Two Valid Measures of Self-rated Physical Activity and Capacity

Physical activity and sedentary time after lifestyle interventions at the Norwegian Healthy Life Centres

AIMS

This study evaluates long-term changes in physical activity and its associations with various predictors after a behavior change program at the Norwegian Healthy Life Centers.

BACKGROUND

Physical activity is recommended and is part of public health strategies to prevent noncommunicable diseases.

METHODS

This longitudinal cohort, based on a controlled randomized trial, studies a population of 116 Healthy Life Center participants in South-Western Norway who wore SenseWear Armbands to measure time spent in moderate to vigorous physical activity and sedentary time based on metabolic equivalents. The measurements were obtained at baseline, immediately post-intervention, and 24 months after baseline. Linear mixed model analyses were performed to assess predictors for change in physical activity and sedentary time.

FINDINGS

High physical activity levels at baseline were maintained during the 24-month study period. Young, male participants with good self-rated health, utilizing local PA facilities were most active, and young participants utilizing local facilities were also less sedentary. The participants with higher levels of education were less active initially but caught up with the difference during follow-up. A high degree of controlled regulation, characterized by bad conscience and external pressure, predicted more sedentary behavior and a trend toward being less physically active. Autonomous motivation was associated with less time spent on sedentary behaviors. People with high self-efficacy for physical activity were more sedentary initially but showed a reduction in their sedentary behavior.The study supports the importance of attending local training facilities and adopting motivation for behavioral change that is not based on guilt and external rewards. Interventions aimed at improving physical activity among people at risk for noncommunicable diseases benefit from habitual use of local training facilities, strengthening their self-perceived health and the development of internalized motivation. However, it has not been shown to mitigate social health disparities.

Subjective Daily Physical Activity Measures in Heart Disease: A Systematic Review

BACKGROUND

The measurement of daily physical activity (DPA) is important for the prognosis and quantifying clinical outcomes in individuals with heart disease. The measurement of DPA is more feasible using subjective measures when compared with objective measures. The purpose of this systematic review of the literature was to identify the subjective measures of DPA that have established reliability and validity in individuals with heart disease to assist clinician and researcher instrument selection.

METHODS

A systematic search of PubMed, CINAHL, MEDLINE, and ProQuest databases was performed. Methodological rigor was assessed using 3 different quality appraisal tools. Qualitative synthesis of included studies was performed.

RESULTS

Twenty-two unique studies covering 19 subjective DPA measures were ultimately included. Methodological rigor was generally fair, and validity coefficients were moderate at best.

CONCLUSIONS

Only 4 subjective measures that have established test-retest reliability and that provide an estimate of energy expenditure, metabolic equivalents, or minutes of DPA were compared against accelerometry or a DPA diary in patients with heart disease: SWISS Physical Activity Questionnaire, Total Activity Measure 1 and 2, and Mobile Physical Activity Logger. Depending on the clinician or researcher needs, instrument selection would depend on the recall period and the DPA construct being measured.

A proposal for a self-rated frailty index and status for patient-oriented research

Objective

Frailty indices are important predictors of major health outcomes, but mostly designed by and for researchers and specialists. Three of the most commonly used theory-based indices are composite measures that are subject to arbitrary assumptions and biases introduced due to data processing. A complicated index can be simplified with fewer items. The theory-based frailty indices are not optimal and neglect patients’ perspectives. This study aims to compare different definitions of frailty and propose a self-rated measure of frailty index and status.

Results

Frailty was defined differently by laypeople and researchers/clinicians. Patients’ and laypeople’s perspectives seemed neglected. Existing frailty indices had shortcomings related to the use of composite measures, assumptions of frailty theories, and the lack of novel information. To avoid these shortcomings, we suggested asking individuals “on a scale of 0 to 10, how frail do you think you are?” and “by answering yes or no, do you consider yourself to be frail?” to determine frailty on continuous and dichotomous scales respectively. However, there will be other issues emerging with these new measures, such as the need for feasibility and validity studies, as well as acceptability by researchers.

The Norwegian Healthy Life Study: protocol for a pragmatic RCT with longitudinal follow-up on physical activity and diet for adults

BACKGROUND

The Norwegian Directorate of Health recommends that Healthy Life Centres (HLCs) be established in primary health care to support behaviour change and reduce the risk of non-communicable diseases. The aim of the present study protocol is to present the rationale, design and methods of a combined pragmatic randomized controlled trial (RCT) and longitudinal cohort study of the effects of attending HLCs concerning physical activity, sedentary behaviour and diet and to explore how psychological well-being and motivational factors may mediate short- and long-term effects.

METHODS

The present study will combine a 6-month RCT with a longitudinal cohort study (24 months from baseline) conducted at six HLCs from June 2014 to Sept 2017. Participants are randomized to behavioural change interventions or a 6-month waiting list control group.

DISCUSSION

A randomized trial of interventions in HLCs has the potential to influence the development of policy and practice for behaviour change interventions and patient education programmes in Norway. We discuss some of the important preconditions for obtaining valid results from a complex intervention and outline some of the characteristics of ecological approaches in health care research that can enable a pragmatic intervention study.

TRIAL REGISTRATION

The study was retrospectively registered on September 19, 2014 and is available online at ClinicalTrials.gov (ID: NCT02247219 ).