Changing behaviour

Individual change in behaviour has the potential to decrease the burden of chronic disease due to smoking, diet and low physical activity. Smoking quit rates can be increased by simple advice from a physician or trained counsellor, overall and in people at high risk of smoking related disease, with low intensity advice as effective as high intensity advice. Advice from a nurse, telephone counselling, individualised self help materials and taking exercise may also be beneficial. Training health professionals increases the frequency of offering antismoking interventions but may not increase their effectiveness. Nicotine replacement therapy, bupropion and nortriptyline may improve short term quit rates as part of smoking cessation strategies. Moclobemide, selective serotonin reuptake inhibitors, anxiolytics and acupuncture have not been shown to be beneficial. Smoking cessation programmes increase quit rates in pregnant women, but nicotine patches may not be beneficial compared with placebo. Physical activity in sedentary people may be increased by counselling, with input from exercise specialists possibly being more effective than physicians, in women over 80 years and in younger adults. Advice on eating a low cholesterol diet leads to a mean 0.2 to 0.3 mmol/L decrease in blood cholesterol concentration in the long term, but no consistent effect of this on morbidity or mortality has been shown. Intensive interventions to reduce sodium intake lead to small decreases in blood pressure, but may not reduce morbidity or mortality. Advice to lose weight leads to greater weight loss than no advice, and cognitive behavioural therapy may be more effective than dietary advice

Interventions for promoting physical activity (review)

Background Little is known about the effectiveness of strategies to enable people to achieve and maintain recommended levels of physical activity. Objectives To assess the effectiveness of interventions designed to promote physical activity in adults aged 16 years and older, not living in an institution. Search strategy We searched The Cochrane Library (issue 1 2005), MEDLINE, EMBASE, CINAHL, PsycLIT, BIDS ISI, SPORTDISCUS, SIGLE, SCISEARCH(fromearliest dates available toDecember 2004). Reference lists of relevant articles were checked.No language restrictions were applied. Selection criteria Randomised controlled trials that compared different interventions to encourage sedentary adults not living in an institution to become physically active. Studies required a minimum of six months follow up from the start of the intervention to the collection of final data and either used an intention-to-treat analysis or, failing that, had no more than 20% loss to follow up. Data collection and analysis At least two reviewers independently assessed each study quality and extracted data. Study authors were contacted for additional information where necessary. Standardised mean differences and 95% confidence intervals were calculated for continuous measures of self-reported physical activity and cardio-respiratory fitness. For studies with dichotomous outcomes, odds ratios and 95% confidence intervals were calculated. Main results The effect of interventions on self-reported physical activity (19 studies; 7598 participants) was positive and moderate (pooled SMD random effects model 0.28 95%CI 0.15 to 0.41) as was the effect of interventions (11 studies; 2195 participants) on cardio-respiratory fitness (pooled SMD random effects model 0.52 95% CI 0.14 to 0.90). There was significant heterogeneity in the reported effects as well as heterogeneity in characteristics of the interventions. The heterogeneity in reported effects was reduced in higher quality studies,when physical activity was self-directed with some professional guidance and when there was on-going professional support. Authors’ conclusions Our review suggests that physical activity interventions have a moderate effect on self-reported physical activity, on achieving a predetermined level of physical activity and cardio-respiratory fitness. Due to the clinical and statistical heterogeneity of the studies, only limited conclusions can be drawn about the effectiveness of individual components of the interventions. Future studies should provide greater detail of the components of interventions

Can a simple measure of vigorous physical activity predict future mortality? Results from the OXCHECK study.

BACKGROUND: As epidemiological studies have become more complex, demands for short, easily administered measures of risk factors have increased. This study investigates whether such a measure of physical activity is associated with the risk of death from all causes and death from specific causes. METHODS: A prospective follow-up study of 11,090 men and women, aged 35-64 years, recruited from five UK general practices who responded to a postal questionnaire in 1989. Self-reported frequency of vigorous-intensity physical activity and data on confounding factors were collected at baseline survey. Death notifications up to 31 December 2001 were provided by the Office for National Statistics. The relative risk (and 95% confidence interval) of dying associated with each level of exposure to physical activity was estimated by the hazard ratio in a series of Cox regression models. RESULTS: After >10 years' follow-up there were 825 deaths among the 10 522 subjects with no previous history of angina or myocardial infarction. Participation in vigorous exercise was associated with a significantly lower risk of all-cause mortality. Similar associations were found for ischaemic heart disease and cancer mortality, although the relationships were not significant at the 5% level. CONCLUSIONS: Simple measures of self-reported vigorous physical activity are associated with the risk of future mortality, at least all-cause mortality in a somewhat selected group. Interpretation of the finding should be treated with caution due to the reliance on self-report and the possibility that residual confounding may underlie the associations. Because moderate-intensity physical activity is also beneficial to health, short physical activity questionnaires should include measures of such physical activity in the future

National level promotion of physical activity: results from England's ACTIVE for LIFE campaign.

