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Malkowski OS, Townsend NP, Kelson MJ, Foster CEM, Western MJ. Socio-economic inequalities in the breadth of internet use before and during the COVID-19 pandemic among older adults in England. PLoS One 2024; 19:e0303061. [PMID: 38722879 PMCID: PMC11081243 DOI: 10.1371/journal.pone.0303061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
Understanding digital exclusion in older adults during the COVID-19 pandemic could help tailor responses to future outbreaks. This cohort study used data from older adults aged 60+ years in England who participated in wave nine (2018/2019) of the main English Longitudinal Study of Ageing (ELSA) survey, and/or wave one of the ELSA COVID-19 sub-study (June/July 2020). Using latent class analysis and latent transition analysis, we aimed to identify distinct subgroups of older adults characterised by different patterns of internet use pre- and intra-pandemic, explore the extent to which individuals remained in the same subgroup or transitioned to a different subgroup during the COVID-19 pandemic, and examine longitudinal associations of socio-economic factors (education, occupational class, and wealth) with latent class membership. Preliminary tests showed that the types of internet activities differed between men and women; therefore, subsequent analyses were stratified by biological sex. Three clusters (low, medium, and high) were identified in male participants at both timepoints. Among female participants, three clusters were distinguished pre-pandemic and two (low versus high) during the pandemic. The latent classes were characterised by participants' breadth of internet use. Higher education, occupational class, and wealth were associated with greater odds of membership in the medium and/or high classes, versus the low class, in men and women. A high degree of stability in latent class membership was observed over time. However, men experienced a stark decrease in online health information-seeking. Our results highlight that inequality regarding the range of functional and social opportunities provided by the internet prevailed during the pandemic. Policymakers should ensure that digital access and upskilling initiatives are equitable for all.
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Affiliation(s)
- Olivia S. Malkowski
- Department for Health, Centre for Motivation and Health Behaviour Change, University of Bath, Bath, United Kingdom
| | - Nick P. Townsend
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Mark J. Kelson
- Department of Mathematics, Institute of Data Science and Artificial Intelligence, University of Exeter, Exeter, United Kingdom
| | - Charlie E. M. Foster
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Max J. Western
- Department for Health, Centre for Motivation and Health Behaviour Change, University of Bath, Bath, United Kingdom
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Stevenson RDM, Chowdhury EA, Inza VB, Western MJ, Walsh NE, Jones SL, Bilzon JLJ. Development of the intelligent knee osteoarthritis lifestyle app: a person-based approach. BMC Musculoskelet Disord 2024; 25:189. [PMID: 38431553 PMCID: PMC10908108 DOI: 10.1186/s12891-024-07313-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/26/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Knee osteoarthritis is one of the most prevalent long term health conditions globally. Exercise and physical activity are now widely recognised to significantly reduce joint pain, improve physical function and quality of life in patients with knee osteoarthritis. However, prescribed exercise without regular contact with a healthcare professional often results in lower adherence and poorer health outcomes. Digital mobile health (mHealth) technologies offer great potential to support people with long-term conditions such as knee osteoarthritis more efficiently and effectively and with relatively lower cost than existing interventions. However, there are currently very few mHealth interventions for the self-management of knee osteoarthritis. The aim of the present study was to describe the development process of a mHealth app to extend the support for physical activity and musculoskeletal health beyond short-term, structured rehabilitation through self-management, personalised physical activity, education, and social support. METHODS The development of the intelligent knee osteoarthritis lifestyle application intervention involved an iterative and interconnected process comprising intervention 'planning' and 'optimisation' informed by the person-based approach framework for the development of digital health interventions. The planning phase involved a literature review and collection of qualitative data obtained from focus groups with individuals with knee osteoarthritis (n = 26) and interviews with relevant physiotherapists (n = 5) to generate 'guiding principles' for the intervention. The optimisation phase involved usability testing (n = 7) and qualitative 'think aloud' sessions (n = 6) with potential beneficiaries to refine the development of the intervention. RESULTS Key themes that emerged from the qualitative data included the need for educational material, modifying activities to suit individual abilities and preferences as well as the inclusion of key features such as rehabilitation exercises. Following a user-trial further changes were made to improve the usability of the application. CONCLUSIONS Using a systematic person-based, development approach, we have developed the intelligent knee osteoarthritis lifestyle application to help people maintain physical activity behaviour. The app extends the support for physical activity and musculoskeletal health beyond short-term, structured rehabilitation through personalised physical activity guidance, education, and social support.
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Affiliation(s)
- Richard D M Stevenson
- Department for Health, The University of Bath, Bath, BA2 7AY, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Bath, Bath, UK
| | - Enhad A Chowdhury
- Department for Health, The University of Bath, Bath, BA2 7AY, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Bath, Bath, UK
| | - Victor B Inza
- Visual Computing Centre, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
| | - Max J Western
- Department for Health, The University of Bath, Bath, BA2 7AY, UK
| | - Nicola E Walsh
- Faculty of Health and Applied Science, University of the West of England, Bristol, UK
| | - Simon L Jones
- Department of Computer Science, The University of Bath, Bath, BA2 7AY, UK
| | - James L J Bilzon
- Department for Health, The University of Bath, Bath, BA2 7AY, UK.
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Bath, Bath, UK.
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Krukowski RA, Ross KM, Western MJ, Cooper R, Busse H, Forbes C, Kuntsche E, Allmeta A, Silva AM, John-Akinola YO, König LM. Digital health interventions for all? Examining inclusivity across all stages of the digital health intervention research process. Trials 2024; 25:98. [PMID: 38291539 PMCID: PMC10826214 DOI: 10.1186/s13063-024-07937-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/15/2024] [Indexed: 02/01/2024] Open
Abstract
Digital interventions offer many possibilities for improving health, as remote interventions can enhance reach and access to underserved groups of society. However, research evaluating digital health interventions demonstrates that such technologies do not equally benefit all and that some in fact seem to reinforce a "digital health divide." By better understanding these potential pitfalls, we may contribute to narrowing the digital divide in health promotion. The aim of this article is to highlight and reflect upon study design decisions that might unintentionally enhance inequities across key research stages-recruitment, enrollment, engagement, efficacy/effectiveness, and retention. To address the concerns highlighted, we propose strategies including (1) the standard definition of "effectiveness" should be revised to include a measure of inclusivity; (2) studies should report a broad range of potential inequity indicators of participants recruited, randomized, and retained and should conduct sensitivity analyses examining potential sociodemographic differences for both the effect and engagement of the digital interventions; (3) participants from historically marginalized groups should be involved in the design of study procedures, including those related to recruitment, consent, intervention implementation and engagement, assessment, and retention; (4) eligibility criteria should be minimized and carefully selected and the screening process should be streamlined; (5) preregistration of trials should include recruitment benchmarks for sample diversity and comprehensive lists of sociodemographic characteristics assessed; and (6) studies within trials should be embedded to systematically test recruitment and retention strategies to improve inclusivity. The implementation of these strategies would enhance the ability of digital health trials to recruit, randomize, engage, and retain a broader and more representative population in trials, ultimately minimizing the digital divide and broadly improving population health.
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Affiliation(s)
- Rebecca A Krukowski
- Department of Public Health Sciences, School of Medicine, University of Virginia, PO Box 800765, Charlottesville, VA, 22908-0765, USA.
| | - Kathryn M Ross
- Department of Clinical & Health Psychology, College of Public Health & Health Professions, University of Florida, PO Box 100165, Gainesville, FL, 32610-0165, USA
| | - Max J Western
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Rosie Cooper
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford, UK
| | - Heide Busse
- Leibniz Institute for Prevention Research and Epidemiology- BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Cynthia Forbes
- Hull York Medical School, University of Hull, Allam Medical Building, Cottingham Road, Hull, UK
| | - Emmanuel Kuntsche
- Centre for Alcohol Policy Research, La Trobe University, Plenty Road and Kingsbury Drive, Melbourne, 3086 VIC, Australia
| | - Anila Allmeta
- University of Bayreuth, Fritz-Hornschuch-Straße 13, 95326, Kulmbach, Germany
| | - Anabelle Macedo Silva
- Instituto de Estudos Em Saúde Coletiva IESC/ Universidade Federal Do Rio de Janeiro /Leibiniz Science Campus Digital Public Health/Ministério Público Do Estado Do Rio de Janeiro, Rua das Bauhineas 200, Bl B 1602, Península, Barra da Tijuca, Rio de Janeiro, 22776-090, Brazil
| | - Yetunde O John-Akinola
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, College of Medicine, Queen Elizabeth Road, UCH Campus, Ibadan, Nigeria
| | - Laura M König
- University of Bayreuth, Faculty of Life Sciences: Food, Nutrition and Health University of Vienna, Faculty of Psychology, Wächtergasse 1, 1010, Vienna, Austria
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Stevenson RDM, Chowdhury EA, Lobo J, Western MJ, Bilzon JLJ. Influence of the intelligent knee osteoarthritis lifestyle app (iKOALA) on knee joint pain. BMC Musculoskelet Disord 2024; 25:90. [PMID: 38263125 PMCID: PMC10807134 DOI: 10.1186/s12891-024-07198-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/11/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND The intelligent knee osteoarthritis lifestyle app (iKOALA) has been co-developed with target users to extend the support for physical activity (PA) and musculoskeletal health, beyond short-term structured rehabilitation, using personalised PA guidance, education, and social support. The purpose of this study was to assess the preliminary effectiveness and usability of the iKOALA digital intervention on indices of musculoskeletal (MSK) health, symptoms, and physical activity levels in a broad range of individuals with knee osteoarthritis (KOA) over 12 weeks to inform the design of a larger randomised controlled trial. METHODS Thirty-eight (33 female) participants living in the UK with a mean (SD) age of 58 (± 9) years diagnosed radiographically or clinically with KOA completed a 12-week user trial of the iKOALA. Participants completed an in-app physical activity questionnaire which intelligently recommended suitable strengthening and aerobic based activities to individuals. Throughout the trial, participants wore a physical activity monitor and were given access to functions within the app (physical activity (PA) reminders, information and education, symptom and PA tracking as well as social support forums) to support them in maintaining their PA plan. Participants completed a MSK questionnaire for chronic symptoms and quality of life (MSK-HQ) as well as an acute iKOALA symptoms questionnaire (confidence, fatigue, mood, pain during the day/night, sleep and ability to walk) in the week prior to starting and following completion of the trial. RESULTS Physical activity levels were consistent over the 12 weeks with total daily steps of 9102 (± 3514) in week 1, 9576 (± 4214) in week 6 and 9596 (± 3694) in week 12. Group mean changes in all iKOALA MSK symptom scores and the total MSK-HQ (pre 33.1 (7.6) vs. post 40.2 (7.6)) score improved significantly (p < .001, 95% CI [-8.89, -5.16]) over the 12-week period. CONCLUSIONS Physical activity levels were maintained at a high level throughout the 12 weeks. Significant improvements in mean MSK symptom scores and the total MSK-HQ score were also observed. Efforts to ensure more generalised reach amongst sex and socioeconomic status of the digital intervention in a randomised controlled clinical trial are warranted.
