Simultaneous validation of five activity monitors for use in adult populations

Breaking up prolonged sedentary behavior to improve cardiometabolic health (BREAK2): protocol for a dose-finding adaptive randomization trial

BACKGROUND

Excessive sedentary behavior is highly prevalent in developed nations and is a risk factor for cardiovascular disease (CVD) morbidity and mortality. As such, health agencies have provided general recommendations to "sit less, move more" by interspersing brief periods of activity. However, a lack of empirical evidence describing how often (e.g. every 30 min, every 60 min) and for how long (e.g., 1 min activity bouts, 5 min activity bouts) sedentary time should be interrupted (a "sedentary break") to yield health benefit has precluded more quantitative, actionable guidelines. To date, rigorous and methodical dose escalation experiments have not been conducted to elucidate effective and tolerated sedentary break doses. The objective of the proposed study is to determine the minimally effective dose (e.g., the lowest dose) for two elements of a sedentary break (frequency and duration) that yields improvements in established CVD risk factors. The maximally tolerated dose (e.g. the highest dose that does not cause undue physical/psychological distress) for both frequency and duration of sedentary breaks will also be determined.

METHODS

This study is a randomized crossover trial conducted under laboratory conditions among 324 adults without chronic medical conditions. Participants complete two trial conditions (8 h each), a sedentary break (intervention) condition and an uninterrupted sitting (control) condition, in a randomized order. The sedentary break condition consists of 1 of 25 possible frequency/duration combinations (e.g. walk every 30 min for 5 min), selected according to a Bayesian adaptive randomization method. Primary outcomes used to inform the adaptive randomization are glucose and blood pressure serially assessed over each trial condition. Constructs of dose toxicity (tolerability, safety, physical exhaustion/fatigue, and affect) are also serially assessed.

DISCUSSION

This study will elucidate the minimally effective and maximally tolerated frequency and duration of a sedentary break that yields improvements in established CVD risk factors, information important for the development of quantitative sedentary behavior guidelines.

TRIAL REGISTRATION

This trial has been registered with the Clinical Trials Registry maintained by the National Library of Medicine at the National Institutes of Health on April 29, 2022. The registration ID is NCT05353322.

Accelerometer-assessed physical activity levels 32-37 years after anterior cruciate ligament rupture - Does initial treatment strategy or the presence of osteoarthritis matter?

OBJECTIVES

To quantify physical activity 32-37 years after acute anterior cruciate ligament injury with respect to the World Health Organization physical activity recommendation, and to compare physical activity levels between: i) individuals managed with anterior cruciate ligament surgery and rehabilitation vs. rehabilitation alone, and ii) individuals with and without symptomatic osteoarthritis.

DESIGN

Prospective longitudinal cohort.

METHODS

Participants (n = 234) within 14 days of anterior cruciate ligament rupture (confirmed arthroscopically) were allocated to early anterior cruciate ligament repair and rehabilitation or rehabilitation alone. Thirty-two to 37 years after anterior cruciate ligament injury, 80 participants provided valid accelerometer data assessing physical activity and underwent an x-ray to assess osteoarthritis. Symptomatic osteoarthritis was defined as radiographic osteoarthritis plus knee pain and/or symptoms. Differences in physical activity parameters between treatment and osteoarthritis groups were assessed with analysis of covariance, adjusted for potential confounding.

RESULTS

Tibiofemoral symptomatic osteoarthritis was observed in 35 (47 %) participants (anterior cruciate ligament surgery 44 %; rehabilitation-alone 50 %). Participants spent a mean of 37.1 (95 % confidence interval 31.6-42.6) min/day in moderate to vigorous physical activity. Recommended levels of physical activity (≥150 min/week of moderate to vigorous physical activity) were reached by 66 % of participants with tibiofemoral symptomatic osteoarthritis [mean (95 % confidence interval): 35.4 (26.2-44.7) min/day of moderate to vigorous physical activity] and 77 % without tibiofemoral symptomatic osteoarthritis [39.1 (31.5-46.8) min/day moderate to vigorous physical activity]. Adjusted analyses found no differences in physical activity parameters between treatment groups or between participants with or without tibiofemoral symptomatic osteoarthritis.

CONCLUSIONS

More than 30 years after anterior cruciate ligament injury, over two-thirds of participants reached recommended levels of physical activity. Physical activity levels did not differ based on the initial treatment strategy or presence of tibiofemoral symptomatic osteoarthritis.

Acceptability and feasibility of research grade wearables for monitoring heat stress in Kenyan farmers

Sub-Saharan Africa faces increasing heat events due to climate change, affecting health and productivity. Wearable technology, though promising for monitoring these impacts, is underexplored in this region. This pilot study evaluated the acceptability and feasibility of research-grade wearables for monitoring heat stress among Kenyan subsistence farmers. In Siaya, 48 farmers (50% women) were monitored for 14 days using sensors to measure heart rate, core temperature, sleep, activity, and geo-location, alongside environmental data loggers for wet bulb globe temperature. Participants mostly rated their experience on a 5-point Likert scale and provided additional non-Likert feedback, with over 95% reporting high device likability and minimal disruption. Data availability was 88% for actigraphy and 100% for core temperature, with a median completeness of 100% for most devices. Women experienced greater heat strain than men. These findings demonstrate that research-grade wearables are acceptable and feasible for real-time heat stress monitoring in rural Africa.

Do publicly funded community physical activity programs for middle-aged and older adults in Ireland work?

To strengthen practice-based evidence, pragmatic, yet rigorous, evaluation of real-world programs is necessary. This study sought to add to the evidence for the effectiveness of physical activity programs for middle-aged and older adults offered by publicly funded local sports partnerships (LSPs) in Ireland. We analysed data from 468 individuals aged 50 + years, who took part in the Move for Life cluster randomised feasibility trial. Outcomes were accelerometer-based moderate-to-vigorous intensity physical activity (MVPA), light intensity physical activity (LiPA), standing time, and sedentary time; self-reported compliance with physical activity guidelines, body composition, physical function, and mental well-being. LSP programs included Women on Wheels/Bike for Life, Go for Life Games, Get Ireland Walking, and Men on the Move. We used a difference-in-differences approach to estimate program effects. We found evidence of positive program effects on accelerometer-derived MVPA (Women on Wheels/Bike for Life, Get Ireland Walking), LiPA (Go for Life Games), and sedentary time (Women on Wheels/Bike for Life, Go for Life Games) (p < .05), plus evidence of positive effects on self-reported physical activity for all LSP programs (p < .05). We did not find evidence of program effects on body composition. Outcomes related to physical function were mixed. Men on the Move was the only program where mental well-being scores increased significantly relative to the control group. Despite sample size limitations, the results support the effectiveness of LSP programs over a 6-month period, notably in terms of energy expenditure outcomes, while identifying areas for improvement regarding outcomes related to body composition, physical function and, particularly, mental well-being.

Methodological Choices on 24-h Movement Behavior Assessment by Accelerometry: A Scoping Review

BACKGROUND

There are no reviews describing current measurement protocols and accelerometer processing decisions that are being used in 24-h MovBeh studies, across the lifespan. We aim to synthesise information on methods for assessing 24-h movement behaviors using accelerometry across all age groups.

MAIN BODY

PubMed, PsycINFO, SPORTDiscus, and EMBASE were searched until December 2022. Observational or intervention reports describing accelerometry methods in studies on combinations of movement behaviors, with a 24-h protocol across all ages, were included. This review included 102 studies: three studies in toddlers, 15 in preschoolers, 17 in children, 23 in adolescents and 44 in adults and older adults. The Actigraph GT3X was the most commonly used device; the majority of the included reports collected data for seven days, including three weekdays and one weekend day, with a ≥ 16 h/day per 24-h period for valid data. The criteria for non-wear time varied between ≥ 20 and  ≥ 90 min of consecutive zero counts, depending on the age group. The most common epoch used was 15 or 60 s for youth and adults, respectively. The choice of sleep algorithms and SB/PA cut-points, of the included reports, depended on age and the original validation/calibration study. To deal with non-compliant participants, exclusion of non-compliant participants from the analysis was most frequently used. Most studies used diaries/logs to complement the accelerometer data.

CONCLUSIONS

Accelerometer protocols and methodological decisions varied considerably between reports. Therefore, consensus on methodological decisions is needed to improve precision and comparability between studies, which is challenging given the complexity of the procedures, the number of available brands and types of accelerometers, and the plethora of programming options.

A digital intervention to reduce home-office workers' sedentary behaviour: protocol for the evaluation of the Click2Move programme, a cluster randomised controlled trial

BACKGROUND

A new paradigm of hybrid working exists, with most office workers sharing their work between the office and home office environment. Working from home increases time spent or prolonged sitting, which is associated with an increased risk of chronic disease. Interventions to reduce sitting time, specifically designed for both the office and home-office environments, are required to address this growing public health issue. This study presents a protocol to evaluate the effectiveness of a digital intervention (Click2Move) to reduce sitting time and improve employees' health and occupational wellbeing among hybrid office workers.

