1
|
Watson ED, Marshall PW, Morrison NMV, Moloney N, O'Halloran P, Rabey M, Niazi IK, Stevens K, Kingsley M. Breaking the cycle of reoccurring low back pain with integrated motivational interviewing and cognitive behavioural therapy to facilitate education and exercise advice: a superiority randomised controlled trial study protocol. BMC Public Health 2024; 24:2415. [PMID: 39237978 DOI: 10.1186/s12889-024-19930-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 08/29/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Non-specific low back pain is a common and costly global issue. Many people with low back pain live for years with ongoing symptom recurrence and disability, making it crucial to find effective prevention strategies. Motivational interviewing (MI) is an evidence-based patient-centred counselling style that helps motivate individuals to change their behaviours. In combination, MI and cognitive-behavioural therapy (MI-CBT) has the potential to yield long term improvements in pain and disability and reduce incidence of recurrence. METHOD This is a two-arm superiority randomised controlled trial comparing MI-CBT and Education (n = 83) with Education only (n = 83). Participants that have recovered from a recent episode of non-specific low back pain (7th consecutive day with pain ≤ 2 on a 0-10 numeric pain rating scale) will be eligible for inclusion into the study. Both groups will receive five 30-min sessions over a 10-week period as well as the Navigating Pain booklet, homework book and a standardised exercise programme. In the intervention group, MI-CBT techniques will be used to provide individualised support, identify beliefs, and increase engagement with the resources provided. Outcomes measures include pain (current and in the last 7 days) as rated on the numeric pain rating scale. This will be used to determine recurrence (number of participants who report back pain ≥ 3 out of 10 on the numeric pain rating scale). Furthermore, self-reported (1) pain intensity; (2) pain catastrophizing; (3) fear-avoidance beliefs; (4) pain self-efficacy; (5) depression and anxiety; (6) disability will be measured. All outcomes will be measured at baseline, and again at 3-, 6-, and 12-months post allocation. DISCUSSION The effective delivery of self-management strategies to prevent recurrence of low back pain is an important aspect that requires urgent attention. This study will provide new information on the effectiveness of using an MI-CBT approach to facilitate self-management through education and exercise to improve low back pain outcomes. Evidence emerging from this trial has the potential to inform clinical practice and healthcare management of non-specific low back pain. TRIAL REGISTRATION Prospectively registered with Australian New Zealand Clinical Trials Registry: ACTRN12623000746639 (10/07/2023).
Collapse
Affiliation(s)
- Estelle D Watson
- Department of Exercise Science, Faculty of Science, University of Auckland, Auckland, New Zealand.
| | - Paul W Marshall
- Department of Exercise Science, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Natalie M V Morrison
- Translational Health Research Institute Western Sydney University, Sydney, Australia
| | - Niamh Moloney
- Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Paul O'Halloran
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Martin Rabey
- Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Imran Khan Niazi
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
| | - Kirk Stevens
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
| | - Michael Kingsley
- Department of Exercise Science, Faculty of Science, University of Auckland, Auckland, New Zealand
- Holsworth Research Initiative, La Trobe University, Melbourne, Australia
| |
Collapse
|
2
|
Zhu S, Sinha D, Kirk M, Michalopoulou M, Hajizadeh A, Wren G, Doody P, Mackillop L, Smith R, Jebb SA, Astbury NM. Effectiveness of behavioural interventions with motivational interviewing on physical activity outcomes in adults: systematic review and meta-analysis. BMJ 2024; 386:e078713. [PMID: 38986547 PMCID: PMC11234249 DOI: 10.1136/bmj-2023-078713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVE To evaluate the effectiveness of behavioural interventions that include motivational interviewing on physical activity outcomes in adults. DESIGN Systematic review and meta-analysis. STUDY SELECTION A search of seven databases for randomised controlled trials published from inception to 1 March 2023 comparing a behavioural intervention including motivational interviewing with a comparator without motivational interviewing on physical activity outcomes in adults. Outcomes of interest were differences in change in quantitative measures of total physical activity, moderate to vigorous physical activity (MVPA), and sedentary time. DATA EXTRACTION AND SYNTHESIS Two reviewers extracted data and assessed risk of bias. Population characteristics, intervention components, comparison groups, and outcomes of studies were summarised. For overall main effects, random effects meta-analyses were used to report standardised mean differences (SMDs) and 95% confidence intervals (CIs). Differential effects based on duration of follow-up, comparator type, intervention duration, and disease or health condition of participants were also examined. RESULTS 129 papers reporting 97 randomised controlled trials totalling 27 811 participants and 105 comparisons were included. Interventions including motivational interviewing were superior to comparators for increases in total physical activity (SMD 0.45, 95% CI 0.33 to 0.65, equivalent to 1323 extra steps/day; low certainty evidence) and MVPA (0.45, 0.19 to 0.71, equivalent to 95 extra min/week; very low certainty evidence) and for reductions in sedentary time (-0.58, -1.03 to -0.14, equivalent to -51 min/day; very low certainty evidence). Evidence for a difference in any outcome compared with comparators of similar intensity was lacking. The magnitude of effect diminished over time, and evidence of an effect of motivational interviewing beyond one year was lacking. Most interventions involved patients with a specific health condition, and evidence of an effect of motivational interviewing to increase MVPA or decrease sedentary time was lacking in general population samples. CONCLUSIONS Certainty of the evidence using motivational interviewing as part of complex behavioural interventions for promoting total physical activity in adults was low, and for MVPA and sedentary time was very low. The totality of evidence suggests that although interventions with motivational interviewing increase physical activity and decrease sedentary behaviour, no difference was found in studies where the effect of motivational interviewing could be isolated. Effectiveness waned over time, with no evidence of a benefit of motivational interviewing to increase physical activity beyond one year. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020219881.