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Affiliation(s)
- Richard D M Stevenson
- Department for Health, The University of Bath, Bath, BA2 7AY, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Bath, BA2 7AY, UK
| | - Enhad A Chowdhury
- Department for Health, The University of Bath, Bath, BA2 7AY, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Bath, BA2 7AY, UK
| | - Jesudas Lobo
- Department of Computer Science, The University of Bath, Bath, BA2 7AY, UK
| | - Max J Western
- Department for Health, The University of Bath, Bath, BA2 7AY, UK
| | - James L J Bilzon
- Department for Health, The University of Bath, Bath, BA2 7AY, UK.
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Bath, BA2 7AY, UK.
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König LM, Krukowski RA, Kuntsche E, Busse H, Gumbert L, Gemesi K, Neter E, Mohamed NF, Ross KM, John-Akinola YO, Cooper R, Allmeta A, Silva AM, Forbes CC, Western MJ. Reducing intervention- and research-induced inequalities to tackle the digital divide in health promotion. Int J Equity Health 2023; 22:249. [PMID: 38049789 PMCID: PMC10696856 DOI: 10.1186/s12939-023-02055-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/06/2023] [Indexed: 12/06/2023] Open
Abstract
Social inequalities are an important contributor to the global burden of disease within and between countries. Using digital technology in health promotion and healthcare is seen by some as a potential lever to reduce these inequalities; however, research suggests that digital technology risks re-enacting or evening widening disparities. Most research on this digital health divide focuses on a small number of social inequality indicators and stems from Western, educated, industrialized, rich, and democratic (WEIRD) countries. There is a need for systematic, international, and interdisciplinary contextualized research on the impact of social inequality indicators in digital health as well as the underlying mechanisms of this digital divide across the globe to reduce health disparities. In June 2023, eighteen multi-disciplinary researchers representing thirteen countries from six continents came together to discuss current issues in the field of digital health promotion and healthcare contributing to the digital divide. Ways that current practices in research contribute to the digital health divide were explored, including intervention development, testing, and implementation. Based on the dialogue, we provide suggestions for overcoming barriers and improving practices across disciplines, countries, and sectors. The research community must actively advocate for system-level changes regarding policy and research to reduce the digital divide and so improve digital health for all.
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Affiliation(s)
- Laura M König
- Faculty of Life Sciences: Food, Nutrition and Health, University of Bayreuth, Bayreuth, Germany.
- Faculty of Psychology, University of Vienna, Wächtergasse 1/504, 1010, Vienna, Austria.
| | - Rebecca A Krukowski
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, USA
| | - Emmanuel Kuntsche
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Heide Busse
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Leibniz Science Campus Digital Public Health Bremen, Bremen, Germany
| | | | - Kathrin Gemesi
- Institute for Nutritional Medicine, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | | | - Nor Firdous Mohamed
- Department of Psychology, Faculty of Human Development, University Pendidikan Sultan Idris, Tanjong Malim, Malaysia
| | | | - Yetunde O John-Akinola
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rosie Cooper
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Anila Allmeta
- Faculty of Life Sciences: Food, Nutrition and Health, University of Bayreuth, Bayreuth, Germany
| | - Anabelle Macedo Silva
- Instituto de Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cynthia C Forbes
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Max J Western
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath, UK
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Western MJ, Welsh T, Keen K, Bishop V, Perkin OJ. Exercise snacking to improve physical function in pre-frail older adult memory clinic patients: a 28-day pilot study. BMC Geriatr 2023; 23:471. [PMID: 37542234 PMCID: PMC10403822 DOI: 10.1186/s12877-023-04169-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/13/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Finding innovative yet feasible ways of preventing physical and cognitive decline in those at risk is a critical global challenge, with exercise being championed as a key precursor to robust health in later life. Exercise snacking, here defined as short bouts of sporadic [muscle-strengthening] exercise, is one such strategy designed to overcome typical participation barriers observed in older adults. This study examined the acceptability of exercise snacking amongst pre-frail older adults and explored the efficacy of this approach in improving physical function. METHODS In this single group design, 21 pre-frail outpatients with mild-cognitive impairment were recruited from a UK memory clinic. To be eligible, participants were aged ≥ 65-years who scored 3-8 (inclusive) on the short physical performance battery (SPPB) and were not regularly engaging in sport or exercise. Participants completed a 28-day, twice daily, exercise snacking intervention, consisting of five muscle-strengthening exercises, with the aim being to complete as many repetitions as possible of each exercise in a minute. Acceptability of the intervention was measured quantitatively and qualitatively using a survey and topic guide informed by the Theoretical Framework of Acceptability. Pre- and post-intervention physical function was measured using the SPPB, timed up-and-go (TUG), and 60s standing balance and sit-to-stand tests. RESULTS Eighteen participants provided follow-up data and showed 85% adherence to the exercise snacking intervention, measured as the proportion of all sessions completed out of a possible 56. Participants rated the intervention as highly acceptable (4.6/5) suggesting it supported their self-efficacy (4.3/5) was enjoyable (4.1/5) and had a low burden (2.1/5). Qualitative findings suggested the ease of use, flexibility of the programme, and perceived effectiveness was important, and particularly useful for non-exercisers. Changes in SPPB score (8(1) vs. 9(3), p < 0.01), TUG (11.32(4.02) vs. 9.18(5.25) seconds, p < 0.01) and in the 60-second sit-to-stand test (17 ± 5 vs. 23 ± 7 repetitions, p < 0.01) were seen between baseline and follow-up. CONCLUSIONS Exercise snacking is an acceptable and potentially efficacious format of exercise for pre-frail memory clinic attendees who are at heightened risk of falling and frailty. Large scale randomised controlled trials are required to confirm whether exercise snacking is effective in the short and long term. CLINICALTRIALS GOV REGISTRATION NCT05439252 (30/06/2022).
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Affiliation(s)
- Max J Western
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath, BA2 7AY, UK.
| | - Tomas Welsh
- Research Institute for Care of Older People, The RICE Centre, Royal United Hospital, Combe Park, Bath, BA1 3NG, UK
- University of Bristol, Bristol, BS8 1QU, UK
- Royal United Hospitals Bath NHS Foundation Trust, Bath, BA1 3NG, UK
| | - Kristen Keen
- Research Institute for Care of Older People, The RICE Centre, Royal United Hospital, Combe Park, Bath, BA1 3NG, UK
| | - Vanessa Bishop
- Research Institute for Care of Older People, The RICE Centre, Royal United Hospital, Combe Park, Bath, BA1 3NG, UK
| | - Oliver J Perkin
- Centre for Nutrition, Exercise and Metabolism, Department for Health, University of Bath, Bath, BA2 7AY, UK
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Liang IJ, Francombe-Webb J, McGuigan PM, Perkin OJ, Thompson D, Western MJ. The acceptability of homebased exercise snacking and Tai-chi snacking amongst high and low function UK and Taiwanese older adults. Front Aging 2023; 4:1180939. [PMID: 37593678 PMCID: PMC10428172 DOI: 10.3389/fragi.2023.1180939] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/21/2023] [Indexed: 08/19/2023]
Abstract
Introduction: Exercise "snacking" and Tai-chi 'snacking' protocols are designed to overcome typical barriers to older adults' participation in muscle strength and balance exercise, using short bouts of home-based exercise. This study aimed to investigate the acceptability of homebred exercise- and Tai-chi snacking in British and Taiwanese older adults of high and low physical function. Methods: Thirty-three British and Thirty Taiwanese older adults took part in semi-structured interviews, after trying 1-week of exercise- and Tai-chi snacking. The interview schedule and deductive framework analysis was based on the seven components of the Theoretical Framework of Acceptability (TFA). Differences between the Taiwanese and United Kingdom participants and those considered high versus low physical function were also analysed. Results: Both snacking regimes were found to be convenient and easy to implement. Participants reported that no activity had to be given up, and considered the programmes would be beneficial to their physical and mental health. Interestingly, more UK-based participants preferred the elegant and relaxing movements of Tai-chi snacking, yet participants with low physical function experienced difficulties when mastering Tai-chi movements. A few high physical function participants perceived exercise snacking to be tedious. Discussion: Overall, the snacking exercise was found to be acceptable and useful. Personal affective attitude and different cultural backgrounds may affect exercise participation. Nevertheless, it is important to consider individuals' physical function when designing exercise regime. The findings indicate that making Tai-chi snacking easier to master initially, building in progression and adding some upper body movements in the exercise snacking may further enhance acceptability.
