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Zhao X, Forbes A, Ghazaleh HA, He Q, Huang J, Asaad M, Cheng L, Duaso M. Interventions and behaviour change techniques for improving physical activity level in working-age people (18-60 years) with type 2 diabetes: A systematic review and network meta-analysis. Int J Nurs Stud 2024; 160:104884. [PMID: 39250878 DOI: 10.1016/j.ijnurstu.2024.104884] [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: 01/04/2024] [Revised: 07/10/2024] [Accepted: 08/20/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND The escalating prevalence of type 2 diabetes within the working-age population (18-60 years) imposes a substantial societal burden. Whilst physical activity is crucial for diabetes management, limited evidence exists to inform optimal strategies for promoting physical activity in this population. We aimed to evaluate and compare the effect of interventions for increasing physical activity in working-age adults with type 2 diabetes. METHODS We searched Web of Science, the Cochrane Library, Medline, Embase, PsycINFO, ClinicalTrials.gov, and ICTRP from inception to April 30, 2023. Randomised controlled trials that reported the effect of interventions (education, training or behavioural) to promote physical activity (either self-reported or objective) in people aged 18-60 years were included. Two independent reviewers conducted summary data extraction and quality assessment. Pairwise random-effects, Frequentist network meta-analyses, and subgroup analysis were used to obtain pooled effects. RESULTS A total of 52 trials were included in this systematic review. Compared to control group, the physical activity interventions demonstrated statistically significant effects on objectively measured physical activity (SMD 0.77, 95 % CI 0.27-1.27), self-reported physical activity (SMD 0.88, 95 % CI 0.40-1.35), and overall physical activity (SMD 0.82, 95 % CI 0.48-1.16); a statistically and clinically meaningful reduction on glycated haemoglobin A1c (HbA1c) was also identified (MD -0.50 %, 95 % CI -0.66, -0.35). In terms of intervention types, education interventions exerted the largest effect on objectively measured physical activity; however, psychological interventions had the largest effects on overall physical activity compared to other intervention types. Four behaviour change techniques were related to statistically significant reduction in HbA1c: goal setting (outcome), information about health consequences, demonstration of the behaviour, and prompts/cues. Subgroup analysis showed that delivery mode, intervention setting, and facilitator were associated with statistically significant effect on physical activity and HbA1c. CONCLUSIONS Psychologically modelled education incorporating behaviour change techniques may be the most beneficial way to promote physical activity and glycaemic control in working-age adults with type 2 diabetes. Delivery mode, intervention setting, and facilitator type should be considered when designing interventions for improving physical activity level in working-age people with type 2 diabetes.
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Affiliation(s)
- Xiaoyan Zhao
- Care for Long Term Conditions Division, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.
| | - Angus Forbes
- Care for Long Term Conditions Division, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Haya Abu Ghazaleh
- Care for Long Term Conditions Division, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Qianyu He
- Division of Psychology and Mental Health, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Jing Huang
- Care for Long Term Conditions Division, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Mariam Asaad
- Care for Long Term Conditions Division, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Li Cheng
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Maria Duaso
- Care for Long Term Conditions Division, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Silva-Smith AL, Hanson CL, Neubeck L, Rowat A, McHale S. Physical Activity Interventions Framed by the Health Action Process Approach for Adults with Long-Term Conditions: A Scoping Review. Int J Behav Med 2024:10.1007/s12529-024-10305-2. [PMID: 39009797 DOI: 10.1007/s12529-024-10305-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Interventions that use the Health Action Process Approach (HAPA) model show promise for increasing PA frequency, duration, and intensity. However, there is limited understanding of how HAPA model variables have been operationalized for PA interventions in chronic disease to promote behavior change and sustained PA or whether the phase or continuous form of the HAPA model was used. The aim of this scoping review is to describe how the HAPA model variables for PA interventions were operationalized and provide details of implementation. METHOD We searched five databases to identify studies published between January 1992 and March 2024. We aimed to describe (1) the characteristics of interventions including setting, delivery mode, duration, and content; (2) which HAPA variables were operationalized and the strategies used; and (3) the physical activity measures and outcome effects. RESULTS The search identified 23 interventions in 30 papers (12 protocols, 3 quasi-experimental studies, and 15 randomized controlled trials (RCTs)). Seven of the 15 RCTs reported significant positive effects of the HAPA model on PA behavior outcomes. Interventions operationalized between three and nine HAPA constructs showed significant variability in how the HAPA model is used in intervention research. PA measures varied from self-report to validated objective instruments. CONCLUSION We found a lack of clarity in decisions about which HAPA constructs were included in interventions. The wide variability in operationalized HAPA constructs made it challenging to compare interventions. Researchers should provide more detail about intervention design and implementation procedures to enhance transparency.
