conflicted with an ethic of hedonism but e-cigarettes did not. Older men saw e-cigarette use as functional in a narrative of family responsibility. Older women gave their health low priority and found e-cigarettes too much trouble. E-cigarettes had potential to overcome some normative barriers to smoking cessation.
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