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Affiliation(s)
| | | | | | | | | | - Max J. Western
- Department for Health, University of Bath, Bath, England, United Kingdom
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Ladlow P, Western MJ, Greaves CJ, Thompson JL, Withall J, de Koning J, Bollen JC, Moorlock SJ, Guralnik JM, Fox KR, Stathi A. The REtirement in ACTion exercise programme and its effects on elements of long term functionality in older adults. Front Public Health 2023; 11:1151035. [PMID: 37575112 PMCID: PMC10420051 DOI: 10.3389/fpubh.2023.1151035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Background The prevention of mobility-related disability amongst adults is a global healthcare priority. Cost-effective community-based strategies to improve physical function and independence in older adults with mobility limitations are needed. This study investigated the effectiveness of the REtirement in ACTion (REACT) exercise intervention on individual markers of physical function at 6-and 12-months. Methods The REACT multicentre randomised controlled trial assigned 777 older adults (female, 514; male 263) (mean age 77·6 [SD 6·8] years) with reduced lower limb physical functioning (Short Physical Performance Battery [SPPB] score 4-9) to receive brief healthy ageing advice or a 12-month, group-based, multimodal exercise programme delivered in local communities. Estimated differences in the three individual component scores of the SPPB (strength, balance, gait speed) and physical functional outcomes recorded at 6- and 12-months were assessed. Results The intervention group demonstrated significant improvements in strength (OR = 1.88, 95% CI = 1.36-2.59, p < 0.001) and balance (OR = 1.96, 95% CI = 1.39-2.67, p < 0.001) at 12-months, but not in gait speed (OR = 1.32, 95% CI = 0.91-1.90, p = 0.139). In comparison to the control group, at six-and 12-months, the intervention group reported statistically significant improvements in Mobility Assessment Tool-Short Form (MAT-SF), physical component score from SF-36 questionnaire, and strength and endurance items of subjectively reported physical activity (PASE 10-item). Greater than 75% adherence (attending ≥48 of the 64 exercise sessions delivered in 12-months) was associated with superior functional outcomes. Conclusion The REACT exercise programme provides local, regional and national service providers with an effective solution to increase muscle strength and balance in older adults at risk of mobility disability.
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Affiliation(s)
- Peter Ladlow
- Department for Health, Faculty of Humanities and Social Sciences, University of Bath, Bath, United Kingdom
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, United Kingdom
| | - Max J. Western
- Department for Health, Faculty of Humanities and Social Sciences, University of Bath, Bath, United Kingdom
| | - Colin J. Greaves
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Janice L. Thompson
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Janet Withall
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jolanthe de Koning
- Department for Health, Faculty of Humanities and Social Sciences, University of Bath, Bath, United Kingdom
| | - Jessica C. Bollen
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Sarah J. Moorlock
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Jack M. Guralnik
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Kenneth R. Fox
- Centre for Exercise, Sport and Health Science, University of Bristol, Bristol, United Kingdom
| | - Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
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Schoenfelder A, Metcalf B, Langford J, Stathi A, Western MJ, Hillsdon M. The Analytical and Clinical Validity of the pfSTEP Digital Biomarker of the Susceptibility/Risk of Declining Physical Function in Community-Dwelling Older Adults. Sensors (Basel) 2023; 23:5122. [PMID: 37299849 PMCID: PMC10255880 DOI: 10.3390/s23115122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023]
Abstract
Measures of stepping volume and rate are common outputs from wearable devices, such as accelerometers. It has been proposed that biomedical technologies, including accelerometers and their algorithms, should undergo rigorous verification as well as analytical and clinical validation to demonstrate that they are fit for purpose. The aim of this study was to use the V3 framework to assess the analytical and clinical validity of a wrist-worn measurement system of stepping volume and rate, formed by the GENEActiv accelerometer and GENEAcount step counting algorithm. The analytical validity was assessed by measuring the level of agreement between the wrist-worn system and a thigh-worn system (activPAL), the reference measure. The clinical validity was assessed by establishing the prospective association between the changes in stepping volume and rate with changes in physical function (SPPB score). The agreement of the thigh-worn reference system and the wrist-worn system was excellent for total daily steps (CCC = 0.88, 95% CI 0.83-0.91) and moderate for walking steps and faster-paced walking steps (CCC = 0.61, 95% CI 0.53-0.68 and 0.55, 95% CI 0.46-0.64, respectively). A higher number of total steps and faster paced-walking steps was consistently associated with better physical function. After 24 months, an increase of 1000 daily faster-paced walking steps was associated with a clinically meaningful increase in physical function (0.53 SPPB score, 95% CI 0.32-0.74). We have validated a digital susceptibility/risk biomarker-pfSTEP-that identifies an associated risk of low physical function in community-dwelling older adults using a wrist-worn accelerometer and its accompanying open-source step counting algorithm.
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Affiliation(s)
| | - Brad Metcalf
- Sports and Health Sciences, University of Exeter, Exeter EX1 2LU, UK; (B.M.); (J.L.)
| | - Joss Langford
- Sports and Health Sciences, University of Exeter, Exeter EX1 2LU, UK; (B.M.); (J.L.)
- Activinsights Ltd., Huntingdon PE28 0NJ, UK
| | - Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK;
| | - Max J. Western
- Department of Health, University of Bath, Bath BA2 7AY, UK;
| | - Melvyn Hillsdon
- Sports and Health Sciences, University of Exeter, Exeter EX1 2LU, UK; (B.M.); (J.L.)
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10
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Malkowski OS, Kanabar R, Western MJ. Socio-economic status and trajectories of a novel multidimensional metric of Active and Healthy Ageing: the English Longitudinal Study of Ageing. Sci Rep 2023; 13:6107. [PMID: 37055521 PMCID: PMC10102137 DOI: 10.1038/s41598-023-33371-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/12/2023] [Indexed: 04/15/2023] Open
Abstract
Healthy ageing research largely has a unidimensional focus on physical health, negating the importance of psychosocial factors in the maintenance of a good quality-of-life. In this cohort study, we aimed to identify trajectories of a new multidimensional metric of Active and Healthy Ageing (AHA), including their associations with socio-economic variables. A latent AHA metric was created for 14,755 participants across eight waves of data (collected between 2004 and 2019) from the English Longitudinal Study of Ageing (ELSA), using Bayesian Multilevel Item Response Theory (MLIRT). Then, Growth Mixture Modelling (GMM) was employed to identify sub-groups of individuals with similar trajectories of AHA, and multinomial logistic regression examined associations of these trajectories with socio-economic variables: education, occupational class, and wealth. Three latent classes of AHA trajectories were suggested. Participants in higher quintiles of the wealth distribution had decreased odds of being in the groups with consistently moderate AHA scores (i.e., 'moderate-stable'), or the steepest deterioration (i.e., 'decliners'), compared to the 'high-stable' group. Education and occupational class were not consistently associated with AHA trajectories. Our findings reiterate the need for more holistic measures of AHA and prevention strategies targeted at limiting socio-economic disparities in older adults' quality-of-life.
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Affiliation(s)
- Olivia S Malkowski
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Ricky Kanabar
- Department of Social and Policy Sciences, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Max J Western
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK.
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11
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Remskar M, Western MJ, Maynard OM, Ainsworth B. Exercising body but not mind: A qualitative exploration of attitudes to combining physical activity and mindfulness practice for mental health promotion. Front Psychol 2022; 13:984232. [PMID: 36571001 PMCID: PMC9780497 DOI: 10.3389/fpsyg.2022.984232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/02/2022] [Indexed: 12/13/2022] Open
Abstract
Background Physical activity and mindfulness meditation can be effective for maintaining good mental wellbeing, with early-stage research suggesting even greater effectiveness in tandem. Literature is lacking on the perceptions and acceptability of these practices, particularly in a preventative context. The study aimed to explore attitudes toward mental health and its maintenance through physical activity and mindfulness meditation in the university student population. Methods Semi-structured qualitative interviews were conducted with a sample of 16 students from 10 United Kingdom universities (M age = 23 years, SD = 3.22) recruited through social media and stratified to have varied wellbeing symptoms, physical activity levels, and experience with mindfulness meditation. Reflexive thematic analysis was used to elicit meaning from the data. Results Four main themes were constructed. Participants held a "Dualist view of health," in which mental and physical aspects were seen as distinct but connected, and prioritized physical health maintenance. The "Low-point paradox," where engagement is most difficult during the time of greatest need, was identified as a crucial psychological barrier across health behaviors. "Unfamiliarity with mindfulness practice" was common, as were misconceptions inhibiting practice. Finally, participants were intrigued by combining physical activity and mindfulness, supposing that "Whole is greater than the sum of its parts," with mutual reinforcement of the two techniques cited as biggest motivating factor. Conclusion Effective preventative mental health strategies for adults, including university students, should accommodate for common psychological barriers and facilitators to health maintenance behaviors, including misconceptions surrounding mindfulness, to increase acceptability. Combining physical activity and mindfulness meditation is one promising preventative approach that warrants further investigation.
