'Snacktivity™' to increase physical activity: Time to try something different?

Exercise Snacks and Other Forms of Intermittent Physical Activity for Improving Health in Adults and Older Adults: A Scoping Review of Epidemiological, Experimental and Qualitative Studies

Exercise snacks, including other variants of brief intermittent bouts, are an emerging approach for increasing physical activity, although their operationalisation is unstandardised and their health benefits remain unclear. This scoping review aimed to explore characterisations of exercise snacks and summarise their effects on health in adults and older adults. Clinical trial registers (clinicaltrials.gov and ANZCTR) and electronic databases (PubMed, CINAHL, CENTRAL, PsycINFO) were searched from inception to 1 June 2023, for ongoing and published studies of exercise snacks. Backwards and forwards citation tracking was also conducted to identify additional eligible studies. Studies were included if they investigated exercise snacks-brief intermittent bouts of physical activity spread across the day-in adults or older adults. We included epidemiological, experimental, quasi-experimental and qualitative studies that examined the effect of exercise snacks on any health outcomes or described barriers to and enablers of these approaches. Thirty-two studies were included (7 trial registers, 1 published protocol, 3 epidemiological studies and 20 trials reported across 21 studies). Three main terms were used to describe exercise snacks: exercise snack(ing), snacktivity and vigorous intermittent lifestyle physical activity (VILPA). Participants were predominantly physically inactive but otherwise healthy adults or older adults. Exercise snacks were feasible and appeared safe. Epidemiological studies showed steep, near-linear associations of VILPA with reduced all-cause, cardiovascular and cancer mortality as well as reduced incidence of major adverse cardiovascular events and cancer. The limited trial evidence showed exercise snacks had modest effects on improving cardiorespiratory fitness, whereas effects on physical function, mood, quality of life and other health outcomes were equivocal. In conclusion, exercise snacks appear feasible and safe for adults and older adults and may have promising health benefits, but this is mostly based on findings from a limited number of small quasi-experimental studies, small randomised trials or qualitative studies. More studies are needed in individuals with chronic disease. This emerging physical activity approach may have appeal for individuals who find structured exercise unfeasible.Registration https://osf.io/qhu24/.

User engagement with organizational mHealth stress management intervention - A mixed methods study

Mobile health (mHealth) demonstrates great promise for providing effective and accessible interventions within an organizational context. Compared with traditional workplace interventions, mHealth solutions may be significantly more scalable and easier to standardize. However, inadequate user engagement is a major challenge with mHealth solutions that can negatively impact the potential benefits of an intervention. More research is needed to better understand how to ensure sufficient engagement, which is essential for designing and implementing effective interventions. To address this issue, this study employed a mixed methods approach to investigate what factors influence user engagement with an organizational mHealth intervention. Quantitative data were collected using surveys (n = 1267), and semi-structured interviews were conducted with a subset of participants (n = 17). Primary findings indicate that short and consistent interactions as well as user intention are key drivers of engagement. These results may inform future development of interventions to increase engagement and effectiveness.

The Relationship Between Psychological Distress and Physical Activity Is Non-linear and Differs by Domain: a Cross-Sectional Study

BACKGROUND

There is increasing evidence for the relationship between physical activity (PA), sedentary behaviour and mental health. Limited data exists on sex-specific associations. We aimed to identify associations between PA dose and domain and television time with psychological distress, including sex-stratified models.

METHODS

A total of 22,176 adults from the Melbourne Collaborative Cohort Study follow-up 2 cohort (2003-2007) participated in this cross-sectional study. Occupational, household, transport, leisure PA, hours watching television and psychological distress were assessed. Restricted cubic splines were used to examine the relationships between PA domains, television viewing time and psychological distress.

RESULTS

The relationships between PA and psychological distress were non-linear (p < 0.05) and differed by PA domain. There were dose-dependent, inverse associations between distress with transport (B[95% CI] = -0.39[-0.49, -0.30]) and leisure PA (B[95% CI] = -0.35[-0.46, -0.25]). The effect estimates for transport and leisure PA with distress were larger for women. For household domain, a U-shaped curve with an elongated tail was seen. Median PA was associated with lower distress compared with lower quantities (B[95% CI] = -0.12[-0.22, -0.03]); however, this association was not evident with increasing household PA. There were no clear associations between occupational PA and distress. Higher television viewing was associated with higher distress (B[95% CI] = 0.16[0.02, 0.30]).

