Qualitative and quantitative research into the development and feasibility of a video-tailored physical activity intervention

Background: Continued low adherence to physical activity recommendations illustrates the need to refine intervention strategies and increase their effectiveness. The purpose of this study was to conduct formative research related to the development of a next generation of computer-tailored interventions that use online tailored video-messages to increase physical activity. Methods: Five focus groups (n = 30), aimed at males and females, aged between 35 and 60 years, that do not meet the physical activity recommendation, were conducted to allow in-depth discussion of various elements related to the development of an online video-tailored intervention. In addition, a series of questions were delivered to a random sample (n = 1261) of Australians, using CATI survey technology, to gain more information and add a quantitative assessment of feasibility related to the development of the intervention. Focus group data was transcribed, and summarised using Nvivo software. Descriptive and frequency data of the survey was obtained using SPSS 18.0. Results: Nearly all of the focus group participants supported the concept of a video-tailored intervention and 35.8% of survey participants indicated that they would prefer a video-based over a text-based intervention. Participants with a slow internet-connection displayed a lower preference for video-based advice (31.9%); however less than 20% of the survey sample indicated that downloading videos would be slow. The majority of focus group and survey participants did not support the idea of using mobile phones to receive this kind of intervention and indicated that video-tailored messages should be shorter than 5 minutes. Video-delivery of content is very rich in information, which increases the challenge to appropriately tailor content to participant characteristics; focus group outcomes indicated a large diversity in participant preferences. 52.4% of survey participants indicated that the videos should be convincing and motivating. Conclusions: These results provide valuable information to develop an innovative video-tailored physical activity intervention. The results support the feasibility of such intervention, both in terms of users being ready to participate in it, as well as from a point of view whereby current internet infrastructure is able to cope with thedemands of downloading videos. Though promising, a number of specific challenges in the development of these interventions were identified (e.g. the videos need to be short, made professionally, and tailor to a larger number of variables) and will need to be overcome in the development and evaluation of this new type of physical activity intervention

Feasibility and preliminary efficacy of an online intervention to increase physical activity in Nova Scotian cancer survivors: A Randomized Controlled Trial

Background: Physical activity (PA) behavior change interventions among cancer survivors have used face-to-face, telephone, email, and print-based methods. However, computer-tailored, Internet-delivered programs may be a more viable option to achieve PA behavior change. Objective: The objective of this study is to test the feasibility and preliminary efficacy of a Web-based PA behavior change program among cancer survivors. Methods: Nova Scotian cancer survivors (N=415) who previously expressed interest in a research study were approached. Interested participants were asked to complete an online assessment of PA and quality of life (QOL) before being randomized to either a theory-based PA behavior change program using the PA tracking website UWALK (UCAN; n=48) or usual care (UC; n=47). After the intervention (9 weeks), participants completed another online assessment of PA and QOL as well as measures to evaluate the program and website. Descriptive analyses from surveys and Web analytic software were used to assess feasibility and mean change scores were used to test efficacy. Results: Of all contacted survivors, 95 (22.3%, 95/415) completed baseline measures and were randomized with 84 (88%, 84/95) completing the 9-week assessment. The behavior change program and website were rated highly on the satisfaction items. Average logins were 10.3 (1.1 per week) and 26.0% (111/432) of the weekly modules were completed. Most participants (71%, 29/41) indicated they were more aware of their daily PA levels and 68% (28/41) found the site easily navigable. Adjusted group differences in total exercise minutes favored the UCAN group by an increase of 42 minutes (95% CI -65 to 150; P=.44, d=0.17). Results were more pronounced, though still nonsignificant, among those not meeting guidelines at baseline where UCAN increased PA by 52 minutes compared to a decrease of 15 minutes in UC (adjusted between group difference=75, 95% CI -95 to 244; P=.38, d=0.27). Conclusions: We found that Internet-delivery may be a feasible alternative to more costly methods to promote PA among Nova Scotian cancer survivors. Moreover, there was a trend toward increased PA among those in the UCAN group, especially among those who were not meeting PA guidelines at baseline. Future research should focus on recruiting inactive cancer survivors and engaging them in the website to determine the optimal potential of Web-based interventions for promoting PA in cancer survivors