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Affiliation(s)
- Masha Remskar
- Department of Psychology, Bath Center for Mindfulness and Community, University of Bath, Bath, United Kingdom,Department for Health, Center for Motivation and Health Behavior Change, University of Bath, Bath, United Kingdom,*Correspondence: Masha Remskar,
| | - Max J. Western
- Department for Health, Center for Motivation and Health Behavior Change, University of Bath, Bath, United Kingdom
| | - Olivia M. Maynard
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Ben Ainsworth
- Department of Psychology, Bath Center for Mindfulness and Community, University of Bath, Bath, United Kingdom,Digital Interventions Group, Department of Psychology, University of Southampton, Southampton, United Kingdom
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12
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Western MJ, Malkowski OS. Associations of the Short Physical Performance Battery (SPPB) with Adverse Health Outcomes in Older Adults: A 14-Year Follow-Up from the English Longitudinal Study of Ageing (ELSA). Int J Environ Res Public Health 2022; 19:ijerph192316319. [PMID: 36498395 PMCID: PMC9739256 DOI: 10.3390/ijerph192316319] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/28/2022] [Accepted: 12/03/2022] [Indexed: 05/30/2023]
Abstract
The Short Physical Performance Battery (SPPB) is an objective tool for evaluating three domains (balance, repeated chair stands, and gait speed) of lower extremity physical function in older age. It is unclear how the associations between SPPB scores and health outcomes persist over time. The aim of this 14-year cohort study was to investigate associations between SPPB scores and health outcomes among participants aged 60+ years in the English Longitudinal Study of Ageing (ELSA). The exposures were SPPB scores (total and domain-specific) at baseline (Wave 2). The outcomes were mobility impairments, difficulties in performing basic activities of daily living (ADL) or instrumental activities of daily living (IADL), and falls, measured at seven subsequent timepoints (Waves 3 to 9). The analyses involved linear and logistic multilevel regressions. After adjusting for potential confounders, a one-point increase in the total SPPB score was associated with a 0.13 (95% CI: -0.16, -0.10) decrease in mobility impairment, a 0.06 (-0.08, -0.05) decrease in ADL disabilities, a 0.06 (-0.07, -0.04) decrease in IADL disabilities, and 8% (0.90, 0.95) lower odds of falling (averaged across all follow-ups). Associations between the SPPB domains and health outcomes were more varied. The SPPB may be a useful measure for identifying older adults at a high risk of adverse outcomes.
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13
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Stathi A, Withall J, Greaves CJ, Thompson JL, Taylor G, Medina-Lara A, Green C, Snowsill T, Johansen-Berg H, Bilzon J, Gray S, Cross R, Western MJ, Koning JLD, Ladlow P, Bollen JC, Moorlock SJ, Guralnik JM, Rejeski WJ, Hillsdon M, Fox KR. A group-based exercise and behavioural maintenance intervention for adults over 65 years with mobility limitations: the REACT RCT. Public Health Res 2022. [DOI: 10.3310/mqbw6832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background
Mobility limitation in older age reduces quality of life, generates substantial health- and social-care costs, and increases mortality.
Objective
The REtirement in ACTion (REACT) trial aimed to establish whether or not a community-based active ageing intervention could prevent decline in physical functioning in older adults already at increased risk of mobility limitation.
Design
A multicentre, pragmatic, two-arm, parallel-group randomised controlled trial with parallel process and health economic evaluations.
Setting
Urban and semi-rural locations across three sites in England.
Participants
Physically frail or pre-frail older adults (aged ≥ 65 years; Short Physical Performance Battery score of 4–9). Recruitment was primarily via 35 primary care practices.
Interventions
Participants were randomly assigned to receive brief advice (three healthy ageing education sessions) or a 12-month, group-based, multimodal exercise and behavioural maintenance programme delivered in fitness and community centres. Randomisation was stratified by site and used a minimisation algorithm to balance age, sex and Short Physical Performance Battery score. Data collection and analyses were blinded.
Main outcome measures
The primary outcome was change in lower limb physical function (Short Physical Performance Battery score) at 24 months, analysed using an intention-to-treat analysis. The economic evaluation adopted the NHS and Personal Social Services perspective.
Results
Between June 2016 and October 2017, 777 participants (mean age 77.6 years, standard deviation 6.8 years; 66% female; mean Short Physical Performance Battery score 7.37, standard deviation 1.56) were randomised to the intervention arm (n = 410) or the control arm (n = 367). Data collection was completed in October 2019. Primary outcome data at 24 months were provided by 628 (80.8%) participants. At the 24-month follow-up, the Short Physical Performance Battery score was significantly greater in the intervention arm (mean 8.08, standard deviation 2.87) than in the control arm (mean 7.59, standard deviation 2.61), with an adjusted mean difference of 0.49 (95% confidence interval 0.06 to 0.92). The difference in lower limb function between intervention and control participants was clinically meaningful at both 12 and 24 months. Self-reported physical activity significantly increased in the intervention arm compared with the control arm, but this change was not observed in device-based physical activity data collected during the trial. One adverse event was related to the intervention. Attrition rates were low (19% at 24 months) and adherence was high. Engagement with the REACT intervention was associated with positive changes in exercise competence, relatedness and enjoyment and perceived physical, social and mental well-being benefits. The intervention plus usual care was cost-effective compared with care alone over the 2 years of REACT; the price year was 2019. In the base-case scenario, the intervention saved £103 per participant, with a quality-adjusted life-year gain of 0.04 (95% confidence interval 0.006 to 0.074) within the 2-year trial window. Lifetime horizon modelling estimated that further cost savings and quality-adjusted life-year gains were accrued up to 15 years post randomisation.
Conclusion
A relatively low-resource, 1-year multimodal exercise and behavioural maintenance intervention can help older adults to retain physical functioning over a 24-month period. The results indicate that the well-established trajectory of declining physical functioning in older age is modifiable.
Limitations
Participants were not blinded to study arm allocation. However, the primary outcome was independently assessed by blinded data collectors. The secondary outcome analyses were exploratory, with no adjustment for multiple testing, and should be interpreted accordingly.
Future work
Following refinements guided by the process evaluation findings, the REACT intervention is suitable for large-scale implementation. Further research will optimise implementation of REACT at scale.
Trial registration
This trial is registered as ISRCTN45627165.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | | | - Colin J Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Janice L Thompson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Gordon Taylor
- University of Exeter Medical School, St Luke’s Campus, Exeter, UK
| | | | - Colin Green
- University of Exeter Medical School, St Luke’s Campus, Exeter, UK
| | - Tristan Snowsill
- University of Exeter Medical School, St Luke’s Campus, Exeter, UK
| | - Heidi Johansen-Berg
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional MRI of the Brain, Wellcome Centre for Integrative Neuroimaging, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - James Bilzon
- Department for Health, University of Bath, Bath, UK
| | - Selena Gray
- Faculty of Health and Applied Sciences, University of the West of England Bristol, Bristol, UK
| | - Rosina Cross
- Department for Health, University of Bath, Bath, UK
| | | | | | - Peter Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - Jessica C Bollen
- University of Exeter Medical School, St Luke’s Campus, Exeter, UK
| | - Sarah J Moorlock
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Worrell Professional Centre, Winston-Salem, NC, USA
| | - Melvyn Hillsdon
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Kenneth R Fox
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
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14
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Essery R, Pollet S, Bradbury K, Western MJ, Grey E, Denison-Day J, Smith KA, Hayter V, Kelly J, Somerville J, Stuart B, Becque T, Zhang J, Slodkowska-Barabasz J, Mowbray F, Ferrey A, Yao G, Zhu S, Kendrick T, Griffin S, Mutrie N, Robinson S, Brooker H, Griffiths G, Robinson L, Rossor M, Ballard C, Gallacher J, Rathod S, Gudgin B, Phillips R, Stokes T, Niven J, Little P, Yardley L. Parallel randomized controlled feasibility trials of the "Active Brains" digital intervention to protect cognitive health in adults aged 60-85. Front Public Health 2022; 10:962873. [PMID: 36203694 PMCID: PMC9530972 DOI: 10.3389/fpubh.2022.962873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/30/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction Multidomain interventions to address modifiable risk factors for dementia are promising, but require more cost-effective, scalable delivery. This study investigated the feasibility of the "Active Brains" digital behavior change intervention and its trial procedures. Materials and methods Active Brains aims to reduce cognitive decline by promoting physical activity, healthy eating, and online cognitive training. We conducted 12-month parallel-design randomized controlled feasibility trials of "Active Brains" amongst "lower cognitive scoring" (n = 180) and "higher cognitive scoring" (n = 180) adults aged 60-85. Results We collected 67.2 and 76.1% of our 12-month primary outcome (Baddeley verbal reasoning task) data for the "lower cognitive score" and "higher cognitive score" groups, respectively. Usage of "Active Brains" indicated overall feasibility and satisfactory engagement with the physical activity intervention content (which did not require sustained online engagement), but engagement with online cognitive training was limited. Uptake of the additional brief telephone support appeared to be higher in the "lower cognitive score" trial. Preliminary descriptive trends in the primary outcome data might indicate a protective effect of Active Brains against cognitive decline, but further investigation in fully-powered trials is required to answer this definitively. Discussion Whilst initial uptake and engagement with the online intervention was modest, it was in line with typical usage of other digital behavior change interventions, and early indications from the descriptive analysis of the primary outcome and behavioral data suggest that further exploration of the potential protective benefits of Active Brains are warranted. The study also identified minor modifications to procedures, particularly to improve online primary-outcome completion. Further investigation of Active Brains will now seek to determine its efficacy in protecting cognitive performance amongst adults aged 60-85 with varied levels of existing cognitive performance.
