Evidence-based Physical Activity Interventions Research Articles

Effectiveness of implementing evidence-based approaches to promote physical activity in a Midwestern micropolitan area using a quasi-experimental hybrid type I study design.

Much evidence-based physical activity (PA) interventions have been tested and implemented in urban contexts. However, studies that adapt, implement, and evaluate the effectiveness of these interventions in micropolitan rural contexts are needed. The study aimed to evaluate the effectiveness of the Active Ottumwa intervention to promote PA in a micropolitan community. Between 2013 - 2019, we implemented Active Ottumwa in a micropolitan setting, and subsequently implemented and evaluated its effectiveness using a Hybrid Type I design. In this paper, we describe the intervention's effectiveness in promoting PA. We collected PA data over 24months from a cohort of community residents using accelerometers and PA data from two cross-sectional community surveys administered in 2013 and 2018, using the Global Physical Activity Questionnaire. From the cohort, we found significant change in PA over 24months (P = 0.03) corresponding to a 45-min daily decrease in sedentary activity, a daily increase of 35-min in light PA and 9min in moderate-to-vigorous PA. There was a statistically significant (P = 0.01) increasing trend at the population-level in the moderate-to-vigorous composition of 7min between the two cross-sectional assessments (95% CI: 0.1%-1.34%). The study demonstrates that the adapted evidence-based PA interventions in a micropolitan context is effective.

Assessing the scalability of evidence-based healthy eating and physical activity interventions in early childhood education and care: A cross-sectional study of end-user perspectives.

ObjectivesTo describe early childhood education and care (ECEC) services: i) perceptions regarding the scalability of healthy eating and physical activity interventions; and ii) associations between scalability and service characteristics. MethodsA cross-sectional survey was conducted with a randomly selected sample of ECEC services across Australia. The scalability of 12 healthy eating and physical activity interventions were assessed using items based on the Intervention Scalability Assessment Tool. Higher scores represented a higher perceived scalability. ResultsFrom 453 participants, the highest scoring healthy eating and physical activity interventions were ‘Providing healthy eating education and activities for children’ (M43.05) (out of 50), and ‘Providing sufficient opportunities for child physical activity’ (M41.43). The lowest scoring was ‘Providing families with lunchbox guidelines’ (M38.99) and ‘Engaging families in activities to increase child physical activity’ (M38.36). Services located in rural areas, compared to urban, scored the overall scalability of both healthy eating and physical activity interventions significantly lower. ConclusionsPerceptions regarding scalability of healthy eating and physical activity interventions in the ECEC setting vary according to service characteristics. Implications for Public HealthFindings identify where government investment and implementation efforts may be prioritised to facilitate scale-up. Investigation into the barriers and support required for lower scoring interventions is warranted.

Community and Organizational Readiness to Adopt a Physical Activity Intervention in Micropolitan Settings.

Assessing community and organizational readiness is key to successfully implementing programs. The purpose of this study was to assess the baseline readiness of micropolitan communities to adopt an evidence-based physical activity (PA) intervention by exploring three dimensions: (1) attitudes and current efforts toward prevention, (2) community and organizational climate that facilitates (or impedes) change, and (3) capacity to implement change. Data were collected from community leaders in 14 communities through an online survey in June 2021 (n = 149). Data were analyzed in aggregate using descriptive statistics for multiple-choice responses and content analysis for open ended responses. One-way repeated analyses of variance were used to compare mean score differences. In reference to their attitudes prior to the pandemic, respondents said that addressing PA was "somewhat a priority" in their professional positions (M = 2.01, SD = 0.94), their organizations (M = 2.08, SD = 0.91), and their communities (M = 2.28, SD = 0.88). Current PA efforts included statewide initiatives, community sponsored events/clubs, and youth sports leagues. The community climate included both PA facilitators (mainly outdoor PA resources) and barriers (cost, lack of social services, and an unsupportive PA environment). Individual-level capacity (M = 2.94; SD = 1.21) to adopt a PA program was regarded lower than the community's capacity (M = 3.95; SD = 0.82), and perceptions of capacity at the community level improved even more if technical assistance (M = 3.96; SD = 0.84) or financial support (M = 4.12; SD = 0.80) were provided. Readiness varied by dimension, suggesting the need for tailored implementation supports including technical assistance and financial support.