METHODS

A two-arm cluster randomised controlled trial will be undertaken among hybrid office employees. In total, 200 employees will be recruited across four companies across Europe (The Netherlands, Spain, Ireland, and Slovenia). Participants within each company will be randomly allocated to the intervention or control group at the unit/cluster level. The intervention group will receive the novel multicomponent Click2Move intervention (including environmental, organisational, and individual strategies) for 12 months, and the control groups will maintain their usual work practices. The primary outcome will be occupational sedentary time measured via activPAL3TM at baseline and at 3, 6 and 12 months follow-up. Secondary outcomes will include device-based (activPAL3TM) and self-reported (Global Physical Activity Questionnaire and Workforce Sitting Questionnaire) physical activity and sedentary behaviour; self-reported musculoskeletal disorders (Standardised Nordic Questionnaire) and pain (Numeric Rating Scale); self-reported presenteeism and absenteeism (Health and Work Performance Questionnaire), job satisfaction (Need for Recovery scale) and fatigue (single-item 5-point Likert scale). Focus groups will be conducted with employees post-intervention. Linear mixed models, accounting for covariates, will be employed to determine the effects of the intervention. Additionally, we will perform a full process evaluation analysis.

DISCUSSION

The proposed study will offer a comprehensive evaluation of a digital intervention aimed at reducing sedentary behaviour among hybrid office workers, offering practical solutions to enhance the health, wellbeing and productivity of a growing segment of the workplace.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06247228. Registered 30 January 2024.

The pleasure of moving: A compositional data analysis of the association between replacing sedentary time with physical activity on affective valence in daily life

Although the independent within-person association between physical activity and sedentary behaviour with valence in daily life has been extensively studied, few studies have used compositional data analysis to examine how different movement behaviour compositions are related to valence in daily life. This study aimed to examine the within-person association between wake-time movement behaviour compositions with affective valence and the extent to which replacing time spent sedentary with physical activity was associated with valence within individuals in daily life. A 7-day ecological momentary study design was used whereby 94 Canadian university students (Mage = 19.45, SD = 2.21, 78.7 % female) reported on affective valence using an adapted version of the Feeling Scale at 7 randomly timed prompts each day. In addition, activPAL accelerometers were worn continuously by participants on their right thigh for the duration of the study to determine time spent engaging in sedentary behaviours and physical activity. Compositional data analysis with isotemporal substitution models were used to examine the within-person association between movement behaviour compositions and affective valence. The within-person association between movement behaviours and affective valence was weak (r2 = 0.013). Nevertheless, engaging in less sedentary time than usual and instead engaging in physical activity was significantly related to more positive affective valence. Considering light intensity physical activity (LPA) and moderate-to-vigorous intensity physical activity (MVPA) separately, replacing time spent sedentary with time engaged in MVPA and LPA both had a significant positive association on affective valence, although the association with MVPA was stronger than the association with LPA. The results provide unique insights into how replacing sedentary time with physical activity in daily life, especially MVPA, may be associated with more feelings of pleasure. These results may be useful to help inform the development of just-in-time adaptive interventions.

Move for Life an intervention for inactive adults aged 50 years and older: a cluster randomised feasibility trial

Background

Move for Life (MFL) is a theory-informed intervention that was developed to augment established physical activity (PA) programmes and enable inactive adults aged 50 years and older to be more active. This study examined the feasibility of MFL and sought to provide evidence of its potential for improving PA and associated health outcomes.

Methods

A 3-arm cluster randomised feasibility trial compared MFL intervention, usual provision (UP) and control (CON) groups at baseline (T0), post-intervention (T1, at 8, 10 or 12- weeks) and 6-month follow up (T2). We used purposive sampling strategies to recruit participants according to characteristics of interest. Feasibility outcomes assessed recruitment, fidelity, adherence, retention and data completion rates based on pre-set criteria. Primary outcomes were accelerometer-based moderate-to-vigorous intensity PA (MVPA) and self-reported compliance with physical activity guidelines (PAGL). Secondary outcomes included light intensity PA (LiPA), standing time, sedentary time, body composition (adiposity), physical function and psychological well-being. We used linear mixed models (continuous outcomes) or generalized estimated equations (categorical outcomes) to estimate group differences over time in the study outcomes.

Results

Progression criteria for feasibility outcomes were met, and 733 individuals were recruited. Considering a 6-month period (T0-T2), while self-reported compliance with PAGL increased in MFL relative to UP and CON and in UP relative to CON, standing time decreased in MFL relative to CON and sedentary time increased in the latter compared to UP. Waist circumference decreased in MFL relative to UP and CON. MFL outperformed UP in the Timed Up and Go Test while MFL and UP increased the distance covered in the Six-Minute Walk Test compared to CON. Psychological well-being increased in MFL relative to CON (all p < 0.05).

Conclusion

Findings show that MFL is feasible, while data are promising with regards to the potential of improving community PA programmes for adults aged 50 or more years.

Clinical trial registration

https://www.isrctn.com/Registration#ISRCTN11235176.

UPDATE trial: investigating the effects of ultra-processed versus minimally processed diets following UK dietary guidance on health outcomes: a protocol for an 8-week community-based cross-over randomised controlled trial in people with overweight or obesity, followed by a 6-month behavioural intervention

INTRODUCTION

Obesity increases the risk of morbidity and mortality. A major driver has been the increased availability of ultra-processed food (UPF), now the main UK dietary energy source. The UK Eatwell Guide (EWG) provides public guidance for a healthy balanced diet but offers no UPF guidance. Whether a healthy diet can largely consist of UPFs is unclear. No study has assessed whether the health impact of adhering to dietary guidelines depends on food processing. Furthermore, our study will assess the impact of a 6-month behavioural support programme aimed at reducing UPF intake in people with overweight/obesity and high UPF intakes.

METHODS AND ANALYSIS

UPDATE is a 2×2 cross-over randomised controlled trial with a 6-month behavioural intervention. Fifty-five adults aged ≥18, with overweight/obesity (≥25 to <40 kg/m2), and ≥50% of habitual energy intake from UPFs will receive an 8-week UPF diet and an 8-week minimally processed food (MPF) diet delivered to their home, both following EWG recommendations, in a random order, with a 4-week washout period. All food/drink will be provided. Participants will then receive 6 months of behavioural support to reduce UPF intake. The primary outcome is the difference in weight change between UPF and MPF diets from baseline to week 8. Secondary outcomes include changes in diet, waist circumference, body composition, heart rate, blood pressure, cardiometabolic risk factors, appetite regulation, sleep quality, physical activity levels, physical function/strength, well-being and aspects of behaviour change/eating behaviour at 8 weeks between UPF/MPF diets, and at 6-month follow-up. Quantitative assessment of changes in brain MRI functional resting-state connectivity between UPF/MPF diets, and qualitative analysis of the behavioural intervention for feasibility and acceptability will be undertaken.

ETHICS AND DISSEMINATION

Sheffield Research Ethics Committee approved the trial (22/YH/0281). Peer-reviewed journals, conferences, PhD thesis and lay media will report results.

TRIAL REGISTRATION NUMBER

NCT05627570.

Accelerometer-assessed physical activity patterns during the first two years after a non-surgically treated ACL injury

OBJECTIVES

To describe physical activity patterns and analyze changes during the first two years after a non-surgically treated ACL injury, and to assess correlations between accelerometer-assessed physical activity and self-reported knee function and knee-related quality of life.

DESIGN

Prospective cohort study.

PARTICIPANTS

128 patients (61 females, 25.2 ± 7.1 years) with acute ACL injury.

MAIN OUTCOME MEASURES

Physical activity patterns were measured with accelerometry. Self-reported knee function was assessed using the International Knee Documentation Committee Subjective Knee Form, and knee-related quality of life was assessed using the Anterior Cruciate Ligament Quality of Life questionnaire.

RESULTS

Moderate to vigorous physical activity (MVPA) and steps per day increased from baseline to 3 months (p < .001), with no further increase from 3 to 24 months (p > .05). Time in MVPA did not correlate to patient-reported outcome measures at 3, 6, 12, or 24 months (p > .05).

CONCLUSIONS

Physical activity increased from acute phase to 3 months after non-surgically treated ACL injury, but almost one in four patients did not reach recommended levels of physical activity. Physical activity did not correlate with knee function or quality of life. Patients may need improved support to return to physical activity after ACL injury.

LEVEL OF EVIDENCE

Level II.

TRIAL REGISTRATION

NCT02931084.

