The effect of behaviour change interventions on changes in physical activity and anthropometrics in ambulatory hospital settings: a systematic review and meta-analysis

Adherence, acceptability, and usability of a smartphone app to promote physical exercise in patients with peripheral arterial disease and intermittent claudication

This study presents the development and assessment of a mobile application - the WalkingPAD app - aimed at promoting adherence to physical exercise among patients with Peripheral Arterial Disease (PAD). The assessment of adherence, acceptability, and usability was performed using mixed methods. Thirty-eight patients participated in the study with a mean age of 63.4 years (SD = 6.8). Thirty patients used the application for three months, responded to a semi-structured interview, and completed a task test and the System Usability Scale (SUS, ranging from 0 to 100). The application's adherence rate was 73%. When patients were asked about their reasons for using the app, the main themes that emerged were motivation, self-monitoring, and support in fulfilling a commitment. The average SUS score was 82.82 (SD = 18.4), indicating high usability. An upcoming version of the WalkingPAD app is expected to redesign both tasks - opening the app and looking up the walking history - which were rated as the most difficult tasks to accomplish. The new version of the WalkingPAD app will incorporate participants' comments and suggestions to enhance usability for this population.

Developing the developmental origins of health and disease (DOHaD) awareness scale to assess an education module for improving dietary behavior among college students

Objective

This study aimed to develop and validate the Developmental Origins of Health and Disease (DOHaD) awareness scale and examine whether having a DOHaD education module may affect dietary behavior in college students.

Background

Some studies conducted within the scope of the DOHaD hypothesis show associations between early-life environmental factors, especially maternal health and nutritional status, with the next generation's health and disease status. Despite the increase in elucidating of the underpinning mechanisms of early life determinants and chronic disease risk, there is limited knowledge on how public perceive and understand DOHaD concepts.

Methods

The study consisted of three phases: identification of DOHaD awareness scale components, development and validation, interrater reliability of the scale, and a confirmatory study. Two-hundred college students to confirm face validity of the scale, one-hundred for reproducibility and one-hundred for the confirmatory study. Confirmatory study included a pre-intervention period in which baseline parameters (such as anthropometric measurements, HEI-2015 (Healthy Eating Index-2015), physical activity levels, and DOHaD awareness scale scores) were measured at two different time points, and an educational module on DOHaD concepts was provided to the participants. The study was reported in accordance with the Guidelines for Reporting Reliability and Agreement Studies (GRRAS).

Results

Content validity ratio, exploratory factor analysis, and Cronbach's alpha values indicated that a reliable and valid instrument to assess the awareness of DOHaD concepts in college students was developed. Despite the lack of a control group, DOHaD concept education was associated with improved anthropometric measurements, healthier eating parameters, increased physical activity levels, and a better understanding of DOHaD concepts.

Conclusions

Translating DOHaD concepts into healthier behaviors can support improvements in lifestyle, and the use of the DOHaD awareness scale may serve as a valuable tool to encourage healthy behaviors among college students.

Behaviour change interventions to improve physical activity in adults: a systematic review of economic evaluations

BACKGROUND

Behaviour change interventions can result in lasting improvements in physical activity (PA). A broad implementation of behaviour change interventions are likely to be associated with considerable additional costs, and the evidence is unclear whether they represent good value for money. The aim of this study was to investigate costs and cost-effectiveness of behaviour change interventions to increase PA in community-dwelling adults.

METHODS

A search for trial-based economic evaluations investigating behaviour change interventions versus usual care or alternative intervention for adults living in the community was conducted (September 2023). Studies that reported intervention costs and incremental cost-effectiveness ratios (ICERs) for PA or quality-adjusted life years (QALYs) were included. Methodological quality was assessed using the Consensus Health Economic Criteria (CHEC-list). A Grading of Recommendations Assessment, Development and Evaluation style approach was used to assess the certainty of evidence (low, moderate or high certainty).