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Affiliation(s)
- Amy L Silva-Smith
- Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences, University of Colorado at Colorado Spring, 1420 Austin Bluffs Parkway, Colorado Springs, CO, USA.
| | - Coral L Hanson
- Centre for Cardiovascular Health, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4DN, UK
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4DN, UK
| | - Lis Neubeck
- Centre for Cardiovascular Health, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4DN, UK
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4DN, UK
| | - Anne Rowat
- Nursing & Health Care School, University of Glasgow, 57/504 Oakfield Avenue, Glasgow, G12 8LL, UK
| | - Sheona McHale
- Centre for Cardiovascular Health, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4DN, UK
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4DN, UK
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Bindschedler A, Ziller C, Gerber EY, Behrendt F, Crüts B, Parmar K, Gerth HU, Gäumann S, Dierkes W, Schuster-Amft C, Bonati LH. Feasibility of an Application-Based Outpatient Rehabilitation Program for Stroke Survivors: Acceptability and Preliminary Results for Patient-Reported Outcomes. Bioengineering (Basel) 2024; 11:135. [PMID: 38391621 PMCID: PMC10886035 DOI: 10.3390/bioengineering11020135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The majority of stroke survivors experience long-term impairments. Regular physical activity and other lifestyle modifications play an important role in rehabilitation. Outpatient rehabilitation using telemedicine might be suitable to improve functional ability and long-term secondary prevention. The Strokecoach Intervention Program (SIP, Strokecoach GmbH, Cologne, Germany) comprises training, coaching and monitoring with the aim of improving or at least maintaining functional independence and preventing further stroke through more targeted physical activity. The SIP is provided as blended care, which refers to the integrated and coordinated delivery of healthcare services that combines traditional in-person interactions with technology-mediated interventions, optimizing the use of both face-to-face and virtual modalities to enhance patient outcomes. OBJECTIVE The aim of this study was to evaluate the acceptance of the SIP by the participants and its practical application, as well as to obtain initial indications of effects of the SIP on the basis of patient-related outcome measures, blood pressure measurements and recording of physical activity in parallel with the intervention. METHODS Data from individuals with stroke participating in the SIP were analyzed retrospectively. Within the SIP, participants received an application-based training program, were instructed to measure their blood pressure daily and to wear an activity tracker (pedometer). During the intervention period of either 6 or 12 weeks, the participants were supported and motivated by a personal coach via a messenger application. The primary outcomes of the analysis were recruitment, acceptance of and satisfaction with the SIP. Secondary outcomes included functional measures, mobility and health-related quality of life. RESULTS A total of 122 individuals with stroke could be recruited for the SIP. A total of 96 out of 122 were able to start the program (54% female, mean age 54.8 (SD = 13.1), 6.1 (SD = 6.6) years after stroke onset) and 88 completed the SIP. Participants wore the activity tracker on 66% and tracked their blood pressure on 72% of their intervention days. A further analyzed subgroup of 38 participants showed small improvements in patient-reported outcomes such as health-related quality of life (SF-36) with an increase of 12 points in the subdomain mental health, vitality (12.6) and physical functioning (9.1). However, no statistically significant improvements were found in other performance-based measures (Timed Up and Go test, gait speed). CONCLUSIONS This study showed that a blended therapy approach for stroke survivors with mild to moderate impairments in the chronic phase is feasible and was highly accepted by participants, who benefitted from the additional coaching.