The Effect of an Electronic Passive Prompt Intervention on Prolonged Occupational Sitting and Light-Intensity Physical Activity in Desk-Based Adults Working from Home during COVID-19 in Ireland

This study aimed to assess the effect of passive prompts on occupational physical behaviours (PBs) and bouts of prolonged sitting among desk-based workers in Ireland who were working from home during the COVID-19 pandemic. Electronic passive prompts were delivered every 45 min, asking participants to walk for five minutes, during working hours. Twenty-eight participants (aged 30-67 years) completed the six-week intervention between October 2020 and April 2021. PBs were measured using an activPAL3TM accelerometer, following a 24 h wear protocol, worn for the duration of the study. Participants were highly sedentary at both baseline (77.71% of work hours) and during the intervention (75.81% of work hours). However, the number of prolonged occupational sedentary bouts > 90 min was reduced compared to baseline (0.56 ± 0.08 vs. 0.77 ± 0.11, p = 0.009). Similar reductions were observed in the time spent in sustained sitting > 60 and >90 min when compared to baseline sedentary patterns (60 min: -31.27 ± 11.91 min, p = 0.014; 90 min: -27.97 ± 9.39 min, p = 0.006). Light-intensity physical activity (LIPA) significantly increased during the intervention (+14.29%, p = 0.001). This study demonstrates that passive prompts, delivered remotely, can both reduce the number and overall time spent in prolonged bouts of occupational sedentary behaviour and increase occupational LIPA.

Barriers to Physical Activity in Children and Adults Living With Type 1 Diabetes: A Complex Link With Real-life Glycemic Excursions

OBJECTIVES

Ever since the first research on barriers to physical activity (PA) highlighting fear of hypoglycemia as a major barrier, many studies have attempted to understand their demographic and behavioural determinants. However, no research has been conducted on whether these perceived barriers toward PA are based on real-life-experienced adverse glycemic effects of exercise.

METHODS

Sixty-two adults and 53 children/adolescents living with type 1 diabetes, along with their parents, completed the Barriers to Physical Activity in Type 1 Diabetes-1 (BAPAD-1) questionnaire on barriers to PA. Continuous glucose-monitoring data were collected during 1 week of everyday life for 26 adults and 33 children/adolescents. Multiple linear regressions were used to explore links between BAPAD-1 scores and glycemic excursions experienced during and after everyday-life self-reported PA sessions, controlling for behavioural (accelerometry) and demographic confounders.

RESULTS

In children/adolescents, the more time spent in hypoglycemia on nights after PA sessions, the more they reported hypoglycemic risk as a barrier (ß=+0.365, p=0.034). Conversely, in adults, the higher the proportion of PA sessions accompanied by a drop in blood glucose, the less hypoglycemia was a barrier (ß=-0.046, p=0.004). In parents, BAPAD-1 scores were unrelated to children/adolescents' everyday-life exercise-induced hypo/hyperglycemia.

CONCLUSIONS

In children/adolescents, fear of hypoglycemia was predominant in those exposed to nocturnal hypoglycemia associated with PA sessions. In adults, fewer barriers may mean they accept a bigger drop in their glycemia during PA. This shows the importance of finding and promoting age-specific solutions to prevent exercise-induced hypoglycemia.

Motivational support intervention to reduce smoking and increase physical activity in smokers not ready to quit: the TARS RCT

Background

Physical activity can support smoking cessation for smokers wanting to quit, but there have been no studies on supporting smokers wanting only to reduce. More broadly, the effect of motivational support for such smokers is unclear.

Objectives

The objectives were to determine if motivational support to increase physical activity and reduce smoking for smokers not wanting to immediately quit helps reduce smoking and increase abstinence and physical activity, and to determine if this intervention is cost-effective.

Design

This was a multicentred, two-arm, parallel-group, randomised (1 : 1) controlled superiority trial with accompanying trial-based and model-based economic evaluations, and a process evaluation.

Setting and participants

Participants from health and other community settings in four English cities received either the intervention (n = 457) or usual support (n = 458).

Intervention

The intervention consisted of up to eight face-to-face or telephone behavioural support sessions to reduce smoking and increase physical activity.

Main outcome measures

The main outcome measures were carbon monoxide-verified 6- and 12-month floating prolonged abstinence (primary outcome), self-reported number of cigarettes smoked per day, number of quit attempts and carbon monoxide-verified abstinence at 3 and 9 months. Furthermore, self-reported (3 and 9 months) and accelerometer-recorded (3 months) physical activity data were gathered. Process items, intervention costs and cost-effectiveness were also assessed.

Results

The average age of the sample was 49.8 years, and participants were predominantly from areas with socioeconomic deprivation and were moderately heavy smokers. The intervention was delivered with good fidelity. Few participants achieved carbon monoxide-verified 6-month prolonged abstinence [nine (2.0%) in the intervention group and four (0.9%) in the control group; adjusted odds ratio 2.30 (95% confidence interval 0.70 to 7.56)] or 12-month prolonged abstinence [six (1.3%) in the intervention group and one (0.2%) in the control group; adjusted odds ratio 6.33 (95% confidence interval 0.76 to 53.10)]. At 3 months, the intervention participants smoked fewer cigarettes than the control participants (21.1 vs. 26.8 per day). Intervention participants were more likely to reduce cigarettes by ≥ 50% by 3 months [18.9% vs. 10.5%; adjusted odds ratio 1.98 (95% confidence interval 1.35 to 2.90] and 9 months [14.4% vs. 10.0%; adjusted odds ratio 1.52 (95% confidence interval 1.01 to 2.29)], and reported more moderate-to-vigorous physical activity at 3 months [adjusted weekly mean difference of 81.61 minutes (95% confidence interval 28.75 to 134.47 minutes)], but not at 9 months. Increased physical activity did not mediate intervention effects on smoking. The intervention positively influenced most smoking and physical activity beliefs, with some intervention effects mediating changes in smoking and physical activity outcomes. The average intervention cost was estimated to be £239.18 per person, with an overall additional cost of £173.50 (95% confidence interval -£353.82 to £513.77) when considering intervention and health-care costs. The 1.1% absolute between-group difference in carbon monoxide-verified 6-month prolonged abstinence provided a small gain in lifetime quality-adjusted life-years (0.006), and a minimal saving in lifetime health-care costs (net saving £236).

Conclusions

There was no evidence that behavioural support for smoking reduction and increased physical activity led to meaningful increases in prolonged abstinence among smokers with no immediate plans to quit smoking. The intervention is not cost-effective.

Limitations

Prolonged abstinence rates were much lower than expected, meaning that the trial was underpowered to provide confidence that the intervention doubled prolonged abstinence.

Future work

Further research should explore the effects of the present intervention to support smokers who want to reduce prior to quitting, and/or extend the support available for prolonged reduction and abstinence.

Trial registration

This trial is registered as ISRCTN47776579.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 4. See the NIHR Journals Library website for further project information.

A socio-ecological approach to reduce the physical activity drop-out ratio in primary care-based patients with type 2 diabetes: the SENWI study protocol for a randomized control trial

Background

Physical activity (PA) is a key behaviour for patients with type 2 diabetes (T2DM). However, healthcare professionals’ (HCP) recommendations (walking advice), which are short-term and individually focused, did not reduce the PA drop-out ratio in the long run. Using a socio-ecological model approach may contribute to reducing patient dropout and improving adherence to PA. The aim of this study is threefold: first, to evaluate the effectiveness of a theory-driven Nordic walking intervention using a socio-ecological approach with T2DM patients in Spain; second, to explore the feasibility on the PA adherence process in T2DM patients while participating in the SENWI programme; and third, to understand the HCPs’ opinion regarding its applicability within the Spanish healthcare system.

Methods

A three-arm randomized control trial (n = 48 each group) will assess the efficacy of two primary care-based PA interventions (Nordic walking vs. Nordic walking plus socio-ecological approach; two sessions per week for twelve weeks) compared to a control group (usual HCPs’ walking advice on PA). Inclusion criteria will include physically inactive patients with T2DM, older than 40 years and without health contraindications to do PA. PA levels and drop-out ratio, quality of life and metabolic and health outcomes will be assessed at baseline, post-intervention and at 9- and 21-month follow-ups. The effect of the different interventions will be assessed by a two-factor analysis of variance: treatment group vs time. Also, a two-factor ANOVA test will be performed with linear mixed models for repeated measures.

A qualitative analysis using focus groups will explore the reasons for the (in)effectiveness of the new PA interventions. Qualitative outcomes will be assessed at post-intervention using thematic analysis.

Discussion

Compared with the general PA walking advice and Nordic walking prescriptions, integrating a socio-ecological approach into Spanish primary care visits could be an effective way to reduce the PA drop-out ratio and increase PA levels in patients with T2DM. Such interventions are necessary to understand the role that multiple socio-complex process in day-to-day PA behaviour has in patients with T2DM in the Spanish context.

Trial registration

ClinicalTrials.gov NCT05159089. Physical Activity Drop-out Ratio in Patients’ Living with Type 2 Diabetes. Prospectively registered on 15 December 2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06742-7.