RESULTS

Sixteen studies were included using a variety of economic perspectives. The behaviour change interventions were heterogeneous with 62% of interventions being informed by a theoretical framework. The median CHEC-list score was 15 (range 11 to 19). Median intervention cost was US$313 per person (range US$83 to US$1,298). In 75% of studies the interventions were reported as cost-effective for changes in PA (moderate certainty of evidence). For cost per QALY/gained, 45% of the interventions were found to be cost-effective (moderate certainty of evidence). No specific type of behaviour change intervention was found to be more effective.

CONCLUSIONS

There is moderate certainty that behaviour change interventions are cost-effective approaches for increasing PA. The heterogeneity in economic perspectives, intervention costs and measurement should be considered when interpreting results. There is a need for increased clarity when reporting the functional components of behaviour change interventions, as well as the costs to implement them.

What should all health professionals know about movement behaviour change? An international Delphi-based consensus statement

The WHO has called for action to integrate physical activity promotion into healthcare settings, yet there is a lack of consensus on the competencies required by health professionals to deliver effective movement behaviour change support. The objective of this study was to establish key competencies relevant for all health professionals to support individuals to change their movement behaviours. Consensus was obtained using a three-phase Delphi process. Participants with expertise in physical activity and sedentary behaviour were asked to report what knowledge, skills and attributes they believed health professionals should possess in relation to movement behaviour change. Proposed competencies were developed and rated for importance. Participants were asked to indicate agreement for inclusion, with consensus defined as group level agreement of at least 80%. Participants from 11 countries, working in academic (55%), clinical (30%) or combined academic/clinical (13%) roles reached consensus on 11 competencies across 3 rounds (n=40, n=36 and n=34, respectively). Some competencies considered specific to certain disciplines did not qualify for inclusion. Participants agreed that health professionals should recognise, take ownership of, and practise interprofessional collaboration in supporting movement behaviour change; support positive culture around these behaviours; communicate using person-centred approaches that consider determinants, barriers and facilitators of movement behaviours; explain the health impacts of these behaviours; and recognise how their own behaviour influences movement behaviour change support. This consensus defines 11 competencies for health professionals, which may serve as a catalyst for building a culture of advocacy for movement behaviour change across health disciplines.

The effect of a multi-component behavior change technique intervention on physical activity among individuals on primary prevention statin therapy: A dose-finding trial protocol

BACKGROUND

Statin therapy is a mainstay of cardiovascular disease (CVD) prevention, but research shows that statin therapy alone is insufficient for preventing incident CVD and mortality. Combining statin medication with increased physical activity (PA) can lower mortality risk more than either statin or PA alone. However, PA levels often remain the same and may even decline following statin prescription. Additional information is needed to identify how to increase PA among statin users and determine the minimal length of an intervention (i.e., intervention dose) necessary to increase PA.

OBJECTIVE

The study aims to identify the required dose of a behavior change technique (BCT) intervention to increase PA among individuals on primary prevention statin therapy who have an elevated risk for cardiovascular disease (CVD).

METHODS

The study will utilize the modified time-to-event continual reassessment method (TiTE-CRM) in 42 participants. We expect insights relating to dose-efficacy models and BCTs (Behavior Change Techniques) to improve PA in adults at risk for CVD. This trial will also examine potential mechanisms of action (MoAs) for interventions to increase PA, identify any effect a PA intervention may have on medication adherence, and determine whether participants respond uniformly to their respective behavioral interventions.

ETHICS AND DISSEMINATION

This trial was approved by the Northwell Health Institutional Review Board (IRB) and all participants will complete informed consent. The trial results will be published in a peer-reviewed journal. All publications resulting from this series of personalized trials will follow the CONSORT reporting guidelines.

REGISTRATION DETAILS

This trial is registered on www.

CLINICALTRIALS

gov (Number NCT05273723).

The effect of motivational interviewing and/or cognitive behaviour therapy techniques on gestational weight gain - a systematic review and meta-analysis

BACKGROUND

Women with gestational weight gain (GWG) that is below or above recommendations are at risk of adverse perinatal outcomes. Motivational interviewing and/or cognitive behaviour therapy have demonstrated efficacy in initiating and sustaining behaviour change, including weight control. The objective of this review was to investigate the effect of antenatal interventions that include components of motivational interviewing and/or cognitive behaviour therapy on gestational weight gain.