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Affiliation(s)
| | - Carina Ziller
- Research Department, Reha Rheinfelden, 4310 Rheinfelden, Switzerland
| | - Eve-Yaël Gerber
- Research Department, Reha Rheinfelden, 4310 Rheinfelden, Switzerland
- Faculty of Psychology, University of Basel, 4055 Basel, Switzerland
| | - Frank Behrendt
- Research Department, Reha Rheinfelden, 4310 Rheinfelden, Switzerland
- School of Engineering and Computer Science, Bern University of Applied Sciences, 2501 Biel, Switzerland
| | | | - Katrin Parmar
- Research Department, Reha Rheinfelden, 4310 Rheinfelden, Switzerland
- Department of Neurology, University Hospital Basel, 4031 Basel, Switzerland
| | - Hans Ulrich Gerth
- Research Department, Reha Rheinfelden, 4310 Rheinfelden, Switzerland
- Department of Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Szabina Gäumann
- Research Department, Reha Rheinfelden, 4310 Rheinfelden, Switzerland
| | | | - Corina Schuster-Amft
- Research Department, Reha Rheinfelden, 4310 Rheinfelden, Switzerland
- School of Engineering and Computer Science, Bern University of Applied Sciences, 2501 Biel, Switzerland
- Department of Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
| | - Leo H Bonati
- Research Department, Reha Rheinfelden, 4310 Rheinfelden, Switzerland
- Department of Neurology, University Hospital Basel, 4031 Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
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Mair JL, Salamanca-Sanabria A, Augsburger M, Frese BF, Abend S, Jakob R, Kowatsch T, Haug S. Effective Behavior Change Techniques in Digital Health Interventions for the Prevention or Management of Noncommunicable Diseases: An Umbrella Review. Ann Behav Med 2023; 57:817-835. [PMID: 37625030 PMCID: PMC10498822 DOI: 10.1093/abm/kaad041] [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] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Despite an abundance of digital health interventions (DHIs) targeting the prevention and management of noncommunicable diseases (NCDs), it is unclear what specific components make a DHI effective. PURPOSE This narrative umbrella review aimed to identify the most effective behavior change techniques (BCTs) in DHIs that address the prevention or management of NCDs. METHODS Five electronic databases were searched for articles published in English between January 2007 and December 2022. Studies were included if they were systematic reviews or meta-analyses of DHIs targeting the modification of one or more NCD-related risk factors in adults. BCTs were coded using the Behavior Change Technique Taxonomy v1. Study quality was assessed using AMSTAR 2. RESULTS Eighty-five articles, spanning 12 health domains and comprising over 865,000 individual participants, were included in the review. We found evidence that DHIs are effective in improving health outcomes for patients with cardiovascular disease, cancer, type 2 diabetes, and asthma, and health-related behaviors including physical activity, sedentary behavior, diet, weight management, medication adherence, and abstinence from substance use. There was strong evidence to suggest that credible source, social support, prompts and cues, graded tasks, goals and planning, feedback and monitoring, human coaching and personalization components increase the effectiveness of DHIs targeting the prevention and management of NCDs. CONCLUSIONS This review identifies the most common and effective BCTs used in DHIs, which warrant prioritization for integration into future interventions. These findings are critical for the future development and upscaling of DHIs and should inform best practice guidelines.
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Affiliation(s)
- Jacqueline Louise Mair
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Alicia Salamanca-Sanabria
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
| | - Mareike Augsburger
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
- Klenico Health AG, Zurich, Switzerland
| | - Bea Franziska Frese
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
- Centre for Digital Health Interventions, Institute of Technology Management, University of St.Gallen, St.Gallen, Switzerland
| | - Stefanie Abend
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Robert Jakob
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Tobias Kowatsch
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St.Gallen, St.Gallen, Switzerland
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
| | - Severin Haug
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
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Cody R, Beck J, Brand S, Donath L, Faude O, Hatzinger M, Imboden C, Kreppke JN, Lang UE, Ludyga S, Mans S, Mikoteit T, Oswald A, Schweinfurth N, Zahner L, Gerber M. Short-term outcomes of physical activity counseling in in-patients with Major Depressive Disorder: Results from the PACINPAT randomized controlled trial. Front Psychiatry 2023; 13:1045158. [PMID: 36741581 PMCID: PMC9889670 DOI: 10.3389/fpsyt.2022.1045158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
Introduction A physical activity counseling intervention based on a motivation-volition model was developed and delivered to in-patients with Major Depressive Disorders with the aim of increasing lifestyle physical activity. The aim of this study is to evaluate the short-term outcomes of this intervention. Methods A multi-center randomized controlled trial was conducted in four Swiss psychiatric clinics. Adults who were initially insufficiently physically active and were diagnosed with Major Depressive Disorder according to ICD-10 were recruited. The sample consisted of 113 participants in the intervention group (M age = 42 years, 56% women) and 107 in the control group (M age = 40 years, 49% women). Motivation and volition determinants of physical activity were assessed with questionnaires. Implicit attitudes were assessed with an Implicit Association Test. Physical activity was self-reported and measured with hip-worn accelerometers over 7 consecutive days starting on the day following the data collection. Results According to accelerometer measures, step count decreased on average 1,323 steps less per day (95% CI = -2,215 to -431, p < 0.01) over time in the intervention group compared to the control group. A trend was recognized indicating that moderate-to-vigorous physical activity decreased on average 8.37 min less per day (95% CI = -16.98 to 0.23, p < 0.06) over time in the intervention group compared to the control group. The initial phase of the intervention does not seem to have affected motivational and volitional determinants of and implicit attitudes toward physical activity. Conclusion Physical activity counseling may be considered an important factor in the transition from in-patient treatment. Methods to optimize the intervention during this period could be further explored to fulfill the potential of this opportunity. Clinical trial registration https://www.isrctn.com/ISRCTN10469580, identifier ISRCTN10469580.
