Hypertension Health Behavior Change and Older Adults: the effect of an Appreciative Education Approach

Making lifestyle changes has been found to be effective in controlling hypertension. Positive psychology may provide alternatives to existing health behavior change approaches. Appreciative Education (AE), a positive psychology approach, was applied to an existing hypertension control intervention, Lifestyle University (LU), and compared to the Social Cognitive Theory (SCT) approach, in a segment of the existing intervention. This study used quasi-experimental, mixed methods pre/post-test, repeated measures design. Two-groups of community-dwelling adults, aged 50+, control SCT (n= 60), and experimental AE (n=33), were compared using the LU intervention. Seven dependent variables were measured at pre-test, post-test 1 and post-test 2. Repeated measures ANOVA demonstrated the AE intervention to be more effective than the SCT intervention in increasing self-selected (p=0.0002) and fast gait (p=0.002) speed. Pearson correlation revealed an inverse relationship between systolic blood pressure and International Physical Activity Questionnaire (IPAQ) scores (rs = -0.40, p = 0.008). The AE group was not more effective than the SCT group in reducing mean systolic and diastolic blood pressure, BMI, physical activity (IPAQ), and fruit and vegetable consumption (EATS). In the grounded theory qualitative analysis of interview data, both groups shared four health behavior themes: accountability, consumption changes, learning aids and activities, and other behavior changes. Two of the three perception themes, peer influence (SCT) and health relationships (AE), reflected the differences between the two approaches while the enjoyment theme emerged from both groups. Results of this study suggest future interventions designed from the ground up, using the AE approach, may be an effective health behavior change alternative

Novel sedentary behaviour measurement methods: application for self-monitoring in adults

With the introduction of the technological age, increasing mechanisation has led to labour saving devices which have all-but engineered physical activity out of our lives and sedentary behaviour has now become the default behaviour during waking hours. Interventions that previously focused on improving levels of physical activity are now attempting to concurrently increase levels of physical activity and decrease time spent in sedentary behaviour. One method that has shown promise in interventions to increase physical activity and healthy eating in adults is the behaviour change technique of self-monitoring. There is now a robust set of literature indicating self-monitoring as the most promising behaviour change technique in this area. Self-monitoring is tied inherently into the recent rise in wearable technology. These new devices have the ability to track a variety of behavioural and physiological parameters and immediately make the information returnable to the user via connected mobile applications. The potential pervasive nature of these technologies and their use of robust behaviour change techniques could make them a useful tool in interventions to reduce sedentary behaviour. Therefore the overall purpose of this three study dissertation was to identify and validate technology that can self-monitor sedentary behaviour and to determine its feasibility in reducing sedentary behaviour. Study 1 Purpose: The aim of this study was to review the characteristics and measurement properties of currently available self-monitoring devices for sedentary behaviour and/or physical activity. Methods: To identify technologies, four scientific databases were systematically searched using key terms related to behaviour, measurement, and population. Articles published through October 2015 were identified. To identify technologies from the consumer electronic sector, systematic searches of three Internet search engines were also performed through to October 1st, 2015. Results: The initial database searches identified 46 devices and the Internet search engines identified 100 devices yielding a total of 146 technologies. Of these, 64 were further removed because they were currently unavailable for purchase or there was no evidence that they were designed for, had been used in, or could readily be modified for self-monitoring purposes. The remaining 82 