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Affiliation(s)
- Rosie Essery
- University of Southampton, Southampton, United Kingdom,*Correspondence: Rosie Essery
| | | | - Katherine Bradbury
- University of Southampton, Southampton, United Kingdom,NIHR ARC Wessex, Southampton, United Kingdom
| | | | | | | | | | | | - Joanne Kelly
- University of Southampton, Southampton, United Kingdom
| | | | - Beth Stuart
- University of Southampton, Southampton, United Kingdom,Queen Mary University of London, London, United Kingdom
| | - Taeko Becque
- University of Southampton, Southampton, United Kingdom
| | - Jin Zhang
- University of Southampton, Southampton, United Kingdom
| | | | | | - Anne Ferrey
- University of Oxford, Oxford, United Kingdom
| | - Guiqing Yao
- University of Leicester, Leicester, United Kingdom
| | - Shihua Zhu
- University of Southampton, Southampton, United Kingdom
| | - Tony Kendrick
- University of Southampton, Southampton, United Kingdom
| | | | | | | | | | - Gareth Griffiths
- NIHR Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | | | | | - John Gallacher
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Shanaya Rathod
- Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Bernard Gudgin
- Patient and Public Involvement Contributor, University of Southampton, Southampton, United Kingdom
| | - Rosemary Phillips
- Patient and Public Involvement Contributor, University of Southampton, Southampton, United Kingdom
| | - Tom Stokes
- Patient and Public Involvement Contributor, University of Southampton, Southampton, United Kingdom
| | - John Niven
- Patient and Public Involvement Contributor, University of Southampton, Southampton, United Kingdom
| | - Paul Little
- University of Southampton, Southampton, United Kingdom
| | - Lucy Yardley
- University of Southampton, Southampton, United Kingdom,University of Bristol, Bristol, United Kingdom
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15
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Stathi A, Greaves CJ, Thompson JL, Withall J, Ladlow P, Taylor G, Medina-Lara A, Snowsill T, Gray S, Green C, Johansen-Berg H, Sexton CE, Bilzon JLJ, deKoning J, Bollen JC, Moorlock SJ, Western MJ, Demnitz N, Seager P, Guralnik JM, Rejeski WJ, Hillsdon M, Fox KR. Effect of a physical activity and behaviour maintenance programme on functional mobility decline in older adults: the REACT (Retirement in Action) randomised controlled trial. Lancet Public Health 2022; 7:e316-e326. [PMID: 35325627 PMCID: PMC8967718 DOI: 10.1016/s2468-2667(22)00004-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 12/09/2021] [Accepted: 12/20/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Mobility limitations in old age can greatly reduce quality of life, generate substantial health and social care costs, and increase mortality. Through the Retirement in Action (REACT) trial, we aimed to establish whether a community-based active ageing intervention could prevent decline in lower limb physical functioning in older adults already at increased risk of mobility limitation. METHODS In this pragmatic, multicentre, two-arm, single-blind, parallel-group, randomised, controlled trial, we recruited older adults (aged 65 years or older and who are not in full-time employment) with reduced lower limb physical functioning (Short Physical Performance Battery [SPPB] score 4-9) from 35 primary care practices across three sites (Bristol and Bath; Birmingham; and Devon) in England. Participants were randomly assigned to receive brief advice (three healthy ageing education sessions) or a 12-month, group-based, multimodal physical activity (64 1-h exercise sessions) and behavioural maintenance (21 45-min sessions) programme delivered by charity and community or leisure centre staff in local communities. Randomisation was stratified by site and adopted a minimisation approach to balance groups by age, sex, and SPPB score, using a centralised, online, randomisation algorithm. Researchers involved in data collection and analysis were masked but participants were not because of the nature of the intervention. The primary outcome was change in SPPB score at 24 months, analysed by intention to treat. This trial is registered with ISRCTN, ISRCTN45627165. FINDINGS Between June 20, 2016, and Oct 30, 2017, 777 participants (mean age 77·6 [SD 6·8] years; 66% female; mean SPPB score 7·37 [1·56]) were randomly assigned to the intervention (n=410) and control (n=367) groups. Primary outcome data at 24 months were provided by 628 (81%) participants (294 in the control group and 334 in the intervention group). At the 24-month follow-up, the SPPB score (adjusted for baseline SPPB score, age, sex, study site, and exercise group) was significantly greater in the intervention group (mean 8·08 [SD 2·87]) than in the control group (mean 7·59 [2·61]), with an adjusted mean difference of 0·49 (95% CI 0·06-0·92; p=0·014), which is just below our predefined clinically meaningful difference of 0·50. One adverse event was related to the intervention; the most common unrelated adverse events were heart conditions, strokes, and falls. INTERPRETATION For older adults at risk of mobility limitations, the REACT intervention showed that a 12-month physical activity and behavioural maintenance programme could help prevent decline in physical function over a 24-month period. FUNDING National Institute for Health Research Public Health Research Programme (13/164/51).
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Affiliation(s)
- Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
| | - Colin J Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Janice L Thompson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Janet Withall
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK; Department for Health, University of Bath, Bath, UK
| | - Peter Ladlow
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough, UK
| | - Gordon Taylor
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Tristan Snowsill
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Selena Gray
- Faculty of Health and Applied Sciences, University of the West of England (UWE) Bristol, Bristol, UK
| | - Colin Green
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Heidi Johansen-Berg
- Oxford Centre for Functional MRI of the Brain, Wellcome Centre for Integrative Neuroimaging, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Claire E Sexton
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Global Brain Health Institute, Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Jessica C Bollen
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sarah J Moorlock
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Naiara Demnitz
- Danish Research Centre for Magnetic Resonance, Centre for Functional Diagnostic Imaging and Research, Copenhagen University Hospital -Amager and Hvidovre, Hvidovre, Denmark
| | - Poppy Seager
- Oxford Centre for Functional MRI of the Brain, Wellcome Centre for Integrative Neuroimaging, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Melvyn Hillsdon
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Kenneth R Fox
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
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16
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Western MJ, Armstrong MEG, Islam I, Morgan K, Jones UF, Kelson MJ. The effectiveness of digital interventions for increasing physical activity in individuals of low socioeconomic status: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2021; 18:148. [PMID: 34753490 PMCID: PMC8576797 DOI: 10.1186/s12966-021-01218-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 10/20/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Digital technologies such as wearables, websites and mobile applications are increasingly used in interventions targeting physical activity (PA). Increasing access to such technologies makes an attractive prospect for helping individuals of low socioeconomic status (SES) in becoming more active and healthier. However, little is known about their effectiveness in such populations. The aim of this systematic review was to explore whether digital interventions were effective in promoting PA in low SES populations, whether interventions are of equal benefit to higher SES individuals and whether the number or type of behaviour change techniques (BCTs) used in digital PA interventions was associated with intervention effects. METHODS A systematic search strategy was used to identify eligible studies from MEDLINE, Embase, PsycINFO, Web of Science, Scopus and The Cochrane Library, published between January 1990 and March 2020. Randomised controlled trials, using digital technology as the primary intervention tool, and a control group that did not receive any digital technology-based intervention were included, provided they had a measure of PA as an outcome. Lastly, studies that did not have any measure of SES were excluded from the review. Risk of Bias was assessed using the Cochrane Risk of Bias tool version 2. RESULTS Of the 14,589 records initially identified, 19 studies were included in the final meta-analysis. Using random-effects models, in low SES there was a standardised mean difference (SMD (95%CI)) in PA between intervention and control groups of 0.06 (- 0.08,0.20). In high SES the SMD was 0.34 (0.22,0.45). Heterogeneity was modest in both low (I2 = 0.18) and high (I2 = 0) SES groups. The studies used a range of digital technologies and BCTs in their interventions, but the main findings were consistent across all of the sub-group analyses (digital interventions with a PA only focus, country, chronic disease, and duration of intervention) and there was no association with the number or type of BCTs. DISCUSSION Digital interventions targeting PA do not show equivalent efficacy for people of low and high SES. For people of low SES, there is no evidence that digital PA interventions are effective, irrespective of the behaviour change techniques used. In contrast, the same interventions in high SES participants do indicate effectiveness. To reduce inequalities and improve effectiveness, future development of digital interventions aimed at improving PA must make more effort to meet the needs of low SES people within the target population.
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Affiliation(s)
- Max J. Western
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY UK
| | - Miranda E. G. Armstrong
- Centre for Exercise, Nutrition and Health Science, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK
| | - Ishrat Islam
- PRIME Centre Wales, School of Medicine, Cardiff University, Cardiff, CF14 4YS UK
| | - Kelly Morgan
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, CF10 3BD UK
| | - Una F. Jones
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, CF14 4XN UK
| | - Mark J. Kelson
- Department of Mathematics/Institute of Data Science and Artificial Intelligence, University of Exeter, Laver Building, Exeter, EX4 4QE UK
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17
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Essery R, Pollet S, Smith KA, Mowbray F, Slodkowska-Barabasz J, Denison-Day J, Hayter V, Bradbury K, Grey E, Western MJ, Milton A, Hunter C, Ferrey AE, Müller AM, Stuart B, Mutrie N, Griffin S, Kendrick T, Brooker H, Gudgin B, Phillips R, Stokes T, Niven J, Little P, Yardley L. Planning and optimising a digital intervention to protect older adults' cognitive health. Pilot Feasibility Stud 2021; 7:158. [PMID: 34407886 PMCID: PMC8371874 DOI: 10.1186/s40814-021-00884-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND By 2050, worldwide dementia prevalence is expected to triple. Affordable, scalable interventions are required to support protective behaviours such as physical activity, cognitive training and healthy eating. This paper outlines the theory-, evidence- and person-based development of 'Active Brains': a multi-domain digital behaviour change intervention to reduce cognitive decline amongst older adults. METHODS During the initial planning phase, scoping reviews, consultation with PPI contributors and expert co-investigators and behavioural analysis collated and recorded evidence that was triangulated to inform provisional 'guiding principles' and an intervention logic model. The following optimisation phase involved qualitative think aloud and semi-structured interviews with 52 older adults with higher and lower cognitive performance scores. Data were analysed thematically and informed changes and additions to guiding principles, the behavioural analysis and the logic model which, in turn, informed changes to intervention content. RESULTS Scoping reviews and qualitative interviews suggested that the same intervention content may be suitable for individuals with higher and lower cognitive performance. Qualitative findings revealed that maintaining independence and enjoyment motivated engagement in intervention-targeted behaviours, whereas managing ill health was a potential barrier. Social support for engaging in such activities could provide motivation, but was not desirable for all. These findings informed development of intervention content and functionality that appeared highly acceptable amongst a sample of target users. CONCLUSIONS A digitally delivered intervention with minimal support appears acceptable and potentially engaging to older adults with higher and lower levels of cognitive performance. As well as informing our own intervention development, insights obtained through this process may be useful for others working with, and developing interventions for, older adults and/or those with cognitive impairment.