CONCLUSIONS

Increasing PA and reducing television viewing may contribute to reduced psychological distress, particularly in women. Future interventions should incorporate leisure and transport PA and decrease television viewing to assess the impact on mental health.

Patterns of physical activity and sedentary behavior in child and adolescent cancer survivors assessed using wrist accelerometry: A cluster analysis approach

Physical activity levels among childhood cancer survivors are typically quantified as a total amount using time spent in various intensities. Yet, most analyses do not consider the transitory nature of children's behaviors and a more detailed approach could provide complimentary information. We aimed to explore various behavior profiles of survivors' daily and hourly physical activity patterns. We measured 8-18-year-old survivors' activity levels over 7 days using wrist accelerometry and cluster analysis. Of the 37 participant datasets, survivors engaged in mean (SD) 36.3 (19.0) min/day of MVPA and 4.1 (1.9) hrs/day of sedentary activity. The cluster analysis revealed five daily movement patterns: 'most active' (prevalence 11%), 'active' (22%), 'moderately active + moderately sedentary' (35%), 'moderately active + high sedentary' (5%) and 'least active' (27%). Younger survivors and those with less time since treatment completion were more likely to be in the active clusters. Hourly behaviors were characterized by short bursts of MVPA and moderate bouts of sedentary activity. Our approach provides an insightful analysis into the nature and timing of childhood cancer survivors' movement behaviours. Our findings may assist in the development of targeted interventions to improve physical activity levels.

Day-to-day variability in accelerometer-measured physical activity in mid-aged Australian adults

PURPOSE

The aim was to use accelerometer data to describe day-to-day variability in physical activity in a single week, according to sociodemographic variables, in mid-aged Australian adults.

METHODS

Data were from participants in the How Areas in Brisbane Influence HealTh and AcTivity (HABITAT) study who took part in a 2014 sub-study (N = 612; Mean age 60.6 [SD 6.9; range 48-73]). Participants wore a triaxial accelerometer (ActiGraph wGT3X-BT) on their non-dominant wrist for seven days, and data were expressed as acceleration in gravitational equivalent units (1 mg = 0.001 g). These were, used to estimate daily acceleration (during waking hours) and daily time spent in moderate-vigorous physical activity (MVPA, defined as ≥ 100mg). Coefficient of variation (calculated as [standard deviation/mean of acceleration and MVPA across the seven measurement days] * 100%) was used to describe day-to-day variability.

RESULTS

Average values for both acceleration (24.1-24.8 mg/day) and MVPA (75.9-79.7 mins/day) were consistent across days of the week, suggesting little day-to-day variability (at the group level). However, over seven days, average individual day-to-day variability in acceleration was 18.8% (SD 9.3%; range 3.4-87.7%) and in MVPA was 35.4% (SD 15.6%; range 7.3-124.6%), indicating considerable day-to-day variability in some participants. While blue collar workers had the highest average acceleration (28.6 mg/day) and MVPA (102.5 mins/day), their day-to-day variability was low (18.3% for acceleration and 31.9% for MVPA). In contrast, variability in acceleration was highest in men, those in professional occupations and those with high income; and variability in MVPA was higher in men than in women.

CONCLUSION

Results show group-level estimates of average acceleration and MVPA in a single week conceal considerable day-to-day variation in how mid-age Australians accumulate their acceleration and MVPA on a daily basis. Overall, there was no clear relationship between overall volume of activity and variability. Future studies with larger sample sizes and longitudinal data are needed to build on the findings from this study and increase the generalisability of these findings to other population groups.

Promoting participation in physical activity through Snacktivity: A qualitative mixed methods study

BACKGROUND

Public health guidance acknowledges the benefits of physical activity of any duration. We have proposed a whole-day approach to promoting physical activity called Snacktivity™, which encourages frequent 2-5 minute 'activity snacks' of moderate-to-vigorous intensity.

METHODS

Using repeated semi-structured interviews and a think aloud protocol, this study aimed to understand participants' experiences of integrating Snacktivity™ into daily life, to provide insights to refine the delivery of Snacktivity™ interventions. Physically inactive adults recruited via primary care and a community health service engaged with an intervention to encourage Snacktivity™ over three weeks, which included using a Fitbit and linked mobile phone app (SnackApp). Participants took part in semi-structured interviews on two occasions during the intervention, with a sub-group participating in a think aloud study. Three study data sets were generated and independently explored using inductive thematic analysis, with findings combined into a single set of themes.

