Pre-school-based behaviour change intervention to increase physical activity levels amongst young children: a feasibility cluster randomised controlled trial

Background

A significant rise in childhood obesity worldwide over the past three decades highlights the urgent need for early interventions, especially in preschools as key settings for child development. This study aimed to assess the feasibility and fidelity of a randomised controlled trial of "I'm an Active Hero" (IAAH), a theory- and evidence-based multi-component behaviour change intervention targeting physical activity and sedentary behaviour amongst preschool-aged children.

Methods

Two preschools in Taif city, Saudi Arabia were randomly assigned to either the intervention (n = 3 classrooms) or the usual curriculum control group (n = 3 classrooms). The intervention ran for 10 weeks from February to April 2023 and consisted of teacher-led physical activity and sedentary behaviour sessions in preschools, with an additional interactive home component. Primary outcome measures included intervention fidelity, recruitment rates, attrition rates, and compliance with trial procedures. Secondary outcomes included body mass index (BMI), objectively measured physical activity, and sedentary time via the ActiGraph GT3X accelerometer. Outcomes were measured at baseline and at 10 weeks in both study arms.

Results

The preschool intervention component had high fidelity (93.3%), but the home component fidelity was lower (74%). A cluster-level recruitment rate of 12% (13/112 centres) was attained, whilst the individual-level recruitment rate stood at 36% (52/143 children, mean age of 4.16 years; 23 girls). Attrition was 10%. Compliance varied with 90% for BMI, 71% for accelerometery, and 45% for questionnaires. The intervention group showed small decreases in BMI, slight increases in physical activity, and decreases in sedentary time at follow-up compared to the control group. Parents, facilitators, and assistant teachers considered the intervention to be feasible and beneficial.

Conclusion

The IAAH intervention was feasible to implement in Saudi Arabian preschools. Facilitators showed high fidelity in delivering it. However, preliminary data did not demonstrate effectiveness. A more comprehensive evaluation across a broader population is warranted. The intervention could be revised to optimise recruitment, compliance, and fidelity of the home-based component. Successful elements from this pilot should be retained whilst adaptations to implementation are made to strengthen key areas.Clinical trial registration: ClinicalTrials.gov, NCT05754359.

Enhanced muscle activity during interrupted sitting improves glycemic control in overweight and obese men

The efficacy of interrupting prolonged sitting may be influenced by muscle activity patterns. This study examined the effects of interrupting prolonged sitting time with different muscle activity patterns on continuously monitored postprandial glycemic response. Eighteen overweight and obese men (21.0 ± 1.2 years; 28.8 ± 2.2 kg/m2) participated in this randomized four-arm crossover study, including uninterrupted sitting for 8.5 h (SIT) and interruptions in sitting with matched energy expenditure and duration but varying muscle activity: 30-min walking at 4 km/h (ONE), sitting with 3-min walking at 4 km/h (WALK) or squatting (SQUAT) every 45 min for 10 times. Net incremental area under the curve (netiAUC) for glucose was compared between conditions. Quadriceps, hamstring, and gluteal muscles electromyogram (EMG) patterns including averaged muscle EMG amplitude (aEMG) and EMG activity duration were used to predict the effects on glucose netiAUC. Compared with SIT (10.2 mmol/L/h [95%CI 6.3 to 11.7]), glucose netiAUC was lower during sitting interrupted with any countermeasure (ONE 9.2 mmol/L/h [8.0 to 10.4], WALK 7.9 mmol/L/h [6.4 to 9.3], and SQUAT 7.9 mmol/L/h [6.4 to 9.3], all p < 0.05). Furthermore, WALK and SQUAT resulted in a lower glucose netiAUC compared with ONE (both p < 0.05). Only increased aEMG in quadriceps (-0.383 mmol/L/h [-0.581 to -0.184], p < 0.001) and gluteal muscles (-0.322 mmol/L/h [-0.593 to -0.051], p = 0.022) was associated with a reduction in postprandial glycemic response. Collectively, short, frequent walking or squatting breaks effectively enhance glycemic control in overweight and obese men compared to a single bout of walking within prolonged sitting. These superior benefits seem to be associated with increased muscle activity intensity in the targeted muscle groups during frequent transitions from sitting to activity.

Feasibility of Project Mentor: A Mentoring Program Based on Self-Determination Theory for Adolescents Classified as Overweight

Purpose: This study examined the feasibility of Project Mentor, a mentoring program based on self-determination theory (SDT) for youth classified as overweight or obese. Methods: In Study 1, youth (N = 23) ranging from 12-18 years of age were randomly assigned to a mentoring intervention or wait-list control condition. Study 2 served as a replication sample and consisted of N = 38 youth who participated in the mentoring program. As part of a process evaluation, attendance and exercise heart rate were monitored to assess whether participants exercised at a moderate-to-vigorous level as intended. Mentees also rated whether mentors created a need-supportive environment. For outcome evaluation, basic need satisfaction, behavioral regulation, fitness, and body composition were assessed at pre, post, and follow-up. Results: Across both studies, participants attended over 80% of the exercise sessions and exercised at a moderate to vigorous intensity level. Mentees also perceived that mentors created a need-supportive environment. Post-test and follow-up basic need scores were higher than baseline values and autonomous motivation increased for mentoring program participants. Effect sizes were generally moderate to large in magnitude based on partial eta-squared and Cohen d. Aerobic fitness (i.e., Vo2peak) showed a moderate to large increase at post-test that was partially maintained at follow-up. Body composition changes were nonsignificant and small in magnitude. Participants in the wait-list control reported showed small changes or decreases across SDT related constructs, fitness, and body composition across both studies. Conclusions: Results across both studies support the feasibility of a mentoring program focused on CARE (competence, autonomy, relatedness, and enjoyment).

Physical Activity Interventions for Postnatal Weight Management: A Systematic Literature Review

Physical activity (PA) maintains weight and reduces postnatal weight retention (PWR), thereby lowering obesity-related comorbidities. There is only limited evidence on the most effective postnatal PA for Malaysian women. This review identified evidence-based literature on the effectiveness of PA interventions in managing weight in postnatal women and the preferred type of intervention for them. A systematic literature search was conducted following the preferred reporting items for systematic reviews and meta-analyses guidelines. Randomised controlled trials and quasi-experimental research related to PA interventions for women during the postnatal period (18 months after delivery) published in English from 2011 to 2021 were searched in ProQuest, Scopus, Springer Link and PubMed using the following keywords: 'physical activity', 'weight management' and 'postnatal women'. Intervention groups with weight and body mass index measured after any supervised PA guidance/counselling with a minimum follow-up of 10 weeks were included in the analysis. Those with pharmacological management and a comparator control group were excluded. A total of six articles met the inclusion criteria. Using the revised Cochrane risk of bias tool for randomised trials, one of these articles was classified as low-risk, two as having some concerns and three as having a high risk of bias. Walking, yoga and Pilates were found to be the most appropriate and preferred types of physical activity, despite having a small but significant impact on postnatal women's weight management. Healthcare professionals should adopt programmes that explicitly target these PA interventions to manage PWR.

Physical activity monitoring in Alzheimer's disease during sport interventions: a multi-methodological perspective

Introduction

Assessment methods for physical activity and fitness are of upmost importance due to the possible beneficial effect of physical conditioning on neurodegenerative diseases. The implementation of these methods can be challenging when examining elderly or cognitively impaired participants. In the presented study, we compared three different assessment methods for physical activity from the Dementia-MOVE trial, a 6-months intervention study on physical activity in Alzheimer's disease. The aim was to determine the comparability of physical activity assessments in elderly participants with cognitive impairment due to Alzheimer's disease.

Material or methods

38 participants (mean age 70 ± 7 years) with early-stage Alzheimer's disease (mean MoCA 18.84 ± 4.87) were assessed with (1) fitness trackers for an average of 12 (± 6) days, (2) a written diary on daily activities and (3) a questionnaire on physical activity at three intervention timepoints. For comparison purposes, we present a transformation and harmonization method of the physical assessment output parameters: Metabolic equivalent of task (MET) scores, activity intensity minutes, calorie expenditure and moderate-to-vigorous physical activity (MVPA) scores were derived from all three modalities. The resulting parameters were compared for absolute differences, correlation, and their influence by possible mediating factors such as cognitive state and markers from cerebrospinal fluid.

Results

Participants showed high acceptance and compliance to all three assessment methods. MET scores and MVPA from fitness trackers and diaries showed high overlap, whilst results from the questionnaire suggest that participants tended to overestimate their physical activity in the long-term retrospective assessment. All activity parameters were independent of the tested Alzheimer's disease parameters, showing that not only fitness trackers, but also diaries can be successfully applied for physical activity assessment in a sample affected by early-stage Alzheimer's disease.

Discussion

Our results show that fitness trackers and physical activity diaries have the highest robustness, leading to a highly comparable estimation of physical activity in people with Alzheimer's disease. As assessed parameters, it is recommendable to focus on MET, MVPA and on accelerometric sensor data such as step count, and less on activity calories and different activity intensities which are dependent on different variables and point to a lower reliability.