METHODS

This review was designed and reported in accordance with guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Five electronic databases were systematically searched to March 2022. Randomised controlled trials evaluating interventions with identified components of motivational interviewing and/or cognitive behaviour therapies were included. Pooled proportions of appropriate GWG and GWG above or below guidelines, and standardised mean difference for total gestational weight gain, were calculated. Risk of bias in included studies was evaluated using the Risk of Bias 2 tool, and the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence.

RESULTS

Twenty-one studies (8030 participants) were included. Overall, MI and/or CBT interventions had a small effect on the total gestational weight gain (SMD: -0.18, 95% confidence interval: -0.27 to -0.09, p < 0.001) and improved the proportion of women achieving recommended gestational weight gain (29% versus 23% in the comparison, p < 0.001). The GRADE assessment indicated that overall quality of evidence is very uncertain, however sensitivity analyses to account for high risk of bias produced similar results to original meta-analyses. The magnitude of effect was greater in women with overweight or obesity when compared to women with BMI < 25 kg/m².

CONCLUSION

Motivational interviewing and/or cognitive behaviour therapy techniques may be effective for promoting healthy gestational weight gain. Nevertheless, a high proportion of women do not achieve recommended gestational weight gain. Future interventions should consider factors, including clinician and consumer perspectives, in the design and delivery of psychosocial interventions that aim to support healthy gestational weight gain.

TRIAL REGISTRATION

The protocol for this review was registered with the PROSPERO International register of systematic reviews (registration number CRD42020156401).

A walking programme for adults living in the community after hip fracture: A feasibility randomized controlled trial

OBJECTIVE

To test the feasibility of a walking programme for community-dwelling adults recovering from hip fracture.

DESIGN

A randomized controlled trial with embedded qualitative analysis.

SETTING

Community.

PARTICIPANTS

Aged at least 60 years and living in the community after hip fracture.

INTERVENTIONS

In addition to standard care, the experimental group received weekly home-based physiotherapy for 12 weeks to facilitate 100 minutes/week of moderate-intensity walking.

MAIN OUTCOME MEASURES

Feasibility domains of demand, acceptability, implementation, practicality and limited efficacy.

RESULTS

Of 158 potentially eligible, 38 participated (23 women, mean age 80 years, SD 9). The recruitment rate of 24% indicated low demand. Participants considered the walking programme highly acceptable. The programme was implemented as intended; the experimental group received a mean of 11 (SD 1) consultations and averaged more than 100 min of walking per week. The programme was practical with no serious adverse events and no between-group difference in risk of falling or hospital readmissions. Demonstrating evidence of efficacy, there were moderate standardized mean differences for physical activity favouring the experimental group, who increased daily moderate-intensity physical activity compared to the control group (MD 8 min, 95% CI 2-13). There were no between-group differences in mobility, walking confidence or quality of life.

CONCLUSION

A walking programme for community-dwelling older adults after hip fracture was acceptable, could be implemented as intended and was practical and demonstrated preliminary evidence of efficacy in increasing physical activity. However, low demand would threaten the feasibility of such a programme.

Effect of non-pharmacological interventions on adults with cardiovascular risk in a rural community

Background

Non-communicable diseases (NCDs) are the leading cause of morbidity and mortality worldwide, with three-fourth of deaths occurring in low- and middle-income countries (LMICs) like India. Currently, three out of the top five causes of morbidity and mortality in the country are NCDs.

Objective

This study evaluated the impact of non-pharmacological interventions as a comprehensive approach toward adults with cardiovascular risk in Indian rural communities.

Material and Methods

It was a quasi-experimental study conducted in Rishikesh, a holy city of Uttarakhand known as the world's yoga capital at the foothills of Himalaya. Out of 87 villages, four villages were randomly selected. Eighty-eight participants were enrolled (22 from each village and household). It was a multi-stage random sampling. All the participants with cardiovascular risk and age >30 years were recruited. Pregnant, severely ill, and unwilling to consent were excluded. Non-pharmacological intervention as a comprehensive approach, including yoga, meditation, mental health counseling, dietary counseling, tobacco, and alcohol cessation counseling has been provided to cardiovascular risk participants.