technologies were included in this review (73 devices self-monitored physical activity, 9 devices self-monitored sedentary time). Of the 82 devices included, this review identified no published articles in which these devices were used for the purpose of self-monitoring physical activity and/or sedentary behaviour; however, a number of technologies were found via Internet searches that matched the criteria for self-monitoring and provided immediate feedback on physical activity (ActiGraph Link, Microsoft Band, and Garmin Vivofit) and sedentary behaviour (activPAL VT, the LumoBack, and Darma). Conclusions: There are a large number of devices that self-monitor physical activity; however, there is a greater need for the development of tools to self-monitor sedentary time. The novelty of these devices means they have yet to be used in behaviour change interventions, although the growing field of wearable technology may facilitate this to change. Study 2 Purpose: The aim of this study was to examine the criterion and convergent validity of the LumoBack as a measure of sedentary behaviour compared to direct observation, the ActiGraph wGT3X+ and the activPAL under laboratory and free-living conditions in a sample of healthy adults. Methods: In the laboratory experiment, 34 participants wore a LumoBack, ActiGraph and activPAL monitor and were put through seven different sitting conditions. In the free-living experiment, a sub-sample of 12 participants wore the LumoBack, ActiGraph and activPAL monitor for seven days. Validity were assessed using Bland-Altman plots, mean absolute percentage error (MAPE), and intraclass correlation coefficient (ICC). T-test and Repeated Measures Analysis of Variance were also used to determine any significant difference in measured behaviours. Results: In the laboratory setting, the LumoBack had a mean bias of 76.2, 72.1 and -92.3 seconds when compared to direct observation, ActiGraph and activPAL, respectively, whilst MAPE was less than 4%. Furthermore, the ICC was 0.82 compared to the ActiGraph and 0.73 compared to the activPAL. In the free-living experiment, mean bias was -4.64, 8.90 and 2.34 seconds when compared to the activPAL for sedentary behaviour, standing time and stepping time respectively. Mean bias was -38.44 minutes when compared to the ActiGraph for sedentary time. MAPE for all behaviours were 0.75. Conclusion: The LumoBack has acceptable validity and reliability as a measure of sedentary behaviour. Study 3 Purpose: The aim of this study was to explore the use of the LumoBack as a behaviour change tool to reduce sedentary behaviour in adults. Methods: Forty-two participants (≥25 years) who had an iPhone 4S or later model wore the LumoBack without any feedback for one week for baseline measures of behaviour. Participants then wore the LumoBack for a further five weeks whilst receiving feedback on sedentary behaviour via a sedentary vibration from the device and feedback on the mobile application. Sedentary behaviour, standing time, and stepping time were objectively assessed using the LumoBack. Differences in behaviour were determined between baseline, week 1 and week 5. Participant engagement with the LumoBack was determined using Mobile app analytics software. Results: There were no statistically significant differences in behaviour between baseline and the LumoBack intervention period (p>0.05). Participants engaged most with the Steps card on the LumoBack app with peaks in engagement seen at week 5. Conclusion: This study indicates that using the LumoBack on its own was not effective in reducing sedentary behaviour in adults. Self-monitoring and feedback may need to be combined with other behaviour change strategies such as environmental restructuring to be effective. General Conclusion This thesis found that there are currently an abundance of technologies which self-monitors physical activity but a lack of devices which measuring sedentary behaviour. One such device, the LumoBack, has shown to have acceptable validity as a measure of sedentary behaviour. Whilst the use of the LumoBack as a behaviour change tool did not elicit any significant changes, its ability to be a pervasive behavioural intervention and the use of user-defined nudging can make the LumoBack, and other similar low cost, valid objective sedentary behaviour self-monitors key components in multi-faceted interventions