Collapse
Affiliation(s)
- SuFen Zhu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Deepra Sinha
- St Hugh's College, University of Oxford, Oxford, UK
| | - Megan Kirk
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Moscho Michalopoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Anisa Hajizadeh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gina Wren
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul Doody
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lucy Mackillop
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Ralph Smith
- Sport and Exercise Medicine Department, Nuffield Orthopaedic Centre Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nerys M Astbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
3
|
Payne C, Gesch J, Smits E, Brakenridge C, Johnston V, Gardiner PA, Comans T, Bell R, Gane E. Feasibility of a physiotherapist-supervised walking program with telephone coaching to increase physical activity following acquired brain injury. BRAIN IMPAIR 2024; 25:IB23095. [PMID: 38810091 DOI: 10.1071/ib23095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 05/09/2024] [Indexed: 05/31/2024]
Abstract
Background Physical activity has health benefits for adults with acquired brain injury, but it is a challenge to increase physical activity during inpatient rehabilitation. The objectives of this pilot study were to determine whether a physiotherapy-supervised inpatient walking program was feasible and able to improve physical activity and sedentary behaviour in the short and medium term. Methods Adults with acquired brain injury receiving inpatient rehabilitation undertook twice-weekly supervised walks plus behavioural therapy for 4 weeks. Feasibility was measured via recruitment, participation and drop out rates, adverse events and intervention delivery costs. Physical activity and sedentary behaviour were measured with an activPAL. Assessments were conducted at baseline, post-intervention and 3-6 months post-intervention. Results The program was safe to deliver (no adverse events), recruitment rate was 55% (16/29) and the participation rate for eligible individuals was high (14/19, 74%). However, the program had a high drop out rate (7/16, 44%) and physical activity and sedentary behaviour did not significantly change during the 4-week intervention. Costs were AU$427.71/participant. Physical activity and sedentary behaviour did improve 3-6 months after the intervention (vs baseline, on average: +3913 steps per day, 95% CI: 671, 7156). Conclusion This pilot study demonstrated a supervised physiotherapy walking program is safe and feasible to recruit in an inpatient setting. However, drop out during the study was high and behaviour change did not occur. More work is required to boost physical activity during sub-acute rehabilitation for acquired brain injury.
Collapse
Affiliation(s)
- Caitlyn Payne
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Janelle Gesch
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Qld, Australia; and Brain Injury Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Esther Smits
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Qld, Australia
| | - Charlotte Brakenridge
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Qld, Australia; and School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Qld, Australia
| | - Venerina Johnston
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia; and Centre for Health Research, University of Southern Queensland, Darling Heights, Qld, Australia
| | - Paul A Gardiner
- School of Public Health, The University of Queensland, Brisbane, Qld, Australia
| | - Tracy Comans
- Centre for Health Services Research, The University of Queensland, Brisbane, Qld, Australia
| | - Ryan Bell
- Brain Injury Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Elise Gane
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Qld, Australia; and School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia; and Centre for Functioning and Health Research, Metro South Health, Brisbane, Qld, Australia
| |
Collapse
|
4
|
Adhikari K, Teare GF, Belon AP, Lee B, Kim MO, Nykiforuk C. Screening, brief intervention, and referral to treatment for tobacco consumption, alcohol misuse, and physical inactivity: an equity-informed rapid review. Public Health 2024; 226:237-247. [PMID: 38091812 DOI: 10.1016/j.puhe.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 09/26/2023] [Accepted: 11/01/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVE This rapid review systematically synthesizes evidence of the effectiveness of the Screening, Brief Intervention, and Referral (SBIR/T) approach for tobacco use, alcohol misuse, and physical inactivity. STUDY DESIGN This was a rapid review. METHODS We searched primary studies between 2012 and 2022 in seven electronic databases. The search strategy used concepts related to alcohol-related disorders, intoxication, cigarette, nicotine, physical activity, exercise, sedentary, screening, therapy, and referral. We reviewed both title/abstract and full-text using a priori set inclusion and exclusion criteria to identify the eligible studies. We appraised study quality, extracted data, and summarized the characteristics of the included studies. We applied health equity lenses in the synthesis. RESULTS Of the 44 included studies, most focused on alcohol misuse. SBIR/T improved patients' attitudes toward alcohol behavior change, improved readiness and referral initiation for change, and effectively reduced alcohol consumption. Few studies pertained to smoking and physical inactivity. Most studies on smoking demonstrated effectiveness pertaining to patients' acceptance of referral recommendations, improved readiness and attempts to quitting smoking, and reduced or cessation of smoking. Findings were mixed about the effectiveness of SBIR/T in improving physical activity. Minimal studies exist on the impacts of SBIR/T for these three risk factors on healthcare resource use or costs. Studies considering diverse population characteristics in the design and effectiveness assessment of the SBIR/T intervention are lacking. CONCLUSIONS More research on the impacts of SBIR/T on tobacco use, alcohol misuse, and physical inactivity is required to inform the planning and delivery of SBIR/T for general and disadvantaged populations.
Collapse
Affiliation(s)
- K Adhikari
- Provincial Population and Public Health, Alberta Health Services, Canada; Department of Community Health Sciences, University of Calgary, Canada.
| | - G F Teare
- Provincial Population and Public Health, Alberta Health Services, Canada; Department of Community Health Sciences, University of Calgary, Canada
| | - A P Belon
- Centre for Healthy Communities, School of Public Health, University of Alberta, Canada
| | - B Lee
- Centre for Healthy Communities, School of Public Health, University of Alberta, Canada
| | - M O Kim
- Centre for Healthy Communities, School of Public Health, University of Alberta, Canada
| | - C Nykiforuk
- Centre for Healthy Communities, School of Public Health, University of Alberta, Canada
| |
Collapse
|
5
|
Larisch LM, Kallings LV, Thedin Jakobsson B, Blom V. "It depends on the boss" - a qualitative study of multi-level interventions aiming at office workers' movement behaviour and mental health. Int J Qual Stud Health Well-being 2023; 18:2258564. [PMID: 37731364 PMCID: PMC10515662 DOI: 10.1080/17482631.2023.2258564] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 09/09/2023] [Indexed: 09/22/2023] Open
Abstract
PURPOSE This embedded qualitative study explored the acceptability, feasibility, and fidelity of two multi-level RCT interventions among office workers, aiming at improving movement behaviour to enhance mental health and cognition. The interventions addressed the organizational, environmental, and individual level. METHODS Semi-structured interviews and focus group discussions were conducted with 38 stakeholders after completion of the interventions. Data were analysed using reflexive thematic analysis. RESULTS The interventions were well appreciated, and office workers attributed improvements in movement behaviour and wellbeing to the interventions. Especially the cognitive behavioural therapy (CBT) based counselling and free gym access were appreciated, feasible and delivered as planned. Participants described existing workplace norms as barriers to more activity, particularly for reducing sitting. Support from managers and team support were considered crucial components. However, delivering these components was difficult. CONCLUSIONS The findings support the design of the multi-level interventions for changing movement behaviour. Results highlight the potential of CBT for this target group and the importance of manager and team support. Desired effects of similar multi-level interventions, including CBT, might be achieved in future studies that carefully address the issues with feasibility and acceptability and the resulting low fidelity of some intervention components that were identified in this study.