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Affiliation(s)
- Rosie Essery
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK.
| | - Sebastien Pollet
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Kirsten A Smith
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Fiona Mowbray
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Joanna Slodkowska-Barabasz
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - James Denison-Day
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Victoria Hayter
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Katherine Bradbury
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | | | | | - Alexander Milton
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Cheryl Hunter
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Anne E Ferrey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andre Matthias Müller
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, 117549, Singapore.,Centre for Sport & Exercise Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Beth Stuart
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Nanette Mutrie
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | - Simon Griffin
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Tony Kendrick
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | | | - Bernard Gudgin
- Public and Patient Involvement (PPI) representative, Southampton, UK
| | - Rosemary Phillips
- Public and Patient Involvement (PPI) representative, Southampton, UK
| | - Tom Stokes
- Public and Patient Involvement (PPI) representative, Southampton, UK
| | - John Niven
- Public and Patient Involvement (PPI) representative, Southampton, UK
| | - Paul Little
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK. .,School of Psychological Science, University of Bristol, Bristol, UK.
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Chowdhury EA, Inza VC, Western MJ, Walsh NE, Bilzon JLJ, Jones SL. P106 Planning and development of a long-term digital self-management tool for osteoarthritis: the Intelligent Knee Osteoarthritis Lifestyle App. Rheumatology (Oxford) 2021. [DOI: 10.1093/rheumatology/keab247.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Aims
There is strong evidence for beneficial effects of physical activity for people with knee osteoarthritis (KOA). While supervised exercise programmes are effective, they are resource intensive, typically of limited duration and hard to implement at scale. More accessible options should be developed to enable individuals to adopt and maintain appropriate physically active lifestyles. Smartphone apps can monitor activity and symptoms, providing feedback to support self-management. We aimed to co-design a KOA self-management app, with physiotherapists and people experiencing KOA, to support long-term physical activity.
Methods
We followed the Person-Based Approach to developing health interventions. We initially undertook a rapid review of clinical exercise guidelines and KOA position statements. Views from potential app users were elicited via focus groups, to determine attitudes towards physical activity, KOA self-management technology, and identify desired app features. Physiotherapists were interviewed to establish factors that feed into physical activity advice and recommendations in a clinical context, and determine which features they deemed appropriate to incorporate into an app. We then mapped established behaviour change techniques to potential features. Combining these sources of information, we developed guiding principles, then iteratively developed and refined the app through “think aloud” interviews with potential users and interviews with physiotherapists to assess appropriateness and safety.
Results
Literature scoping established positive effects for a range of exercise modes, with NICE guidelines highlighting physical activity, education and weight management as core treatments for KOA. Patient focus groups highlighted uncertainty about the potential benefits and/or harms associated with physical activity, as well as confusion regarding appropriate sources of information. Patients emphasised the importance of symptom tracking and the benefits of social support as an important factor in motivation to engage in and sustain activity. Interviews with physiotherapists revealed physical and psycho-social characteristics of patients to consider when recommending physical activities. Physiotherapists and patients both expressed the necessity for activities to be tailored to individual capabilities and preferences.
Conclusion
The Intelligent Knee Osteoarthritis Lifestyle App (iKOALA) is an evidence-based smartphone app to support long-term self-management for individuals with KOA. The app facilitates appropriate physical activity adoption and maintenance; provides feedback from linked wearable activity trackers; gives information and intelligently tailored physical activity options from patient preferences and symptoms. Broader self-management aspects include rehabilitation exercise content, symptom tracking and alerts, weight management tools and education resources. Crucially, for long-term maintenance, the app includes forum features, fostering social relatedness among users. The app has received positive feedback from potential users in terms of usability and perceived utility. Physiotherapists have provided positive clinical impressions and validated the appropriateness of the content and features. The app is undergoing extended user testing with patients, following which, we aim to assess the effectiveness of the app in a randomised trial.
Disclosure
E.A. Chowdhury: None. V. Ceballos Inza: None. M.J. Western: None. N.E. Walsh: None. J.L.J. Bilzon: None. S.L. Jones: None.
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Affiliation(s)
- Enhad A Chowdhury
- Department for Health, University of Bath, Bath, UNITED KINGDOM
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Bath, Bath, UNITED KINGDOM
| | - Victor Ceballos Inza
- Visual Computing Centre, King Abdullah University of Science and Technology, Thuwal, SAUDI ARABIA
- Department of Computer Science, University of Bath, Bath, UNITED KINGDOM
| | - Max J Western
- Department for Health, University of Bath, Bath, UNITED KINGDOM
- Centre for Motivation and Health Behaviour Change, University of Bath, Bath, UNITED KINGDOM
| | - Nicola E Walsh
- Centre for Health and Clinical Research, University of the West of England, Bristol, UNITED KINGDOM
| | - James L J Bilzon
- Department for Health, University of Bath, Bath, UNITED KINGDOM
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Bath, Bath, UNITED KINGDOM
| | - Simon L Jones
- Department of Computer Science, University of Bath, Bath, UNITED KINGDOM
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Essery R, Denison-Day J, Grey E, Priestley E, Bradbury K, Mutrie N, Western MJ. Development of the Digital Assessment of Precise Physical Activity (DAPPA) Tool for Older Adults. Int J Environ Res Public Health 2020; 17:ijerph17217949. [PMID: 33138167 PMCID: PMC7663633 DOI: 10.3390/ijerph17217949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 12/05/2022]
Abstract
Physical activity (PA) is central to maintaining health and wellbeing as we age. Valid, reliable measurement tools are vital for understanding, and evaluating PA. There are limited options for comprehensively, accurately and affordably measuring older adults’ PA at scale at present. We aimed to develop a digital PA measurement tool specifically for adults aged 65+ using a person-based approach. We collated evidence from target users, field experts and the relevant literature to learn how older adults comprehend PA and would accept a digital tool. Findings suggest that older adults’ PA is often integrated into their daily life activities and that commonly applied terminology (e.g., moderate and vigorous) can be difficult to interpret. We also found that there is increasing familiarity with digital platforms amongst older adults, and that technological simplicity is valued. These findings informed the development of a digital tool that asks users to report their activities across key PA domains and dimensions from the previous 7-days. Users found the tool easy to navigate and comprehensive in terms of activity reporting. However, real-world usability testing revealed that users struggled with seven-day recall. Further work will address the identified issues, including creating a single-day reporting option, before commencing work to validate this new tool.
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Affiliation(s)
- Rosie Essery
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP), University of Southampton, Southampton SO17 1BJ, UK; (R.E.); (J.D.-D.); (E.P.); (K.B.)
| | - James Denison-Day
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP), University of Southampton, Southampton SO17 1BJ, UK; (R.E.); (J.D.-D.); (E.P.); (K.B.)
| | - Elisabeth Grey
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath BA2 7AY, UK;
| | - Emma Priestley
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP), University of Southampton, Southampton SO17 1BJ, UK; (R.E.); (J.D.-D.); (E.P.); (K.B.)
| | - Katherine Bradbury
- Centre for Clinical and Community Applications of Health Psychology (CCCAHP), University of Southampton, Southampton SO17 1BJ, UK; (R.E.); (J.D.-D.); (E.P.); (K.B.)
| | - Nanette Mutrie
- Physical Activity for Health Research Centre (PAHRC), Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh EH8 8AQ, UK;
| | - Max J. Western
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath BA2 7AY, UK;
- Correspondence:
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20
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Peacock OJ, Western MJ, Batterham AM, Chowdhury EA, Stathi A, Standage M, Tapp A, Bennett P, Thompson D. Effect of novel technology-enabled multidimensional physical activity feedback in primary care patients at risk of chronic disease - the MIPACT study: a randomised controlled trial. Int J Behav Nutr Phys Act 2020; 17:99. [PMID: 32771018 PMCID: PMC7414690 DOI: 10.1186/s12966-020-00998-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Technological progress has enabled the provision of personalised feedback across multiple dimensions of physical activity that are important for health. Whether this multidimensional approach supports physical activity behaviour change has not yet been examined. Our objective was to examine the effectiveness of a novel digital system and app that provided multidimensional physical activity feedback combined with health trainer support in primary care patients identified as at risk of chronic disease. METHODS MIPACT was a parallel-group, randomised controlled trial that recruited patients at medium (≥10 and < 20%) or high (≥20%) risk of cardiovascular disease and/or type II diabetes from six primary care practices in the United Kingdom. Intervention group participants (n = 120) received personal multidimensional physical activity feedback using a customised digital system and web-app for 3 months plus five health trainer-led sessions. All participants received standardised information regarding physical activity. Control group participants (n = 84) received no further intervention. The primary outcome was device-based assessment of physical activity at 12 months. RESULTS Mean intervention effects were: moderate-vigorous physical activity: -1.1 (95% CI, - 17.9 to 15.7) min/day; moderate-vigorous physical activity in ≥10-min bouts: 0.2 (- 14.2 to 14.6) min/day; Physical Activity Level (PAL): 0.00 (- 0.036 to 0.054); vigorous physical activity: 1.8 (- 0.8 to 4.2) min/day; and sedentary time: 10 (- 19.3 to 39.3) min/day. For all of these outcomes, the results showed that the groups were practically equivalent and statistically ruled out meaningful positive or negative effects (>minimum clinically important difference, MCID). However, there was profound physical activity multidimensionality, and only a small proportion (5%) of patients had consistently low physical activity across all dimensions. CONCLUSION In patients at risk of cardiovascular disease and/or type II diabetes, MIPACT did not increase mean physical activity. Using a sophisticated multidimensional digital approach revealed enormous heterogeneity in baseline physical activity in primary care patients, and practitioners may need to screen for low physical activity across dimensions rather than rely on disease-risk algorithms that are heavily influenced by age. TRIAL REGISTRATION This trial is registered with the ISRCTN registry ( ISRCTN18008011 ; registration date 31 July 2013).