Results

Data of 76 participants were analyzed as the per-protocol analysis method. The drop-out rate was 13.63%. Male and female participants were 52 (68.4%) and 24 (31.6%) in number. Mean age of the participants was 55.28 ± 13.64 years. Diastolic blood pressure or DBP (P = 0.017*), systolic blood pressure or SBP (P = 0.008**), waist circumference (WC) (P = 0.000**), waist-to-hip ratio (P = 0.000**) and waist-to-height ratio (P = 0.000**) significantly improved in the post intervention group.

Conclusion

Non-pharmacological interventions as a comprehensive approach can significantly reduce modifiable risk factors for cardio-metabolic disease.

Physical activity and exercise training in cystic fibrosis

BACKGROUND

Physical activity (including exercise) may form an important part of regular care for people with cystic fibrosis (CF). This is an update of a previously published review.

OBJECTIVES

To assess the effects of physical activity interventions on exercise capacity by peak oxygen uptake, lung function by forced expiratory volume in one second (FEV1), health-related quality of life (HRQoL) and further important patient-relevant outcomes in people with cystic fibrosis (CF).

SEARCH METHODS

We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. The most recent search was on 3 March 2022. We also searched two ongoing trials registers: clinicaltrials.gov, most recently on 4 March 2022; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), most recently on 16 March 2022.  SELECTION CRITERIA: We included all randomised controlled trials (RCTs) and quasi-RCTs comparing physical activity interventions of any type and a minimum intervention duration of two weeks with conventional care (no physical activity intervention) in people with CF.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected RCTs for inclusion, assessed methodological quality and extracted data. We assessed the certainty of the evidence using GRADE.  MAIN RESULTS: We included 24 parallel RCTs (875 participants). The number of participants in the studies ranged from nine to 117, with a wide range of disease severity. The studies' age demographics varied: in two studies, all participants were adults; in 13 studies, participants were 18 years and younger; in one study, participants were 15 years and older; in one study, participants were 12 years and older; and seven studies included all age ranges. The active training programme lasted up to and including six months in 14 studies, and longer than six months in the remaining 10 studies. Of the 24 included studies, seven implemented a follow-up period (when supervision was withdrawn, but participants were still allowed to exercise) ranging from one to 12 months. Studies employed differing levels of supervision: in 12 studies, training was supervised; in 11 studies, it was partially supervised; and in one study, training was unsupervised. The quality of the included studies varied widely. This Cochrane Review shows that, in studies with an active training programme lasting over six months in people with CF, physical activity probably has a positive effect on exercise capacity when compared to no physical activity (usual care) (mean difference (MD) 1.60, 95% confidence interval (CI) 0.16 to 3.05; 6 RCTs, 348 participants; moderate-certainty evidence). The magnitude of improvement in exercise capacity is interpreted as small, although study results were heterogeneous. Physical activity interventions may have no effect on lung function (forced expiratory volume in one second (FEV1) % predicted) (MD 2.41, 95% CI ‒0.49 to 5.31; 6 RCTs, 367 participants), HRQoL physical functioning (MD 2.19, 95% CI ‒3.42 to 7.80; 4 RCTs, 247 participants) and HRQoL respiratory domain (MD ‒0.05, 95% CI ‒3.61 to 3.51; 4 RCTs, 251 participants) at six months and longer (low-certainty evidence). One study (117 participants) reported no differences between the physical activity and control groups in the number of participants experiencing a pulmonary exacerbation by six months (incidence rate ratio 1.28, 95% CI 0.85 to 1.94) or in the time to first exacerbation over 12 months (hazard ratio 1.34, 95% CI 0.65 to 2.80) (both high-certainty evidence); and no effects of physical activity on diabetic control (after 1 hour: MD ‒0.04 mmol/L, 95% CI ‒1.11 to 1.03; 67 participants; after 2 hours: MD ‒0.44 mmol/L, 95% CI ‒1.43 to 0.55; 81 participants; moderate-certainty evidence). We found no difference between groups in the number of adverse events over six months (odds ratio 6.22, 95% CI 0.72 to 53.40; 2 RCTs, 156 participants; low-certainty evidence). For other time points (up to and including six months and during a follow-up period with no active intervention), the effects of physical activity versus control were similar to those reported for the outcomes above. However, only three out of seven studies adding a follow-up period with no active intervention (ranging between one and 12 months) reported on the primary outcomes of changes in exercise capacity and lung function, and one on HRQoL. These data must be interpreted with caution. Altogether, given the heterogeneity of effects across studies, the wide variation in study quality and lack of information on clinically meaningful changes for several outcome measures, we consider the overall certainty of evidence on the effects of physical activity interventions on exercise capacity, lung function and HRQoL to be low to moderate.