Development and feasibility of a theory-guided and evidence-based physical activity intervention in pregnant women with high risk for gestational diabetes mellitus: a pilot clinical trial

BackgroundPhysical activity has been utilized as an effective strategy to prevent gestational diabetes mellitus (GDM). However, most pregnant women with high risk for GDM did not achieve the recommended physical activity level. Furthermore, relevant physical activity protocols have varied without theory-guided and evidence-based tailored to pregnant women with high risk for GDM. This study aimed to develop and pilot test a theory-guided and evidence-based physical activity intervention protocol for pregnant women with high risk for GDM.MethodsThe study design was guided by the Medical Research Council Framework for Developing and Evaluating Complex Intervention (the MRC framework). The preliminary protocol for physical activity intervention was developed based on self-efficacy theory, research evidence identified from systematic reviews and clinic trials, stakeholder engagement, context, and economic considerations. The preliminary intervention protocol was validated through a content validity study by an expert panel of 10 experts. A single-blinded randomized controlled trial (RCT) was designed to test the feasibility and acceptability of the intervention.ResultsThe validity of the preliminary intervention protocol was excellent as consensus was achieved. The final 13 sessions of self-efficacy enhancing physical activity intervention protocol were developed, including knowledge education, exercise clinic visits and video, and group discussions with face-to-face and online blended sessions. In the feasibility study, 34 pregnant women with high risk for GDM were randomized for the intervention (n = 17) or the control group (n = 17). The recruitment and retention rates were 82.9% and 58.9%, respectively. Women in the intervention group had a lower incidence of GDM (26.7% vs. 36.5%) than the control group (P >0.05). All participants were satisfied with the intervention and agreed that the intervention was helpful.ConclusionsThe developed self-efficacy-enhancing physical activity intervention is a feasible and acceptable intervention for enhancing physical activity among pregnant women with high risk for GDM and is ready to be tested in a more extensive RCT study.Trial registrationThe study was registered on 4 February 2022 (ChiCTR2200056355) by the Chinese Clini Trial Registry (CHiCTR).

Use of a toolbox of tailored evidence-based interventions to improve children’s physical activity and cardiorespiratory fitness in primary schools: results of the ACTIPROS cluster-randomized feasibility trial

BackgroundSchool-based physical activity (PA) promotion is usually conducted by providing one specific intervention. In contrast, the ACTIvity PROmotion via Schools (ACTIPROS) toolbox provides a set of twelve evidence-based PA interventions serving different domains of the Health Promoting Schools framework that primary schools can select according to their requirements. In this study, we tested the feasibility of the toolbox approach in primary schools.MethodsA two-arm cluster-randomized feasibility trial at primary schools (n = 5 intervention schools [IS], n = 5 control schools) located in the Federal State of Bremen, Germany, was conducted. Children’s habitual PA (GENEActiv, Activinsights Ltd.) and motor skills (Deutscher Motorik Test; DMT) were measured at the beginning (t0: Sept and Oct 2021) and at the end of the school year (t1: June and July 2022). Between Oct 2021 and July 2022, the ACTIPROS toolbox was implemented at IS. Teachers documented intervention choices and implementation within a short questionnaire (SIQ) at t1.ResultsIS successfully implemented at least one intervention of the toolbox. In total, seven out of twelve possible interventions were selected. Two schools decided to replace an intervention with another during the trial. Results of the SIQ indicated that IS tended to choose similar interventions while implementation frequency was highly different. N = 429 students from two classes per school were recruited. The mean consent rate was 75.1% (n = 322). At t0 and t1, n = 304 (94.4%) and n = 256 (79.3%) of consented children took part in the DMT, respectively. The accelerometry sample included one class per participating school. At t0 and t1, n = 166 and n = 151 devices were handed out to students and n = 133 (80.1%) and n = 106 (70.2%) valid records could be retrieved, respectively. Linear mixed models showed an intervention effect of 15.5 min (95% CI: 4.5; 26.6) in children’s daily MVPA at IS between t0 and t1 compared to controls.ConclusionsAll IS were able to implement at least one intervention from the toolbox, and unsuitable interventions were successfully replaced in a timely manner, highlighting the feasibility of implementing the ACTIPROS toolbox. Good consent rates for accelerometer and motor skills data were achieved. Results indicate a substantial increase in MVPA associated with the ACTIPROS toolbox and need to be tested in a larger sample.Trial registrationGerman Clinical Trials Register DRKS00025840.

