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Lourenço P, Bastos T, Pizarro A, Corredeira R. The long-term effects of a 24-week outdoor exercise program in persons with schizophrenia: Results of a 12-week follow-up period. Schizophr Res 2025; 278:47-56. [PMID: 40112445 DOI: 10.1016/j.schres.2025.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 01/30/2025] [Accepted: 03/03/2025] [Indexed: 03/22/2025]
Abstract
This study aims to examine the long-term mental and physical health benefits of a 24-week outdoor exercise program after a 12-week follow-up. Forty-seven outpatients with schizophrenia completed a 24-week supervised exercise program twice a week, of whom forty-six were assessed after the follow-up period. Demographic and clinical measures were collected. Physical health was evaluated using anthropometric measures, six minutes walk test, Eurofit and accelerometer. Mental health was evaluated using Rosenberg Self-Esteem scale, Behavioural Exercise Regulations Questionnaire and World Health Organization Quality of Life Scale - Brief Version questionnaires. Participants were assessed at baseline, post-intervention and 12-week follow up. After follow-up, there were significant differences in time, between groups and in time*group in six minutes walk test. Previously observed improvements in functional exercise capacity were lost by 12-week. Flexibility scores were maintained during intervention but worsened significantly by 12-week. On the other hand, participants reported significant improvements in quality of life - physical domain by 12-week. Moderate-to-vigorous physical activity decreased and sedentary behaviour and number of flamingo errors increased but failed to achieve statistical significance. Persons with schizophrenia will lost physical health benefits previously achieved during an outdoor exercise program when supervised exercise cease.
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Affiliation(s)
- Paulo Lourenço
- Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport of the University of Porto, Portugal.
| | - Tânia Bastos
- Centre of Research, Education, Innovation, and Intervention in Sport, Faculty of Sport, University of Porto, Porto, Portugal
| | - Andreia Pizarro
- Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport of the University of Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Rui Corredeira
- Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport of the University of Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
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Edwardson CL, Abell L, Clarke-Cornwell A, Dunstan DW, Gray LJ, Healy GN, Hadjiconstantinou M, Wilson P, Maylor B, Munir F, Biddle SJ. Implementation and engagement of the SMART Work & Life sitting reduction intervention: an exploratory analysis on intervention effectiveness. Int J Behav Nutr Phys Act 2023; 20:148. [PMID: 38115044 PMCID: PMC10729557 DOI: 10.1186/s12966-023-01548-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/09/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND To enhance the impact of interventions, it is important to understand how intervention engagement relates to study outcomes. We report on the level of implementation and engagement with the SMART Work & Life (SWAL) programme (delivered with (SWAL plus desk) and without a height-adjustable desk (SWAL)) and explore the effects of different levels of this on change in daily sitting time in comparison to the control group. METHODS The extent of intervention delivery by workplace champions and the extent of engagement by champions and participants (staff) with each intervention activity was assessed by training attendance logs, workplace champion withdrawal dates, intervention activities logs and questionnaires. These data were used to assess whether a cluster met defined criteria for low, medium, or high implementation and engagement or none of these. Mixed effects linear regression analyses tested whether change in sitting time varied by: (i) the number of intervention activities implemented and engaged with, and (ii) the percentage of implementation and engagement with all intervention strategies. RESULTS Workplace champions were recruited for all clusters, with 51/52 (98%) attending training. Overall, 12/27 (44.4%) SWAL and 9/25 (36.0%) SWAL plus desk clusters implemented all main intervention strategies. Across remaining clusters, the level of intervention implementation varied. Those in the SWAL (n = 8 (29.6%) clusters, 80 (32.1%) participants) and SWAL plus desk (n = 5 (20.0%) clusters, 41 (17.1%) participants) intervention groups who implemented and engaged with the most intervention strategies and had the highest percentage of cluster implementation and engagement with all intervention strategies sat for 30.9 (95% CI -53.9 to -7.9, p = 0.01) and 75.6 (95% CI -103.6 to -47.7, p < 0.001) fewer minutes/day respectively compared to the control group at 12 month follow up. These differences were larger than the complete case analysis. The differences in sitting time observed for the medium and low levels were similar to the complete case analysis. CONCLUSIONS Most intervention strategies were delivered to some extent across the clusters although there was large variation. Superior effects for sitting reduction were seen for those intervention groups who implemented and engaged with the most intervention components and had the highest level of cluster implementation and engagement. TRIAL REGISTRATION ISRCTN11618007. Registered on 24 January 2018. https://www.isrctn.com/ISRCTNISRCTN11618007 .