AUTHORS' CONCLUSIONS

Physical activity interventions for six months and longer likely improve exercise capacity when compared to no training (moderate-certainty evidence). Current evidence shows little or no effect on lung function and HRQoL (low-certainty evidence). Over recent decades, physical activity has gained increasing interest and is already part of multidisciplinary care offered to most people with CF. Adverse effects of physical activity appear rare and there is no reason to actively discourage regular physical activity and exercise. The benefits of including physical activity in an individual's regular care may be influenced by the type and duration of the activity programme as well as individual preferences for and barriers to physical activity. Further high-quality and sufficiently-sized studies are needed to comprehensively assess the benefits of physical activity and exercise in people with CF, particularly in the new era of CF medicine.

The super wicked problem of ocean health: a socio-ecological and behavioural perspective

We are dependent on our oceans for economic, health and social benefits; however, demands on our oceans are escalating, and the state of the oceans is deteriorating. Only 2% of countries are on track to achieve the desired outcomes for the sustainable development goal (SDG 14) for the oceans by 2030, and the changes needed to prevent further degradation, or limit the impact of existing degradation, are not being undertaken fast enough. This paper uses a socio-ecological lens to explore the nature of actors and behaviours for change at the local, community, state, national and international levels, and introduces the need for technology, information- and knowledge-sharing, and policy as interconnected mediators, that work both in concert, and independently, to address the 'super wicked' problem of ocean health and to promote resilience. We recommend the need to develop transformational teams and leaders, as well as transformative policies within a holistic and integrated system to ensure ocean health initiatives are greater than the sum of their parts and are actual, realistic, achievable and evidence-informed pathways to change. This article is part of the theme issue 'Nurturing resilient marine ecosystems'.

Behaviour change interventions to increase physical activity in hospitalised patients: a systematic review, meta-analysis and meta-regression

BACKGROUND

Low physical activity levels are a major problem for people in hospital and are associated with adverse outcomes.

OBJECTIVE

This systematic review, meta-analysis and meta-regression aimed to determine the effect of behaviour change interventions on physical activity levels in hospitalised patients.

METHODS

Randomised controlled trials of behaviour change interventions to increase physical activity in hospitalised patients were selected from a database search, supplemented by reference list checking and citation tracking. Data were synthesised with random-effects meta-analyses and meta-regression analyses, applying Grades of Recommendation, Assessment, Development and Evaluation criteria. The primary outcome was objectively measured physical activity. Secondary measures were patient-related outcomes (e.g. mobility), service level outcomes (e.g. length of stay), adverse events and patient satisfaction.

RESULTS

Twenty randomised controlled trials of behaviour change interventions involving 2,568 participants (weighted mean age 67 years) included six trials with a high risk of bias. There was moderate-certainty evidence that behaviour change interventions increased physical activity levels (SMD 0.34, 95% CI 0.14-0.55). Findings in relation to mobility and length of stay were inconclusive. Adverse events were poorly reported. Meta-regression found behaviour change techniques of goal setting (SMD 0.29, 95% CI 0.05-0.53) and feedback (excluding high risk of bias trials) (SMD 0.35, 95% CI 0.11-0.60) were independently associated with increased physical activity.

CONCLUSIONS

Targeted behaviour change interventions were associated with increases in physical activity in hospitalised patients. The trials in this review were inconclusive in relation to the patient-related or health service benefits of increasing physical activity in hospital.