Validity of the activPAL monitor to measure stepping activity and activity intensity: A systematic review

BACKGROUND

Accumulating step counts and engaging in moderate-to-vigorous intensity physical activity is positively associated with numerous health benefits. The activPAL is a thigh-worn monitor that is frequently used to measure physical activity.

RESEARCH QUESTION

Can the activPAL accurately measure stepping activity and identify physical activity intensity?

METHODS

We systematically reviewed validation studies examining the accuracy of activPAL physical activity outcomes relative to a criterion measure in adults (>18 years). Citations were not restricted to language or date of publication. Sources were searched up to May 16, 2021 and included Scopus, EMBASE, MEDLINE, CINAHL, and Academic Search Premier. The study was pre-registered in Prospero (ID# CRD42021248240). Study quality was determined using a modified Hagströmer Bowles checklist.

RESULTS

Thirty-nine studies (20 laboratory arms, 17 semi-structured arms, 11 uncontrolled protocol arms; 1272 total participants) met the inclusion criteria. Most studies demonstrated a high validity of the activPAL to measure steps across laboratory (12/15 arms), semi-structured (10/13 arms) and uncontrolled conditions (5/7 arms). Studies that demonstrated low validity were generally conducted in unhealthy populations, included slower walking speeds, and/or short walking distances. Few studies indicated that the activPAL accurately measured physical activity intensity across laboratory (0/6 arms), semi-structured (0/5 arms) and uncontrolled conditions (2/5 arms). Using the default settings, the activPAL overestimates light-intensity activity but underestimates moderate-to-vigorous intensity activity. The overall study quality was 11.5 ± 2.0 out of 19.

CONCLUSION

Despite heterogeneous methodological and statistical approaches, the included studies generally provide supporting evidence that the activPAL can accurately detect stepping activity but not physical activity intensity. Strategies that use alternative data processing methods have been developed to better characterize physical activity intensity, but all methods still underestimate vigorous-intensity activity.

Effectiveness of a healthcare-based mobile intervention on sedentary patterns, physical activity, mental well-being and clinical and productivity outcomes in office employees with type 2 diabetes: study protocol for a randomized controlled trial

BACKGROUND

Prolonged sedentary time is associated with an increased incidence of chronic disease including type 2 diabetes mellitus (DM2). Given that occupational sedentary time contributes significantly to the total amount of daily sedentariness, incorporating programmes to reduce occupational sedentary time in patients with chronic disease would allow for physical, mental and productivity benefits. The aim of this study is to evaluate the short-, medium- and long-term effectiveness of a mHealth programme for sitting less and moving more at work on habitual and occupational sedentary behaviour and physical activity in office staff with DM2. Secondary aims. To evaluate the effectiveness on glycaemic control and lipid profile at 6- and 12-month follow-up; anthropometric profile, blood pressure, mental well-being and work-related post-intervention outcomes at 3, 6 and 12 months.

METHODS

Multicentre randomized controlled trial. A sample size of 220 patients will be randomly allocated into a control (n = 110) or intervention group (n = 110), with post-intervention follow-ups at 6 and 12 months. Health professionals from Spanish Primary Health Care units will randomly invite patients (18-65 years of age) diagnosed with DM2, who have sedentary office desk-based jobs. The control group will receive usual healthcare and information on the health benefits of sitting less and moving more. The intervention group will receive, through a smartphone app and website, strategies and real-time feedback for 13 weeks to change occupational sedentary behaviour.

VARIABLES

(1) Subjective and objective habitual and occupational sedentary behaviour and physical activity (Workforce Sitting Questionnaire, Brief Physical Activity Assessment Tool, activPAL3TM); 2) Glucose, HbA1c; 3) Weight, height, waist circumference; 4) Total, HDL and LDL cholesterol, triglycerides; (5) Systolic, diastolic blood pressure; (6) Mental well-being (Warwick-Edinburgh Mental Well-being); (7) Presenteeism (Work Limitations Questionnaire); (8) Impact of work on employees´ health, sickness absence (6th European Working Conditions Survey); (9) Job-related mental strain (Job Content Questionnaire). Differences between groups pre- and post- intervention on the average value of the variables will be analysed.

DISCUSSION

If the mHealth intervention is effective in reducing sedentary time and increasing physical activity in office employees with DM2, health professionals would have a low-cost tool for the control of patients with chronic disease.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04092738. Registered September 17, 2019.

Detecting accelerometer non-wear periods using change in acceleration combined with rate-of-change in temperature

Background

Accelerometery is commonly used to estimate physical activity, sleep, and sedentary behavior. In free-living conditions, periods of device removal (non-wear) can lead to misclassification of behavior with consequences for research outcomes and clinical decision making. Common methods for non-wear detection are limited by data transformations (e.g., activity counts) or algorithm parameters such as minimum durations or absolute temperature thresholds that risk over- or under-estimating non-wear time. This study aimed to advance non-wear detection methods by integrating a ‘rate-of-change’ criterion for temperature into a combined temperature-acceleration algorithm.

Methods

Data were from 39 participants with neurodegenerative disease (36% female; age: 45–83 years) who wore a tri-axial accelerometer (GENEActiv) on their wrist 24-h per day for 7-days as part of a multi-sensor protocol. The reference dataset was derived from visual inspection conducted by two expert analysts. Linear regression was used to establish temperature rate-of-change as a criterion for non-wear detection. A classification and regression tree (CART) decision tree classifier determined optimal parameters separately for non-wear start and end detection. Classifiers were trained using data from 15 participants (38.5%). Outputs from the CART analysis were supplemented based on edge cases and published parameters.

Results

The dataset included 186 non-wear periods (85.5% < 60 min). Temperature rate-of-change over the first five minutes of non-wear was − 0.40 ± 0.17 °C/minute and 0.36 ± 0.21 °C/minute for the first five minutes following device donning. Performance of the DETACH (DEvice Temperature and Accelerometer CHange) algorithm was improved compared to existing algorithms with recall of 0.942 (95% CI 0.883 to 1.0), precision of 0.942 (95% CI 0.844 to 1.0), F1-Score of 0.942 (95% CI 0.880 to 1.0) and accuracy of 0.996 (0.994–1.000).

Conclusion

The DETACH algorithm accurately detected non-wear intervals as short as five minutes; improving non-wear classification relative to current interval-based methods. Using temperature rate-of-change combined with acceleration results in a robust algorithm appropriate for use across different temperature ranges and settings. The ability to detect short non-wear periods is particularly relevant to free-living scenarios where brief but frequent removals occur, and for clinical application where misclassification of behavior may have important implications for healthcare decision-making.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-022-01633-6.

A cluster analysis of device-measured physical activity behaviours and the association with chronic conditions, multi-morbidity and healthcare utilisation in adults aged 45 years and older

Most adults do not meet physical activity guidelines with negative implications for health. The aim of this study was to profile adults using multiple physical activity behaviours and to investigate associations with chronic conditions, multi-morbidity and healthcare utilisation. The study used data generated from a sample of adults aged 45 years and older (N = 485), recruited to the Move for Life randomised control trial. Participants wore an accelerometer for eight consecutive days. Hierarchical cluster analysis was conducted using the variables: moderate to vigorous intensity physical activity, light intensity physical activity, step count, waking sedentary time, standing time and bed hours. Descriptive statistics were used to investigate associations with self-reported number of chronic illnesses, multi-morbidity and healthcare utilisation. Four distinct physical activity behaviour profiles were identified: inactive-sedentary (n = 50, 10.3%), low activity (n = 295, 60.8%), active (n = 111, 22.9%) and very active (n = 29, 6%). The inactive-sedentary cluster had the highest prevalence of chronic illnesses, in particular, mental illness (p = 0.006) and chronic lung disease (p = 0.032), as well as multi-morbidity, complex multi-morbidity and healthcare utilisation. The prevalence of any practice nurse visit (p = 0.033), outpatient attendances (p = 0.04) and hospital admission (p = 0.034) were higher in less active clusters. The results have provided an insight into how physical activity behaviour is associated with chronic illness and healthcare utilisation. A group within the group has been identified that is more likely to be unwell. Provisions need to be made to reduce barriers for participation in physical activity for adults with complex multi-morbidity and very low physical activity.