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Affiliation(s)
- Charlotte L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester, LE5 4PW, UK.
- NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK.
| | - Lucy Abell
- Department of Population Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
| | - Alex Clarke-Cornwell
- School of Health & Society, University of Salford, Salford, Greater Manchester, M6 6PU, UK
| | - David W Dunstan
- Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, 3125, Australia
| | - Laura J Gray
- NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK
- Department of Population Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
| | - Genevieve N Healy
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
| | | | - Panna Wilson
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, LE5 4PW, UK
| | - Benjamin Maylor
- Diabetes Research Centre, University of Leicester, Leicester, LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK
| | - Fehmidah Munir
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, LE11 3TU, UK
| | - Stuart Jh Biddle
- Centre for Health Research, University of Southern Queensland, Springfield Central, QLD, 4300, Australia
- Faculty of Sport & Health Sciences, University of Jyväskylä, Jyväskylä, FI-40014, Finland
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Jahangiry L, Farhangi MA. Obesity paradigm and web-based weight loss programs: an updated systematic review and meta-analysis of randomized controlled trials. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2021; 40:16. [PMID: 33832547 PMCID: PMC8033688 DOI: 10.1186/s41043-021-00240-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 03/23/2021] [Indexed: 05/14/2023]
Abstract
BACKGROUNDS Web-based therapeutic approaches are new and attractive tools for primary health care systems due to their time and cost-saving nature and their accessibility for different populations. The aim of the current systematic review and meta-analysis is to summarize the results of studies evaluating the effect of web-based interventional programs on weight loss among overweight and obese individuals. METHODS A literature review from 2000 to 2016 was conducted. Studies were included in the study if they had adult participants with body mass index (BMI) ≥ 25 kg/m2, a web-user intervention arm, and a non-web user control arm, with the primary aim of weight loss. Weight change in the interventional group versus control group was pooled with the random-effect model. Data were extracted on sample characteristics, drop-outs, weight loss, intervention duration, and the amount of weight loss. The mean weighted difference and 95% confidence intervals (CI) were calculated. RESULTS Eight studies met the inclusion criteria and included in the final model. Overall, using the web-based interventions had a weak non-significant effect on weight loss in overweight and obese individuals (WMD 0.56 kg, CI - 3.474, 4.592; P = 0.786). The most important reason was the unadjusted baseline weight of experimental and control groups in included studies, although the stratified analysis showed that, low study quality score and not using feedback and goal-setting in the study were the main factors diminishing the effectiveness of web-based intervention treatment group. CONCLUSION The results of the current meta-analysis indicated no effectiveness of web-based interventional programs in the weight loss of overweight and obese individuals. Although the great between-study heterogeneity and a small number of included studies further highlight the need for additional researches in this field.
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Affiliation(s)
- Leila Jahangiry
- Health Education and Health Promotion Department, School of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahdieh Abbasalizad Farhangi
- Research Center for Evidence-Based Medicine, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Mclaughlin M, Delaney T, Hall A, Byaruhanga J, Mackie P, Grady A, Reilly K, Campbell E, Sutherland R, Wiggers J, Wolfenden L. Associations Between Digital Health Intervention Engagement, Physical Activity, and Sedentary Behavior: Systematic Review and Meta-analysis. J Med Internet Res 2021; 23:e23180. [PMID: 33605897 PMCID: PMC8011420 DOI: 10.2196/23180] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/18/2020] [Accepted: 12/07/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The effectiveness of digital health interventions is commonly assumed to be related to the level of user engagement with the digital health intervention, including measures of both digital health intervention use and users' subjective experience. However, little is known about the relationships between the measures of digital health intervention engagement and physical activity or sedentary behavior. OBJECTIVE This study aims to describe the direction and strength of the association between engagement with digital health interventions and physical activity or sedentary behavior in adults and explore whether the direction of association of digital health intervention engagement with physical activity or sedentary behavior varies with the type of engagement with the digital health intervention (ie, subjective experience, activities completed, time, and logins). METHODS Four databases were searched from inception to December 2019. Grey literature and reference lists of key systematic reviews and journals were also searched. Studies were eligible for inclusion if they examined a quantitative association between a measure of engagement with a digital health intervention targeting physical activity and a measure of physical activity or sedentary behavior in adults (aged ≥18 years). Studies that purposely sampled or recruited individuals on the basis of pre-existing health-related conditions were excluded. In addition, studies were excluded if the individual engaging with the digital health intervention was not the target of the physical activity intervention, the