Leave the screen: The influence of everyday behaviors on self-reported interoception

The influence of physical activity on interoception is apparent, however little is known about within-person variability following physical activity and sedentary behavior in daily life. To test this, 70 healthy adults (Mage 21.67 ± 2.50) wore thigh-mounted accelerometers for 7-days, with self-reported interoception recorded on movement-triggered smartphones. Participants additionally reported the predominant activity type performed across the last 15 min. Investigating this timeframe, multi-level analyses revealed that each one-unit increase in physical activity was associated with an increase in self-reported interoception (B = 0.0025, p = .013), whereas contrastingly, each one-minute increase in sedentary behavior was associated with a decrease (B = −0.06. p = .009). Investigating the influence of different activity types in comparison to screen time behavior, both partaking in exercise (B = 4.48, p < .001) and daily-life physical activity (B = 1.21, p < .001) were associated with an increase in self-reported interoception. Regarding other behavior categories, non-screen time behavior both with (B = 1.13, p < .001) and without (B = 0.67, p = .004) social interaction were also associated with an increase in self-reported interoception compared to screen-time behavior. Extending from previous laboratory-based studies, these findings indicate that physical activity influences interoceptive processes in real-life, further supplemented by the novel and contrasting findings regarding sedentary behavior. Furthermore, associations with activity type reveal important mechanistic information, highlighting the importance of reducing screen-time behavior to preserve and support interoceptive perceptions. Findings can be used to inform health recommendations for reducing screen-time behavior and guiding evidence-based physical activity interventions to promote interoceptive processes.

An individualized mobile health intervention to promote physical activity in adults with obstructive sleep apnea: An intervention mapping approach.

Combining continuous positive airway pressure with physical activity (PA) might be a promising strategy to treat obstructive sleep apnea (OSA). This article describes how intervention mapping (IM) can guide the development, content, and mechanisms of action of a mobile application to promote PA in adults with OSA. To develop the program, the IM approach was followed. This article presents the first three steps of IM to develop a mixed intervention (with interventionists and a digital application) aiming to: (1) assess patients' health problems and needs in a literature review to determine their expectations and perceived facilitators and barriers to PA behavior change and thus select the determinants of behavior; (2) formulate the expected intervention outcomes and objectives to be met to achieve the overall program goals; and (3) select and implement the behavior change techniques (BCTs) to achieve the change objectives. The literature review identified the relevant determinants (e.g., self-efficacy, coping, planning, and habit) of PA behavior using the health action process approach and multiprocess action control. These results were used to specify the program outcomes for PA adapted to physical, psychological, and social parameters. Overall, 11 performance objectives and 30 change objectives were defined. Lastly, BCTs and practical applications were identified. The study provides a theoretical and methodological basis for researchers and practitioners given the current paucity of evidence-based PA interventions for adults with OSA. It addresses the lack of BCTs (framing and prompts/cue techniques) and meaningful behavioral determinants (identity and habit) in most interventions.

P02-09 The dissemination of an effective school-based PA intervention programme: Sigue la Huella (Follow the footprint)

BackgroundA widespread dissemination of effective evidence-based physical activity (PA) interventions is needed whether a greater proportion of the population, who could potentially benefit from it, wants to be reached (Finch et al., 2016). ‘Sigue la Huella' (Follow the Footprint), is one of the few effective evidence-informed PA school-based interventions conducted on adolescents in Europe, with the support of the family and the community (Murillo et al., 2014). The main aim of this study is to describe and analyze the process of dissemination of this intervention program.MethodsThe ‘Sigue la Huella' was implemented at one secondary school situated in Jaca/Huesca (Spain). The Replicating Effective Programs (REP) framework was used, because provides a roadmap for disseminating effective interventions (Kilbourne et al., 2007). The intervention was delivered through workshops, ongoing technical assistance to the teachers, and the distribution of an instructional guide among the teachers and the school staff. A quasi-experimental design was adopted to examine the effect of ‘Sigue la Huella' after its dissemination process. PA was assessed using accelerometers at baseline and after the intervention of 14 weeks. In addition, we evaluated the dissemination process using the PRACTIS guide (Koorts et al., 2018).ResultsFrom an initial evaluation of the dissemination process, several key learnings emerged:To identify strategies for effective stakeholders engagement;To overcome some barriers such as the excess workload of the teachers in charge of disseminating the intervention program;For better measures to determine the success of dissemination approaches (e.g., reliable and valid indicators of organizational and policy change).ConclusionsThis study provides a comprehensive overview of the dissemination process of an effective school-based program identifying contextual barriers and facilitators that influence program implementation in new contexts and the direction of specific strategies to address those barriers.