RESULTS

Eleven adults participated in the interview study who were interviewed twice (total interviews completed n = 21, 1 participant declined the second interview), of whom six completed the think aloud study (total voice recordings n = 103). Three main themes emerged from the combined data; lived experience of participating in Snacktivity™, motivation for Snacktivity™ and experiences with the Snacktivity™ technology. Participants undertook a variety of activity snacks, utilising their environment, which they believed improved their psychological wellbeing. Participants were enthusiastic about Snacktivity™, with some stating that activity snacks were more accessible than traditional exercise, but perceived they were often prevented from doing so in the presence of others. Participants were mostly enthusiastic about using the Snacktivity™ technology.

CONCLUSION

Participants were able to incorporate Snacktivity™ into their lives, particularly at home, and found this approach acceptable. Participants felt they experienced health benefits from Snacktivity™ although barriers to participation were reported. This study offers insights for translating guidance into practice and supporting people to become more physically active.

Snacktivity™ to promote physical activity and reduce future risk of disease in the population: protocol for a feasibility randomised controlled trial and nested qualitative study

BACKGROUND

Many people do not regularly participate in physical activity, which may negatively impact their health. Current physical activity guidelines are focused on promoting weekly accumulation of at least 150 min of moderate to vigorous intensity physical activity (MVPA). Whilst revised guidance now recognises the importance of making small changes to physical activity behaviour, guidance still focuses on adults needing to achieve at least 150 min of MVPA per week. An alternative 'whole day' approach that could motivate the public to be more physically active, is a concept called Snacktivity™. Instead of focusing on achieving 150 min per week of physical activity, for example 30 min of MVPA over 5 days, Snacktivity™ encourages the public to achieve this through small, but frequent, 2-5 min 'snacks' of MVPA throughout the whole day.

METHODS

The primary aim is to undertake a feasibility trial with nested qualitative interviews to assess the feasibility and acceptability of the Snacktivity™ intervention to inform the design of a subsequent phase III randomised trial. A two-arm randomised controlled feasibility trial aiming to recruit 80 inactive adults will be conducted. Recruitment will be from health and community settings and social media. Participants will be individually randomised (1:1 ratio) to receive either the Snacktivity™ intervention or usual care. The intervention will last 12 weeks with assessment of outcomes completed before and after the intervention in all participants. We are interested in whether the Snacktivity™ trial is appealing to participants (assessed by the recruitment rate) and if the Snacktivity™ intervention and trial methods are acceptable to participants (assessed by Snacktivity™/physical activity adherence and retention rates). The intervention will be delivered by health care providers within health care consultations or by researchers. Participants' experiences of the trial and intervention, and health care providers' views of delivering the intervention within health consultations will be explored.

DISCUSSION

The development of physical activity interventions that can be delivered at scale are needed. The findings from this study will inform the viability and design of a phase III trial to assess the effectiveness and cost-effectiveness of Snacktivity™ to increase physical activity.

TRIAL REGISTRATION

ISRCTN: 64851242.

SnacktivityTM, Giant Games and Immersive Virtual Reality Exercises: A Rapid Narrative Review of These New Physical Activity Practices among Older People Living in Nursing Homes and Long-Term Care Facilities

In developed countries, the increasing number of older adults raises many public health challenges. Physical activity can enable healthy aging, as it is beneficial for both mental and physical health. Despite this, not all older adults engage in physical activity or have access to it. To counteract this, new physical practices such as SnacktivityTM, giant games and immersive virtual reality exercises are being developed. The main objective of this rapid narrative review is to summarize the effects of SnacktivityTM, giant games and immersive Virtual Reality (VR) exercise among older adults living in nursing homes and long-term care facilities. A scientific review was performed using the search engines PubMed, PsycInfo and Web of Science on 7 July 2022. Fifty-nine items are identified in total, and five items are included in the literature review. Synthesis of the studies shows that immersive virtual reality and giant games improve the motivation and enjoyment of older adults and are beneficial for their functional abilities. Furthermore, no interventional studies have tested the effect of SnacktivityTM in older adults. This review suggests that future studies should be conducted to further explore the effects of these new physical activity practices in older adults living in nursing homes or long-term care facilities.