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Affiliation(s)
| | - Max J Western
- Department for Health, University of Bath, Bath, BA2 7AY, UK
| | - Alan M Batterham
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | | | - Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Martyn Standage
- Department for Health, University of Bath, Bath, BA2 7AY, UK
| | - Alan Tapp
- Bristol Business School, University of West of England, Bristol, UK
| | - Paul Bennett
- Department for Health, University of Bath, Bath, BA2 7AY, UK
| | - Dylan Thompson
- Department for Health, University of Bath, Bath, BA2 7AY, UK.
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21
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Withall J, Greaves CJ, Thompson JL, de Koning JL, Bollen JC, Moorlock SJ, Fox KR, Western MJ, Snowsill T, Medina-Lara A, Cross R, Ladlow P, Taylor G, Zisi V, Clynes J, Gray S, Agyapong-Badu S, Guralnik JM, Rejeski WJ, Stathi A. The Tribulations of Trials: Lessons Learnt Recruiting 777 Older Adults Into REtirement in ACTion (REACT), a Trial of a Community, Group-Based Active Aging Intervention Targeting Mobility Disability. J Gerontol A Biol Sci Med Sci 2020; 75:2387-2395. [PMID: 32147709 PMCID: PMC7662171 DOI: 10.1093/gerona/glaa051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Challenges of recruitment to randomized controlled trials (RCTs) and successful strategies to overcome them should be clearly reported to improve recruitment into future trials. REtirement in ACTion (REACT) is a United Kingdom-based multicenter RCT recruiting older adults at high risk of mobility disability to a 12-month group-based exercise and behavior maintenance program or to a minimal Healthy Aging control intervention. METHODS The recruitment target was 768 adults, aged 65 years and older scoring 4-9 on the Short Physical Performance Battery (SPPB). Recruitment methods include the following: (a) invitations mailed by general practitioners (GPs); (b) invitations distributed via third-sector organizations; and (c) public relations (PR) campaign. Yields, efficiency, and costs were calculated. RESULTS The study recruited 777 (33.9% men) community-dwelling, older adults (mean age 77.55 years (SD 6.79), mean SPPB score 7.37 (SD 1.56)), 95.11% white (n = 739) and broadly representative of UK quintiles of deprivation. Over a 20-month recruitment period, 25,559 invitations were issued. Eighty-eight percent of the participants were recruited via GP invitations, 5.4% via the PR campaign, 3% via word-of-mouth, and 2.5% via third-sector organizations. Mean recruitment cost per participant was £78.47, with an extra £26.54 per recruit paid to GPs to cover research costs. CONCLUSIONS REACT successfully recruited to target. Response rates were lower than initially predicted and recruitment timescales required adjustment. Written invitations from GPs were the most efficient method for recruiting older adults at risk of mobility disability. Targeted efforts could achieve more ethnically diverse cohorts. All trials should be required to provide recruitment data to enable evidence-based planning of future trials.
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Affiliation(s)
- Janet Withall
- Department for Health, University of Bath, UK,Address correspondence to: Janet Withall, PhD, Department for Health, University of Bath, Claverton Down, Bath BA2 7AY, UK. E-mail:
| | - Colin J Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | - Janice L Thompson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | | | | | - Sarah J Moorlock
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | - Kenneth R Fox
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, UK
| | | | - Tristan Snowsill
- Institute of Health Research, College of Medicine and Health, South Cloisters, University of Exeter, St Luke’s Campus, UK
| | | | | | - Peter Ladlow
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
| | - Gordon Taylor
- University of Exeter Medical School, St Luke’s Campus, UK
| | - Vasiliki Zisi
- Department of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | | | - Selena Gray
- Faculty of Health and Applied Sciences (HAS), University of the West of England (UWE Bristol), Frenchay Campus, Bristol, UK
| | - Sandra Agyapong-Badu
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
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22
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Stathi A, Withall J, Greaves CJ, Thompson JL, Taylor G, Medina-Lara A, Green C, Bilzon J, Gray S, Johansen-Berg H, Sexton CE, Western MJ, de Koning JL, Bollen JC, Moorlock SJ, Demnitz N, Seager P, Guralnik JM, Jack Rejeski W, Fox KR. A community-based physical activity intervention to prevent mobility-related disability for retired older people (REtirement in ACTion (REACT)): study protocol for a randomised controlled trial. Trials 2018; 19:228. [PMID: 29665854 PMCID: PMC5905123 DOI: 10.1186/s13063-018-2603-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 03/14/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The REtirement in ACTion (REACT) study is a multi-centre, pragmatic, two-arm, parallel-group randomised controlled trial (RCT) with an internal pilot phase. It aims to test the effectiveness and cost-effectiveness of a community, group-based physical activity intervention for reducing, or reversing, the progression of functional limitations in older people who are at high risk of mobility-related disability. METHODS/DESIGN A sample of 768 sedentary, community-dwelling, older people aged 65 years and over with functional limitations, but who are still ambulatory (scores between 4 and 9 out of 12 in the Short Physical Performance Battery test (SPPB)) will be randomised to receive either the REACT intervention, delivered over a period of 12 months by trained facilitators, or a minimal control intervention. The REACT study incorporates comprehensive process and economic evaluation and a nested sub-study which will test the hypothesis that the REACT intervention will slow the rate of brain atrophy and of decline in cognitive function assessed using magnetic resonance imaging (MRI). Outcome data will be collected at baseline, 6, 12 and 24 months for the main study, with MRI sub-study data collected at baseline, 6 and 12 months. The primary outcome analysis (SPPB score at 24 months) will be undertaken blinded to group allocation. Primary comparative analyses will be on an intention-to-treat (ITT) basis with due emphasis placed on confidence intervals. DISCUSSION REACT represents the first large-scale, pragmatic, community-based trial in the UK to target the non-disabled but high-risk segment of the older population with an intervention to reduce mobility-related disability. A programme that can successfully engage this population in sufficient activity to improve strength, aerobic capacity, coordination and balance would have a major impact on sustaining health and independence. REACT is also the first study of its kind to conduct a full economic and comprehensive process evaluation alongside the RCT. If effective and cost-effective, the REACT intervention has strong potential to be implemented widely in the UK and elsewhere. TRIAL REGISTRATION ISRCTN, ID: ISRCTN45627165 . Retrospectively registered on 13 June 2016. Trial sponsor: University of Bath. Protocol Version 1.5.
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Affiliation(s)
- Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Janet Withall
- 0000 0001 2162 1699grid.7340.0Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY UK
| | - Colin J. Greaves
- 0000 0004 1936 8024grid.8391.3University of Exeter Medical School, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Janice L. Thompson
- 0000 0004 1936 7486grid.6572.6School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Gordon Taylor
- 0000 0001 2162 1699grid.7340.0Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY UK
| | - Antonieta Medina-Lara
- 0000 0004 1936 8024grid.8391.3University of Exeter Medical School, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Colin Green
- 0000 0004 1936 8024grid.8391.3University of Exeter Medical School, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - James Bilzon
- 0000 0001 2162 1699grid.7340.0Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY UK
| | - Selena Gray
- 0000 0001 2034 5266grid.6518.aFaculty of Health and Applied Sciences (HAS), University of the West of England (UWE Bristol), Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY UK
| | - Heidi Johansen-Berg
- 0000 0004 1936 8948grid.4991.5Wellcome Centre for Integrative Neuroimaging, FMRIB, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Claire E. Sexton
- 0000 0004 1936 8948grid.4991.5Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK ,0000 0001 2297 6811grid.266102.1Global Brain Health Institute, Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA USA
| | - Max J. Western
- 0000 0001 2162 1699grid.7340.0Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY UK
| | - Jolanthe L. de Koning
- 0000 0001 2162 1699grid.7340.0Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY UK
| | - Jessica C. Bollen
- 0000 0004 1936 8024grid.8391.3University of Exeter Medical School, St Luke’s Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Sarah J. Moorlock
- 0000 0004 1936 7486grid.6572.6School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Naiara Demnitz
- 0000 0004 1936 8948grid.4991.5Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK
| | - Poppy Seager
- 0000 0004 1936 8948grid.4991.5Wellcome Centre for Integrative Neuroimaging, FMRIB, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Jack M. Guralnik
- 0000 0001 2175 4264grid.411024.2Department of Epidemiology and Public Health, University of Maryland, School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201-1559 USA
| | - W. Jack Rejeski
- 0000 0001 2185 3318grid.241167.7Department of Health and Exercise Science, Wake Forest University, Worrell Professional Center 2164B, PO Box 7868, Winston-Salem, NC 27109 USA
| | - Ken R. Fox
- 0000 0004 1936 7603grid.5337.2Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, BS8 1TZ UK
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Chowdhury EA, Western MJ, Nightingale TE, Peacock OJ, Thompson D. Assessment of laboratory and daily energy expenditure estimates from consumer multi-sensor physical activity monitors. PLoS One 2017; 12:e0171720. [PMID: 28234979 PMCID: PMC5325221 DOI: 10.1371/journal.pone.0171720] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/23/2017] [Indexed: 11/18/2022] Open
Abstract
Wearable physical activity monitors are growing in popularity and provide the opportunity for large numbers of the public to self-monitor physical activity behaviours. The latest generation of these devices feature multiple sensors, ostensibly similar or even superior to advanced research instruments. However, little is known about the accuracy of their energy expenditure estimates. Here, we assessed their performance against criterion measurements in both controlled laboratory conditions (simulated activities of daily living and structured exercise) and over a 24 hour period in free-living conditions. Thirty men (n = 15) and women (n = 15) wore three multi-sensor consumer monitors (Microsoft Band, Apple Watch and Fitbit Charge HR), an accelerometry-only device as a comparison (Jawbone UP24) and validated research-grade multi-sensor devices (BodyMedia Core and individually calibrated Actiheart™). During discrete laboratory activities when compared against indirect calorimetry, the Apple Watch performed similarly to criterion measures. The Fitbit Charge HR was less consistent at measurement of discrete activities, but produced similar free-living estimates to the Apple Watch. Both these devices underestimated free-living energy expenditure (-394 kcal/d and -405 kcal/d, respectively; P<0.01). The multi-sensor Microsoft Band and accelerometry-only Jawbone UP24 devices underestimated most laboratory activities and substantially underestimated free-living expenditure (-1128 kcal/d and -998 kcal/d, respectively; P<0.01). None of the consumer devices were deemed equivalent to the reference method for daily energy expenditure. For all devices, there was a tendency for negative bias with greater daily energy expenditure. No consumer monitors performed as well as the research-grade devices although in some (but not all) cases, estimates were close to criterion measurements. Thus, whilst industry-led innovation has improved the accuracy of consumer monitors, these devices are not yet equivalent to the best research-grade devices or indeed equivalent to each other. We propose independent quality standards and/or accuracy ratings for consumer devices are required.