Measuring intra-individual physical activity variability using consumer-grade activity devices

Many existing sedentary behavior and physical activity studies focus on primary outcomes that assess change by comparing participants' activity from baseline to post-intervention. With the widespread availability of consumer-grade devices that track activity daily, researchers do not need to rely on those endpoint measurements alone. Using activity trackers, researchers can collect remote data about the process of behavior change and future maintenance of the change by measuring participants' intra-individual physical activity variability. Measuring intra-individual physical activity variability can enable researchers to create tailored and dynamic interventions that account for different physical activity behavior change trajectories, and by that, improve participants' program adherence, enhance intervention design and management, and advance interventions measurements' reliability. We propose an application of intra-individual physical activity variability as a measurement and provide three use cases within interventions. Intra-individual physical activity variability can be used: prior to the intervention period, where relationships between participants' intra-individual physical activity variability and individual characteristics can be used to predict adherence and subsequently tailor interventions; during the intervention period, to assess progress and subsequently boost interventions; and after the intervention, to obtain a reliable representation of the change in primary outcome.

Effect of physical activity intervention on cognitive function in China: A cluster randomized trial

INTRODUCTION

Current randomized trial evidence on the effect of physical activity (PA) intervention on cognitive function is scarce and mainly found in well-educated populations, limiting its generalizability. Furthermore, the modification effect of education levels remains understudied. We conducted a cluster randomized trial to evaluate the effects of PA intervention on cognitive function in a general older population, and whether education modifies such effects.

METHODS

Eight villages were randomized to the intervention (four villages, n = 240) or the control (four villages, n = 271). The intervention group received an 8-week multilevel PA intervention based on a socio-ecological model, while the control did not. The intervention has been condensed to three levels with activities occurring at the individual (telephone counseling, printed material, and training sessions), interpersonal (peer group), and community levels (group sharing and coaching). The primary outcome was changes in global cognition (overall cognitive function) measured by the Telephone Interview for Cognitive Status (TICS-10) at 12-month follow-up. Repeated measurements were modeled using the linear mixed model, which assumed that the missing values were missing at random.

RESULTS

The mean age was 70.94 years (standard deviation 5.71) and 55.6% were women. Compared to the control, the orientation improved from baseline at 12-month follow-up (0.24 points [95% confidence interval (CI), 0.03 to 0.46 points; P = 0.03]). Stratified analysis showed that the global cognition and orientation improved at 12-month follow-up among illiterate participants in the intervention (for global cognition, mean difference, 0.57 points [95% CI, 0.03 to 1.10], P = 0.04; for orientation, mean difference, 0.31 points [95% CI, 0.04 to 0.58], P = 0.03).

DISCUSSION

These results confirm the improvements in orientation in older adults, as well as in global cognition and orientation in the illiterate at 12-month follow-up.

Effect of a Wearable Device-Based Physical Activity Intervention in North Korean Refugees: Pilot Randomized Controlled Trial

BACKGROUND

Effective health interventions for North Korean refugees vulnerable to metabolic disorders are currently unelucidated.

OBJECTIVE

This study aimed to evaluate the effects of digital health interventions in North Korean refugees using a wearable activity tracker (Fitbit device).

METHODS

We conducted a prospective, randomized, open-label study on North Korean refugees aged 19-59 years between June 2020 and October 2021 with a 12-week follow-up period. The participants were randomly assigned to either an intervention group or a control group in a 1:1 ratio. The intervention group received individualized health counseling based on Fitbit data every 4 weeks, whereas the control group wore the Fitbit device but did not receive individualized counseling. The primary and secondary outcomes were the change in the mean daily step count and changes in the metabolic parameters, respectively.

RESULTS

The trial was completed by 52 North Korean refugees, of whom 27 and 25 were in the intervention and control groups, respectively. The mean age was 43 (SD 10) years, and 41 (78.8%) participants were women. Most participants (44/52, 95.7%) had a low socioeconomic status. After the intervention, the daily step count in the intervention group increased, whereas that in the control group decreased. However, there were no significant differences between the 2 groups (+83 and -521 steps in the intervention and control groups, respectively; P=.500). The effects of the intervention were more prominent in the participants with a lower-than-average daily step count at baseline (<11,667 steps/day). After the 12-week study period, 85.7% (12/14) and 46.7% (7/15) of the participants in the intervention and control groups, respectively, had an increased daily step count (P=.05). The intervention prevented the worsening of the metabolic parameters, including BMI, waist circumference, fasting blood glucose level, and glycated hemoglobin level, during the study period.

CONCLUSIONS

The wearable device-based physical activity intervention did not significantly increase the average daily step count in the North Korean refugees in this study. However, the intervention was effective among the North Korean refugees with a lower-than-average daily step count; therefore, a large-scale, long-term study of this intervention type in an underserved population is warranted.

TRIAL REGISTRATION

Clinical Research Information Service KCT0007999; https://cris.nih.go.kr/cris/search/detailSearch.do/23622.

The Effects of Physical Activity on Academic Performance in School-Aged Children: A Systematic Review

Schools offer a unique environment to influence children's physical activity (PA) levels positively. This study aims to systematically review the evidence surrounding how PA affects academic performance by analysing how the frequency, intensity, time, and type of PA mediate academic performance outcomes. This review was conducted using the PRISMA framework. Keyword searches were conducted in Science Direct, PubMed, and SPORTDiscus. Children that were obese, typically developing, typical weight, disabled, with a developmental disability, from a low socio-economic background, or an ethnic minority were included. A total of 19 studies were included, with a total of 6788 participants, a mean age of 9.3 years (50.2% boys, and 49.8% girls). Overall, 63.2% were nondisabled, while 36.8% were diagnosed with a disability. Two authors met, reviewed papers with regard to the inclusion criteria, and agreed on outputs to be included. Evidence suggests that associations between PA and academic performance were primarily positive or nonsignificant. PA levels of 90 min plus per week were associated with improved academic performance, as was PA performed at moderate to vigorous intensity. The optimal duration of PA was 30-60 min per session, whilst various sports induced positive academic effects. Importantly, findings support that PA does not have a deleterious effect on academic performance but can enhance it.

Physical activity interventions for the mental health of children: A systematic review

OBJECTIVE

This systematic review explored the effectiveness of using physical activity (PA) interventions to enhance psychological well-being and reduce psychological ill-being (e.g., anxiety and depression) in children aged six to 11 years old from the general population.

METHODS

Electronic databases were searched for studies published between January 2005 and June 2020: Web of Science, ProQuest Psychology Journals, PsycINFO, Pub Med, ASSIA, CINHAL PLUS, SPORTDiscus, EMBASE and Wiley Online Library. Search terms included 'physical activity intervention', 'psychological well-being' and 'child*'. After removing duplicates, 11 390 studies were independently screened by two authors based on inclusion/exclusion criteria and assessed for risk of bias.

RESULTS

A total of 23 studies were narratively synthesized and categorized into four domains: Quality of Life (QOL), body image, self-esteem and psychological ill-being. Evidence was provided for the impact of PA interventions in improving QOL, body image and self-esteem. Despite the positive effect on psychological well-being, evidence for a reduction in the frequency and severity of symptoms associated with psychological ill-being in children is less clear.

CONCLUSIONS

Reviewed studies support the use of PA interventions in enhancing the psychological well-being of children in school and community settings. More research is warranted to understand the impact of PA interventions on reducing psychological ill-being in children from the general population.

An Analysis of the Role of Mental Health in a Randomized Trial of a Walking Intervention for Black Veterans With Chronic Pain

Black patients and those with co-occurring mental health disorders are disproportionately affected by chronic pain, but few interventions target these populations. This is a secondary analysis of a randomized trial of a walking-focused proactive counseling intervention for Black Veterans with chronic musculoskeletal pain (ACTION). The primary aim was to examine intervention effectiveness among Veterans with an electronic health record-documented mental health diagnosis [depressive disorder, anxiety disorder, substance use disorder, post-traumatic stress disorder or serious mental illness (n = 205)] and those without a diagnosis (n = 175). About 380 Black Veterans receiving care at the Atlanta VA Health Care System were enrolled from 2016 to 2019 and randomized to the intervention or usual care (UC) (1:1). The intervention featured 6 telephone coaching sessions over 8-14 weeks to encourage walking. Participants with a mental health disorder were more likely to complete all counseling sessions (56% vs 38%) and reported improvements in global perceptions of pain and pain intensity/interference (secondary outcomes) at 3-months vs UC. Among participants without a mental health disorder, the intervention was associated with an improvement in pain-related disability at 6-months (primary outcome). Black chronic pain patients with co-occurring mental health disorders may require more intensive treatment to affect improvement in pain-related disability. PERSPECTIVE: This study examines the effectiveness of a walking intervention for chronic pain among Black Veterans with a mental health disorder. These patients were more engaged with the intervention than those without a mental health disorder. However, they did not experience reductions in pain-related disability, suggesting more intensive treatment is needed.