Feasibility, acceptability and validation of wearable devices for climate change and health research in the low-resource contexts of Burkina Faso and Kenya: Study protocol

As the epidemiological transition progresses throughout sub-Saharan Africa, life lived with diseases is an increasingly important part of a population's burden of disease. The burden of disease of climate-sensitive health outcomes is projected to increase considerably within the next decades. Objectively measured, reliable population health data is still limited and is primarily based on perceived illness from recall. Technological advances like non-invasive, consumer-grade wearable devices may play a vital role in alleviating this data gap and in obtaining insights on the disease burden in vulnerable populations, such as heat stress on human cardiovascular response. The overall goal of this study is to investigate whether consumer-grade wearable devices are an acceptable, feasible and valid means to generate data on the individual level in low-resource contexts. Three hundred individuals are recruited from the two study locations in the Nouna health and demographic surveillance system (HDSS), Burkina Faso, and the Siaya HDSS, Kenya. Participants complete a structured questionnaire that comprises question items on acceptability and feasibility under the supervision of trained data collectors. Validity will be evaluated by comparing consumer-grade wearable devices to research-grade devices. Furthermore, we will collect demographic data as well as the data generated by wearable devices. This study will provide insights into the usage of consumer-grade wearable devices to measure individual vital signs in low-resource contexts, such as Burkina Faso and Kenya. Vital signs comprising activity (steps), sleep (duration, quality) and heart rate (hr) are important measures to gain insights on individual behavior and activity patterns in low-resource contexts. These vital signs may be associated with weather variables-as we gather them from weather stations that we have setup as part of this study to cover the whole Nouna and Siaya HDSSs-in order to explore changes in behavior and other variables, such as activity, sleep, hr, during extreme weather events like heat stress exposure. Furthermore, wearable data could be linked to health outcomes and weather events. As a result, consumer-grade wearables may serve as a supporting technology for generating reliable measurements in low-resource contexts and investigating key links between weather occurrences and health outcomes. Thus, wearable devices may provide insights to better inform mitigation and adaptation interventions in these low-resource settings that are direly faced by climate change-induced changes, such as extreme weather events.

Descriptive Epidemiology of Interruptions to Free-Living Sitting Time in Middle-Age and Older Adults

National guidelines recommend physically active interruptions to sitting time, however, the characteristics of these interruptions are broadly stated and ill-defined. A robust methodology for population surveillance for such interruptions is needed.

PURPOSE

To describe the frequency and characteristics (i.e., duration, stepping time, and estimated intensity) of all interruptions and physically active interruptions to adults' free-living sitting time (i.e., transitions from sitting to upright posture) across segments of the population.

METHODS

Australian Diabetes, Obesity and Lifestyle (AusDiab) study participants (321 men; 406 women; mean ± SD 58.0 ± 10.3 years) wore the activPAL3TM for ≥1 valid day. The characteristics of interruptions from laboratory studies demonstrating health benefits were selected to define active interruptions (≥5 min upright and/or ≥ 2 min stepping) and ambulatory interruptions (≥2 min stepping). The frequency and characteristics of all, active, and ambulatory interruptions were described and compared by age, gender, diabetes status, and body mass index.

RESULTS

Adults averaged 55.0 ± 21.8 interruptions per day, but only 20.3 ± 6.7 were active and 14.0 ± 5.4 were ambulatory. Median (25th, 75th percentile) duration was 2.6 (0.9, 7.8) minutes, stepping time was 0.8 (0.3, 2.0) minutes, and estimated energy expenditure was 4.3 (1.4, 12.5) MET-min. Those who were older, had obesity, or had diabetes had significantly (p < 0.05) fewer interruptions of all types and less stepping time during active interruptions than their counterparts (Cohen's d < 0.2).

CONCLUSION

Free-living interruptions were often less active than interruptions performed in effective acute laboratory studies and their content varied widely between population groups. Monitoring all interruptions as well as those that are more active is advisable to provide a comprehensive understanding of free-living sedentary behavior.

Increasing physical activity in Cancer Survivors through a Text-messaging Exercise motivation Program (ICanSTEP)

PURPOSE

Cancer survivors are often sedentary. Self-monitoring may promote physical activity through self-activation. We conducted a pilot trial to evaluate whether wearable activity tracker with personalized text message feedback would increase physical activity.

METHODS

We enrolled 30 patients with solid tumor cancers into a non-randomized prospective intervention trial (NCT02627079): 15 had completed treatment in the past year and 15 under active treatment. Each participant received an activity tracker and daily text messages personalized to their activity level. We assessed patient-reported outcomes and 6-min walk (6 MW) at baseline and 3 months.

RESULTS

Twenty-six participants completed the study. There was substantial variation in baseline activity. Overall, 39% of participants increased their steps taken by at least 20%, and 23% increased their 6 MW distance by 20% or more. More participants who had completed treatment strongly agreed (73%) that the intervention increased their exercise levels than those receiving active treatment (47%). At 3 months, there was a significant improvement in median Beck Depression Inventory-II and Godin Leisure Index composite scores. At 6 months, 72% still wore their activity tracker at least 4 days per week.

CONCLUSION

We found that the intervention was well-accepted with a high completion rate at 3 months and continued self-use at 6 months. In this pilot study of combined activity tracker and motivational messaging, we found a signal for increased physical activity over a 3-month period. Future research is needed to study this technique for its impact on activity and other physical and psychological measures of well-being.

IMPLICATION FOR CANCER SURVIVORS

Activity tracker with personalized motivational messaging may be useful in promoting physical activity in cancer survivors.

Secondary Prevention of Stroke: Study Protocol for a Telehealth-Delivered Physical Activity and Diet Pilot Randomized Trial (ENAbLE-Pilot)

BACKGROUND

Increasing physical activity (PA) and improving diet quality are opportunities to improve secondary stroke prevention, but access to appropriate services is limited. Interventions co-designed with stroke survivors and delivered by telehealth are a potential solution.

AIM

The aim of this study is to test the feasibility, safety, and potential efficacy of a 6-month, telehealth-delivered PA and/or dietary (DIET) intervention.

METHODS

Pilot randomized trial. 80 adults with previous stroke who are living at home with Internet access and able to exercise will be randomized in a 2 × 2 factorial (4-arm) pilot randomized, open-label, blinded outcome assessment trial to receive PA, DIET, PA + DIET, or control interventions via telehealth. The PA intervention aims to support participants to meet the minimum recommended levels of PA (150 min/week moderate exercise), and the DIET intervention aims to support participants to follow the AusMed (Mediterranean-style) diet. The control group receives usual care plus education about PA and healthy eating. The co-primary outcomes are feasibility (proportion and characteristics of eligible participants enrolled and proportion of scheduled intervention sessions attended) and safety (adverse events) at 6 months. The secondary outcomes include recurrent stroke risk factors (blood pressure, physical activity levels, and diet quality), fatigue, mood, and quality of life. Outcomes are measured at 3, 6, and 12 months.

CONCLUSION

This trial will produce evidence for the feasibility, safety, and potential effect of telehealth-delivered PA and DIET interventions for people with stroke. Results will inform development of an appropriately powered trial to test effectiveness to reduce major risk factors for recurrent stroke.

TRIAL REGISTRATION

ACTRN12620000189921.

Associations of Sedentary Patterns with Cardiometabolic Biomarkers in Physically Active Young Males

PURPOSE

Sitting time (ST) is a serious global health issue and positively associated with cardiometabolic disease. The present study investigated associations between objectively measured ST, sedentary patterns, and cardiometabolic biomarkers in physically active young males.

METHODS

Cross-sectional analysis was completed in 94 males 18-35 yr of age. Total ST, prolonged sedentary bouts (≥30 min with no interruption), and sedentary breaks (transitions from sitting/lying to standing/stepping) were assessed using activPAL. Lipids, insulin, C-peptide, C-reactive protein (CRP), vascular cellular adhesion molecule-1, intercellular adhesion molecule 1, E-selectin, P-selectin, leptin, resistin, and adiponectin were measured using assay kits. The expression of specific proteins related to endothelial dysfunction was determined using quantitative real-time polymerase chain reaction. Associations between total ST, prolonged sedentary bouts, and sedentary breaks with cardiometabolic biomarkers and total ST and levels of gene expression were assessed using generalized linear models.

RESULTS

Total ST was significantly associated with triglycerides (B = 1.814), insulin (B = 2.117), homeostasis model assessment of insulin resistance (B = 0.071), and E-selectin (B = 2.052). Leptin (B = 0.086), E-selectin (B = 1.623), and P-selectin (B = 2.519) were significantly associated with prolonged sedentary bouts, whereas leptin (B = -0.017) and CRP (B = -0.016) were associated with sedentary breaks. After adjustment for moderate to vigorous physical activity, the associations between triglycerides (B = 2.048) and total ST, and between CRP (B = -0.016) and sedentary breaks, remained significant. E-selectin mRNA levels (B = 0.0002) were positively associated with ST with or without adjustment for moderate to vigorous physical activity.

CONCLUSIONS

Total ST and prolonged sedentary bouts were positively associated with several cardiometabolic biomarkers, with interruptions in ST potentially contributing to reduced cardiometabolic risk in physically active young male adults.