Optimising a multi-strategy implementation intervention to improve the delivery of a school physical activity policy at scale: findings from a randomised noninferiority trial

Background

To maximise their potential health benefits, school-based physical activity policies need to be implemented at scale. This paper describes the third in a sequence of trials that sought to optimise an effective strategy (PACE) to assist schools’ implementation of a physical activity policy. Specifically, it aimed to determine the probability that a multi-strategy intervention adapted to reduce in-person contact (Adapted PACE) was “as good as” the original intervention (PACE) in increasing the weekly minutes of structured physical activity implemented by classroom teachers.

Methods

A noninferiority cluster randomised controlled trial was undertaken with 48 primary schools in New South Wales, Australia. Schools were randomised to receive PACE or a model with adaptations made to the delivery modes (Adapted PACE). Teachers’ scheduled minutes of weekly physical activity was assessed at baseline (Oct 2018-Feb 2019) and 12-month follow-up (Oct-Dec 2019). The noninferiority margin was set at − 16.4 minutes based on previous data and decision panel consensus. A linear mixed model analysed within a Bayesian framework was used to explore noninferiority between the two PACE models. A cost minimisation analysis was conducted from the health service provider perspective, using the Australian dollar (AUD).

Results

The posterior estimate for the between group difference at follow-up was − 2.3 minutes (95% credible interval = − 18.02, 14.45 minutes). There was an estimated 96% probability of Adapted PACE being considered noninferior (only 4% of the posterior samples crossed the noninferiority margin of − 16.4 minutes). That is, the minutes of physical activity implemented by teachers at Adapted PACE schools was not meaningfully less than the minutes of physical activity implemented by teachers at PACE schools. The mean total cost was AUD$25,375 (95% uncertainty interval = $21,499, $29,106) for PACE and AUD$16,421 (95% uncertainty interval = $13,974, $19,656) for Adapted PACE; an estimated reduction of AUD$373 (95% uncertainty interval = $173, $560) per school.

Conclusions

It is highly probable that Adapted PACE is noninferior to the original model. It is a cost-efficient alternative also likely to be a more suitable approach to supporting large scale implementation of school physical activity policies.

Trial registration

Retrospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619001229167).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01345-6.

Evaluating telehealth lifestyle therapy versus telehealth psychotherapy for reducing depression in adults with COVID-19 related distress: the curbing anxiety and depression using lifestyle medicine (CALM) randomised non-inferiority trial protocol

BACKGROUND

There is increasing recognition of the substantial burden of mental health disorders at an individual and population level, including consequent demand on mental health services. Lifestyle-based mental healthcare offers an additional approach to existing services with potential to help alleviate system burden. Despite the latest Royal Australian New Zealand College of Psychiatrists guidelines recommending that lifestyle is a 'first-line', 'non-negotiable' treatment for mood disorders, few such programs exist within clinical practice. Additionally, there are limited data to determine whether lifestyle approaches are equivalent to established treatments. Using an individually randomised group treatment design, we aim to address this gap by evaluating an integrated lifestyle program (CALM) compared to an established therapy (psychotherapy), both delivered via telehealth. It is hypothesised that the CALM program will not be inferior to psychotherapy with respect to depressive symptoms at 8 weeks.

METHODS

The study is being conducted in partnership with Barwon Health's Mental Health, Drugs & Alcohol Service (Geelong, Victoria), from which 184 participants from its service and surrounding regions are being recruited. Eligible participants with elevated psychological distress are being randomised to CALM or psychotherapy. Each takes a trans-diagnostic approach, and comprises four weekly (weeks 1-4) and two fortnightly (weeks 6 and 8) 90-min, group-based sessions delivered via Zoom (digital video conferencing platform). CALM focuses on enhancing knowledge, behavioural skills and support for improving dietary and physical activity behaviours, delivered by an Accredited Exercise Physiologist and Accredited Practising Dietitian. Psychotherapy uses cognitive behavioural therapy (CBT) delivered by a Psychologist or Clinical Psychologist, and Provisional Psychologist. Data collection occurs at baseline and 8 weeks. The primary outcome is depressive symptoms (assessed via the Patient Health Questionnaire-9) at 8 weeks. Societal and healthcare costs will be estimated to determine the cost-effectiveness of the CALM program. A process evaluation will determine its reach, adoption, implementation and maintenance.

DISCUSSION

If the CALM program is non-inferior to psychotherapy, this study will provide the first evidence to support lifestyle-based mental healthcare as an additional care model to support individuals experiencing psychological distress.

TRIAL REGISTRATION

Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12621000387820 , Registered 8 April 2021.