Exercise improves depression through positive modulation of brain-derived neurotrophic factor (BDNF). A review based on 100 manuscripts over 20 years

The aim of this review was to explore the relevant neurobiology and the association between peripheral levels of brain-derived neurotrophic factor (BDNF) and acute and short to long-term exercise regimes, as well as its relation to depression and antidepressant treatment. A 20-year literature search was conducted. The screening process resulted in 100 manuscripts. Antidepressants as well as acute exercise, particularly high-intensity, elevates BDNF in healthy humans and clinical populations, as evidenced from aerobic and resistance-based studies. Although exercise is increasingly recognised in the management of depression, acute and short-term exercise studies have failed to establish a relationship between the severity of depression and changes in peripheral BDNF. The latter rapidly returns to baseline, possibly indicating a quick re-uptake by the brain, aiding its neuroplasticity functions. The timescale of administration needed for the antidepressants to stimulate biochemical changes is longer than similar increases with acute exercise.

The Effect of Physical Activity Interventions Carried Out in Outdoor Natural Blue and Green Spaces on Health Outcomes: A Systematic Review

In the last few years, interest about the natural environment and its influences on health conditions has been growing. In particular, physical activity interventions carried out in blue and green environment are being investigated as a potential strategy to increase health outcomes in people with and without chronic conditions. Many recent studies reported positive results, but a high number of these studies were focused on people with mental or physical disorders. In this scenario, the present systematic review, conducted according to the PRISMA statement, was aimed at investigating the existing evidence regarding the effects of physical activity interventions carried out in green-blue space settings involving healthy people. A literature search was performed through PubMed, Cochrane, Cinahl, and Psychinfo, and the quality of each study was assessed. Out of 239 identified articles, 75 full texts were screened. Six eligible studies showed an improvement in health outcomes, such as well-being, mood, and physical performance, in the experimental group compared with the control group. No exhaustive conclusion can be drawn based on available evidence. However, this systematic review highlighted the need to extend this kind of intervention to reveal more robust evidence that green and blue exercises benefit health.

A Self-Determination Theory and Acceptance and Commitment Therapy-based intervention aimed at increasing adherence to physical activity

The purpose of the present study was to evaluate the effectiveness of a physical activity (PA) intervention program designed to enhance levels of engagement in PA. Despite robust evidence supporting the beneficial effects of PA on overall health, only about 22% of individuals engage in the recommended minimum amount of PA. Recent surveys suggested that most individuals express intentions to be physically active, though the psychological state of amotivation dismissed these struggles. In the current study, we pilot-tested a new intervention program, aimed at enhancing engagement in PA among sedentary individuals. The intervention was based on two behavioral change and motivational psychological frameworks: Self-Determination Theory (SDT) and Acceptance and Commitment Therapy (ACT). During a 14-week intervention program, 94 sedentary Israeli college students (Mage = 24.4, SD = 1.42, Females = 89) were randomly assigned into one of three groups: SDT and ACT-based intervention, traditional intervention, and a non-treatment group. Prior to and following the intervention, participants completed the Behavioral Regulation in Exercise Questionnaire-3 (BREQ-3) to examine motivation to exercise and the International Physical Activity Measurement IPAQ to evaluate their training frequency. Results showed that the SDT and ACT-based intervention group exhibited a significant increase in motivation to exercise between time 1 and time 2, while the other two groups (i.e., the traditional intervention program and the non-treatment group) showed insignificant differences in motivation to exercise. Furthermore, neither of the groups showed significant differences in their training frequency per week. However, those in the SDT and ACT-based groups reported an increase in activity intensity from time 1 to time 2 compared to the two other groups. Further, exercise psychology consultants and scholars can use the intervention protocol and utilize these findings to improve PA behaviors and promote health in the general population. Limitations, future directions, and implications are discussed in detail.

Examining the Dose-Response Relationship between Outdoor Jogging and Physical Health of Youths: A Long-Term Experimental Study in Campus Green Space

Many studies have demonstrated that outdoor physical activity positively affects the physical health of young people. Here, we aimed to examine the extent to which outdoor jogging was associated with the physical health of youths, and then to decipher whether a dose–response relationship exists between them. A total of 2852 youths from a Chinese university were enrolled in a long-term experimental study between September 2018 and September 2019. We conducted two waves of physical health tests for 2852 youths (before and after the jogging interventions in 2018 and 2019, respectively) using China’s National Student Physical Health Standard (NSPHS). Paired t-tests were used to examine statistical differences. A multiple regression model was used to evaluate the associations between jogging and physical health. The results showed that: statistically significant changes in the two waves of physical health outcomes were suggested after jogging interventions; outdoor jogging in campus green space was associated with participants’ physical health after controlling for covariates; and a dose–response relationship between jogging and physical health outcomes was revealed, with 120–140 km/year (approximately 3.43–4 km/week) being the most effective intervention dose. Our findings have implications for promoting physical health in youth groups by encouraging outdoor physical activity.

Effectiveness of an adapted physical activity intervention for weight management in adolescents with intellectual disability: A randomized controlled trial

OBJECTIVE

To evaluate the effectiveness of a 9-month school-based adapted physical activity (APA) program for reducing weight among adolescents with intellectual disability (ID).

METHODS

In this randomized controlled trial, adolescents with ID, aged 12-18 years, who were overweight/or with obesity were randomly assigned into intervention and control groups. The APA intervention consisted of aerobic and resistance exercises with an overall moderate intensity and was delivered at a frequency of two sessions per week for 9 months. Changes in body mass index (BMI, primary outcome) and changes in BMIz, weight, percent body fat, waist circumference and waist-to-height ratio (secondary outcomes) were examined using general linear models.

RESULTS

In total 61 subjects (39 in the intervention and 22 in the control) completed the study and were included in the analyses. At 9 months, the intervention group exhibited a reduced BMI of -0.66 kg/m² (95% CI -1.06 to -0.25 kg/m² , p = 0.002), while a significant increase in BMI was observed in the control group. A significant post-intervention between-group difference in change in BMI (-1.31 kg/m² [95% CI -1.99 to -0.63], p < 0.01) was found in favour of the intervention group. Similar results were also observed for all secondary outcomes.

CONCLUSIONS

This study provides evidence that a 9-month APA intervention induced clinically meaningful effects on weight loss in adolescents with ID.

Effects of Regular Long-Term Circuit Training (Once per Week) on Cardiorespiratory Fitness in Previously Sedentary Adults

The purpose of the study was (1) to investigate the effects of regular long-term circuit training (once per week) on cardiorespiratory fitness (CRF) in sedentary adults and (2) to compare training progress with the effects of continued exercise participation by regularly active age-matched individuals. Ten sedentary, middle-aged (51 ± 6 years) individuals (sedentary group, SG) of both sexes performed 32 weeks (1 training session/week) of supervised circuit training and 10 weeks of self-managed training. Effects were compared to an age-matched group (51 ± 8 years; n = 10) of regularly active individuals (active group, AG). CRF (expressed as peak oxygen uptake: VO₂peak; peak power output: PPO) and systemic blood pressure (BP) during the incremental test were measured at the start and after the training intervention. CRF decreased significantly within the AG (VO₂peak: 43.1 ± 7.3 vs. 40.3 ± 6.5 mL/min/kg, p < 0.05; PPO: 3.3 ± 0.6 vs. 3.1 ± 0.6; p < 0.05) but was maintained in the SG. In addition, significant improvements in restoration of the oxygen level in leg muscles after exercise and reduced systolic BP (180 ± 14 vs. 170 ± 17 mmHg, p = 0.01) at submaximal exercise were found within the SG. However, differences in changes from pre to post did not reach significance between groups. In contrast to the regularly active individuals, circuit training once per week over 32 weeks prevented the aging-related decline of CRF in previously sedentary subjects and reduced systolic BP during submaximal exercise, indicating improved exercise tolerance.

The Association Between Logging Steps Using a Website, App, or Fitbit and Engaging With the 10,000 Steps Physical Activity Program: Observational Study

Background

Engagement is positively associated with the effectiveness of digital health interventions. It is unclear whether tracking devices that automatically synchronize data (eg, Fitbit) produce different engagement levels compared with manually entering data.

Objective

This study examines how different step logging methods in the freely available 10,000 Steps physical activity program differ according to age and gender and are associated with program engagement.

Methods

A subsample of users (n=22,142) of the free 10,000 Steps physical activity program were classified into one of the following user groups based on the step-logging method: Website Only (14,617/22,142, 66.01%), App Only (2100/22,142, 9.48%), Fitbit Only (1705/22,142, 7.7%), Web and App (2057/22,142, 9.29%), and Fitbit Combination (combination of web, app, and Fitbit; 1663/22,142, 7.51%). Generalized linear regression and binary logistic regression were used to examine differences between user groups’ engagement and participation parameters. The time to nonusage attrition was assessed using Cox proportional hazards regression.

