Two-Arm Randomized Pilot Intervention Trial to Decrease Sitting Time and Increase Sit-To-Stand Transitions in Working and Non-Working Older Adults.

BACKGROUND: Excessive sitting has been linked to poor health. It is unknown whether reducing total sitting time or increasing brief sit-to-stand transitions is more beneficial. We conducted a randomized pilot study to assess whether it is feasible for working and non-working older adults to reduce these two different behavioral targets. METHODS: Thirty adults (15 workers and 15 non-workers) age 50-70 years were randomized to one of two conditions (a 2-hour reduction in daily sitting or accumulating 30 additional brief sit-to-stand transitions per day). Sitting time, standing time, sit-to-stand transitions and stepping were assessed by a thigh worn inclinometer (activPAL). Participants were assessed for 7 days at baseline and followed while the intervention was delivered (2 weeks). Mixed effects regression analyses adjusted for days within participants, device wear time, and employment status. Time by condition interactions were investigated. RESULTS: Recruitment, assessments, and intervention delivery were feasible. The 'reduce sitting' group reduced their sitting by two hours, the 'increase sit-to-stand' group had no change in sitting time (p < .001). The sit-to-stand transition group increased their sit-to-stand transitions, the sitting group did not (p < .001). CONCLUSIONS: This study was the first to demonstrate the feasibility and preliminary efficacy of specific sedentary behavioral goals. TRIAL REGISTRATION: clinicaltrials.gov NCT02544867.The pilot study was supported by funds provided by the Department of Family Medicine & Public Health, UCSD. The work of Andrew J Atkin was supported by the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence (RES-590-28-0002). Funding from the British Heart Foundation, Department of Health, Economic and Social Research Council, Medical Research Council, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.This is the final version of the article. It was first available from PLOS via http://dx.doi.org/10.1371/journal.pone.014542

Implementation-effectiveness trial of an ecological intervention for physical activity in ethnically diverse low income senior centers.

BackgroundAs the US population ages, there is an increasing need for evidence based, peer-led physical activity programs, particularly in ethnically diverse, low income senior centers where access is limited.Methods/designThe Peer Empowerment Program 4 Physical Activity' (PEP4PA) is a hybrid Type II implementation-effectiveness trial that is a peer-led physical activity (PA) intervention based on the ecological model of behavior change. The initial phase is a cluster randomized control trial randomized to either a peer-led PA intervention or usual center programming. After 18 months, the intervention sites are further randomized to continued support or no support for another 6 months. This study will be conducted at twelve senior centers in San Diego County in low income, diverse communities. In the intervention sites, 24 peer health coaches and 408 adults, aged 50 years and older, are invited to participate. Peer health coaches receive training and support and utilize a tablet computer for delivery and tracking. There are several levels of intervention. Individual components include pedometers, step goals, counseling, and feedback charts. Interpersonal components include group walks, group sharing and health tips, and monthly celebrations. Community components include review of PA resources, walkability audit, sustainability plan, and streetscape improvements. The primary outcome of interest is intensity and location of PA minutes per day, measured every 6 months by wrist and hip accelerometers and GPS devices. Secondary outcomes include blood pressure, physical, cognitive, and emotional functioning. Implementation measures include appropriateness &amp; acceptability (perceived and actual fit), adoption &amp; penetration (reach), fidelity (quantity &amp; quality of intervention delivered), acceptability (satisfaction), costs, and sustainability.DiscussionUsing a peer led implementation strategy to deliver a multi-level community based PA program can enhance program adoption, implementation, and sustainment.Trial registrationClinicalTrials.gov, USA ( NCT02405325 ). Date of registration, March 20, 2015. This website also contains all items from the World Health Organization Trial Registration Data Set

Collaboration between physical activity researchers and transport planners: a qualitative study of attitudes to data driven approaches