Perceived environment and physical activity: a meta-analysis of selected environmental characteristics

BACKGROUND: Several narrative reviews have been conducted on the literature examining environmental correlates of physical activity (PA). To date these reviews have been unable to provide definitive summaries of observed associations. This study utilizes meta-analytical techniques to calculate summaries of associations between selected environmental characteristics and PA. METHODS: Published studies were identified from electronic databases and searches of personal files. Studies were examined to determine the environmental constructs most frequently studied. Included studies (N = 16) examined at least one identified construct and determined associations between perceived environmental constructs and PA using logistic regression. Data were analyzed separately for crude and adjusted ORs using general-variance based fixed effect models. RESULTS: No significant associations emerged between environmental characteristics and PA using crude OR. The perceived presence of PA facilities (OR 1.20, 95% 1.06–1.34), sidewalks (OR 1.23, 95% 1.13–1.32), shops and services (OR 1.30, 95% 1.14–1.46) and perceiving traffic not to be a problem (OR 1.22, 95% 1.08–1.37) were positively associated with activity using adjusted ORs. Variance in PA accounted for by significant associations ranged from 4% (heavy traffic not a problem) to 7% (presence of shops and services). CONCLUSION: Results of the meta-analysis support the relevance of perceived environmental characteristics for understanding population PA. These results should encourage the use of comprehensive ecological models that incorporate variables beyond basic demographic information

The development of an internet-based outpatient cardiac rehabilitation intervention: a Delphi study

Background: Face-to-face outpatient cardiac rehabilitation (OCR) programs are an important and effective component in the management of cardiovascular disease. However, these programs have low participation rates, especially among patients who live rural or remote. Hence, there is a need to develop OCR programs that provide an alternative to face-to-face contact such as by using the Internet. Only a very limited number of Internet-based OCR programs have been developed and evaluated. Therefore, the purpose of this study was to identify issues that are relevant to the development of an Internet-based OCR intervention. Methods: A three-round Delphi study among cardiac rehabilitation experts was conducted. In the first round, 43 experts outlined opinions they had on the development of an online ORC platform into an open-ended electronic questionnaire. In the second round, 42 experts completed a structured (five-point scale) electronic questionnaire based on first round results, in which they scored items on their relevance. In the third round, the same experts were asked to re-rate the same items after feedback was given about the group median relevance score to establish a level of consensus. Results: After the third round, high consensus was reached in 120 of 162 (74%) questionnaire items, of which 93 (57% of 162 items) also had high relevance according to the experts. The results indicate that experts strongly agreed on desired website content, data obtained from the patient, and level of interaction with patients that should be part of an Internet-based OCR intervention. Conclusion: The high rates of consensus and relevance observed among cardiac rehabilitation experts are an indication that they perceived the development and implementation of an Internet-based ORC intervention as feasible, and as a valuable alternative to face-to-face programs. In many ways the experts indicated that an Internet based ORC program should mimic a traditional face-to-face program, and emphasize the crucial role of the cardiac rehabilitation manager who interacts with patients from a distance. The present study revealed practical insights into how Internet OCR interventions should be designed and opens the door for the development of such an intervention to be subsequently examined in a longitudinal and experimental study

Effectiveness of a web- and mobile phone-based intervention to promote physical activity and healthy eating in middle-Aged males: Randomized controlled trial of the manup study