Results

App Only users were significantly younger and Fitbit user groups had higher proportions of women compared with other groups. The following outcomes were significant and relative to the Website Only group. The App Only group had fewer website sessions (odds ratio [OR] −6.9, 95% CI −7.6 to −6.2), whereas the Fitbit Only (OR 10.6, 95% CI 8.8-12.3), Web and App (OR 1.5, 95% CI 0.4-2.6), and Fitbit Combination (OR 8.0; 95% CI 6.2-9.7) groups had more sessions. The App Only (OR −0.7, 95% CI −0.9 to −0.4) and Fitbit Only (OR −0.5, 95% CI −0.7 to −0.2) groups spent fewer minutes on the website per session, whereas the Fitbit Combination group (OR 0.2, 95% CI 0.0-0.5) spent more minutes. All groups, except the Fitbit Combination group, viewed fewer website pages per session. The mean daily step count was lower for the App Only (OR −201.9, 95% CI −387.7 to −116.0) and Fitbit Only (OR −492.9, 95% CI −679.9 to −305.8) groups but higher for the Web and App group (OR 258.0, 95% CI 76.9-439.2). The Fitbit Only (OR 5.0, 95% CI 3.4-6.6), Web and App (OR 7.2, 95% CI 5.9-8.6), and Fitbit Combination (OR 15.6, 95% CI 13.7-17.5) groups logged a greater number of step entries. The App Only group was less likely (OR 0.65, 95% CI 0.46-0.94) and other groups were more likely to participate in Challenges. The mean time to nonusage attrition was 35 (SD 26) days and was lower than average in the Website Only and App Only groups and higher than average in the Web and App and Fitbit Combination groups.

Conclusions

Using a Fitbit in combination with the 10,000 Steps app or website enhanced engagement with a real-world physical activity program. Integrating tracking devices that synchronize data automatically into real-world physical activity interventions is one strategy for improving engagement.

Comparing Methods to Identify Wear-Time Intervals for Physical Activity With the Fitbit Charge 2

There is no established method for processing data from commercially available physical activity trackers. This study aims to develop a standardized approach to defining valid wear time for use in future interventions and analyses. Sixteen African American women (mean age = 62.1 years and mean body mass index = 35.5 kg/m2) wore the Fitbit Charge 2 for 20 days. Method 1 defined a valid day as ≥10-hr wear time with heart rate data. Method 2 removed minutes without heart rate data, minutes with heart rate ≤ mean - 2 SDs below mean and ≤2 steps, and nighttime. Linear regression modeled steps per day per week change. Using Method 1 (n = 292 person-days), participants had 20.5 (SD = 4.3) hr wear time per day compared with 16.3 (SD = 2.2) hr using Method 2 (n = 282) (p < .0001). With Method 1, participants took 7,436 (SD = 3,543) steps per day compared with 7,298 (SD = 3,501) steps per day with Method 2 (p = .64). The proposed algorithm represents a novel approach to standardizing data generated by physical activity trackers. Future studies are needed to improve the accuracy of physical activity data sets.

Neighbourhood walkability and physical activity: moderating role of a physical activity intervention in overweight and obese older adults with metabolic syndrome

BACKGROUND

While urban built environments might promote active ageing, an infrequently studied question is how the neighbourhood walkability modulates physical activity changes during a physical activity intervention programme in older adults. We assessed the influence of objectively assessed neighbourhood walkability on the change in physical activity during the intervention programme used in the ongoing PREvención con DIeta MEDiterránea (PREDIMED)-Plus trial.

METHOD

The present study involved 228 PREDIMED-Plus senior participants aged between 55 and 75, recruited in Palma de Mallorca (Spain). Overweight/obese older adults with metabolic syndrome were randomised to an intensive weight-loss lifestyle intervention or a control group. A walkability index (residential density, land use mix, intersections density) was calculated using geographic information systems (1 km sausage-network buffer). Physical activity was assessed using accelerometer and a validated questionnaire, at baseline and two follow-up visits (6-months and 1-year later). Generalised additive mixed models were fitted to estimate the association between the neighbourhood walkability index and changes in physical activity during follow-up.

RESULTS

Higher neighbourhood walkability (1 z-score increment) was associated with moderate-to-vigorous accelerometer assessed physical activity duration, (β = 3.44; 95% CI = 0.52; 6.36 min/day). When analyses were stratified by intervention arm, the association was only observed in the intervention group (β = 6.357; 95% CI = 2.07;10.64 min/day) (P for interaction = 0.055).

CONCLUSIONS

The results indicate that the walkability of the neighbourhood could support a physical activity intervention, helping to maintain or increase older adults' physical activity.

Effects of classroom-based active breaks on cognition, sitting and on-task behaviour in children with intellectual disability: a pilot study

BACKGROUND

Classroom-based active breaks can help typically developing children reduce sitting, increase physical activity and improve cognitive functions and on-task behaviour. Yet, this strategy has not been tested in children with intellectual disability (ID) - a population who are insufficiently active. This study aimed to investigate the effects of a 5-week active breaks intervention on cognitive functions and on-task behaviour in schoolchildren with ID.

METHODS

Twenty-four children, aged between 8 and 12 years (37.5% girls), were recruited. Children's cognitive functions (response inhibition, lapses of attention, interference and working memory) were measured at baseline and end of trial using computer-based tests. Sitting, standing and movement patterns were assessed with inclinometers, and on-task behaviour was directly observed in the classroom before and after active breaks, at baseline, mid-trial and end of trial. Linear mixed models were used to investigate the intervention effects on cognitive functions and sedentary patterns; generalised linear mixed models were used to analyse on-task behaviour data.

RESULTS

A significant time × group interaction was found for working memory favouring the intervention (B = 11.56, 95% confidence interval [1.92, 21.21]). No significant effects were found in relation to the other measures of children's cognition or on-task behaviour. Stepping time and bouts of sitting were positively affected.

CONCLUSIONS

Classroom-based active breaks can increase physical activity and reduce sedentary behaviour in children with ID and might also benefit their working memory. Further research is required to clarify the effects on cognition and to investigate whether this strategy has other benefits in this population.

School-Based Exercise Intervention Improves Blood Pressure and Parameters of Arterial Stiffness in Children: A Randomized Controlled Trial

PURPOSE

To evaluate the effectiveness of a school-based exercise intervention on endurance performance (EP), blood pressure (BP), and arterial stiffness in children.

METHODS

A total of 105 students (mean age = 8.2 [0.6] y; 51% girls; body mass index = 17.8 [3.0] kg/m2) were randomized to the intervention group (IG, n = 51) and control group (CG, n = 54). During a 37-week experimental period, the IG received an exercise intervention (2 × 45 min/wk) in addition to their regular school physical education class (3 × 45 min/wk). EP, peripheral and central BP, pulse pressure, augmentation pressure, augmentation index, and aortic pulse wave velocity were assessed.

RESULTS

Following the intervention, significant changes (P < .05) in EP, peripheral and central systolic BP, pulse pressure, augmentation pressure, augmentation index, and aortic pulse wave velocity were found in the IG. Children in the CG displayed significant changes in peripheral and central diastolic BP. An analysis of the baseline-to-post changes revealed significant between-group differences in EP (P < .001), pulse pressure (P = .028), augmentation pressure (P = .007), and aortic pulse wave velocity (P = .037) that favored the IG and in peripheral and central diastolic BP that favored the CG.

CONCLUSION

The school-based exercise intervention had beneficial effects not only on EP but also on different hemodynamic parameters.

Use of Fitbit Data to Evaluate the Effects of an Athletic Performance and Injury Prevention Training Program on Daily Physical Levels in Underrepresented Minority Female High School Athletes: A Prospective Study

A marginal number of adolescents meet the recommended guidelines of 60 minutes of moderate to vigorous daily physical activity, and even fewer underrepresented minority females achieve this metric as compared to their male and white counterparts. While potential interventions exist to address these low levels of activity, which is a known risk for acute injuries and chronic disease, there is lack of consensus on the devices used to measure the intensity of daily activity levels. Wearable activity trackers such as Fitbit™ have been utilized to quantify human motion and exercise intensity, but there is little precedence for these measures being assessed in adolescent wearers. Thus, our objective was to assess the feasibility of using Fitbit to assess daily physical activity levels in underrepresented minority adolescent females, who attend an economically challenged urban high school, over the course of a physical activity intervention. We also aimed to identify candidate Fitbit outcome measures for future prospective studies. A 10-week physical activity intervention was implemented in a cohort of 24 high school female athletes. From within this cohort, a sample of five students were provided Fitbit™ devices, from which we obtained data sets from three students. Activity on the days of the exercise intervention was measured and compared to activity on non-intervention days. Post-hoc assessments were performed based on individual heart rate reserves, the predefined levels set by the Inspire Fitbit™ device and the American College of Sports Medicine (ACSM) 2009 guidelines. The results showed that while compliance is challenging, wearable devices can be used to assess daily physical activity levels and intensities in underrepresented minority high school female athletes during an extended physical activity intervention. Of the Fitbit outcomes currently available, assessment of moderate-vigorous activity (min/day) appeared to be the best as a measure of global physical activity. Prospective research is now warranted to validate these thresholds, and to test novel interventions for their ability to transition inactive adolescents at risk of sports-related injuries and long-term chronic disease, into a more active lifestyle.