Keynote 1

Title of HEPA 2022 Keynote presentationLeveraging Citizen Science as part of an Ecosystem Approach to Health-Enhancing Physical Activity.Description of HEPA 2022 Keynote presentationDuring the past 50 years, the positive effects of health-enhancing physical activity have continued to expand exponentially; yet many populations worldwide remain insufficiently active and, thus, unable to fully realize the benefits that regular physical activity offers. While a substantial number of evidence-based physical activity interventions have been successfully tested, few have specifically targeted the local environmental contexts that have a key impact on daily physical activity levels across the life course. A major focus of this presentation is to describe a technology-enabled participatory research model, called the Our Voice global citizen science research initiative, which actively engages community residents worldwide in assessing, analyzing, and building practical solutions to local environmental barriers to health-enhancing physical activity. Current results of Our Voice projects, which span six continents and have included residents ages 9 to >95, indicate that community residents themselves, irrespective of circumstances, age, or culture, may in fact be the planet’s most valuable “renewable resource” for helping to change local environments for active and healthy living.

Measuring behavior change technique delivery and receipt in physical activity behavioral interventions.

Research on physical activity behavioral support has mainly focused on measuring the absence or presence of behavior change techniques (BCTs) delivered by a counselor. We present a method to measure BCT delivery and receipt in physical activity behavioral support interventions. The method was developed and tested using transcripts from behavior change counseling sessions delivered as part of a theory- and evidence-based physical activity intervention for adults with disabilities. Using existing methods, a new method was developed to code counselor and clients' verbal statements (BCTs and other statements). Two coders independently coded 30 transcripts of audio-recorded counseling sessions. Interrater reliability was assessed using percentage agreement and Prevalence Adjusted Bias Adjusted Kappa (PABAK). Forty-eight codes were developed for counselor statements (35 BCT delivery and 13 other statements) and 46 codes for client statements (34 BCT receipt and 12 other statements). The average interrater reliability was considered nearly perfect for the counselor statements (84% agreement; PABAK = .98) and client statements (86% agreement; PABAK = .98). The BCT delivered and received were most frequently related to Goals and Planning (counselor:36%, client:35%), Support Strategies (counselor:21%, client:17%) and Self Belief (counselor:13%, client:24%). This study presents a reliable coding method to measure BCT delivery and receipt in physical activity behavioral support interventions. The method can be used to enhance intervention fidelity assessment and study interactions between counselors and clients with and without disabilities. Measuring and evaluating BCT delivery and receipt can provide new insights into what types of behavioral support work best under which circumstances. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Physical Activity and Fitness in Childhood Cancer Survivors (PACCS) Study: Protocol for an International Mixed Methods Study.