The feasibility of an exercise intervention to improve sleep (time, quality and disturbance) in people with rheumatoid arthritis: a pilot RCT

Current rheumatology guidelines recommend exercise as a key component in the management of people with RA, however, what is lacking is evidence on its impact on sleep. Objective is to assess the feasibility of a walking-based intervention on TST, sleep quality, and sleep disturbance and to generate potential effect size estimates for a main trial. Participants were recruited at weekly rheumatology clinics and through social media. Patients with RA were randomized to a walking-based intervention consisting of 28 sessions, spread over 8 weeks (2-5 times/week), with 1 per week being supervised by a physiotherapist, or to a control group who received verbal and written advice on the benefits of exercise. Primary outcomes were recruitment, retention, protocol adherence and participant experience. The study protocol was published and registered in ClinicalTrials.gov NCT03140995. One hundred and one (101) people were identified through clinics, 36 through social media. Of these, 24 met the eligibility criteria, with 20 randomized (18% recruitment; 100% female; mean age 57 (SD 7.3 years). Ten intervention participants (100%) and eight control participants (80%) completed final assessments, with both groups equivalent for all variables at baseline. Participants in the intervention group completed 87.5% of supervised sessions and 93% of unsupervised sessions. No serious adverse events were related to the intervention. Pittsburgh Sleep Quality Index global score showed a significant mean improvement between the exercise group-6.6 (SD 3.3) compared to the control group-0.25 (SD 1.1) (p = 0.012); Intervention was feasible, safe and highly acceptable to study participants, with those participants in the exercise group reporting improvements in sleep duration and sleep quality compared to the control group. Based on these findings, a fully powered randomized trial is recommended. Trial registration number: ClinicalTrials.gov Identifier: NCT03140995 (April 25th, 2017).

The Influence of Different Physical Activity Behaviours on the Gut Microbiota of Older Irish Adults

OBJECTIVE

A 24-hour day is made up of time spent in a range of physical activity (PA) behaviours, including sleep, sedentary time, standing, light-intensity PA (LIPA) and moderate-to-vigorous PA (MVPA), all of which may have the potential to alter an individual's health through various different pathways and mechanisms. This study aimed to explore the relationship between PA behaviours and the gut microbiome in older adults.

DESIGN

Cross-sectional study.

SETTINGS AND PARTICIPANTS

Participants (n=100; age 69.0 [3.0] years; 44% female) from the Mitchelstown Cohort Rescreen (MCR) Study (2015-2017).

METHODS

Participants provided measures of gut microbiome composition (profiled by sequencing 16S rRNA gene amplicons), and objective measures of PA behaviours (by a 7-day wear protocol using an activPAL3 Micro).

RESULTS

Standing time was positively correlated with the abundance of butyrate-producing and anti-inflammatory bacteria, including Ruminococcaceae, Lachnospiraceae and Bifidobacterium, MVPA was positively associated with the abundance of Lachnospiraceae bacteria, while sedentary time was associated with lower abundance of Ruminococcaceae and higher abundance of Streptococcus spp.

CONCLUSION

Physical activity behaviours appear to influence gut microbiota composition in older adults, with different PA behaviours having diverging effects on gut microbiota composition.

Randomised controlled trial of tailored support to increase physical activity and reduce smoking in smokers not immediately ready to quit: protocol for the Trial of physical Activity-assisted Reduction of Smoking (TARS) Study

INTRODUCTION

Smoking reduction can lead to increased success in quitting. This study aims to determine if a client-focused motivational support package for smoking reduction (and quitting) and increasing (or otherwise using) physical activity (PA) can help smokers who do not wish to quit immediately to reduce the amount they smoke, and ultimately quit. This paper reports the study design and methods.

METHODS AND ANALYSIS

A pragmatic, multicentred, parallel, two group, randomised controlled superiority clinical trial, with embedded process evaluation and economics evaluation. Participants who wished to reduce smoking with no immediate plans to quit were randomised 1:1 to receive either (1) tailored individual health trainer face-to-face and/or telephone support to reduce smoking and increase PA as an aid to smoking reduction (intervention) or (2) brief written/electronic advice to reduce or quit smoking (control). Participants in both arms of the trial were also signposted to usual local support for smoking reduction and quitting. The primary outcome measure is 6-month carbon monoxide-confirmed floating prolonged abstinence following participant self-reported quitting on a mailed questionnaire at 3 and 9 months post-baseline. Participants confirmed as abstinent at 9 months will be followed up at 15 months.

ETHICS AND DISSEMINATION

Approved by SW Bristol National Health Service Research Committee (17/SW/0223). Dissemination will include publication of findings for the stated outcomes, parallel process evaluation and economic evaluation in peer-reviewed journals. Results will be disseminated to trial participants and healthcare providers.

TRIAL REGISTRATION NUMBER

ISRCTN47776579; Pre-results.

An mHealth Workplace-Based "Sit Less, Move More" Program: Impact on Employees' Sedentary and Physical Activity Patterns at Work and Away from Work

BACKGROUND

Most workplace interventions that aim to reduce sedentary behaviour have 38 focused on employees' sedentary patterns at-work but less have focused on understanding the 39 impact beyond working time. The aim of this study was to evaluate the impact of a 13-week m-40 health workplace-based 'sit less, move more' intervention (Walk@WorkApp; W@W-App) on 41 physical activity (PA) and sitting in desk-based employees at-work and away from work.

METHODS

Participants (n = 141) were assigned by hospital to an intervention group (IG; used the W@W-App; n = 90) or an active comparison group (A-CG; monitored occupational activity; n = 51). The W@W-App, installed on the participants´ own smartphones, provided real-time feedback for occupational sitting, standing, and stepping, and gave access to automated strategies to sit less and move more at work. Changes between groups were assessed for total sitting time, sedentary bouts and breaks, and light and moderate-to-vigorous PA (activPAL3TM; min/day) between the baseline and after program completion.

RESULTS

Compared to the A-CG, employees that used the W@W-App program increased their number of daily breaks and the time spent on short sedentary bouts (<20 min, p = 0.047) during weekends. Changes in shortest sedentary bouts (5-10 min) during weekends were also statistically significant (p < 0.05). No changes in workday PA or sitting were observed.

CONCLUSION

Desk-based employees seemed to transfer the W@W-App program knowledge outside of work. Evaluating the impact of workplace (mHealth-based or not) interventions at work but also away from work would provide a better understating of the impact of such interventions.

Adding web-based behavioural support to exercise referral schemes for inactive adults with chronic health conditions: the e-coachER RCT

BACKGROUND

There is modest evidence that exercise referral schemes increase physical activity in inactive individuals with chronic health conditions. There is a need to identify additional ways to improve the effects of exercise referral schemes on long-term physical activity.

OBJECTIVES

To determine if adding the e-coachER intervention to exercise referral schemes is more clinically effective and cost-effective in increasing physical activity after 1 year than usual exercise referral schemes.

DESIGN

A pragmatic, multicentre, two-arm randomised controlled trial, with a mixed-methods process evaluation and health economic analysis. Participants were allocated in a 1 : 1 ratio to either exercise referral schemes plus e-coachER (intervention) or exercise referral schemes alone (control).

SETTING

Patients were referred to exercise referral schemes in Plymouth, Birmingham and Glasgow.

PARTICIPANTS

There were 450 participants aged 16-74 years, with a body mass index of 30-40 kg/m2, with hypertension, prediabetes, type 2 diabetes, lower limb osteoarthritis or a current/recent history of treatment for depression, who were also inactive, contactable via e-mail and internet users.

INTERVENTION

e-coachER was designed to augment exercise referral schemes. Participants received a pedometer and fridge magnet with physical activity recording sheets, and a user guide to access the web-based support in the form of seven 'steps to health'. e-coachER aimed to build the use of behavioural skills (e.g. self-monitoring) while strengthening favourable beliefs in the importance of physical activity, competence, autonomy in physical activity choices and relatedness. All participants were referred to a standard exercise referral scheme.

PRIMARY OUTCOME MEASURE

Minutes of moderate and vigorous physical activity in ≥ 10-minute bouts measured by an accelerometer over 1 week at 12 months, worn ≥ 16 hours per day for ≥ 4 days including ≥ 1 weekend day.

SECONDARY OUTCOMES

Other accelerometer-derived physical activity measures, self-reported physical activity, exercise referral scheme attendance and EuroQol-5 Dimensions, five-level version, and Hospital Anxiety and Depression Scale scores were collected at 4 and 12 months post randomisation.

RESULTS

Participants had a mean body mass index of 32.6 (standard deviation) 4.4 kg/m2, were referred primarily for weight loss and were mostly confident self-rated information technology users. Primary outcome analysis involving those with usable data showed a weak indicative effect in favour of the intervention group (n = 108) compared with the control group (n = 124); 11.8 weekly minutes of moderate and vigorous physical activity (95% confidence interval -2.1 to 26.0 minutes; p = 0.10). Sixty-four per cent of intervention participants logged on at least once; they gave generally positive feedback on the web-based support. The intervention had no effect on other physical activity outcomes, exercise referral scheme attendance (78% in the control group vs. 75% in the intervention group) or EuroQol-5 Dimensions, five-level version, or Hospital Anxiety and Depression Scale scores, but did enhance a number of process outcomes (i.e. confidence, importance and competence) compared with the control group at 4 months, but not at 12 months. At 12 months, the intervention group incurred an additional mean cost of £439 (95% confidence interval -£182 to £1060) compared with the control group, but generated more quality-adjusted life-years (mean 0.026, 95% confidence interval 0.013 to 0.040), with an incremental cost-effectiveness ratio of an additional £16,885 per quality-adjusted life-year.