study had a non-digital health intervention component, or the digital health interventions targeted multiple health behaviors. A random effects meta-analysis and direction of association vote counting (for studies not included in meta-analysis) were used to address objective 1. Objective 2 used vote counting on the direction of the association. RESULTS Overall, 10,653 unique citations were identified and 375 full texts were reviewed. Of these, 19 studies (26 associations) were included in the review, with no studies reporting a measure of sedentary behavior. A meta-analysis of 11 studies indicated a small statistically significant positive association between digital health engagement (based on all usage measures) and physical activity (0.08, 95% CI 0.01-0.14, SD 0.11). Heterogeneity was high, with 77% of the variation in the point estimates explained by the between-study heterogeneity. Vote counting indicated that the relationship between physical activity and digital health intervention engagement was consistently positive for three measures: subjective experience measures (2 of 3 associations), activities completed (5 of 8 associations), and logins (6 of 10 associations). However, the direction of associations between physical activity and time-based measures of usage (time spent using the intervention) were mixed (2 of 5 associations supported the hypothesis, 2 were inconclusive, and 1 rejected the hypothesis). CONCLUSIONS The findings indicate a weak but consistent positive association between engagement with a physical activity digital health intervention and physical activity outcomes. No studies have targeted sedentary behavior outcomes. The findings were consistent across most constructs of engagement; however, the associations were weak.
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Affiliation(s)
- Matthew Mclaughlin
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Tessa Delaney
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Alix Hall
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Judith Byaruhanga
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Paul Mackie
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, Australia
- Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melbourne, Australia
| | - Alice Grady
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Kathryn Reilly
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Elizabeth Campbell
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
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Farris SG, Abrantes AM. Mental health benefits from lifestyle physical activity interventions: A systematic review. Bull Menninger Clin 2020; 84:337-372. [PMID: 33779237 DOI: 10.1521/bumc.2020.84.4.337] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Lifestyle physical activity (LPA) interventions are a promising alternative to structured exercise interventions for addressing mental health problems. The authors conducted a systematic review of the literature on LPA interventions in any population in order to determine (a) the extent to which mental health outcomes were examined and (b) whether benefits in mental health outcomes were observed. Mental health outcomes were defined as depression, anxiety, perceived stress, health-related quality of life, and psychological well-being. A total of 73 articles were identified as LPA intervention, of which 24.7% (n = 18) reported the effect of LPA intervention on mental health outcomes. The most commonly evaluated mental health outcome was depression, and to a lesser extent anxiety and perceived stress. Overall, findings point to promising effects of LPA interventions across common mental health problems. Key areas for future research are discussed in light of emergent limitations in existing published studies.
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Affiliation(s)
- Samantha G Farris
- Department of Psychology, Rutgers, the State University of New Jersey, Piscataway, New Jersey
| | - Ana M Abrantes
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Behavioral Medicine and Addictions Research Unit, Butler Hospital, Providence, Rhode Island
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Pedometer Feedback Interventions Increase Daily Physical Activity in Phase III Cardiac Rehabilitation Participants. J Cardiopulm Rehabil Prev 2020; 40:183-188. [PMID: 31714397 DOI: 10.1097/hcr.0000000000000472] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the effects of individually tailored interventions designed to increase physical activity (PA) in cardiac patients. METHODS A total of 99 (77 men and 22 women, 61.5 ± 10.7 yr) patients entering a phase III cardiac rehabilitation program completed a 12-wk PA intervention. Patients were randomized to usual care (UC, time-based recommendation), pedometer feedback (PF), newsletter-based motivational messaging (MM), or PF + MM. Both PF groups were given a goal of increasing steps/d by 10% of individual baseline value each week. If the goal for the week was not reached, the same goal was used for the next week. Physical activity was assessed for 7 d before beginning and after completing the program. The change in steps/d, moderate to vigorous intensity PA minutes, and sedentary time were compared among intervention groups. RESULTS Average change in steps/d was found to be significantly greater (P < .01) in the PF (2957 ± 3185) and the PF + MM (3150 ± 3007) compared with UC (264 ± 2065) and MM (718 ± 2415) groups. No group experienced changes in moderate to vigorous intensity PA time and only the PF intervention group decreased sedentary time (baseline 470.2 ± 77.1 to postintervention 447.8 ± 74.9 min/d, P = .01). CONCLUSION The findings from this study demonstrate that using PF was superior to the usual time-based PA recommendations and to newsletter-based MM in patients starting a phase III CR program. Cardiac rehabilitation programs are encouraged to implement PA feedback with individualized PA goals in order to support the increase in PA.