Collapse
Affiliation(s)
- Lisa-Marie Larisch
- The Swedish School of Sport and Health Sciences, Department of Physical Activity and Health, Stockholm, Sweden
| | - Lena V. Kallings
- The Swedish School of Sport and Health Sciences, Department of Physical Activity and Health, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Britta Thedin Jakobsson
- The Swedish School of Sport and Health Sciences, Department of Physical Activity and Health, Stockholm, Sweden
- The Swedish School of Sport and Health Sciences, Department of Movement, Culture and Society, Stockholm, Sweden
| | - Victoria Blom
- The Swedish School of Sport and Health Sciences, Department of Physical Activity and Health, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Division of Insurance Medicine, Stockholm, Sweden
| |
Collapse
|
6
|
Abstract
This review traces the development of motivational interviewing (MI) from its happenstance beginnings and the first description published in this journal in 1983, to its continuing evolution as a method that is now in widespread practice in many professions, nations and languages. The efficacy of MI has been documented in hundreds of controlled clinical trials, and extensive process research sheds light on why and how it works. Developing proficiency in MI is facilitated by feedback and coaching based on observed practice after initial training. The author reflects on parallels between MI core processes and the characteristics found in 70 years of psychotherapy research to distinguish more effective therapists. This suggests that MI offers an evidence-based therapeutic style for delivering other treatments more effectively. The most common use of MI now is indeed in combination with other treatment methods such as cognitive behaviour therapies.
Collapse
Affiliation(s)
- William R Miller
- Department of Psychology, The University of New Mexico, Albuquerque, NM, USA
| |
Collapse
|
7
|
Herbert J, Schumacher T, Brown LJ, Clarke ED, Collins CE. Delivery of telehealth nutrition and physical activity interventions to adults living in rural areas: a scoping review. Int J Behav Nutr Phys Act 2023; 20:110. [PMID: 37715234 PMCID: PMC10504780 DOI: 10.1186/s12966-023-01505-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/20/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Lifestyle behaviours related to smoking, alcohol, nutrition, and physical activity are leading risk factors for the development of chronic disease. For people in rural areas, access to individualised lifestyle services targeting behaviour change may be improved by using telehealth. However, the scope of literature investigating telehealth lifestyle behaviour change interventions for rural populations is unknown, making it difficult to ascertain whether telehealth interventions require adaptation for rural context via a systematic review. This scoping review aimed to address this gap, by mapping existing literature describing telehealth lifestyle interventions delivered to rural populations to determine if there is scope for systematic review of intervention effectiveness in this research topic. METHODS The PRISMA extension for scoping review checklist guided the processes of this scoping review. A search of eight electronic databases reported in English language until June 2023 was conducted. Eligible studies included adults (18 years and over), who lived in rural areas of high-income countries and undertook at least one synchronous (video or phone consultation) telehealth intervention that addressed either addictive (smoking or alcohol), or non-addictive lifestyle behaviours (nutrition or physical activity). Studies targeting addictive and non-addictive behaviours were separated after full text screening to account for the involvement of addictive substances in smoking and alcohol studies that may impact behaviour change interventions described. Studies targeting nutrition and/or physical activity interventions are presented here. RESULTS The search strategy identified 17179 citations across eight databases, with 7440 unique citations once duplicates were removed. Full texts for 492 citations were retrieved and screened for inclusion with 85 publications reporting on 73 studies eligible for data extraction and analysis. Of this, addictive behaviours were comprised of 15 publications from 13 studies. Non-addictive behaviours included 70 publications from 58 studies and are reported here. Most interventions were delivered within the United States of America (n = 43, 74.1%). The most common study design reported was Randomised Control Trial (n = 27, 46.6%). Included studies involved synchronous telehealth interventions targeting nutrition (11, 18.9%), physical activity (5, 8.6%) or nutrition and physical activity (41, 70.7%) and were delivered predominately via videoconference (n = 17, 29.3%). CONCLUSIONS Despite differences in intervention characteristics, the number of randomised control trials published suggests sufficient scope for future systematic reviews to determine intervention effectiveness related to nutrition and physical activity telehealth interventions for rural populations. TRIAL REGISTRATION The scoping review protocol was not pre-registered.