Baseline White Matter Is Associated With Physical Fitness Change in Preclinical Alzheimer's Disease

White matter (WM) microstructure is a sensitive marker to distinguish individuals at risk of Alzheimer's disease. The association of objective physical fitness (PF) measures and WM microstructure has not been explored and mixed results reported with physical activity (PA). Longitudinal studies of WM with PA and PF measures have had limited investigation. This study explored the relationship between objective PF measures over 24-months with "normal-appearing" WM microstructure. Data acquired on magnetic resonance imaging was used to measure "normal-appearing" WM microstructure at baseline and 24-months. Clinical variables such as cognitive and blood-based measures were collected longitudinally. Also, as part of the randomized controlled trial of a PA, extensive measures of PA and fitness were obtained over the 24 months. Bilateral corticospinal tracts (CST) and the corpus callosum showed a significant association between PF performance over 24-months and baseline WM microstructural measures. There was no significant longitudinal effect of the intervention or PF performance over 24-months. Baseline WM microstructural measures were significantly associated with PF performance over 24-months in this cohort of participants with vascular risk factors and at risk of Alzheimer's disease with distinctive patterns for each PF test.

Impact of Combined Theory-Based Intervention on Psychological Effects and Physical Activity among Chinese Adolescents

PURPOSE

The current study was intended to assess the effect of a facilitated behavioral intervention based on the extended theory of planned behavior (TPB) on psychological constructs and physical activity among adolescents over a period of eight weeks.

METHODS

Students (n = 51, 12 ± 0.3 years of age) in the seventh grade at a junior middle school in China were randomly assigned to two groups: the intervention group (n = 24) and the control group (n = 27). Both groups were pre- and post-tested with the related psychological constructs of the extended TPB, along with behavioral measures of the Physical Activity Scale and ActiGraph accelerometer (model wGT3X-BT). The intervention group took part in 45 min classes once per week for 8 weeks, including five indoor theoretical courses and three outdoor basketball matches. The control group was not required to make any change to their normal school day. Also, 2 × 2 repeated measures analysis of variance (ANOVA) was conducted to compare the differences between the two groups, and then t-test was employed to compare the independent and paired differences.

RESULTS

Significant increases in pre-post subjective norms (SN) (p = 0.041, Cohen's d = 0.62), perceived behavior control (PBC) (p = 0.023, Cohen's d = 0.72), exercise intention (EI) (p = 0.043, Cohen's d = 0.61), and self-efficacy (SE) (p = 0.035, Cohen's d = 1.36) were observed in the intervention group. In addition, participants in the intervention group increased their exercise frequency (p < 0.001, Cohen's d = 1.25) and intensity (p = 0.028, Cohen's d = 0.68), especially their time spent on light intensity physical activity (light-PA%; p = 0.031, Cohen's d = 0.68), and their percentage of sedentary time (SB%) was also reduced (from 68% ± 10% to 58% ± 7%, p < 0.001, Cohen's d = 1.17). Furthermore, the intervention group showed significantly better performance in PBC (p = 0.032, Cohen's d = 0.62), EI (p < 0.001, Cohen's d = 1.32), SE (p < 0.001, Cohen's d = 1.15), SB% (p < 0.001, Cohen's d = 1.22), light-PA% (p < 0.001, Cohen's d = 1.12), and total physical activity (TPA) (p = 0.015, Cohen's d = 0.72) compared to the control group at the post-test. No significant pre post differences were observed for any psychological or behavioral variables in the control group, except for exercise frequency, but the values were still lower than those in the intervention group after the 8-week intervention (3.70 ± 0.72 versus 3.92 ± 0.83).

CONCLUSION

The combined theory-based intervention was effective at improving psychological constructs and physical activity among seventh-grade adolescents in 8 weeks.

Improving the Metabolic and Mental Health of Children with Obesity: A School-Based Nutrition Education and Physical Activity Intervention in Wuhan, China

This study aimed to evaluate the effectiveness of a school-based nutrition education and physical activity intervention on cardiovascular risk profile and mental health outcomes among Chinese children with obesity. Two primary schools were randomly allocated to the control group (CG) and the intervention group (IG). We selected children with obesity from 1340 students in the third and fourth grades as participants. The IG received 8 months of nutrition education and physical activity intervention, while the CG was waitlisted. A generalized estimating equation model was applied to assess repeated variables over time. A total of 171 children with obesity (99 IG and 72 CG) aged 9.8 ± 0.7 years completed the post-intervention stage. Compared with baseline, significant reductions were observed within the IG for depression and fasting plasma glucose at post-intervention. After adjusting for confounders, group and time interaction effects showed that the IG achieved improvements in the risk of poor well-being (p = 0.051) and social anxiety (p = 0.029), had decreased diastolic blood pressure (p = 0.020) and fasting plasma glucose (p < 0.001), and had significantly increased high-density lipoprotein (p < 0.001) from baseline to post-intervention relative to the CG. The effects of school-based nutrition education and physical activity intervention on children with obesity are diverse, including not only the improvement of metabolic health but also mental health promotion.

Impact of a Social Media Campaign on Reach, Uptake, and Engagement with a Free Web- and App-Based Physical Activity Intervention: The 10,000 Steps Australia Program

Social media campaigns provide broad-reach and convenience for promoting freely-available health programs. However, their effectiveness and subsequent engagement of new users is unknown. This study aimed to assess the reach and new member registration rates resulting from a dedicated 10,000 Steps social media campaign (SMC) and to compare program engagement and time to non-usage attrition of new users from the SMC with other users. SMC reach (using Facebook, Instagram, and display advertisements engagement metrics), new-user numbers, engagement (usage of the website and its features), and time to non-usage attrition were assessed using generalized linear regression, binary logistic regression, and Cox proportion hazards regression models. During the SMC, Instagram and display advertisement impressions, Facebook reach and new daily registrations were significantly higher compared with six weeks and one year prior. There were no between-group differences in the average usage of most website/program features. Risk of non-usage attrition was higher among new users from the SMC than new users from one year prior. The SMC was effective in promoting awareness of the 10,000 Steps program. Further research to identify long-term engagement strategies and the most effective combination of social media platforms for promotion of, and recruitment to, health programs is warranted.

Make Your Move Experience: A Worksite Wellness Pilot in South Texas

PURPOSE

To describe the implementation of Make Your Move Experience (MYME) between 2015 and 2017.

DESIGN

Cross-sectional.

SETTING

Make Your Move Experience is a culturally sensitive worksite wellness program in South Texas designed to encourage sedentary workers to engage in physical activity.

PARTICIPANTS

In total, 681 individuals from 19 different organizations.

INTERVENTION

UTHealth School of Public Health in Brownsville staff recruited individuals within local organizations to join MYME. At the end of the 3 months, organizations in which employees met MYME goals earned an incentive-bike rack or hydration station-selected to be permanent features of the local environment and facilitate physical activity.

MEASURES

Participant self-reported gender, physical activity level prior to joining MYME (beginner or experienced), and weekly miles of biking, walking, or running completed.

ANALYSIS

Mean number of miles biked, walked, and ran each month were compared between (1) beginners and experienced, (2) men and women, and (3) in fall 2016 and spring 2017 using t tests.

RESULTS

Beginners initiated physical activity by walking. Men biked more miles than women did (P < .05 all 3 years). Bike riders cycled fewer miles (20.2 miles vs 44.9 miles; P = .03) and walkers covered fewer miles (195.4 miles vs 266.7 miles; P = .04) in fall 2016 compared to spring 2017.

CONCLUSIONS

Participation in MYME, a culturally appropriate intervention delivered at the worksite, facilitated an increase in physical activity levels among sedentary individuals.

The Benefit of Physical Activity in Adolescent and Young Adult Cancer Patients During and After Treatment: A Systematic Review

Cancer and its associated therapies can severely impact the physical and psychosocial functioning of adolescent and young adults (AYAs), both during treatment and well into survivorship. Physical activity during and after cancer treatment could be beneficial to the AYA population, although this cohort has received little scientific attention. A systematic search of the literature was conducted to investigate current exercise interventions in AYA-specific populations. Studies were eligible for inclusion if >50% of the study population was aged between 15 and 25 years and the study included a physical activity intervention during or after cancer treatment. Studies were critically appraised using the Cochrane Risk of Bias tool. Six articles were identified as meeting the criteria, of which 2 were nonrandomized controlled studies and 4 were pilot studies, comprising a total of 135 AYA participants. The quality of studies was variable across all assessed domains. Direct comparison on intervention outcomes was not possible due to the heterogeneity of the studies; however, trends emerged on the feasibility, acceptability, and potential positive impact of physical activity in this cohort. This review highlights the lack of high-quality studies aimed to improve physical and psychosocial functioning in AYA patients across the cancer continuum. Physical activity interventions in this cohort appear to be feasible; however, larger randomized controlled trials are warranted to investigate the direct impact of interventions on health outcomes in this cohort.

Collaborative implementation of a community-based exercise intervention with a partnering rural American Indian community

BACKGROUND

The prevalence and socioeconomic burden of childhood obesity and diabetes has increased rapidly in the United States in the last 30 years. American Indians have the highest prevalence of type 2 diabetes among newly diagnosed youth in the country. Contributing factors include environmental, behavioral, and genetic components. Some American Indian tribal communities have explored innovative ways to combat this epidemic including collaborations with academic centers on community-based research.