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Joseph RP, Daniel CL, Thind H, Benitez TJ, Pekmezi D. Applying Psychological Theories to Promote Long-Term Maintenance of Health Behaviors. Am J Lifestyle Med 2016; 10:356-368. [PMID: 28217036 PMCID: PMC5313056 DOI: 10.1177/1559827614554594] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 06/11/2014] [Accepted: 07/01/2014] [Indexed: 11/17/2022] Open
Abstract
Behavioral health theory provides a framework for researchers to design, implement, and evaluate the effects of health promotion programs. However, limited research has examined theories used in interventions to promote long-term maintenance of health behaviors. The purpose of this review was to evaluate the available literature and identify prominent behavioral health theories used in intervention research to promote maintenance of health behaviors. We reviewed theories used in intervention research assessing long-term maintenance (≥ 6 months post-intervention) of physical activity, weight loss, and smoking cessation. Five prominent behavioral theories were referenced by the 34 studies included in the review: Self-Determination Theory, Theory of Planned Behavior, Social Cognitive Theory, Transtheoretical Model, and Social Ecological Model. Descriptions and examples of applications of these theories are provided. Implications for future research are discussed.
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Affiliation(s)
- Rodney P. Joseph
- Rodney P. Joseph, PhD, College of Nursing and Health Innovation, Arizona State University, 500 North Third Street, Phoenix, AZ 85004; e-mail:
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Hargreaves EA, Mutrie N, Fleming JD. A Web-Based Intervention to Encourage Walking (StepWise): Pilot Randomized Controlled Trial. JMIR Res Protoc 2016; 5:e14. [PMID: 26810251 PMCID: PMC4746436 DOI: 10.2196/resprot.4288] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 09/08/2015] [Accepted: 11/05/2015] [Indexed: 12/01/2022] Open
Abstract
Background Despite Internet-based interventions that incorporate pedometers with appropriate goal-setting processes and other theoretically-based behavior change strategies being proposed as a means of increasing walking behavior, few have incorporated all of these key features or assessed maintenance of behavior change. Objective The objective of our study was to investigate the effect of a 12-week pedometer step goal walking program individually tailored to baseline step counts, combined with an interactive support website for step counts, health parameters and motivation over 12 and 24 weeks. Methods Low active participants (mean [SD] 46.2 [11.2] years) were randomly assigned to the Stepwise (SW) intervention group (n=49) or a comparison (CP) group (n=48). SW received a pedometer, step goal walking program and access to the SW website (containing interactive self-monitoring and goal feedback tools, motivational messages and action and coping planning strategies). CP received a pedometer and locally available physical activity information. Step counts, BMI, resting heart rate, blood pressure and glucose, cholesterol and triglyceride levels, psychological well-being, perceived health, self-efficacy and self-determined motivation were measured at baseline, 12 and 24 weeks. Results Linear mixed model analysis found that both groups’ step counts increased from baseline to week 12 (β = 11,002, CI 5739-16,266, P<.001) and 24 (β = 6810, CI 1190-12,431; P=.02). Group step counts were significantly different at week 24 with SW taking 8939 (CI 274-17604, P=.04) more steps compared to CP. Compared to baseline, both groups had improved triglyceride levels (0.14 mmol/L, CI -0.25 to -0.02, P=.02) at week 12, decreased diastolic blood pressure (4.22 mmHg, CI -6.73 to -1.72) at weeks 12 and 24 (3.17 mmHg, CI -5.55 to -0.78), improved positive (β = .21, CI 0.03-0.38, P=.02) and negative affect (β = -.15, CI -0.28 to -0.03, P=.02) at week 12, and perceived health at week 12 (β = 6.37, CI 2.10-10.65, P=.004) and 24 (β = 8.52, CI 3.98-13.06, P<.001). Total cholesterol increased at week 12 (0.26 mmol/L, CI 0.099-0.423, P=.006) and week 24 (0.38 mmol/L, CI 0.20-0.56, P<.001). Repeated measures ANOVA found motivation for walking improved from baseline with higher task self-efficacy (P<.001, η2 = .13) and autonomous motivation (P<.001, η2=.14) at weeks 12 and 24 and decreased controlled motivation (P=.004, η2=.08) at week 24. Conclusions Both groups had similar improvements in step counts and physical and psychological health after 12 weeks but only the SW group successfully maintained the increased step-counts 24 weeks post-intervention. This suggests the step-goal based walking program combined with Internet-based behavior change tools were important for sustained behavior change.