Collapse
Affiliation(s)
- Jaimee Herbert
- School of Health Sciences (Nutrition and Dietetics), Department of Rural Health, University of Newcastle, 114/148 Johnston St, North Tamworth, NSW, 2340, Australia
| | - Tracy Schumacher
- School of Health Sciences (Nutrition and Dietetics), Department of Rural Health, University of Newcastle, 114/148 Johnston St, North Tamworth, NSW, 2340, Australia
| | - Leanne J Brown
- School of Health Sciences (Nutrition and Dietetics), Department of Rural Health, University of Newcastle, 114/148 Johnston St, North Tamworth, NSW, 2340, Australia
| | - Erin D Clarke
- School of Health Sciences (Nutrition and Dietetics), University of Newcastle, ATC 205, ATC Building, University Drive Callaghan, Newcastle, NSW, 2308, Australia
| | - Clare E Collins
- School of Health Sciences (Nutrition and Dietetics), University of Newcastle, ATC 310, ATC Building, University Drive Callaghan, Newcastle, NSW, 2308, Australia.
| |
Collapse
|
8
|
Nightingale H, Mnatzaganian G, Hooker L, Barrett S, Kingsley M. The effect of motivational interviewing and/or cognitive behaviour therapy techniques on gestational weight gain - a systematic review and meta-analysis. BMC Public Health 2023; 23:626. [PMID: 37005572 PMCID: PMC10067184 DOI: 10.1186/s12889-023-15446-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/15/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Women with gestational weight gain (GWG) that is below or above recommendations are at risk of adverse perinatal outcomes. Motivational interviewing and/or cognitive behaviour therapy have demonstrated efficacy in initiating and sustaining behaviour change, including weight control. The objective of this review was to investigate the effect of antenatal interventions that include components of motivational interviewing and/or cognitive behaviour therapy on gestational weight gain. METHODS This review was designed and reported in accordance with guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Five electronic databases were systematically searched to March 2022. Randomised controlled trials evaluating interventions with identified components of motivational interviewing and/or cognitive behaviour therapies were included. Pooled proportions of appropriate GWG and GWG above or below guidelines, and standardised mean difference for total gestational weight gain, were calculated. Risk of bias in included studies was evaluated using the Risk of Bias 2 tool, and the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence. RESULTS Twenty-one studies (8030 participants) were included. Overall, MI and/or CBT interventions had a small effect on the total gestational weight gain (SMD: -0.18, 95% confidence interval: -0.27 to -0.09, p < 0.001) and improved the proportion of women achieving recommended gestational weight gain (29% versus 23% in the comparison, p < 0.001). The GRADE assessment indicated that overall quality of evidence is very uncertain, however sensitivity analyses to account for high risk of bias produced similar results to original meta-analyses. The magnitude of effect was greater in women with overweight or obesity when compared to women with BMI < 25 kg/m2. CONCLUSION Motivational interviewing and/or cognitive behaviour therapy techniques may be effective for promoting healthy gestational weight gain. Nevertheless, a high proportion of women do not achieve recommended gestational weight gain. Future interventions should consider factors, including clinician and consumer perspectives, in the design and delivery of psychosocial interventions that aim to support healthy gestational weight gain. TRIAL REGISTRATION The protocol for this review was registered with the PROSPERO International register of systematic reviews (registration number CRD42020156401).
Collapse
Affiliation(s)
- Helen Nightingale
- Rural Department of Nursing & Midwifery, La Trobe Rural Health School, La Trobe University, Bendigo, Australia.
| | - George Mnatzaganian
- Rural Department of Community Health, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Leesa Hooker
- Rural Department of Nursing & Midwifery, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Australia
| | - Stephen Barrett
- Research and Innovation, Bendigo Health, Bendigo, Australia
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Michael Kingsley
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
9
|
Pipingas A, Murphy KJ, Davis CR, Itsiopoulos C, Kingsley M, Scholey A, Macpherson H, Segal L, Breckon J, Minihane AM, Meyer D, Ogden E, Dyer KA, Eversteyn E, Hardman RJ, Poorun K, Justice K, Hana M, Buckley JD, White D, Davison K, Clark JS, Bracci EL, Kennedy G. A Mediterranean Diet and Walking Intervention to Reduce Cognitive Decline and Dementia Risk in Independently Living Older Australians: The MedWalk Randomized Controlled Trial Experimental Protocol, Including COVID-19 Related Modifications and Baseline Characteristics. J Alzheimers Dis 2023; 96:409-427. [PMID: 37781806 PMCID: PMC10657681 DOI: 10.3233/jad-230641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Several clinical trials have examined diet and physical activity lifestyle changes as mitigation strategies for risk factors linked to cognitive decline and dementias such as Alzheimer's disease. However, the ability to modify these behaviors longer term, to impact cognitive health has remained elusive. OBJECTIVE The MedWalk trial's primary aim is to investigate whether longer-term adherence to a Mediterranean-style diet and regular walking, delivered through motivational interviewing and cognitive-behavioral therapy (MI-CBT), can reduce age-associated cognitive decline and other dementia risk factors in older, independently living individuals without cognitive impairment. METHODS MedWalk, a one-year cluster-randomized controlled trial across two Australian states, recruited 60-90-year-old people from independent living retirement villages and the wider community. Participants were assigned to either the MedWalk intervention or a control group (maintaining their usual diet and physical activity). The primary outcome is 12-month change in visual memory and learning assessed from errors on the Paired Associates Learning Task of the Cambridge Neuropsychological Test Automated Battery. Secondary outcomes include cognition, mood, cardiovascular function, biomarkers related to nutrient status and cognitive decline, MI-CBT effectiveness, Mediterranean diet adherence, physical activity, quality of life, cost-effectiveness, and health economic evaluation.Progress and Discussion:Although COVID-19 impacts over two years necessitated a reduced timeline and sample size, MedWalk retains sufficient power to address its aims and hypotheses. Baseline testing has been completed with 157 participants, who will be followed over 12 months. If successful, MedWalk will inform interventions that could substantially reduce dementia incidence and ameliorate cognitive decline in the community. TRIAL REGISTRATION Registered on the Australia New Zealand Clinical Trials Registry ANZCTR 12620000978965 (https://www.anzctr.org.au).