LIMITATIONS

A significant proportion (46%) of participants were not included in the primary analysis because of study withdrawal and insufficient device wear-time, so the results must be interpreted with caution. The regression model fit for the primary outcome was poor because of the considerable proportion of participants [142/243 (58%)] who recorded no instances of ≥ 10-minute bouts of moderate and vigorous physical activity at 12 months post randomisation.

FUTURE WORK

The design and rigorous evaluation of cost-effective and scalable ways to increase exercise referral scheme uptake and maintenance of moderate and vigorous physical activity are needed among patients with chronic conditions.

CONCLUSIONS

Adding e-coachER to usual exercise referral schemes had only a weak indicative effect on long-term rigorously defined, objectively assessed moderate and vigorous physical activity. The provision of the e-coachER support package led to an additional cost and has a 63% probability of being cost-effective based on the UK threshold of £30,000 per quality-adjusted life-year. The intervention did improve some process outcomes as specified in our logic model.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN15644451.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 63. See the NIHR Journals Library website for further project information.

Use of Compositional Data Analysis to Show Estimated Changes in Cardiometabolic Health by Reallocating Time to Light-Intensity Physical Activity in Older Adults

BACKGROUND

All physical activity (PA) behaviours undertaken over the day, including sleep, sedentary time, standing time, light-intensity PA (LIPA) and moderate-to-vigorous PA (MVPA) have the potential to influence cardiometabolic health. Since these behaviours are mutually exclusive, standard statistical approaches are unable to account for the impact on time spent in other behaviours.

OBJECTIVE

By employing a compositional data analysis (CoDA) approach, this study examined the associations of objectively measured time spent in sleep, sedentary time, standing time, LIPA and MVPA over a 24-h day on markers of cardiometabolic health in older adults.

METHODS

Participants (n =366; 64.6 years [5.3]; 46% female) from the Mitchelstown Cohort Rescreen Study provided measures of body composition, blood lipid and markers of glucose control. An activPAL3 Micro was used to obtain objective measures of sleep, sedentary time, standing time, LIPA and MVPA, using a 7-day continuous wear protocol. Regression analysis, using geometric means derived from CoDA (based on isometric log-ratio transformed data), was used to examine the relationship between the aforementioned behaviours and markers of cardiometabolic health.

RESULTS

Standing time and LIPA showed diverging associations with markers of body composition. Body mass index (BMI), body mass and fat mass were negatively associated with LIPA (all p <0.05) and positively associated with standing time (all p <0.05). Sedentary time was also associated with higher BMI (p <0.05). No associations between blood markers and any PA behaviours were observed, except for triglycerides, which were negatively associated with standing time (p < 0.05). Reallocating 30 min from sleep, sedentary time or standing time, to LIPA, was associated with significant decreases in BMI, body fat and fat mass.

CONCLUSION

This is the first study to employ CoDA in older adults that has accounted for sleep, sedentary time, standing time, LIPA and MVPA in a 24-h cycle. The findings support engagement in LIPA to improve body composition in older adults. Increased standing time was associated with higher levels of adiposity, with increased LIPA associated with reduced adiposity; therefore, these findings indicate that replacing standing time with LIPA is a strategy to lower adiposity.

Monitoring Occupational Sitting, Standing, and Stepping in Office Employees With the W@W-App and the MetaWearC Sensor: Validation Study

Background

Replacing occupational sitting time with active tasks has several proposed health benefits for office employees. Mobile phones and motion sensors can provide objective information in real time on occupational sitting behavior. However, the validity and feasibility of using mobile health (mHealth) devices to quantify and modify occupational sedentary time is unclear.

Objective

The aim of this study is to validate the new Walk@Work-Application (W@W-App)—including an external motion sensor (MetaWearC) attached to the thigh—for measuring occupational sitting, standing, and stepping in free-living conditions against the activPAL3M, the current gold-standard, device-based measure for postural behaviors.

Methods

In total, 20 office workers (16 [80%] females; mean age 39.5, SD 8.1 years) downloaded the W@W-App to their mobile phones, wore a MetaWearC sensor attached to their thigh using a tailored band, and wore the activPAL3M for 3-8 consecutive working hours. Differences between both measures were examined using paired-samples t tests and Wilcoxon signed-rank tests. Agreement between measures was examined using concordance correlation coefficients (CCCs), 95% CIs, Bland-Altman plots (mean bias, 95% limits of agreement [LoA]), and equivalence testing techniques.

Results

The median recording time for the W@W-App+MetaWearC and the activPAL3M was 237.5 (SD 132.8) minutes and 240.0 (SD 127.5) minutes, respectively (P<.001). No significant differences between sitting (P=.53), standing (P=.12), and stepping times (P=.61) were identified. The CCC identified substantial agreement between both measures for sitting (CCC=0.98, 95% CI 0.96-0.99), moderate agreement for standing (CCC=0.93, 95% CI 0.81-0.97), and poor agreement for stepping (CCC=0.74, 95% CI 0.47-0.88). Bland-Altman plots indicated that sitting time (mean bias –1.66 minutes, 95% LoA –30.37 to 20.05) and standing time (mean bias –4.85 minutes, 95% LoA –31.31 to 21.62) were underreported. For stepping time, a positive mean bias of 1.15 minutes (95% LoA –15.11 to 17.41) was identified. Equivalence testing demonstrated that the estimates obtained from the W@W-App+MetaWearC and the activPAL3M were considered equivalent for all variables excluding stepping time.

Conclusions

The W@W-App+MetaWearC is a low-cost tool with acceptable levels of accuracy that can objectively quantify occupational sitting, standing, stationary, and upright times in real time. Due to the availability of real-time feedback for users, this tool can positively influence occupational sitting behaviors in future interventions.

Trial Registration

ClinicalTrials.gov NCT04092738; https://clinicaltrials.gov/ct2/show/NCT04092738

Self-reported and activPALTM-monitored physical activity and sedentary behaviour in college students: Not all sitting behaviours are linked to perceived stress and anxiety

This study examined relationships between physical activity (PA) and sedentary behaviour (SB) with state-trait anxiety and stress. State-Trait anxiety (State-Trait Anxiety Inventory), psychological stress (Perceived Stress Scale), SB across domains during weekdays and weekends (Last 7-day Sedentary Behaviour Questionnaire) and PA intensities (International Physical Activity Questionnaire) were assessed by self-report in 360 undergraduates (44% females, mean age 20.9 ± 2.93 years). A subsample (n = 121; 53.7% females; mean age 20.8 ± 2.6 years) wore an activPAL^TM to determine total SB, light, and moderate-to-vigorous intensity PA (MVPA). Self-reported MVPA was significantly associated with lower trait anxiety and perceived stress, whereas light PA was only associated with lower perceived stress. Weekend total self-reported SB was related to higher trait anxiety and perceived stress levels, while total SB during the week was not. Of all SB domains, only leisure SB (screen and non-screen based) was associated with higher trait anxiety and perceived stress. PA attenuated the negative relationships between excessive sitting time and trait anxiety but not perceived stress. No associations were found for monitor-based measures of PA and SB. No associations were found between PA or SB variables with state anxiety. Further research is needed to assess causal and reciprocal relationships between PA, SB and mental health in college students.

Effects of downslope walking on Soleus H-reflexes and walking function in individuals with multiple sclerosis: A preliminary study

BACKGROUND

Downslope walking (DSW) is an eccentric-based exercise intervention that promotes neuroplasticity of spinal reflex circuitry by inducing depression of Soleus Hoffman (H)-reflexes in young, neurologically unimpaired adults.

OBJECTIVE

The objective of the study was to evaluate the effects of DSW on spinal excitability (SE) and walking function (WF) in people with multiple sclerosis (PwMS).

METHODS

Our study comprised two experiments on 12 PwMS (11 women; 45.3±11.8 years). Experiment 1 evaluated acute effects of a single 20-minute session of treadmill walking at three different walking grades on SE, 0% or level walking (LW), - 7.5% DSW, and - 15% DSW. Experiment 2 evaluated the effects of 6 sessions of DSW, at - 7.5% DSW (with second session being - 15% DSW) on SE and WF.