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Affiliation(s)
- Elaine Anne Hargreaves
- School of Physical Education, Sport & Exercise Sciences, University of Otago, Dunedin, New Zealand.
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Okazaki K, Okano S, Haga S, Seki A, Suzuki H, Takahashi K. One-year outcome of an interactive internet-based physical activity intervention among university students. Int J Med Inform 2014; 83:354-60. [DOI: 10.1016/j.ijmedinf.2014.01.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 01/21/2014] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
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Kaminsky LA, Jones J, Riggin K, Strath SJ. A pedometer-based physical activity intervention for patients entering a maintenance cardiac rehabilitation program: a pilot study. Cardiovasc Diagn Ther 2013; 3:73-9. [PMID: 24282749 DOI: 10.3978/j.issn.2223-3652.2013.03.03] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 03/19/2013] [Indexed: 12/27/2022]
Abstract
PURPOSE To compare the effects of an individualized pedometer-driven physical activity (PA) intervention with the usual time-based PA recommendations given to patients entering a maintenance cardiac rehabilitation (CR) program. METHODS A total of 18 subjects entering a maintenance CR program were recruited and completed the study. Subjects were randomized into pedometer feedback [PF: n=10 (2 women), 53.3±8.1 yrs] and usual care [UC: n=8 (2 women), 59.4±9.9 yrs] groups. New Lifestyles NL-1000 pedometers were used to monitor ambulatory PA. Subjects in both groups participated in the same maintenance CR program for a total of 8 weeks and all were encouraged to obtain a minimum of 30-40 min/d of moderate-vigorous-intensity physical activity (MVPA), on days they did not attend CR. Subjects in the PF group were given individualized daily stepcount goals (increase 10% of baseline steps/d each week) for weeks 2-8. Ambulatory PA was measured with pedometers, recording both total number of steps/d and min/d of MVPA. Measures were obtained during the first week of the maintenance CR program and during the 8th week. Data were also compared between days subjects attended and on days they did not attend. RESULTS By the 8th week of CR, PF subjects increased daily stepcounts by 42% (2,297±1,606 steps/d, P=0.001), with a 36% increase on CR days (2,654±2,089 steps/d, P=0.003) and a 45% increase on days they did not attend CR (1,872±2,026 steps/d, P=0.017). There were no changes observed in the UC group. CONCLUSIONS Providing pedometers with individualized stepcount goals to patients entering a CR program was superior to the usual time-based PA recommendations for increasing PA.
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Joseph RP, Durant NH, Benitez TJ, Pekmezi DW. Internet-Based Physical Activity Interventions. Am J Lifestyle Med 2013; 8:42-68. [PMID: 25045343 DOI: 10.1177/1559827613498059] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This article provides a comprehensive review of Internet- and Website-based physical activity interventions targeting adult populations. Search procedures identified 72 unique Internet-based physical activity interventions published in peer-reviewed journals. Participants of the studies were predominately White, middle-aged (mean age = 43.3 years), and female (65.9%). Intervention durations ranged from 2 weeks to 13 months (median = 12 weeks). Forty-six of the studies were randomized controlled trials, 21 were randomized trials without a control condition, 2 were non-randomized controlled trials, and 3 used a single-group design. The majority of studies (n = 68) assessed outcomes immediately following the end of the intervention period, and 16 studies provided delayed postintervention assessments. Forty-four of the 72 studies (61.1%) reported significant increases in physical activity. Future directions for Internet-based physical activity interventions include increasing representation of minority and male populations in Internet-based efforts, conducting delayed postintervention follow-up assessments, and incorporating emerging technologies (ie, cellular and Smartphones) into Internet-based physical activity efforts.