Collapse
Affiliation(s)
- Andrew Pipingas
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Karen J. Murphy
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance & UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Courtney R. Davis
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance & UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | | | - Michael Kingsley
- Department of Exercise Sciences, The University of Auckland, Newmarket, New Zealand
- Holsworth Research Initiative, La Trobe University, Bendigo, VIC, Australia
| | - Andrew Scholey
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
- Nutrition Dietetics and Food, School of Clinical Sciences, Monash University, Notting Hill, VIC, Australia
| | - Helen Macpherson
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, VIC, Australia
| | - Leonie Segal
- Economics and Social Policy Group, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Jeff Breckon
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | | | - Denny Meyer
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Edward Ogden
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Kathryn A. Dyer
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance & UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Emily Eversteyn
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Roy J. Hardman
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Kaylass Poorun
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Keri Justice
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Maher Hana
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Jonathan D. Buckley
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance & UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - David White
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Kade Davison
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance & UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Jessie S. Clark
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance & UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Ella L. Bracci
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance & UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Greg Kennedy
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - on behalf of MedWalk collaborative team
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance & UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- Department of Exercise Sciences, The University of Auckland, Newmarket, New Zealand
- Holsworth Research Initiative, La Trobe University, Bendigo, VIC, Australia
- Nutrition Dietetics and Food, School of Clinical Sciences, Monash University, Notting Hill, VIC, Australia
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, VIC, Australia
- Economics and Social Policy Group, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| |
Collapse
|
10
|
Barrett S, Begg S, O’Halloran P, Doran CM, Kingsley M. Physical activity telephone coaching intervention for insufficiently physically active ambulatory hospital patients: Economic evaluation of the Healthy 4U-2 randomised controlled trial. PLoS One 2022; 17:e0270211. [PMID: 35737687 PMCID: PMC9223391 DOI: 10.1371/journal.pone.0270211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/02/2022] [Indexed: 11/19/2022] Open
Abstract
The Healthy 4U-2 randomised controlled trial demonstrated that a physical activity (PA) telephone coaching intervention was effective for improving objectively-measured PA and health-related outcomes. The current study reports on an economic evaluation performed alongside the trial to determine whether this effective intervention is also cost-effective from a healthcare funder perspective. Participants (N = 120) were insufficiently physically active adults recruited from an ambulatory care clinic in a public hospital in regional Australia. The primary outcome was change in moderate-to-vigorous physical activity (MVPA) measured using accelerometers. Changes in quality-adjusted life-years (QALYs) were derived from the 12-Item Short Form Health Survey Questionnaire (SF-12). Incremental cost-effectiveness ratios (ICERs) were calculated for each outcome. Uncertainty of cost-effectiveness results were estimated using non-parametric bootstrapping techniques and sensitivity analyses. The mean intervention cost was $132 per person. The control group incurred higher overall costs compared to intervention ($2,465 vs. $1,743, respectively). Relative to control, the intervention resulted in incremental improvements in MVPA and QALYs and was deemed cost-effective. Probabilistic sensitivity analysis indicated that compared to control, the intervention would be cost-effective for improving MVPA and QALYs at very low willingness to pay thresholds. Sensitivity analyses indicated that results were robust to varied assumptions. This study shows that PA telephone coaching was a low-cost strategy for increasing MVPA and QALYs in insufficiently active ambulatory hospital patients. Findings of health benefits and overall cost-savings are uncommon and PA telephone coaching offers a potentially cost-effective investment to produce important public health outcomes.
Collapse
Affiliation(s)
- Stephen Barrett
- Health Promotion Department, Bendigo Health Care Group, Bendigo, Victoria, Australia
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Stephen Begg
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Paul O’Halloran
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Christopher M. Doran
- Centre for Resilience and Wellbeing, Central Queensland University, Queensland, Australia
| | - Michael Kingsley
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
- Department of Exercise Sciences, University of Auckland, Newmarket, New Zealand
| |
Collapse
|
11
|
Madigan CD, Fong M, Howick J, Kettle V, Rouse P, Hamilton L, Roberts N, Gomersall SR, Daley AJ. Effectiveness of interventions to maintain physical activity behavior (device-measured): Systematic review and meta-analysis of randomized controlled trials. Obes Rev 2021; 22:e13304. [PMID: 34129276 DOI: 10.1111/obr.13304] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 11/28/2022]
Abstract
Physical activity has many physical, mental, and social health benefits. Interventions can be successful at helping people initiate participation, but there is a lack of evidence about the ability of these interventions to help adults maintain their physical activity. This systematic review and meta-analysis aims to address this evidence gap. We investigated the extent to which successful physical activity interventions with demonstrated success within randomized controlled trials result in maintenance of device-measured physical activity (at least 3 months post-intervention end). Five databases were searched, and 8919 titles and abstracts were screened for eligibility, and 29 trials met the inclusion criteria. Of these, 22 were included in the meta-analysis. We found that 60% to 80% of physical activity behavior was maintained, as equivalent to an additional 45 min/week of moderate-to-vigorous physical activity and 945 steps per day compared with comparators. We also examined trials that randomized participants to maintenance interventions after an initial physical activity intervention (n = 7) and we found small effects (standardized mean difference 0.14, 95% confidence interval [CI] 0.1 to 0.27). The evidence suggests that most (60%-80%) of the increases in physical activity in successful programs are maintained for at least 3 months and there are small effects from providing a maintenance intervention to the public. Registration: CRD42019144585.