METHOD

From 2012 to 2017, the University of Oklahoma Health Science Center and the Choctaw Nation of Oklahoma partnered on a National Institutes of Health-funded project to determine if financial incentives would elicit an increase in physical activity in Native youth. This was a community-based behavioral intervention for overweight or obese American Indian youth ages 11-20 living in a rural community at risk for developing diabetes.

RESULTS

Tribal leaders and staff identified culturally appropriate strategies to aid implementation of the trial in their community. Their identified implementation strategies helped standardize the study in order to maintain study integrity. The mutually agreed strategies included co-review of the study by tribal and University research review boards (but designation of the Choctaw Nation review board as the "Board of Record"), training of community-based staff on research ethics and literacy, standardization of the informed consent process by videotaping all study information, creation of a viable and culturally appropriate timeline for study implementation, adapting tribal wellness center operations to accommodate youth, and development of effective two-way communication through training sessions, on-site coordination, and bi-monthly conference calls.

CONCLUSION

In an effort to partner collectively on a randomized clinical research trial to combat childhood diabetes, tribal leaders and staff implemented strategies that resulted in a culturally appropriate and organized community-based behavioral intervention research project.

Evaluation of a Worksite-Based Small Group Team Challenge to Increase Physical Activity

PURPOSE

To investigate whether participants in a small group team challenge had greater completion rates in an institution-wide step-challenge than other participants.

DESIGN

A quasi-experimental, posttest-only design with a comparison group was used to evaluate group differences in completion rates.

SETTING

A large university system provided the opportunity to participate in a physical activity challenge.

PARTICIPANTS

The study was limited to employees who participated in the physical activity challenge.

INTERVENTION

Two institutions offered participants the chance to compete as smaller groups of teams within their institution. These team-challenge participants (N = 414) were compared to participants from the same institutions that did not sign up for a team and tracked their steps individually (N = 1454).

MEASURES

Participants who reported 50 000 steps per week for 5 of the 6 weeks were classified as challenge completers. We also evaluated total step count and controlled for several potential covariates including age, gender, and body mass index.

ANALYSIS

Logistic regression was used to model the dichotomous outcome of challenge completion.

RESULTS

Team-challenge participants were more likely to complete the physical activity challenge than other participants. Team-challenge participants had 1922 more steps per day than individual participants. However, at an institution level, overall completion rates were not higher at institutions that offered a team challenge.

In Patients With Multiple Sclerosis, Both Objective and Subjective Sleep, Depression, Fatigue, and Paresthesia Improved After 3 Weeks of Regular Exercise

Background: Multiple sclerosis (MS) patients suffer from various difficulties including sleep complaints, symptoms of depression and fatigue, paresthesia, and cognitive impairments. There is growing evidence that regular physical activity has a positive effect on both sleep and psychological functioning, though there is limited evidence of this kind for MS patients. The aim of the present study was therefore to investigate the impact on this patient group of a regular exercise program with respect to subjective and objective sleep, depression, paresthesia, fatigue, and cognitive performance. Methods: A total of 46 patients [mean age: 50.74 years; Expanded Disability Status Scale (EDSS): mean: 5.3, 78.4% females] completed this 3-week intervention study. At baseline and 3 weeks later, they answered questionnaires covering sociodemographic information, subjective sleep, depression, fatigue, paresthesia, and subjective physical activity. Objective sleep [sleep electroencephalogram (EEG) recordings] and cognitive performance were also assessed at both time points. Patients participated in a regular exercise activity every weekday for about 60 min. Results: Compared to the baseline, by the end of the study, objective sleep had significantly improved (sleep efficiency, sleep onset latency, and wake time after sleep onset), and symptoms of sleep complaints, depression, fatigue, and paresthesia were significantly reduced. Subjective physical activity (moderate and vigorous) and cognitive performance also increased over the course of the intervention. Conclusions: In patients with MS, participation in regular exercise impacted positively on their objective and subjective sleep, depression, paresthesia, fatigue, and cognitive performance.

Effect and Process Evaluation of a Smartphone App to Promote an Active Lifestyle in Lower Educated Working Young Adults: Cluster Randomized Controlled Trial

BACKGROUND

Mobile technologies have great potential to promote an active lifestyle in lower educated working young adults, an underresearched target group at a high risk of low activity levels.

OBJECTIVE

The objective of our study was to examine the effect and process evaluation of the newly developed evidence- and theory-based smartphone app "Active Coach" on the objectively measured total daily physical activity; self-reported, context-specific physical activity; and self-reported psychosocial variables among lower educated working young adults.

METHODS

We recruited 130 lower educated working young adults in this 2-group cluster randomized controlled trial and assessed outcomes at baseline, posttest (baseline+9 weeks), and follow-up (posttest+3 months). Intervention participants (n=60) used the Active Coach app (for 9 weeks) combined with a Fitbit activity tracker. Personal goals, practical tips, and educational facts were provided to encourage physical activity. The control group received print-based generic physical activity information. Both groups wore accelerometers for objective measurement of physical activity, and individual interviews were conducted to assess the psychosocial variables and context-specific physical activity. Furthermore, intervention participants were asked process evaluation questions and generalized linear mixed models and descriptive statistics were applied.

RESULTS

No significant intervention effects were found for objectively measured physical activity, self-reported physical activity, and self-reported psychosocial variables (all P>.05). Intervention participants evaluated the Active Coach app and the combined use with the Fitbit wearable as self-explanatory (36/51, 70.6%), user friendly (40/51, 78.4%), and interesting (34/51, 66.7%). Throughout the intervention, we observed a decrease in the frequency of viewing graphical displays in the app (P<.001); reading the tips, facts, and goals (P<.05); and wearing the Fitbit wearable (P<.001). Few intervention participants found the tips and facts motivating (10/41, 24.4%), used them to be physically active (8/41, 19.6%), and thought they were tailored to their lifestyle (7/41, 17.1%).

CONCLUSIONS

The lack of significant intervention effects might be due to low continuous user engagement. Advice or feedback that was not perceived as adequately tailored and the difficulty to compete with many popular commercial apps on young people's smartphones may be responsible for a decrease in the engagement. A stand-alone app does not seem sufficient to promote an active lifestyle among lower educated working young adults; therefore, multicomponent interventions (using both technological and human support), as well as context-specific sensing to provide tailored advice, might be needed in this population.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02948803; https://clinicaltrials.gov/ct2/show/results/NCT02948803 (Archived by WebCite at http://www.webcitation.org/71OPFwaoA).

The Relationship Between Physical Activity Level of Parents and That of Their Adolescent Children

BACKGROUND

Intergenerational transmission, which refers to the similarity between parent and their children, is a possible explanation of adolescent physical activity (PA). However, only a few existing studies explore the relationship of parent-adolescent PA in East Asian countries. Therefore, this study aimed to investigate the association of parent-adolescent PA using a nationally representative data in Korea with a large sample size.

METHODS

Data were collected from the Korean National Health and Nutrition Examination Survey conducted from 2010 to 2014. The authors performed a linear mixed effects regression analysis with 1342 cases after using log conversion of parent and adolescent moderate- to vigorous-intensity physical activity (MVPA) levels.

RESULTS

In the study, the median MVPA of adolescents was 150 (interquartile range: 360) minutes per week. Adolescent MVPA levels were significantly correlated with their mother's MVPA (β = 0.055, P = .02). Similar findings of greater association in girls and younger adolescents (age: 13-15 y) were found in subgroup analysis (girls: β = 0.073, P = .05; younger adolescents: β = 0.103, P = .001).

CONCLUSION

Increasing maternal PA levels could stimulate their adolescent's PA levels. Therefore, intervention at the family level may lead to an increase in adolescent PA levels.

Does a physical activity program in the nursing home impact on depressive symptoms? A generalized linear mixed-model approach

OBJECTIVES

Physical activity (PA) may counteract depressive symptoms in nursing home (NH) residents considering biological, psychological, and person-environment transactional pathways. Empirical results, however, have remained inconsistent. Addressing potential shortcomings of previous research, we examined the effect of a whole-ecology PA intervention program on NH residents' depressive symptoms using generalized linear mixed-models (GLMMs).

METHOD

We used longitudinal data from residents of two German NHs who were included without any pre-selection regarding physical and mental functioning (n = 163, M_age = 83.1, 53-100 years; 72% female) and assessed on four occasions each three months apart. Residents willing to participate received a 12-week PA training program. Afterwards, the training was implemented in weekly activity schedules by NH staff. We ran GLMMs to account for the highly skewed depressive symptoms outcome measure (12-item Geriatric Depression Scale-Residential) by using gamma distribution.

RESULTS

Exercising (n = 78) and non-exercising residents (n = 85) showed a comparable level of depressive symptoms at pretest. For exercising residents, depressive symptoms stabilized between pre-, posttest, and at follow-up, whereas an increase was observed for non-exercising residents. The intervention group's stabilization in depressive symptoms was maintained at follow-up, but increased further for non-exercising residents.