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Affiliation(s)
- Rodney P Joseph
- School of Public Health (RPJ, TJB, DWP) and the Division of General Pediatrics and Adolescent Medicine (NHD), University of Alabama at Birmingham, Alabama
| | - Nefertiti H Durant
- School of Public Health (RPJ, TJB, DWP) and the Division of General Pediatrics and Adolescent Medicine (NHD), University of Alabama at Birmingham, Alabama
| | - Tanya J Benitez
- School of Public Health (RPJ, TJB, DWP) and the Division of General Pediatrics and Adolescent Medicine (NHD), University of Alabama at Birmingham, Alabama
| | - Dorothy W Pekmezi
- School of Public Health (RPJ, TJB, DWP) and the Division of General Pediatrics and Adolescent Medicine (NHD), University of Alabama at Birmingham, Alabama
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Lee MK, Park HA, Yun YH, Chang YJ. Development and formative evaluation of a web-based self-management exercise and diet intervention program with tailored motivation and action planning for cancer survivors. JMIR Res Protoc 2013; 2:e11. [PMID: 23612029 PMCID: PMC3628152 DOI: 10.2196/resprot.2331] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Revised: 11/16/2012] [Accepted: 11/17/2012] [Indexed: 01/23/2023] Open
Abstract
Background Most dietary and exercise interventions developed to date for cancer survivors have employed intensive clinic-based face-to-face counseling sessions. However, when the clinic-based face-to-face intervention ends, the participants cannot receive feedback from the experts, and the motivation for regular exercise and diet practices decreases. One way to overcome the shortcomings of clinic-based face-to-face intervention is to employ the Internet to this end. To maximize effectiveness when providing Web-based interventions, action planning should be able to start at the right time, education should be tailored to motivational readiness, and self-efficacy should be enhanced at appropriate intervals. Objective The aim of this study was to develop a Web-based self-management diet and exercise intervention program with the aid of the transtheoretical model (TTM) and to conduct formative evaluations. Methods The Web-based self-management exercise and diet intervention program was developed employing a 5-phase system development life-cycle (SDLC) method. The 5 phases were 1) identification of user requirements, 2) system design, 3) system development, 4) system evaluation, and 5) system application. An expert group composed of 3 content experts, a Web developer, and 2 Web designers, evaluated the usability and accuracy of the content. The program was evaluated by 30 breast cancer survivors for perceived ease of use. Results The Web-based self-managed exercise and diet intervention program contained 5 components differing in screen layout. These components are introduction, assessment, education (tailored information provision), action planning (goal setting, scheduling, keeping a diary), and automatic feedback. Education, action planning, and automatic feedback were tailored to each participant through the assessment. The processes of change, self-efficacy, and decisional balance, which are the principal strategies encouraging behavioral change according to the TTM theory, were reflected in the education, and self-efficacy was also reflected in the automatic feedback. After iterative testing by experts on problems that arose in terms of usability and content accuracy during system operation, the perceived ease of use of the program was evaluated by 29 breast cancer survivors. The end users rated the program as being easy to understand and use (a total usability score of 81.3 points). In addition, program feasibility was evaluated using the percentage of patients (27/30, 90%) who consistently used the program. Conclusions The use of Internet technology allowed immediate and easy access to interventions, real-time monitoring of progress, online education, tailored action planning, and tailored short message services using mobile phones.