Background: The high number of adult males engaging in low levels of physical activity and poor dietary practices, and the health risks posed by these behaviours, necessitate broad-reaching intervention strategies. IT-based (web and mobile phone) interventions can be accessed by large numbers of people, yet there are few reported IT-based interventions targeting males’ physical activity and dietary practices. Objective: This study examines the effectiveness of a 9-month IT-based intervention to improve the physical activity, dietary behaviours and health literacy in middle-aged males compared to a print-based intervention. Methods: Participants, recruited offline (e.g. newspaper ads), were randomized into either an IT-based or print-based intervention arm on a 2:1 basis in favour of the fully automated IT-based arm. Participants were adult males aged 35-54 years living in two regional cities in Queensland Australia who could access the internet, owned a mobile phone and were able to increase their activity level. The intervention, ManUp, was informed by social cognitive and self regulation theories and was specifically designed to target males. Educational materials were provided and self-monitoring of physical activity and nutrition behaviours was promoted. Intervention content was the same in both intervention arms, only the delivery mode differed, and content could be accessed throughout the 9-month study period. Participants’ physical activity, dietary behaviours, and health literacy were measured using online surveys at baseline, 3 months and 9 months. Results: A total of 301 participants completed baseline assessments, 205 in the ITbased arm and 96 in the print-based arm. A total of 124 participants completed all three assessments. There were no significant between group differences in physical 5 activity and dietary behaviours (p ≥0.05). Participants reported an increased number of minutes and sessions of physical activity at 3 months (b(exp)=1.45, 95% CI=1.09-1.95; b(exp)=1.61, 95% CI=1.17-2.22) and 9 months (b(exp)=1.55, 95% CI=1.14-2.10; b(exp)=1.51, 95% CI=1.15-2.00). Overall dietary behaviours improved at 3 months (b(exp)=1.07, 95% CI=1.03-1.11) and 9 months (b(exp)=1.10, 95% CI=1.05-1.13). The proportion of participants in both groups eating higher-fibre bread and low-fat milk increased at 3 months (b(exp) = 2.25, 95% CI = 1.29-3.92; b(exp)=1.65, 95% CI = 1.07-2.55). Participants in the IT-based arm were less likely to report that 30 minutes of physical activity per day improves health (b(exp)=0.48, 95% CI=0.26-0.90) and more likely to report that vigorous intensity physical activity 3 times per week is essential (b(exp)=1.70, 95% CI=1.02-2.82). The average number of logins to the IT-platform at 3 and 9 months was 6.99 (SE=0.86) and 9.22 (SE=1.47), respectively. The average number of self-monitoring entries at 3 and 9 months was 16.69 (SE=2.38) and 22.51 (SE=3.79), respectively. Conclusions: The ManUp intervention was effective in improving physical activity and dietary behaviours in middle aged males with no significant differences between IT- and print-based delivery modes

Effectiveness of a Web 2.0 Intervention to Increase Physical Activity in Real-World Settings: Randomized Ecological Trial

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.Background: The translation of Web-based physical activity intervention research into the real world is lacking and becoming increasingly important. Objective: To compare usage and effectiveness, in real-world settings, of a traditional Web 1.0 Web-based physical activity intervention, providing limited interactivity, to a Web 2.0 Web-based physical activity intervention that includes interactive features, such as social networking (ie, status updates, online “friends,” and personalized profile pages), blogs, and Google Maps mash-ups. Methods: Adults spontaneously signing up for the freely available 10,000 Steps website were randomized to the 10,000 Steps website (Web 1.0) or the newly developed WALK 2.0 website (Web 2.0). Physical activity (Active Australia Survey), quality of life (RAND 36), and body mass index (BMI) were assessed at baseline, 3 months, and 12 months. Website usage was measured continuously. Analyses of covariance were used to assess change over time in continuous outcome measures. Multiple imputation was used to deal with missing data. Results: A total of 1328 participants completed baseline assessments. Only 3-month outcomes (224 completers) were analyzed due to high attrition at 12 months (77 completers). Web 2.0 group participants increased physical activity by 92.8 minutes per week more than those in the Web 1.0 group (95% CI 28.8-156.8; P=.005); their BMI values also decreased more (–1.03 kg/m2, 95% CI –1.65 to -0.41; P=.001). For quality of life, only the physical functioning domain score significantly improved more in the Web 2.0 group (3.6, 95% CI 1.7-5.5; P<.001). The time between the first and last visit to the website (3.57 vs 2.22 weeks; P<.001) and the mean number of days the website was visited (9.02 vs 5.71 days; P=.002) were significantly greater in the Web 2.0 group compared to the Web 1.0 group. The difference in time-to-nonusage attrition was not statistically significant between groups (Hazard Ratio=0.97, 95% CI 0.86-1.09; P=.59). Only 21.99% (292/1328) of participants (n=292 summed for both groups) were still using either website after 2 weeks and 6.55% (87/1328) were using either website after 10 weeks. Conclusions: The website that provided more interactive and social features was more effective in improving physical activity in real-world conditions. While the Web 2.0 website was visited significantly more, both groups nevertheless displayed high nonusage attrition and low intervention engagement. More research is needed to examine the external validity and generalizability of Web-based physical activity interventions