Collapse
Affiliation(s)
- Claire D Madigan
- The School of Sport, Exercise and Health Sciences, The Centre for Lifestyle Medicine and Behaviour (CLiMB), Loughborough University, Loughborough, UK
| | - Mackenzie Fong
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Victoria Kettle
- The School of Sport, Exercise and Health Sciences, The Centre for Lifestyle Medicine and Behaviour (CLiMB), Loughborough University, Loughborough, UK
| | - Peter Rouse
- Department for Health, University of Bath, Bath, UK
| | - Louisa Hamilton
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Nia Roberts
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Sjaan R Gomersall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.,School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Amanda J Daley
- The School of Sport, Exercise and Health Sciences, The Centre for Lifestyle Medicine and Behaviour (CLiMB), Loughborough University, Loughborough, UK
| |
Collapse
|
12
|
Larsen RT, Korfitsen CB, Keller C, Christensen J, Andersen HB, Juhl C, Langberg H. The MIPAM trial - motivational interviewing and physical activity monitoring to enhance the daily level of physical activity among older adults - a randomized controlled trial. Eur Rev Aging Phys Act 2021; 18:12. [PMID: 34215176 PMCID: PMC8254217 DOI: 10.1186/s11556-021-00269-7] [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: 07/14/2020] [Accepted: 06/14/2021] [Indexed: 11/25/2022] Open
Abstract
Background One in four older adults in Denmark and almost half of the very old above 75 do not meet the World Health Organization’s recommendations for a minimum of physical activity (PA). A cost-efficient and effective way to increase focus on and motivation for daily walking might be to use Physical Activity Monitors (PAMs) in combination with behavioural change intervention. Thus, the objective of this randomized controlled study was to investigate the effect of Motivational Interviewing (MI) as an add-on intervention to a PAM-based intervention measured in community-dwelling older adults. Methods This two-arm parallel group randomized controlled effectiveness trial compared a 12-weeks PAM-based intervention with additional MI (PAM+MI group) with a PAM-based intervention alone (PAM group). The primary outcome, average daily step count, was analysed with a linear regression model, adjusted for sex and baseline daily step count. Following the intention-to-treat principle, multiple imputation based on baseline step count, sex and age was performed. Results In total, 38 participants were randomized to the PAM intervention and 32 to the PAM+MI intervention arm. During the intervention period, PAM+MI participants walked on average 909 more steps per day than PAM participants, however insignificant (95%CI: − 71; 1889) and reported 2.3 points less on the UCLA Loneliness Scale (95%CI: − 4.5; − 1.24). Conclusion The use of MI, in addition to a PAM-based intervention among older adults in PA promoting interventions hold a potential clinically relevant effect on physical activity and should thus be investigated further with adequately powered RCTs. Trial registration This study was pre-registered in the clinicaltrials.gov database with identifier: NCT03906162.
Collapse
Affiliation(s)
- Rasmus Tolstrup Larsen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. .,Department of Occupational- and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Christoffer Bruun Korfitsen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Camilla Keller
- Research Governance, Evaluation & Communication, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jan Christensen
- Department of Occupational- and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henning Boje Andersen
- Department of Technology, Technical University of Denmark, Management and Economics, Lyngby, Denmark
| | - Carsten Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - Henning Langberg
- Section of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
13
|
The Effect of a Physical Activity Coaching Intervention on Accelerometer-Measured Sedentary Behaviours in Insufficiently Physically Active Ambulatory Hospital Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115543. [PMID: 34067292 PMCID: PMC8196832 DOI: 10.3390/ijerph18115543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 11/17/2022]
Abstract
Little is known about the impact that physical activity (PA) coaching interventions have on sedentary behaviours. The aim of this study was to investigate if a coaching intervention that increases PA coincidentally influences objectively measured sedentary time in insufficiently physically active adults. We recruited 120 insufficiently physically active ambulatory hospital patients and randomized them to either receive a PA coaching intervention designed to increase objectively measured moderate-to-vigorous-intensity PA (MVPA) or be part of a control group. Participants wore an accelerometer for seven days at baseline, post-intervention (three months) and follow-up (nine months). Changes in the average length of sedentary bouts, proportion of time in sedentary behaviours and number of sedentary bouts were evaluated using mixed-model ANOVAs. At baseline, both groups undertook 67 ± 13 sedentary bouts and spent 69% ± 6% of their time in sedentary behaviours. Compared with control, the intervention group decreased the number of sedentary bouts by 24% and the proportion of time in sedentary behaviours by 7% (p < 0.001). Significant changes were not observed between the groups for average length of sedentary bouts. The PA intervention led to a decrease in the number of sedentary bouts and proportion of time in sedentary behaviours. Future research should investigate PA coaching interventions designed to target simultaneous changes in MVPA and sedentary behaviours.
Collapse
|
14
|
Effects of Two Randomized and Controlled Multi-Component Interventions Focusing On 24-Hour Movement Behavior among Office Workers: A Compositional Data Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084191. [PMID: 33920971 PMCID: PMC8071247 DOI: 10.3390/ijerph18084191] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 01/03/2023]
Abstract
Intervention studies aiming at changing movement behavior have usually not accounted for the compositional nature of time-use data. Compositional data analysis (CoDA) has been suggested as a useful strategy for analyzing such data. The aim of this study was to examine the effects of two multi-component interventions on 24-h movement behavior (using CoDA) and on cardiorespiratory fitness among office workers; one focusing on reducing sedentariness and the other on increasing physical activity. Office workers (n = 263) were cluster randomized into one of two 6-month intervention groups, or a control group. Time spent in sedentary behavior, light-intensity, moderate and vigorous physical activity, and time in bed were assessed using accelerometers and diaries, both for 24 h in total, and for work and leisure time separately. Cardiorespiratory fitness was estimated using a sub-maximal cycle ergometer test. Intervention effects were analyzed using linear mixed models. No intervention effects were found, either for 24-h behaviors in total, or for work and leisure time behaviors separately. Cardiorespiratory fitness did not change significantly. Despite a thorough analysis of 24-h behaviors using CoDA, no intervention effects were found, neither for behaviors in total, nor for work and leisure time behaviors separately. Cardiorespiratory fitness did not change significantly. Although the design of the multi-component interventions was based on theoretical frameworks, and included cognitive behavioral therapy counselling, which has been proven effective in other populations, issues related to implementation of and compliance with some intervention components may have led to the observed lack of intervention effect.