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Affiliation(s)
- Myung Kyung Lee
- Department of Nursing, Dong-A University, Busan, Korea, Republic Of
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Yun YH, Lee KS, Kim YW, Park SY, Lee ES, Noh DY, Kim S, Oh JH, Jung SY, Chung KW, Lee YJ, Jeong SY, Park KJ, Shim YM, Zo JI, Park JW, Kim YA, Shon EJ, Park S. Web-based tailored education program for disease-free cancer survivors with cancer-related fatigue: a randomized controlled trial. J Clin Oncol 2012; 30:1296-303. [PMID: 22412149 DOI: 10.1200/jco.2011.37.2979] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To determine whether an Internet-based tailored education program is effective for disease-free cancer survivors with cancer-related fatigue (CRF). PATIENTS AND METHODS We randomly assigned patients who had completed primary cancer treatment within the past 24 months in any of four Korean hospitals and had reported moderate to severe fatigue for at least 1 week to participate in a 12-week, Internet-based, individually tailored CRF education program or to receive routine care. We based the program on the CRF guidelines of the National Comprehensive Cancer Network (NCCN) and incorporated the transtheoretic model (TTM). At baseline and 12 weeks, we used the Brief Fatigue Inventory (BFI) and Fatigue Severity Scale (FSS) as primary outcomes and the Hospital Anxiety and Depression Scale (HADS) and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) for secondary outcomes. RESULTS We recruited 273 participants and randomly assigned 136 to the intervention group. Compared with the control group, the intervention group had an improvement in fatigue as shown by a significantly greater decrease in BFI global score (-0.66 points; 95% CI -1.04 to -0.27) and FSS total score (-0.49; 95% CI, -0.78 to -0.21). In secondary outcomes, the intervention group experienced a significantly greater decrease in HADS anxiety score (-0.90; 95% CI, -1.51 to -0.29) as well as global quality of life (5.22; 95% CI, 0.93 to 9.50) and several functioning scores of the EORTC QLQ-C30. CONCLUSION An Internet-based education program based on NCCN guidelines and TTM may help patients manage CRF.
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Donkin L, Christensen H, Naismith SL, Neal B, Hickie IB, Glozier N. A systematic review of the impact of adherence on the effectiveness of e-therapies. J Med Internet Res 2011; 13:e52. [PMID: 21821503 PMCID: PMC3222162 DOI: 10.2196/jmir.1772] [Citation(s) in RCA: 566] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 05/24/2011] [Accepted: 05/05/2011] [Indexed: 01/21/2023] Open
Abstract
Background As the popularity of e-therapies grows, so too has the body of literature supporting their effectiveness. However, these interventions are often plagued by high attrition rates and varying levels of user adherence. Understanding the role of adherence may be crucial to understanding how program usage influences the effectiveness of e-therapy interventions. Objective The aim of this study was to systematically review the e-therapy literature to (1) describe the methods used to assess adherence and (2) evaluate the association of adherence with outcome of these interventions. Methods A systematic review of e-therapy interventions was conducted across disease states and behavioral targets. Data were collected on adherence measures, outcomes, and analyses exploring the relationship between adherence measures and outcomes. Results Of 69 studies that reported an adherence measure, only 33 (48%) examined the relationship between adherence and outcomes. The number of logins was the most commonly reported measure of adherence, followed by the number of modules completed. The heterogeneity of adherence and outcome measures limited analysis. However, logins appeared to be the measure of adherence most consistently related to outcomes in physical health interventions, while module completion was found to be most related to outcomes in psychological health interventions. Conclusions There is large variation in the reporting of adherence and the association of adherence with outcomes. A lack of agreement about how best to measure adherence is likely to contribute to the variation in findings. Physical and psychological outcomes seem influenced by different types of adherence. A composite measure encompassing time online, activity completion, and active engagements with the intervention may be the best measure of adherence. Further research is required to establish a consensus for measuring adherence and to understand the role of adherence in influencing outcomes.
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Affiliation(s)
- Liesje Donkin
- Brain & Mind Research Institute, The University of Sydney, Camperdown, Australia.
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The impact of blue space on human health and well-being - Salutogenetic health effects of inland surface waters: a review. Int J Hyg Environ Health 2011; 214:449-60. [PMID: 21665536 DOI: 10.1016/j.ijheh.2011.05.001] [Citation(s) in RCA: 161] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 04/13/2011] [Accepted: 05/13/2011] [Indexed: 11/24/2022]
Abstract
Water is one of the most important physical, aesthetic landscape elements and possesses importance e.g. in environmental psychology, landscape design, and tourism research, but the relationship between water and health in current literature is only investigated in the field of environmental toxicology and microbiology, not explicitly in the research field of blue space and human well-being. Due to the lack of a systematic review of blue space and well-being in the various fields of research, the aim of this review is to provide a systematic, qualitative meta-analysis of existing studies that are relevant to this issue. Benefits for health and well-being clearly related to blue space can be identified with regard to perception and preference, landscape design, emotions, and restoration and recreation. Additionally, direct health benefits have already been stated. The studies included in the review are mostly experimental studies or cross-sectional surveys, focusing on students as the subject group. There is a need for more qualitative and multi-faceted, interdisciplinary studies, using triangulation as a method to achieve a resilient image of reality. A broader study design considering all age groups would contribute to identifying benefits for the whole of society. The inattentiveness to blue space makes it difficult to measure long-term effects of blue space on well-being. There is still little respect for water and health in planning issues, although salutogenetic health benefits can be identified. To close the gap regarding missing systematic concepts, a concept for assessing salutogenetic health effects in blue space is provided. Blue space is considered therein as a multi-dimensional term including four dimensions of appropriation, as well as at least five ontological dimensions of substantiality. The aim of the concept is to support researchers and practitioners analysing health effects in blue space.