CONCLUSION

Implementing an innovative PA intervention appears to be a promising approach to prevent the increase of NH residents' depressive symptoms. At the data-analytical level, GLMMs seem to be a promising tool for intervention research at large, because all longitudinally available data points and non-normality of outcome data can be considered.

Comparing the Effect of a Moderate Physical Activity Intervention on the Mental Health Outcomes of African American and Caucasian Dementia Family Caregivers: A Secondary Data Analysis

Increased attention to the effects of the stressful demands of caregiving on the mental health of dementia caregivers has resulted in the development of numerous interventions. The current study is a secondary analysis of a randomized controlled trial that tested a 12-month moderate physical activity intervention with dementia caregivers. Our secondary data analysis examined racial differences in caregiver mental health outcomes including subjective burden, depressive symptoms, and positive affect, as well as differences in physical activity. A total of 211 community-dwelling dementia family caregivers were randomly assigned to a 12-month Enhanced Physical Activity (treatment) Intervention (EPAI) or a Caregiver Skill Building (control) Intervention (CSBI). Of these, 34 African American and 80 Caucasian caregivers completed the study. At baseline, race was associated with subjective burden and positive affect, but not with depressive symptoms. Post intervention (12 months), there were no racial differences in subjective burden or depressive symptoms. However, race was significantly associated with decreased positive affect (p = 0.003) and decreased total minutes of physical activity (p = 0.012). Findings suggest that the mental health needs of African American caregivers warrant additional exploration, where physical activity may be of benefit. These findings provide a cultural perspective to consider during intervention development for future nurse-driven research.

Cost-Effectiveness of Ready for Recess to Promote Physical Activity in Children

BACKGROUND

Many school-based recess interventions have been shown to be effective in increasing physical activity but their relative efficiency compared to other school-based programs are unknown. This study examined the cost-effectiveness of Ready for Recess, a program designed to increase students' physical activity in 2 elementary schools.

METHODS

Standard cost-effectiveness analysis method was used from a program's perspective for this study. Program effectiveness was measured as total metabolic equivalent (MET) hours gained. Program costs included equipment, training, and personnel costs during the 1-year intervention. The cost-effectiveness was measured as the ratio of program costs to total MET-hours gained.

RESULTS

Ready for Recess cost $27,643.97 for the 2 schools in the first year of implementation. Physical activity increased by 1.8 MET-hours per day per student. Approximately 32 cents were spent on Ready for Recess to produce an additional MET-hour per student per school day in the 2008-2009 school year.

CONCLUSIONS

Ready for Recess was cost-effective in its first year of implementation using 35 cents as a benchmark and it was cost-effective relative to other school-based physical activity interventions. The program may be more cost-effective if implemented for a longer time and on a larger scale.

Effect of Adding Online Social Support Tools to an Adult Walking Program: A Pilot Randomized Controlled Trial

This pilot study examined the efficacy of providing access to online social support tools on adults' step counts during a technology-mediated walking intervention. Sixty-three insufficiently active adults were randomized to a 12-week walking intervention with (SUPPORT) or without (NO SUPPORT) access to online social support tools. Both groups received a pedometer, step goals, and access to relevant websites. The SUPPORT group also received access to online social support tools. A mixed-factor analysis of variance was conducted to examine within- and between-group differences in measures of daily steps, psychosocial indicators, and health. Both groups significantly (p < .05) increased their daily steps over time from baseline by 1,401 (SUPPORT) and 2,461 (NO SUPPORT), with no significant differences between groups. Psychosocial and health improvements were no greater for SUPPORT versus NO SUPPORT. The SUPPORT group's use of the online social support tools was low. Results suggest that giving adults access to online social support tools during a technology-mediated walking program did not lead to an enhanced increase in daily steps versus an identical program without these tools; however, the low use of these tools may have weakened their effect. Future studies should examine SUPPORT versus NO SUPPORT among groups with preexisting social ties.

Managing Noncommunicable Diseases in an African Community: Effects, Compliance, and Barriers to Participation in a 4-Week Exercise Intervention

To determine the compliance, barriers, and effects of participation in a 4-week exercise intervention aimed at reducing risk factors for noncommunicable diseases among community-dwelling adults from a low-resourced area of South Africa. An exercise program and associated pre-posttest were performed by 76 participants (men, n = 26 and women, n = 50) aged 35 to 65 years. Baseline and end tests included height, weight, hip and waist circumference, heart rate, blood pressure, glucose, cholesterol, quality of life, and cardiorespiratory fitness measurements. The intervention consisted of 3 days/week combined aerobic and resistance exercise at an intensity of 70% heart rate reserved as determined at baseline. Compliance and barriers to participation were determined post-intervention by means of attendance registers and interviews. ANCOVA with adjustment for pretest was performed for all repeated variables. The Cronbach's alpha coefficients for exercise benefits were 0.81 and for barriers 0.84. Of the 26 men (40.8 ± 5.45 years) and 50 women (43.6 ± 7.8 years) recruited, 54 completed the intervention (71% compliance). The 4-week aerobic exercise intervention significantly reduced body mass, rate of perceived exertion, and mental components summary in men, and body mass, body mass index, VO2max, rate of perceived exertion, glucose, physical components summary, and mental components summary in women. Participants reported that the exercise milieu as a major barrier to exercise compliance while the interviews reported lack of time. A 1-month exercise intervention elucidated positive changes in risk factors for noncommunicable diseases in a low-resource community. A drop-out rate of 29% in this study is consistent with other exercise intervention trials. Exploration of the reported barriers may be useful for planning to increase compliance with future programs.

Outdoor adventure therapy to increase physical activity in young adult cancer survivors

PURPOSE

Despite the health benefits of physical activity (PA), limited research has examined PA interventions in young adult cancer survivors (YACS). This study used a two-group parallel design to examine the effects of a 7-day outdoor adventure camp vs. waitlist control on PA levels among YACS. Secondary aims examined effects on sedentary behavior and PA correlates.

METHODS

50 camp and 66 control participants were assessed at baseline, end of camp, and 3 months.

RESULTS

Intent-to-treat analyses indicated that, relative to baseline, camp participants had significantly (p = 0.0001) greater increases in PA than controls during camp (+577 vs. +9 minutes/week) and 3 months post-camp (+133 vs. -75 minutes/week, p = 0.001). Camp participants also reported significantly greater improvements in TV viewing (p = 0.001), hours sitting (p = 0.001), PA variety (p = 0.0001), barriers to PA (p = 0.007), and enjoyment of structured activities (p = 0.04) during camp but not 3 months post-camp.

CONCLUSION

A week-long outdoor adventure therapy camp increased PA levels during camp and 3 months after camp termination, although effects were attenuated over time.

IMPLICATIONS FOR CANCER SURVIVORS

Outdoor adventure therapy camps may increase PA and its correlates in YACS, but future research should explore methods to promote sustained PA after camp termination.

Intramyocellular lipids and their dynamics assessed by 1 H magnetic resonance spectroscopy

This report provides an overview on the present knowledge on intramyocellular lipids (IMCL) and their dynamics in the course of interventions with physical activity of variable type and intensity in different population groups, as accessible by examinations using non-invasive volume-selective ¹ H magnetic resonance spectroscopy (¹ H MRS). IMCL serve as energy source in skeletal muscle for fat oxidation in the mitochondria and became intensively studied after discovery of their relation with insulin sensitivity. While baseline levels of IMCL concentration have been shown to be mainly dependent on the metabolic status (insulin sensitivity), on the level of training and on fibre composition in the muscles, studies applying different physical activity protocols revealed the dynamic of their depletion and replenishment. From the findings in human studies, it can be concluded that IMCL levels are potentially useful markers for monitoring metabolic adaptation of skeletal muscle to sportive activities and training.

The features of interventions associated with long-term effectiveness of physical activity interventions in adults aged 55-70 years: a systematic review and meta-analysis

Content, delivery and effects of physical activity (PA) interventions are heterogeneous. There is a need to identify intervention features (content and delivery) related to long-term effectiveness. Behaviour change techniques (BCTs) and modes of intervention delivery were coded in 19 randomised controlled trials included in a systematic review of PA interventions for adults aged 55-70 years, published between 2000 and 2010, with PA outcomes ≥ 12 months after randomisation; protocol registration: PROSPERO CRD42011001459. Meta-analysis, moderator analyses and meta-regression were conducted. Meta-analysis revealed that interventions were effective in promoting PA compared with no/minimal intervention comparators [d = 0.29, 95% CI = 0.19-0.40, I(2) = 79.8%, Q-value = 89.16 (df = 18, p < 0.01)]. Intervention features often concurred and goal setting was the most commonly used BCT. Subgroup analyses suggested that interventions using the BCT feedback may be more effective, whilst interventions using printed materials or the BCTs information on where and when to perform the behaviour and information on consequences of behaviour to the individual may be less effective. Meta-regression revealed that neither the number of BCTs nor self-regulatory BCTs significantly related to effect size. Feedback appears to be a potentially effective candidate BCT for future interventions promoting long-term PA. Considering concurrence of intervention features alongside moderator analyses is important.