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Affiliation(s)
| | - Max J. Western
- Department for Health, University of Bath, Bath, United Kingdom
| | | | | | - Dylan Thompson
- Department for Health, University of Bath, Bath, United Kingdom
- * E-mail:
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Thompson D, Batterham AM, Peacock OJ, Western MJ, Booso R. Feedback from physical activity monitors is not compatible with current recommendations: A recalibration study. Prev Med 2016; 91:389-394. [PMID: 27330025 PMCID: PMC5061550 DOI: 10.1016/j.ypmed.2016.06.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 06/02/2016] [Accepted: 06/12/2016] [Indexed: 01/06/2023]
Abstract
Wearable devices to self-monitor physical activity have become popular with individuals and healthcare practitioners as a route to the prevention of chronic disease. It is not currently possible to reconcile feedback from these devices with activity recommendations because the guidelines refer to the amount of activity required on top of normal lifestyle activities (e.g., 150 minutes of moderate-to-vigorous intensity activity per week over-and-above normal moderate-to-vigorous lifestyle activities). The aim of this study was to recalibrate the feedback from self-monitoring. We pooled data from four studies conducted between 2006 and 2014 in patients and volunteers from the community that included both sophisticated measures of physical activity and 10-year risk for cardiovascular disease and type 2 diabetes (n=305). We determined the amount of moderate-to-vigorous intensity activity that corresponded to FAO/WHO/UNU guidance for a required PAL of 1.75 (Total Energy Expenditure/Basal Metabolic Rate). Our results show that, at the UK median PAL, total moderate-to-vigorous intensity physical activity will be around 735 minutes per week (~11% of waking time). We estimate that a 4% increase in moderate-to-vigorous intensity activity will achieve standardised guidance from FAO/WHO/UNU and will require ~1000 minutes of moderate-to-vigorous intensity activity per week. This study demonstrates that feedback from sophisticated wearable devices is incompatible with current physical activity recommendations. Without adjustment, people will erroneously form the view that they are exceeding recommendations by several fold. A more appropriate target from self-monitoring that accounts for normal moderate-to-vigorous lifestyle activities is ~1000 minutes per week, which represents ~15% of waking time.
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Affiliation(s)
- Dylan Thompson
- Department for Health, University of Bath, Bath BA2 7AY, UK.
| | - Alan M Batterham
- Health and Social Care Institute, Teesside University, Middlesbrough TS1 3BA, UK
| | | | - Max J Western
- Department for Health, University of Bath, Bath BA2 7AY, UK
| | - Rahuman Booso
- Directorate of Health Services, Air Force Head Quarters, P.O. BOX 1592, Colombo 02, Sri Lanka
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Peacock OJ, Western MJ, Batterham AM, Stathi A, Standage M, Tapp A, Bennett P, Thompson D. Multidimensional individualised Physical ACTivity (Mi-PACT)--a technology-enabled intervention to promote physical activity in primary care: study protocol for a randomised controlled trial. Trials 2015; 16:381. [PMID: 26314577 PMCID: PMC4552151 DOI: 10.1186/s13063-015-0892-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/29/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Low physical activity is a major public health problem. New cost-effective approaches that stimulate meaningful long-term changes in physical activity are required, especially within primary care settings. It is becoming clear that there are various dimensions to physical activity with independent health benefits. Advances in technology mean that it is now possible to generate multidimensional physical activity 'profiles' that provide a more complete representation of physical activity and offer a variety of options that can be tailored to the individual. Mi-PACT is a randomised controlled trial designed to examine whether personalised multidimensional physical activity feedback and self-monitoring alongside trainer-supportive sessions increases physical activity and improves health outcomes in at-risk men and women. METHODS/DESIGN We aim to recruit 216 patients from within primary care aged 40 to 70 years and at medium or high risk of cardiovascular disease and/or type II diabetes mellitus. Adopting an unequal allocation ratio (intervention: control) of 2:1, participants will be randomised to one of two groups, usual care or the intervention. The control group will receive usual care from their general practitioner (GP) and standardised messages about physical activity for health. The intervention group will receive physical activity monitors and access to a web-based platform for a 3-month period to enable self-monitoring and the provision of personalised feedback regarding the multidimensional nature of physical activity. In addition, this technology-enabled feedback will be discussed with participants on 5 occasions during supportive one-to-one coaching sessions across the 3-month intervention. The primary outcome measure is physical activity, which will be directly assessed using activity monitors for a 7-day period at baseline, post intervention and at 12 months. Secondary measures (at these time-points) include weight loss, fat mass, and markers of metabolic control, motivation and well-being. DISCUSSION Results from this study will provide insight into the effects of integrated physical activity profiling and self-monitoring combined with in-person support on physical activity and health outcomes in patients at risk of future chronic disease. TRIAL REGISTRATION ISRCTN18008011 Trial registration date: 31 July 2013.
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Affiliation(s)
| | - Max J Western
- Department for Health, University of Bath, Bath, BA2 7AY, UK.
| | - Alan M Batterham
- Health and Social Care Institute, Teesside University, Middlesbrough, UK.
| | - Afroditi Stathi
- Department for Health, University of Bath, Bath, BA2 7AY, UK.
| | - Martyn Standage
- Department for Health, University of Bath, Bath, BA2 7AY, UK.
| | - Alan Tapp
- Bristol Business School, University of the West of England, Bristol, UK.
| | - Paul Bennett
- Department for Health, University of Bath, Bath, BA2 7AY, UK.
| | - Dylan Thompson
- Department for Health, University of Bath, Bath, BA2 7AY, UK.
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Western MJ, Peacock OJ, Stathi A, Thompson D. The understanding and interpretation of innovative technology-enabled multidimensional physical activity feedback in patients at risk of future chronic disease. PLoS One 2015; 10:e0126156. [PMID: 25938455 PMCID: PMC4418766 DOI: 10.1371/journal.pone.0126156] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/30/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Innovative physical activity monitoring technology can be used to depict rich visual feedback that encompasses the various aspects of physical activity known to be important for health. However, it is unknown whether patients who are at risk of chronic disease would understand such sophisticated personalised feedback or whether they would find it useful and motivating. The purpose of the present study was to determine whether technology-enabled multidimensional physical activity graphics and visualisations are comprehensible and usable for patients at risk of chronic disease. METHOD We developed several iterations of graphics depicting minute-by-minute activity patterns and integrated physical activity health targets. Subsequently, patients at moderate/high risk of chronic disease (n=29) and healthcare practitioners (n=15) from South West England underwent full 7-days activity monitoring followed by individual semi-structured interviews in which they were asked to comment on their own personalised visual feedback Framework analysis was used to gauge their interpretation and of personalised feedback, graphics and visualisations. RESULTS We identified two main components focussing on (a) the interpretation of feedback designs and data and (b) the impact of personalised visual physical activity feedback on facilitation of health behaviour change. Participants demonstrated a clear ability to understand the sophisticated personal information plus an enhanced physical activity knowledge. They reported that receiving multidimensional feedback was motivating and could be usefully applied to facilitate their efforts in becoming more physically active. CONCLUSION Multidimensional physical activity feedback can be made comprehensible, informative and motivational by using appropriate graphics and visualisations. There is an opportunity to exploit the full potential created by technological innovation and provide sophisticated personalised physical activity feedback as an adjunct to support behaviour change.
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Affiliation(s)
- Max J. Western
- Department for Health, University of Bath, Bath, BA2 7AY, United Kingdom
| | - Oliver J. Peacock
- Department for Health, University of Bath, Bath, BA2 7AY, United Kingdom
| | - Afroditi Stathi
- Department for Health, University of Bath, Bath, BA2 7AY, United Kingdom
| | - Dylan Thompson
- Department for Health, University of Bath, Bath, BA2 7AY, United Kingdom
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