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Lloret J. Human health benefits supplied by Mediterranean marine biodiversity. MARINE POLLUTION BULLETIN 2010; 60:1640-1646. [PMID: 20822779 DOI: 10.1016/j.marpolbul.2010.07.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 07/24/2010] [Accepted: 07/29/2010] [Indexed: 05/29/2023]
Abstract
This paper summarizes the overall benefits supplied by Mediterranean marine biodiversity to human health and highlights the anthropogenic and environmental causes that are threatening these benefits. First, the Mediterranean Sea is a valuable source of seafood, which is an important component of the so-called "Mediterranean diet". This type of diet has several health benefits, including cardio and cancer protective effects, which are attributed to the high intake of seafood-derived n-3 (omega-3) fatty acids. Second, the Mediterranean marine organisms, particularly the benthic ones, have furnished a large variety of bioactive metabolites, some of which are being developed into new drugs to threat major human diseases such as cancer. Third, the Mediterranean coastal areas provide environments for practising maritime leisure activities that provide physical and psychological benefits to users. Despite all this, fishing, tourism, contamination and sea warming are deteriorating this rich marine ecosystem, which needs to be protected to assure human welfare.
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Affiliation(s)
- Josep Lloret
- University of Girona, Faculty of Sciences, Department of Environmental Sciences, 17071 Girona, Catalonia, Spain.
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Pressler A, Knebel U, Esch S, Kölbl D, Esefeld K, Scherr J, Haller B, Schmidt-Trucksäss A, Krcmar H, Halle M, Leimeister JM. An internet-delivered exercise intervention for workplace health promotion in overweight sedentary employees: a randomized trial. Prev Med 2010; 51:234-9. [PMID: 20638409 DOI: 10.1016/j.ypmed.2010.07.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 07/09/2010] [Accepted: 07/10/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the effect of structured vs. non-structured internet-delivered exercise recommendations on aerobic exercise capacity and cardiovascular risk profile in overweight sedentary employees. METHODS 140 employees of an automobile company (11% female, median age 48 years (range 25-60), BMI 29.0 kg/m(2) (25.0-34.8)) were randomized in a 3:2 ratio to an intervention group receiving structured exercise schedules or a control group choosing workouts individually via an interactive website. The 12-week intervention took place in Munich, Germany, during summer 2008. Main outcome measure was performance at the lactate anaerobic threshold (P(AT)/kg) during ergometry. RESULTS 77 participants completed the study. The intervention group (n=50) improved significantly in P(AT)/kg ((mean (SD)) 1.68 (0.31) vs. 1.81 (0.33) W/kg; p=0.002), VO(2)peak (3.21 (0.63) vs. 3.35 (0.74) L/min; p=0.04), and waist circumference (100.5 (7.9) vs. 98.0 (7.8) cm; p=0.001). The control group (n=27) improved significantly in P(AT)/kg (1.59 (0.38) vs. 1.80 (0.49); p<0.001) and waist circumference (101.9 (8.7) vs. 98.3 (8.5) cm; p<0.001), but not in VO(2)peak. No significant between group differences in these outcome measures were noted. CONCLUSION Structured, internet-delivered exercise recommendations are not superior to internet-delivered non-structured exercise recommendations in a workplace setting. Both lifestyle intervention strategies are, however, limited by high dropout rates.
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Affiliation(s)
- Axel Pressler
- Department of Prevention and Sports Medicine, Technische Universität München, Connollystr. 32, 80809 München, Germany.
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