Collapse
|
15
|
Kinser PA, Thacker LR, Rider A, Moyer S, Amstadter AB, Mazzeo SE, Bodnar-Deren S, Starkweather A. Feasibility, Acceptability, and Preliminary Effects of "Mindful Moms": A Mindful Physical Activity Intervention for Pregnant Women with Depression. Nurs Res 2021; 70:95-105. [PMID: 33630532 PMCID: PMC8366589 DOI: 10.1097/nnr.0000000000000485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Nonpharmacological and accessible therapies that engage individuals in self-management are needed to address depressive symptoms in pregnancy. The 12-week "Mindful Moms" intervention was designed to empower pregnant women with depressive symptomatology to create personal goals and engage in mindful physical activity using prenatal yoga. OBJECTIVES This longitudinal pilot study evaluated the feasibility, acceptability, and preliminary effects of the "Mindful Moms" intervention in pregnant women with depressive symptoms. METHODS We evaluated enrollment and retention data (feasibility) and conducted semistructured interviews (acceptability). We evaluated the intervention's effects over time on participants' depressive symptoms, anxiety, perceived stress, self-efficacy, and maternal-child attachment, and we compared findings to an archival comparison group, also assessed longitudinally. RESULTS Enrollment and retention rates and positive feedback from participants support the intervention's acceptability and feasibility. "Mindful Moms" participants experienced decreases in depressive symptoms, perceived stress, anxiety, ruminations, and maternal-child attachment and no change in physical activity self-efficacy from baseline to postintervention. Comparisons of the "Mindful Moms" intervention to the comparison groups over time indicated differences in depressive symptoms between all groups and a trend in differences in perceived stress. DISCUSSION Results support the feasibility and acceptability of "Mindful Moms" for pregnant women with depressive symptoms and suggest that further research is warranted to evaluate this intervention for reducing depressive and related symptoms. Lack of a concurrent control group, with equivalent attention from study staff, and no randomization limit the generalizability of this study; yet, these preliminary findings support future large-scale randomized controlled trials to further evaluate this promising intervention.
Collapse
|
16
|
Fortier MS, Morgan TL. How optimism and physical activity interplay to promote happiness. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-020-01294-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
17
|
Barrett S, Begg S, O'Halloran P, Howlett O, Lawrence J, Kingsley M. The effect of behaviour change interventions on changes in physical activity and anthropometrics in ambulatory hospital settings: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2021; 18:7. [PMID: 33413512 PMCID: PMC7791684 DOI: 10.1186/s12966-020-01076-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/14/2020] [Indexed: 01/17/2023] Open
Abstract
Background The aim of this systematic review and meta-analysis was to investigate whether behaviour change interventions promote changes in physical activity and anthropometrics (body mass, body mass index and waist circumference) in ambulatory hospital populations. Methods Randomised controlled trials were collected from five bibliographic databases (MEDLINE, Embase, CINAHL, The Cochrane Central Register of Controlled Trials (CENTRAL) and PsycINFO). Meta-analyses were conducted using change scores from baseline to determine mean differences (MD), standardised mean differences (SMD) and 95% confidence intervals (95% CI). The Grades of Recommendation, Assessment, Development and Evaluation approach was used to evaluate the quality of the evidence. Results A total of 29 studies met the eligibility criteria and 21 were included in meta-analyses. Behaviour change interventions significantly increased physical activity (SMD: 1.30; 95% CI: 0.53 to 2.07, p < 0.01), and resulted in significant reductions in body mass (MD: -2.74; 95% CI: − 4.42 to − 1.07, p < 0.01), body mass index (MD: -0.99; 95% CI: − 1.48 to − 0.50, p < 0.01) and waist circumference (MD: -2.21; 95% CI: − 4.01 to − 0.42, p = 0.02). The GRADE assessment indicated that the evidence is very uncertain about the effect of behaviour change interventions on changes in physical activity and anthropometrics in ambulatory hospital patients. Conclusions Behaviour change interventions initiated in the ambulatory hospital setting significantly increased physical activity and significantly reduced body mass, body mass index and waist circumference. Increased clarity in interventions definitions and assessments of treatment fidelity are factors that need attention in future research. PROSPERO registration number: CRD42020172140.
Collapse
Affiliation(s)
- Stephen Barrett
- La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia.,Health Promotion Department, Bendigo Health Care Group, PO Box 126, Bendigo, Victoria, 3552, Australia
| | - Stephen Begg
- La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia
| | - Paul O'Halloran
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, 3068, Australia
| | - Owen Howlett
- La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia.,Research and Innovation, Bendigo Health Care Group, PO Box 126, Bendigo, Victoria, 3552, Australia
| | - Jack Lawrence
- Gurri Wanyarra Welllbing Centre, Bendigo, Victoria, 3550, Australia
| | - Michael Kingsley
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia. .,Department of Exercise Sciences, University of Auckland, Newmarket, 1023, New Zealand.
| |
Collapse
|
18
|
Barrett S, Begg S, O'Halloran P, Kingsley M. A physical activity coaching intervention can improve and maintain physical activity and health-related outcomes in adult ambulatory hospital patients: the Healthy4U-2 randomised controlled trial. Int J Behav Nutr Phys Act 2020; 17:156. [PMID: 33256753 PMCID: PMC7708221 DOI: 10.1186/s12966-020-01063-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 11/23/2020] [Indexed: 01/25/2023] Open
Abstract
Background The Healthy 4 U-2 study sought to evaluate the effect of a twelve-week, physical activity (PA) coaching intervention for changes and maintenance in PA, anthropometrics and health-related outcomes in adults presenting to an ambulatory hospital clinic. Methods One hundred and twenty insufficiently active adults were recruited from an ambulatory hospital clinic and randomised to an intervention group that received an education session and five 20-min telephone sessions of PA coaching, or to a control group that received the education session only. ActiGraph GT3X accelerometers were used to measure moderate-to-vigorous physical activity (MVPA) at baseline, post-intervention (3-months) and follow-up (9-months). Secondary outcome measures (anthropometrics, PA self-efficacy, and health-related quality of life) were also assessed at the three time points. Results At baseline, the mean age and body mass index of participants were 53 ± 8 years and 31 ± 4 kg/m2, respectively. Relative to control, the intervention group increased objectively measured MVPA at post-intervention (p < 0.001) and 9 months follow-up (p < 0.001). At the 9-month follow-up the intervention group completed 22 min/day of MVPA (95% CI: 20 to 25 min/day), which is sufficient to meet the recommended PA guidelines. The intervention group exhibited beneficial changes in body mass (p < 0.001), waist circumference (p < 0.001), body mass index (p < 0.001), PA self-efficacy (p < 0.001), and health-related quality of life (p < 0.001) at the 9-month follow-up. Conclusions This study demonstrates that a low contact PA coaching intervention results in beneficial changes in PA, anthropometrics and health-related outcomes in insufficiently active adults presenting to an ambulatory care clinic. The significant beneficial changes were measured at post-intervention and the 9-month follow-up, demonstrating a maintenance effect of the intervention. Trial registration Prospectively registered on the Australian and New Zealand Clinical Trials Registry (ANZCTR, Trial registration number: ACTRN12619000036112. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-020-01063-x.