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Affiliation(s)
- Robyn Cody
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | | | - Serge Brand
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
- Adult Psychiatric Clinics Universitäre Psychiatrische Klinik für Erwachsene (UPKE), University of Basel, Basel, Switzerland
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
- Substance Use Prevention Research Center and Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
- School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Lars Donath
- Department of Intervention Research in Exercise Training, German Sport University Cologne, Cologne, Germany
| | - Oliver Faude
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | | | | | - Jan-Niklas Kreppke
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Undine E. Lang
- Adult Psychiatric Clinics Universitäre Psychiatrische Klinik für Erwachsene (UPKE), University of Basel, Basel, Switzerland
| | - Sebastian Ludyga
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Sarah Mans
- Private Clinic Wyss, Münchenbuchsee, Switzerland
| | | | - Anja Oswald
- Psychiatric Clinic Sonnenhalde, Riehen, Switzerland
| | - Nina Schweinfurth
- Adult Psychiatric Clinics Universitäre Psychiatrische Klinik für Erwachsene (UPKE), University of Basel, Basel, Switzerland
| | - Lukas Zahner
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Diez de los Rios de la Serna C, Fernández-Ortega P, Lluch-Canut T. Lifestyle Behavior Interventions for Preventing Cancer in Adults with Inherited Cancer Syndromes: Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14098. [PMID: 36360977 PMCID: PMC9655661 DOI: 10.3390/ijerph192114098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: The link between lifestyle behaviors and cancer risk is well established, which is important for people with personal/family history or genetic susceptibility. Genetic testing is not sufficient motivation to prompt healthier lifestyle behaviors. This systematic review aims to describe and assess interventions for promoting healthy behaviors in people at high risk of cancer. (2) Methods: The review was performed according to PRISMA guidelines using search terms related to hereditary cancer and health education to identify studies indexed in: CINAHL, MEDLINE, PubMed, Cochrane Library, Scopus, and Joanna Briggs, and published from January 2010 to July 2022. (3) Results: The search yielded 1558 initial records; four randomized controlled trials were eligible. Three included patients with and without a personal history of cancer who were at increased risk of cancer due to inherited cancer syndromes, and one included people undergoing genetic testing due to family history. Interventions targeted diet, physical activity, and alcohol. (4) Conclusions: There is a paucity of research on interventions for promoting healthy lifestyle behaviors in people with a high risk of cancer. Interventions produced positive short-term results, but there was no evidence that behavioral modifications were sustained over time. All healthcare professionals can actively promote healthy behaviors that may prevent cancer.
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Affiliation(s)
| | - Paz Fernández-Ortega
- School of Nursing, Faculty of Medicine and Health Sciences, Bellvitge Campus, University of Barcelona (UB), 08907 Barcelona, Spain
- Institut Català d’Oncologia (ICO) Barcelona, Bellvitge, 08908 Barcelona, Spain
| | - Teresa Lluch-Canut
- School of Nursing, Faculty of Medicine and Health Sciences, Bellvitge Campus, University of Barcelona (UB), 08907 Barcelona, Spain
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