Essay Depression in sport /

"The streets of Kelly Holmes' hometown in Kent, UK, were lined with more than 40 000 people in September, 2004, waiting to welcome home their hero. Holmes, the winner of the 800 m and 1500 m track gold medals at the Athens Olympics, is the first Briton in more than 80 years to achieve the Olympic middle-distance double. Later awarded the title of Dame Commander of the Most Excellent Order of the British Empire, Holmes was indeed living the dream. Her dream was, however, laced with nightmares. Her battles with depression in the lead up to her Olympic successes now a matter of public record, she provides a graphic example that even elite athletes are susceptible to one of society's largest problems-depression."--p. 36

The utilisation of group process strategies as an intervention tool for the promotion of health related physical activity in older adults

This study contrasted the effects of an enhanced group intervention program against a standard group intervention, with specific reference to the influences of group cohesion on changes in health-related physical activity of older adults. Older adults (N = 122) took part in a 12-week intervention with repeated post-intervention follow-up (6 & 12 months) assessing physical activity behaviour and perceptions of group cohesion. Results indicated significant positive change (p < 0.05) across time, but a non-significant difference between groups, for physical activity behaviour. For group cohesion, results indicated a significant negative (p < 0.05) change across time and similar to physical activity behaviour, a nonsignificant difference between the intervention groups. Further research is needed to understand the mechanism that fosters group cohesion in order to develop future interventions aimed at increasing physical activity behaviour and adherence in older adults

Qualitative and quantitative research into the development and feasibility of a video-tailored physical activity intervention

Abstract Background Continued low adherence to physical activity recommendations illustrates the need to refine intervention strategies and increase their effectiveness. The purpose of this study was to conduct formative research related to the development of a next generation of computer-tailored interventions that use online tailored video-messages to increase physical activity. Methods Five focus groups (n = 30), aimed at males and females, aged between 35 and 60 years, that do not meet the physical activity recommendation, were conducted to allow in-depth discussion of various elements related to the development of an online video-tailored intervention. In addition, a series of questions were delivered to a random sample (n = 1261) of Australians, using CATI survey technology, to gain more information and add a quantitative assessment of feasibility related to the development of the intervention. Focus group data was transcribed, and summarised using Nvivo software. Descriptive and frequency data of the survey was obtained using SPSS 18.0. Results Nearly all of the focus group participants supported the concept of a video-tailored intervention and 35.8% of survey participants indicated that they would prefer a video-based over a text-based intervention. Participants with a slow internet-connection displayed a lower preference for video-based advice (31.9%); however less than 20% of the survey sample indicated that downloading videos would be slow. The majority of focus group and survey participants did not support the idea of using mobile phones to receive this kind of intervention and indicated that video-tailored messages should be shorter than 5 minutes. Video-delivery of content is very rich in information, which increases the challenge to appropriately tailor content to participant characteristics; focus-group outcomes indicated a large diversity in participant preferences. 52.4% of survey participants indicated that the videos should be convincing and motivating. Conclusions These results provide valuable information to develop an innovative video-tailored physical activity intervention. The results support the feasibility of such intervention, both in terms of users being ready to participate in it, as well as from a point of view whereby current internet infrastructure is able to cope with the demands of downloading videos. Though promising, a number of specific challenges in the development of these interventions were identified (e.g. the videos need to be short, made professionally, and tailor to a larger number of variables) and will need to be overcome in the development and evaluation of this new type of physical activity intervention.</p