Collaboration between physical activity (PA) researchers and transport planners is a recommended strategy to combat the physical inactivity epidemic. Data collected by PA researchers could be used to identify, implement and evaluate active transport (AT) projects. However, despite aligned interests, researchers and transport planners rarely collaborate. This study utilized qualitative methods to 1) gain an in-depth understanding of the data utilized in AT planning, 2) explore the utility of Global Positioning Systems (GPS) and accelerometer data in supporting the planning process, 3) identify the benefits and barriers of researcher and transport agency collaboration, and 4) identify the facilitators to collaboration for these groups. Semistructured interviews were conducted with 17 transport modeling, planning or engineering professionals, transport agency directors, and academics with relevant expertise in health or transport planning. A thematic analysis was conducted following structural coding by two researchers. The analysis revealed that geographic and physical activity data that are current, local, objective and specific to individual AT trips would improve upon currently available data sources. Informants believed that research collaboration could increase capacity by providing unbiased data and access to students to assist with targeted research. Collaboration could also increase the relevance of academic research in applied settings. Identified barriers included: setting up contracts, lack of policy and planning mandates that include health, a disconnect between research interests and agency needs, and competing priorities. Researchers may need to initiate discussions with AT practitioners until health is formally included in the planning process as the first step in understanding data needs and identifying mutual research interests. However, regulations that link health and physical activity metrics to funding, as well as training programs that incorporate public health and transport planning, are needed to encourage cross collaboration

Health effects and cost-effectiveness of a multilevel physical activity intervention in low-income older adults; results from the PEP4PA cluster randomized controlled trial.

BackgroundOlder adults are the least active population in the U.S. Low-income communities have fewer physical activity (PA) resources, contributing to less PA and increased chronic disease risk. This study assessed the effect of the multilevel, peer-led, Peer Empowerment Program 4 Physical Activity (PEP4PA) on moderate-to-vigorous PA (MVPA) and health outcomes, over 2&nbsp;years of follow up.MethodsIn a cluster-randomized controlled trial, 12 senior or community centers serving low-income older adults were assigned to a PA intervention (n = 6) or usual programming (n = 6) condition. PEP4PA included self-monitoring, health coaching, group walks, social support, and community advocacy to improve walking conditions. The primary outcome was daily minutes of MVPA (7-day accelerometer). Secondary outcomes included Perceived Quality of Life (PQoL), 6-Minute Walk Test (6-MWT), blood pressure (BP), and depressive symptoms at baseline, 6, 12, 18 and 24&nbsp;months. Mixed effects regression models estimated the effects on outcomes between groups over time and included random effects for repeated measures and center clustering. Effect modification by sex and income status was assessed. We calculated the incremental cost per daily minute of MVPA gained in the intervention group relative to the control group to assess cost effectiveness.ResultsWe enrolled 476 older adults (50 + years). Participants were on average 71&nbsp;years old, 76% female, 60% low income, and 38% identified as racial or ethnic minorities. Compared to the control group, intervention participants sustained roughly a 10&nbsp;min/day increase in MVPA from baseline at all time points and increased mean PQoL scores from unsatisfied at baseline to satisfied at 12, 18 and 24&nbsp;months. Males and higher-income groups had greater improvements in MVPA. No significant effects were observed for 6-MWT or depressive symptoms, and BP results were mixed. The incremental cost per minute MVPA gained per person was $0.25,$0.09, $0.06, and$0.05 at 6, 12, 18 and 24&nbsp;months, respectively.ConclusionsPEP4PA achieved increases in MVPA and PQoL in low-income older adults, over 2&nbsp;years of follow up. The peer-led, community-based intervention provides a sustainable and cost-effective model to improve health behaviors in underserved, aging populations.Trial registrationClinicalTrials.gov ( NCT02405325 ) March 20, 2015

Additional file 1: of Cluster randomized controlled trial of a multilevel physical activity intervention for older adults

Table S1. Changes in exploratory outcomes overtime by intervention and control. (DOCX 16 kb

Additional file 2: of Cluster randomized controlled trial of a multilevel physical activity intervention for older adults

Figure S1. Gender differences in physical activity between intervention and control conditions over time, adjusting for baseline demographic differences, nesting of days within people and people within sites. (DOCX 17 kb

Changes in daily sitting, standing, sit-to-stand transitions and stepping over time by condition.

<p>Changes in daily sitting, standing, sit-to-stand transitions and stepping over time by condition.</p