Collapse
Affiliation(s)
- Stephen Barrett
- La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia.,Health Promotion Department, Bendigo Health Care Group, PO Box 126, Bendigo, Victoria, 3552, Australia
| | - Stephen Begg
- La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia
| | - Paul O'Halloran
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, 3068, Australia
| | - Michael Kingsley
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia. .,Department of Exercise Sciences, University of Auckland, Newmarket, 1023, New Zealand.
| |
Collapse
|
19
|
Hardcastle SJ, Galliott M, Lynch BM, Nguyen NH, Cohen PA, Mohan GR, Johansen NJ, Saunders C. 'If I Had Someone Looking Over My Shoulder…': Exploration of Advice Received and Factors Influencing Physical Activity Among Non-metropolitan Cancer Survivors. Int J Behav Med 2019; 26:551-561. [PMID: 31364038 DOI: 10.1007/s12529-019-09808-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND There are significant geographic inequalities in cancer survival with poorer survival rates in non-metropolitan areas compared to major cities. Physical activity (PA) can reduce cancer recurrence and prevent cardiovascular disease. However, few survivors participate in sufficient PA and the prevalence of inactivity is significantly higher in non-metropolitan survivors. The study investigated non-metropolitan survivors' recollections regarding PA advice received following cessation of active treatment, their knowledge of PA guidelines, and the factors that impact on PA behaviour change. METHOD Sixteen individuals (14 women and 2 men) with breast (n = 8), endometrial (n = 4) or colorectal cancer (n = 4), with a mean age of 60 years (SD = 12) completed semi-structured interviews as part of a larger study to examine the acceptability and utility of wearable trackers to increase PA. Interviews explored survivors' recollections regarding the advice they received concerning PA following active treatment, knowledge of PA guidelines for cancer survivors and the influences on PA behaviour change. Interview transcripts were analysed using thematic analysis. RESULTS Four main themes emerged: (i) insufficient knowledge of guidelines, (ii) support from the treating oncology team, (iii) external accountability, and (iv) barriers to PA. CONCLUSIONS Survivors' knowledge of PA guidelines was limited and they did not often recall their oncologists making specific recommendations concerning PA. Survivors' referred to the desire for accountability and monitoring in order to successfully change PA. Lack of motivation was the main barrier to PA participation. Other barriers included age, health status, and lack of facilities or exercise programs.
Collapse
Affiliation(s)
- Sarah J Hardcastle
- School of Psychology, Curtin University, Perth, WA, Australia. .,School of Medicine, University of Western Australia, Crawley, WA, Australia.
| | | | - Brigid M Lynch
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Nga H Nguyen
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Paul A Cohen
- School of Medicine, University of Western Australia, Crawley, WA, Australia.,St John of God Hospital, Subiaco, Subiaco, WA, Australia
| | | | | | - Christobel Saunders
- School of Medicine, University of Western Australia, Crawley, WA, Australia.,St John of God Hospital, Subiaco, Subiaco, WA, Australia
| |
Collapse
|
20
|
Barrett S, Begg S, O'Halloran P, Kingsley M. Cost-effectiveness of telephone coaching for physically inactive ambulatory care hospital patients: economic evaluation alongside the Healthy4U randomised controlled trial. BMJ Open 2019; 9:e032500. [PMID: 31826893 PMCID: PMC6924747 DOI: 10.1136/bmjopen-2019-032500] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess whether telephone coaching is a cost-effective method for increasing physical activity and health-related quality of life for insufficiently active adults presenting to an ambulatory care clinic in a public hospital. DESIGN An economic evaluation was performed alongside a randomised controlled trial. SETTING Participants were recruited from an ambulatory care clinic in a public hospital in regional Australia. PARTICIPANTS Seventy-two adults (aged 18-69) deemed insufficiently physically active via self-report. INTERVENTIONS Participants were randomised to either an intervention group that received an education session and eight sessions of telephone coaching over a 12-week period, or to a control group that received the education session only. The intervention used in the telephone coaching was integrated motivational interviewing and cognitive behavioural therapy. OUTCOME MEASURES The primary health outcome was change in moderate-to-vigorous physical activity (MVPA), objectively measured via accelerometry. The secondary outcome was the quality-adjusted life-year (QALY) determined by the 12-item Short Form Health Survey Questionnaire. Outcome data were measured at baseline, postintervention (3 months) and follow-up (6 months). Incremental cost-effectiveness ratios (ICERs) were calculated for each outcome. Non-parametric bootstrapping techniques and sensitivity analyses were performed to account for uncertainty. RESULTS The mean intervention cost was $279±$13 per person. At 6 months follow-up, relative to control, the intervention group undertook 18 more minutes of daily MVPA at an ICER of $15/min for each additional minute of MVPA. With regard to QALYs, the intervention yielded an ICER of $36 857 per QALY gained. Sensitivity analyses indicated that results were robust to varied assumptions. CONCLUSION Telephone coaching was a low-cost strategy for increasing MVPA and QALYs in insufficiently physically active ambulatory care hospital patients. Additional research could explore the potential economic impact of the intervention from a broader healthcare perspective. TRIAL REGISTRATION NUMBER ANZCTR: ACTRN12616001331426.
Collapse
Affiliation(s)
- Stephen Barrett
- Health Promotion, Bendigo Health - Bendigo Hospital Campus, Bendigo, Victoria, Australia
| | - Stephen Begg
- La Trobe Holsworth Research Initiative, La Trobe University, Bendigo, Victoria, Australia
| | - Paul O'Halloran
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Michael Kingsley
- La Trobe Holsworth Research Initiative, La Trobe University, Bendigo, Victoria, Australia
| |
Collapse
|