Acceptance of ambient assisted living (AAL) technologies among older Australians : a review of barriers in user experience

One of the great challenges facing Australian society is that of an ageing population. Amongst the issues involved in this drastic demographic change, the most significant aspect is the demand for older Australians to live independently at home. The development of Ambient Assisted Living (AAL) technologies aims to address this issue. The advancement of AAL applications have been done to support the users with their daily-life activities and health concerns by providing increased mobility, security, safety in emergencies, health-monitoring, improved lifestyle, and fall-detection through the use of sensors. However, the optimum uptake of these technologies among the end-users (the elderly Australians) still remains a big concern. Thus, there is an elevated need to understand the needs and preferences of the seniors in order to improve the acceptance of AAL applications. The aim of this study is to investigate the barriers and perceptions in the use of AAL applications amongst older Australians. Focus groups and quantitative surveys have been conducted to provide a detailed analysis of these impediments. The results show that there are different factors that restrict the use of these technologies along with the fact that elderly people have certain preferences when using them. An understanding of these factors has been gained and suggestions have been made to increase the acceptance of AAL devices. This work gives useful insights towards the design of AAL solutions according to user needs

The feasibility and potential effectiveness of a conventional and exergame intervention to alter balance-related outcomes including fall risk: a mixed methods study

Introduction: Fall risk, occurrence and injury is increasing as the world ages, and Africa and other emerging regions will not be spared. Similarly, the rise of noncommunicable diseases, compressed morbidity and lack of physical activity present major challenges. This novel feasibility study explored the use of an exergaming technology compared with a conventional, evidence-based exercise programme (Otago Exercise Programme) to reduce fall risk by improving balance, and to inform a large-scale randomised control trial. Methodology: Mixed methods study in independent older adults with established fall risk. The quantitative component employed feasibility RCT methodology. Cluster randomisation assigned interventions to sites. Single blinding was used. Both interventions were offered for six months. A variety of balance-related endpoints (e.g., Timed Up and Go, Dynamic Gait Index, Mini-BESTest) were used to find the most applicable. Patient-centred variables included questionnaires regarding depression, physical activity levels, quality of life and estimates of self-efficacy for exercise. Qualitative focus groups explored participants' experiences of falls and the exergaming intervention using a phenomenology lens. Results: Site and participant recruitment was simple and readily achievable, with low numbers need to screen required. Eligibility criteria were confirmed and more added. Adherence and attrition were major challenges. Cluster randomisation appeared to exacerbate between-group differences at baseline. The exergaming intervention produced preliminary evidence in its favour, with results approaching Minimal Clinically Important Difference compared with the evidence-based intervention. The experience of the exergaming intervention was regarded as positive by focus group participants. Barriers and facilitators are reported. Discussion: Methodological issues in the literature have prevented firm consensus on the use of exergaming in falls prevention, although studies are abundant. The current study used rigorous methodology in the novel context of a developing region, which offers numerous challenges for older adults. Implications for a large-scale, fully funded RCT are discussed. Lessons learned can be used to scale up service delivery for an under-served population; and promote the aim of well-being for all at all ages

Exercise during stem cell transplantation for haematological cancer - exploring the feasibility of embedding exercise within a clinical pathway in multiple myeloma

The benefit of physical activity during and after cancer treatment has been demonstrated. There is a growing evidence base indicating that structured exercise interventions delivered before and during cancer treatment (‘prehabilitation’) can have positive effects on physical and psychological wellbeing before, reduce deterioration during, and increase rate of recovery following treatment. There is emerging evidence for exercise prior to and during stem cell transplantation in haemato-oncology patients. Guidelines recommend prehabilitation and rehabilitation as integral components of the treatment pathway in multiple myeloma, for whom autologous stem cell transplantation (ASCT) is a preferred first line treatment. However, provision of rehabilitation and structured physical activity support is lacking in haemato-oncology clinical services in the United Kingdom. This thesis aimed to explore the feasibility of embedding exercise within haematooncology clinical pathways, with a focus on ASCT in multiple myeloma. It describes multimethods research that includes: feasibility and outcomes data from a pilot randomised controlled trial of a prehabilitation and rehabilitation intervention embedded within the multiple myeloma ASCT pathway; qualitative interview data on the experiences of myeloma patients who were approached for and declined or took part in exercise research after referral for ASCT; and data from a national survey of haematology health professionals on their beliefs and understanding of exercise during haemato-oncology treatment. Additionally, the impact of the COVID-19 pandemic, the adaptation of the pilot trial and how this allowed for evaluation of feasibility of both face-to-face and remotely delivered exercise support will be described. The pilot trial recruited 50 of 109 (46%) eligible participants with an attrition rate of 34%, mainly related to failure to undergo ASCT. Loss of follow-up for other reasons was low, with 33 of 39 (85%) participants who underwent ASCT completing an assessment at final timepoint. Secondary outcomes indicate benefit of physiotherapist-led exercise prior to, during and after ASCT with improvements in quality of life, fatigue, functional capacity and PA evident on admission for ASCT and 3 months post-ASCT. Eighteen people with myeloma (56% male, mean age 62 years) who declined participation in the trial and sixteen who took part in the trial were interviewed for the qualitative studies. Themes from analysis of the decliners’ study highlighted that travel was the most common reason for declining but it was more than a logistical challenge and that participants welcomed the personalised approach to being asked to participate in research but their recall of research information was variable. Other important findings included the impact of reduced physical activity due to treatment, that there is a lack of support to counteract this and that patients with myeloma may be underreporting common side-effects of treatment to their clinical teams because these are expected despite their impact on engagement in daily activities. Themes from analysis of the pilot trial completers study indicated both altruistic and personal motivations for participating and remaining in the trial but that allocation to control group brought about disappointment and may have led to contamination. There were also disparities in the experience of recovery from ASCT between those who took part in the intervention and those who did not. Participants also recalled the impact of diagnosis and early treatment on physical activity and that they saw exercise as important for preparation and recovery from ASCT. 156 health-professionals completed the survey study. Beliefs of health professionals regarding the role of physical activity during and after treatment for haematological cancer were generally positive. A third (31%) reported knowing relevant guidance related to physical activity for people with cancer and nearly half (47%) reported providing physical activity advice routinely to their patients. Those reporting familiarity with guidance were more likely to give advice. However, misalignment existed between guidelines and advice given by professionals to their patients. Findings from this thesis suggest that it is feasible to embed a prehabilitation and rehabilitation intervention into the myeloma ASCT pathway, indicating possible benefit and that health professionals and patients are accepting and supportive of greater physical activity support during and after haemato-oncology treatment