STUDY OBJECTIVE: To assess the impact of a national campaign on awareness of the campaign, change in knowledge of physical activity recommendations and self reported physical activity. DESIGN: three year prospective longitudinal survey using a multi-stage, cluster random probability design to select participants. SETTING: England. PARTICIPANTS: A nationally representative sample of 3189 adults aged 16-74 years. MAIN OUTCOME MEASURES: Awareness of the advertising element of the campaign, changes in knowledge of physical activity recommendations for health and self reported physical activity. RESULTS: 38% of participants were aware of the main advertising images, assessed six to eight months after the main television advertisement. The proportion of participants knowledgeable about moderate physical activity recommendations increased by 3.0% (95% CI: 1.4%, 4.5%) between waves 1 and 2 and 3.7% (95% CI: 2.1%, 5.3%) between waves 1 and 3. The change in proportion of active people between baseline and waves 1 and 2 was -0.02 (95% CI: -2.0 to +1.7) and between waves 1 and 3 was -9.8 (-7.9 to -11.7). CONCLUSION: The proportion of participants who were knowledgeable about the new recommendations, increased significantly after the campaign. There was however, no significant difference in knowledge by awareness of the main campaign advertisement. There is no evidence that ACTIVE for LIFE improved physical activity, either overall or in any subgroup

Impact of wear time criteria upon physical activity estimates in children

Paper presented at 14th meeting of the International Society of Behavioral Nutrition and Physical Activity: Advancing Behavior Change Science, June 2015, EdinburghPurpose: Lack of compliance with accelerometer wear time requirements can potentially lead to selection bias within a study. In an attempt to maximize participant numbers researchers may be tempted to employ more lenient wear time criteria. However, this may lead to misclassification of physical activity (PA) and sedentary time (ST), both through reducing the monitoring period and through failure to capture distinct periods of the day, resulting in inaccurate estimates of PA and ST and masking of true relationships between PA, ST and health. The present study aimed to explore the misclassification that may occur using three distinct 10 hour periods across the day in comparison to 24 hour continuous wear in children. Methods: 149 children were asked to wear a GENEActiv accelerometer on their left wrist for 24 hours a day, for a period of 7 days. Including only children who complied with the full wear time protocol (n = 78), weekly average estimates of ST and time spent in light, moderate and vigorous PA were created for the full 24 hour criteria and for three 10 hour periods (8am – 6pm, 10am – 8pm, 12pm – 10pm) . Repeated Measures ANOVA were used to assess for significant differences across monitoring periods. Results: In comparison to complete observation (24hours), the 10 hour periods across the day resulted in an underestimation of time spend sedentary and in each activity intensity (ps < 0.05). ST was underestimated by an average of 269 minutes, whilst Moderate to Vigorous PA (MVPA) was underestimated by 30 minutes. Between the 10 hour periods, higher rates of ST were accumulated in the latest period (12pm – 10pm), whilst higher estimates of MVPA were apparent between 8am and 6pm. Conclusions: Time in PA and ST was underestimated with the use of shorter wear periods and researchers may be unknowingly misclassifying PA and ST by not accounting for which period of the day was measured. Future studies should use longer monitoring periods to gain accurate assessment of PA and to establish relationships with health variables

One size does not fit all - Application of accelerometer thresholds in chronic disease

This is the author accepted manuscript. The final version is available from Oxford University Press via the DOI in this record National Institute for Health Research (NIHR

Randomised controlled trials of physical activity promotion in free living populations: a review

This article was first published in:Journal of Epidemiology and Community Health 1995:49:448-453OBJECTIVES--To review evidence on the effectiveness of trials of physical activity promotion in healthy, free living adults. To identify the more effective intervention programmes. METHODS--Computerised databases and references were searched. Experts were contacted and asked for information about existing work. INCLUSION CRITERIA--Randomised controlled trials of healthy, free living adult subjects, where exercise behaviour was the dependent variable were included. CONCLUSIONS--Ten trials were identified. The small number of trials limits the strength of any conclusions and highlights the need for more research. No UK based studies were found. Previously sedentary adults can increase activity levels and sustain them. Promotion of these changes requires personal instruction, continued support, and exercise of moderate intensity which does not depend on attendance at a facility. The exercise should be easily included into an existing lifestyle and should be enjoyable. Walking is the exercise most likely to fulfil these criteria.Financial assistance was provided by the Health Gain Project which is funded by North Thames(West)Regional Health Authority and the Health Education Authority

Fatness, fitness, and cardiometabolic risk factors in middle-aged white men.

The objective was to test the hypothesis that traditional and novel cardiometabolic risk factors would be significantly different in groups of men of different fatness and fitness. Total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, glucose, insulin, high-sensitivity C-reactive protein, alanine aminotransferase, aspartate aminotransferase, γ-glutamyltransferase, leptin, adiponectin, tumor necrosis factor-α, interleukin-6, interleukin-10, fibrinogen, and insulin resistance were assessed in 183 nonsmoking white men aged 35 to 53 years, including 62 who were slim and fit (waist girth ≤90 cm and maximal oxygen consumption [VO(2)max] above average), 24 who were slim and unfit (waist girth ≤90 cm and VO(2)max average or below), 39 who were fat and fit (waist girth ≥100 cm and VO(2)max above average), and 19 who were fat and unfit (waist girth ≥100 cm and VO(2)max average or below). Seventy-six percent gave blood on 2 occasions, and the average of 1 or 2 blood tests was used in statistical tests. Waist girth (centimeters) and fitness (milliliters of oxygen per kilogram of fat-free mass) were associated with high-density lipoprotein cholesterol, leptin, and insulin resistance after adjustment for age, saturated fat intake, and total energy intake. High-density lipoprotein cholesterol, triglycerides, alanine aminotransferase, and insulin resistance were significantly different in men who were fat and fit and those who were fat and unfit. These data suggest that differences in lipid and lipoprotein concentrations, liver function, and insulin resistance may explain why the risks of chronic disease are lower in men who are fat and fit than those who are fat and unfit