RESULTS

Experiment 1 showed significantly greater acute % H-reflex depression following - 15% DSW compared to LW (p = 0.02) and - 7.5% DSW (p = 0.05). Experiment 2 demonstrated significant improvements in WF. PwMS who showed greater acute H-reflex depression during the - 15% DSW session also demonstrated greater physical activity, long-distance WF, and the ability to have greater H-reflex depression after DSW training. Significant changes were not observed in regards to SE.

CONCLUSIONS

Though significant changes were not observed in SE after DSW training, we observed an improvement in WF which merits further investigation of DSW in PwMS.

An evaluation of an intervention designed to help inactive adults become more active with a peer mentoring component: a protocol for a cluster randomised feasibility trial of the Move for Life programme

Background

There is overwhelming evidence to support the promotion of physical activity in adults in terms of benefits to well-being, physical and mental health. Physical activity guidelines suggest that adults should accumulate at least 150 min of moderate to vigorous physical activity per week. In Ireland, the majority of adults do not achieve these guidelines, with costs to health and economy. ‘Move for Life’ (MFL) employs behavioural change techniques delivered by an instructor and peer mentor, using a train-the-trainer (cascade) model. This study will conduct a feasibility cluster randomised controlled trial of the MFL intervention for modifying physical activity behaviours in inactive adults aged 45 years and older.

Methods

The trial is set in eight Local Sports Partnership (LSP) hubs that have structured physical activity programmes. The hubs are the units of randomisation (clusters), and individuals are the units of analysis (participants). Eligible participants will contact one of the hubs, with each hub running four physical activity programmes. Each programme requires between 12–15 inactive adults, resulting in 48–60 participants per hub. Allowing for 20% dropout rate, an additional 96 people will be recruited giving a maximum sample of 576. The hub will be randomised: true control, usual programme or MFL intervention. The true control group will be given information about physical activity but will not be included in a programme for the duration of the trial; the intervention will involve the instructor training one (or more) of the participants to be a peer mentor using an educational toolkit; and usual care groups will have physical activity classes delivered as normal. Baseline data will collect physical activity measures and follow-up measurements will be obtained at 3 and 6 months. All participants will be asked to wear a device for measuring activity on the thigh (activPAL) for 7 days before commencing the programme and at 3 and 6 months. The primary objective of the study is to investigate if it is feasible to deliver the intervention and collect data on moderate to vigorous physical activity (MVPA) on all participants, thereby providing valuable information to guide sample size calculation for a future, more definitive trial.

Trial registration number

ISRCTN11235176

Electronic supplementary material

The online version of this article (10.1186/s40814-019-0473-y) contains supplementary material, which is available to authorized users.

Feasibility, acceptability and efficacy of a text message-enhanced clinical exercise rehabilitation intervention for increasing 'whole-of-day' activity in people living with and beyond cancer

Background

Exercise interventions are typically delivered to people with cancer and survivors via supervised clinical rehabilitation. However, motivating and maintaining activity changes outside of the clinic setting remains challenging. This study investigated the feasibility, acceptability and efficacy of an individually-tailored, text message-enhanced intervention that focused on increasing whole-of-day activity both during and beyond a 4-week, supervised clinical exercise rehabilitation program for people with cancer and survivors.

Methods

Participants (n = 36; mean ± SD age 64.8 ± 9.6 years; 44.1 ± 30.8 months since treatment) were randomized 1:1 to receive the text message-enhanced clinical exercise rehabilitation program, or the standard clinical exercise rehabilitation program alone. Activity was assessed at baseline, 4-weeks (end of the standard program) and 12-weeks (end of enhanced program) using both device (activPAL accelerometer; sitting, standing, light-stepping, moderate-stepping) and self-report [Multimedia Activity Recall for Children and Adults (MARCA); sedentary, light, moderate-to-vigorous physical activity (MVPA)] methods. The MARCA also assessed time use domains to provide context to activity changes. Changes and intervention effects were evaluated using linear mixed models, adjusting for baseline values and potential confounders.

Results

The study had high retention (86%) and participants reported high levels of satisfaction [4.3/5 (±0.8)] with the intervention. Over the first 4 weeks, MARCA-assessed MVPA increased [+ 53.2 (95%CI: 2.9, 103.5) min/d] between groups, favoring the text message-enhanced program, but there were no significant intervention effects on sedentary behavior. By 12 weeks, relative to the standard group, participants in the text message-enhanced group sat less [activPAL overall sitting: − 48.2 (− 89.9, − 5.6) min/16 h awake; MARCA: -80.1 (− 156.5, − 3.8) min/d] and were participating in more physical activity [activPAL light stepping: + 7.0 (0.4, 13.6: min/16 h awake; MARCA MVPA: + 67.3 (24.0, 110.6) min/d]. The time-use domains of Quiet Time [− 63.3 (− 110.5, − 16.0) min/d] and Screen Time [− 62.0 (− 109.7, − 14.2) min/d] differed significantly between groups.

Conclusions

Results demonstrate feasibility, acceptability and efficacy of a novel, text message-enhanced clinical exercise rehabilitation program to support changes in whole-of-day activity, including both physical activity and sedentary behavior. Changes were largely seen at 12-week follow-up, indicating potential for the intervention to result in continued improvement and maintenance of behavior change following a supervised exercise intervention.

Trial registration

This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616000641493; date registered 17/5/16).

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6767-4) contains supplementary material, which is available to authorized users.

Multicentred randomised controlled trial of an augmented exercise referral scheme using web-based behavioural support in individuals with metabolic, musculoskeletal and mental health conditions: protocol for the e-coachER trial

INTRODUCTION

Physical activity is recommended for improving health among people with common chronic conditions such as obesity, diabetes, hypertension, osteoarthritis and low mood. One approach to promote physical activity is via primary care exercise referral schemes (ERS). However, there is limited support for the effectiveness of ERS for increasing long-term physical activity and additional interventions are needed to help patients overcome barriers to ERS uptake and adherence.This study aims to determine whether augmenting usual ERS with web-based behavioural support, based on the LifeGuide platform, will increase long-term physical activity for patients with chronic physical and mental health conditions, and is cost-effective.

METHODS AND ANALYSIS

A multicentre parallel two-group randomised controlled trial with 1:1 individual allocation to usual ERS alone (control) or usual ERS plus web-based behavioural support (intervention) with parallel economic and mixed methods process evaluations. Participants are low active adults with obesity, diabetes, hypertension, osteoarthritis or a history of depression, referred to an ERS from primary care in the UK.The primary outcome measure is the number of minutes of moderate-to-vigorous physical activity (MVPA) in ≥10 min bouts measured by accelerometer over 1 week at 12 months.We plan to recruit 413 participants, with 88% power at a two-sided alpha of 5%, assuming 20% attrition, to demonstrate a between-group difference of 36-39 min of MVPA per week at 12 months. An improvement of this magnitude represents an important change in physical activity, particularly for inactive participants with chronic conditions.

ETHICS AND DISSEMINATION

Approved by North West Preston NHS Research Ethics Committee (15/NW/0347). Dissemination will include publication of findings for the stated outcomes, parallel process evaluation and economic evaluation in peer-reviewed journals.Results will be disseminated to ERS services, primary healthcare providers and trial participants.

TRIAL REGISTRATION NUMBER

ISRCTN15644451; Pre-results.

Comparison of four Fitbit and Jawbone activity monitors with a research-grade ActiGraph accelerometer for estimating physical activity and energy expenditure

BACKGROUND/AIM

Consumer-based physical activity (PA) monitors have become popular tools to track PA behaviours. Currently, little is known about the validity of the measurements provided by consumer monitors. We aimed to compare measures of steps, energy expenditure (EE) and active minutes of four consumer monitors with one research-grade accelerometer within a semistructured protocol.

METHODS

Thirty men and women (18-80 years old) wore Fitbit One (worn at the waist), Fitbit Zip (waist), Fitbit Flex (wrist), Jawbone UP24 (wrist) and one waist-worn research-grade accelerometer (ActiGraph) while participating in an 80 min protocol. A validated EE prediction equation and active minute cut-points were applied to ActiGraph data. Criterion measures were assessed using direct observation (step count) and portable metabolic analyser (EE, active minutes). A repeated measures analysis of variance (ANOVA) was used to compare differences between consumer monitors, ActiGraph, and criterion measures. Similarly, a repeated measures ANOVA was applied to a subgroup of subjects who didn't cycle.

RESULTS

Participants took 3321±571 steps, had 28±6 active min and expended 294±56 kcal based on criterion measures. Comparatively, all monitors underestimated steps and EE by 13%-32% (p<0.01); additionally the Fitbit Flex, UP24, and ActiGraph underestimated active minutes by 35%-65% (p<0.05). Underestimations of PA and EE variables were found to be similar in the subgroup analysis.

CONCLUSION

Consumer monitors had similar accuracy for PA assessment as the ActiGraph, which suggests that consumer monitors may serve to track personal PA behaviours and EE. However, due to discrepancies among monitors, individuals should be cautious when comparing relative and absolute differences in PA values obtained using different monitors.