Parent-targeted mobile phone intervention to increase physical activity in sedentary children: randomized pilot trial

Background

Low levels of moderate-to-vigorous physical activity are associated with adverse health consequences.

Objective

The intent of the study was to determine the feasibility and efficacy of a 12-week physical activity promotion program targeting children, which was delivered to parents through mobile phones.

Methods

Potential participants were recruited through advertisements placed in the newspaper, local hospitals and schools, and an email listserv. Sedentary children aged 6-10 years were randomly assigned to a minimal (MIG) or intensive (IIG) intervention group. Parents in the MIG were given a goal to increase (within 1 month) and maintain their child’s activity at 6000 pedometer steps/day above their baseline levels and to monitor their child’s steps daily. Parents in the IIG were given the same steps/day and monitoring goals, in addition to text messages and articles containing additional behavioral strategies (based on the Social Cognitive Theory) designed to promote their child’s physical activity. The intervention components were delivered via mobile phone. Anthropometrics, body composition, and questionnaires were administered in a clinic. Children wore a New Lifestyles pedometer (NL-1000) each day throughout the intervention and parents were to monitor their child’s step counts daily.

Results

Out of 59 children who screened for the study, a total of 27 children (mean age 8.7, SD 1.4 years; 56%, 15/27 female; 59%, 16/27 African American) were enrolled and completed the study. Overall, 97.90% (2220/2268; 98.20%, 1072/1092 for MIG; 97.60%, 1148/1176 for IIG) of expected step data were successfully entered by the parent or study coordinator. Parents in the MIG and IIG were sent approximately 7 and 13 text messages per week, respectively, averaged over the course of the study. IIG parents accessed an average of 6.1 (SD 4.4) articles over the course of the intervention and accessed a fewer number of articles in the last month compared to the first 2 months of the study (P=.002). Children in both the MIG and IIG significantly increased their physical activity, averaged over 12 weeks, by 1427.6 (SD 583.0; P=.02) and 2832.8 (SD 604.9; P<.001) steps/day above baseline, respectively. The between group difference was not statistically significant (P=.10; effect size=.40), nor was the group by time interaction (P=.57). Regardless of group assignment, children who significantly increased their physical activity reported greater increases in physical activity enjoyment (P=.003). The number of behavioral articles accessed by IIG parents was significantly correlated with change in children’s steps/day (r=.575, P=.04). Changes in children’s steps/day were unrelated to changes in their body composition, mood, and food intake.

Conclusions

Parent-targeted mobile phone interventions are feasible, yet more intense interventions may be needed to support parents’ efforts to increase their children’s physical activity to levels that approximate national recommendations.

Trial Registration

Clinicaltrials.gov NCT01551108; http://clinicaltrials.gov/show/NCT01551108 (Archived by WebCite at http://www.webcitation.org/6TNEOzXNX).

Intervention fidelity and effectiveness of a UK worksite physical activity intervention funded by the BUPA Foundation, UK

The main aim of this study was to test whether the effectiveness of a worksite physical activity intervention delivered in five work organizations varied as a function of intervention fidelity. We conducted a fidelity analysis as part of a large matched-pair cluster randomized controlled trial of a worksite physical activity intervention (AME for Activity). Participants (N = 1260) were employees from five organizations in the UK. The primary trial outcome was physical activity at 9 months post intervention. Adherence, exposure, quality of delivery and participant responsiveness/engagement were measured to assess fidelity. Qualitative data about the context in which the intervention was delivered were collected via focus groups, interviews and field notes. Multi-level modelling was used to provide a comparison of the effect of the intervention on increases in physical activity for worksites where intervention fidelity was good, compared with those where intervention fidelity was poor or moderate. Intervention fidelity was poor in two organizations, moderate in two organizations and good in one organization (local council). Re-analysis of the trial data comparing employees in the local council (N = 443) with employees in all other worksites (N = 611) revealed a significant effect of the intervention on physical activity levels among council employees only. These findings suggest that the measurement of fidelity and the testing of the effects of intervention fidelity on outcomes, as part of the evaluation of complex interventions, are essential to understand the context and conditions in which interventions are most effective.

Motivating effects of cooperative exergame play for overweight and obese adolescents

BACKGROUND

Exergames (i.e., video games that require gross motor activity) may provide intrinsically motivating experiences that engage youth in sustained physical activity.

METHOD

Thirty-one low-income 15- to 19-year-old overweight and obese African American adolescents were randomly assigned to a competitive exergame (n = 17) or a cooperative exergame (n = 14) condition. Participants played a preassigned Wii Active exergame routine that took between 30 and 60 min each school day, and sessions occurred during lunch time or an after-school program over a 6 month period. Participation was voluntary, so students decided whether to come or not on a given day. Cooperative exergame players worked together with a peer to expend calories and earn points, while competitive exergame players competed individually against a peer to expend calories and earn points. Motivation was measured through surveys and interviews at the end of the intervention, and energy expenditure was measured by accelerometry during game play.

RESULTS

Compared with the competitive group, the cooperative players were significantly more intrinsically motivated to play (p = .034, partial eta-squared = 0.366) and more psychologically attracted to the design of the exergame (p = .034, partial eta-squared = 0.320). Intrinsic motivation was significantly positively correlated with energy expenditure during game play: individuals who were motivated by control/choice had higher energy expenditure (p = .026), and those who were more goal motivated (p = .004) and more immersed in game play (p = .024) had lower energy expenditure during game play.

CONCLUSIONS

Cooperative exergame play produced higher intrinsic motivation to play the exergame than competitive exergame play did. Intrinsic motivation that came from a desire for control/choice was related to higher energy expenditure during game play. Cooperative exergame play holds promise as a method for engaging overweight and obese youth in physical activity.

The effectiveness of physical activity monitoring and distance counseling in an occupational setting - results from a randomized controlled trial (CoAct)

BACKGROUND

Lack of physical activity (PA) is a known risk factor for many health conditions. The workplace is a setting often used to promote activity and health. We investigated the effectiveness of an intervention on PA and productivity-related outcomes in an occupational setting.

METHODS

We conducted a randomized controlled trial of 12 months duration with two 1:1 allocated parallel groups of insurance company employees. Eligibility criteria included permanent employment and absence of any condition that risked the participant's health during PA. Subjects in the intervention group monitored their daily PA with an accelerometer, set goals, had access to an online service to help them track their activity levels, and received counseling via telephone or web messages for 12 months. The control group received the results of a fitness test and an information leaflet on PA at the beginning of the study. The intervention's aim was to increase PA, improve work productivity, and decrease sickness absence. Primary outcomes were PA (measured as MET minutes per week), work productivity (quantity and quality of work; QQ index), and sickness absence (SA) days at 12 months. Participants were assigned to groups using block randomization with a computer-generated scheme. The study was not blinded.

RESULTS

There were 544 randomized participants, of which 521 were included in the analysis (64% female, mean age 43 years). At 12 months, there was no significant difference in physical activity levels between the intervention group (n = 264) and the control group (n = 257). The adjusted mean difference was -206 MET min/week [95% Bayesian credible interval -540 to 128; negative values favor control group]. There was also no significant difference in the QQ index (-0.5 [-4.4 to 3.3]) or SA days (0.0 [-1.2 to 0.9]). Of secondary outcomes, body weight (0.5 kg [0.0 to 1.0]) and percentage of body fat (0.6% [0.2% to 1.1%]) were slightly higher in the intervention group. An exploratory subgroup analysis revealed no subgroups in which the intervention affected physical activity. No adverse events were reported.

CONCLUSIONS

The intervention was not found effective, and this study does not provide support for the effectiveness of the workplace PA intervention used here.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT00994565.

Role of technology in supporting quality control and treatment fidelity in a family caregiver clinical trial

This article describes how a family caregiver lifestyle physical activity clinical trial uses research technology to enhance quality control and treatment fidelity. This trial uses a range of Internet, Blaise(®) Windows-based software and Echo Server technologies to support quality control issues, such as data collection, data entry, and study management advocated by the clinical trials literature, and to ensure treatment fidelity concerning intervention implementation (i.e., design, training, delivery, receipt, and enactment) as proposed by the National Institutes of Health Behavior Change Consortium. All research staff are trained to use these technologies. Strengths of this technological approach to support quality control and treatment fidelity include the comprehensive plan, involvement of all staff, and ability to maintain accurate and timely data. Limitations include the upfront time and costs for developing and testing these technological methods, and having support staff readily available to address technological issues if they occur.

Economic evaluation and transferability of physical activity programmes in primary prevention: a systematic review

This systematic review aims to assess the characteristics of, and the clinical and economic evidence provided by, economic evaluations of primary preventive physical exercise interventions, and to analyse their transferability to Germany using recommended checklists. Fifteen economic evaluations from seven different countries met eligibility criteria, with seven of the fifteen providing high economic evidence in the special country context. Most of the identified studies conclude that the investigated intervention provide good value for money compared with alternatives. However, this review shows a high variability of the costing methods between the studies, which limits comparability, generalisability and transferability of the results.