BackgroundSurvivors of childhood cancer represent a growing population with a long life expectancy but high risks of treatment-induced morbidity and premature mortality. Regular physical activity (PA) may improve their long-term health; however, high-quality empirical knowledge is sparse.ObjectiveThe Physical Activity and Fitness in Childhood Cancer Survivors (PACCS) study comprises 4 work packages (WPs) aiming for the objective determination of PA and self-reported health behavior, fatigue, and quality of life (WP 1); physical fitness determination (WP 2); the evaluation of barriers to and facilitators of PA (WP 1 and 3); and the feasibility testing of an intervention to increase PA and physical fitness (WP 4).MethodsThe PACCS study will use a mixed methods design, combining patient-reported outcome measures and objective clinical and physiological assessments with qualitative data gathering methods. A total of 500 survivors of childhood cancer aged 9 to 18 years with ≥1 year after treatment completion will be recruited in follow-up care clinics in Norway, Denmark, Finland, Germany, and Switzerland. All participants will participate in WP 1, of which approximately 150, 40, and 30 will be recruited to WP 2, WP3, and WP 4, respectively. The reference material for WP 1 is available from existing studies, whereas WP 2 will recruit healthy controls. PA levels will be measured using ActiGraph accelerometers and self-reports. Validated questionnaires will be used to assess health behaviors, fatigue, and quality of life. Physical fitness will be measured by a cardiopulmonary exercise test, isometric muscle strength tests, and muscle power and endurance tests. Limiting factors will be identified via neurological, pulmonary, and cardiac evaluations and the assessment of body composition and muscle size. Semistructured, qualitative interviews, analyzed using systematic text condensation, will identify the perceived barriers to and facilitators of PA for survivors of childhood cancer. In WP 4, we will evaluate the feasibility of a 6-month personalized PA intervention with the involvement of local structures.ResultsEthical approvals have been secured at all participating sites (Norwegian Regional Committee for Medical Research Ethics [2016/953 and 2018/739]; the Oslo University Hospital Data Protection Officer; equivalent institutions in Finland, Denmark [file H-19032270], Germany, and Switzerland [Ethics Committee of Northwestern and Central Switzerland, project ID: 2019-00410]). Data collection for WP 1 to 3 is complete. This will be completed by July 2022 for WP 4. Several publications are already in preparation, and 2 have been published.ConclusionsThe PACCS study will generate high-quality knowledge that will contribute to the development of an evidence-based PA intervention for young survivors of childhood cancer to improve their long-term care and health. We will identify physiological, psychological, and social barriers to PA that can be targeted in interventions with immediate benefits for young survivors of childhood cancer in need of rehabilitation.International Registered Report Identifier (IRRID)DERR1-10.2196/35838

Development of a School-Based Physical Activity Intervention Using an Integrated Approach: Project SMART.

Physical activity (PA) is a health-protective factor with multiple benefits for school-age children, yet only 22% of children and adolescents living in the United States (United States) accrue the recommended amount of moderate to vigorous PA. Given the prevalence of insufficient PA among children, promoting and providing PA opportunities during the school day, especially when integrated into the curriculum and linked to the learning standards, is essential for children. The purpose of this paper is to describe the procedure for the development of a school-based PA program using an integrated approach through the modified intervention mapping protocol (IMP). A total of 22 physical education teachers and 167 children from five different elementary schools were involved in the process. The procedure includes the Self-Determination Theory (SDT) that provides a theoretical framework that plays a vital role in motivating students to have a physically active lifestyle. This study applied SDT and IMP to develop and pilot a PA intervention called Project SMART using an integrative community participatory approach. As a pilot PA intervention, Project SMART is an online educational game where the students navigate a virtual journey across the United States A class’s aggregate PA propels the students on their journey, where standards-based modules are unlocked to achieve STEM (science, technology, engineering, and math) and social-emotional learning outcomes while gaining an understanding of the importance of health behaviors and opportunities to habitually engage in healthy decision-making with the support of their peers. Although initially labor intensive for the researchers, the process of tailoring the intervention to the children’s contextual and cultural needs has implications for all theoretically grounded and evidence-based PA interventions.

Testing the effectiveness of community-engaged citizen science to promote physical activity, foster healthier neighborhood environments, and advance health equity in vulnerable communities: The Steps for Change randomized controlled trial design and methods

While low-income midlife and older adults are disproportionately affected by non-communicable diseases that can be alleviated by regular physical activity, few physical activity programs have been developed specifically with their needs in mind. Those programs that are available typically do not address the recognized local environmental factors that can impact physical activity. The specific aim of the Steps for Change cluster-randomized controlled trial is to compare systematically the initial (one-year) and sustained (two-year) multi-level impacts of an evidence-based person-level physical activity intervention (Active Living Every Day [ALED] and age-relevant health education information), versus the ALED program in combination with a novel neighborhood-level citizen science intervention called Our Voice. The study sample (N = 300) consists of insufficiently active adults ages 40 years and over living in or around affordable senior public housing settings. Major study assessments occur at baseline, 12, and 24 months. The primary outcome is 12-month change in walking, and secondary outcomes include other forms of physical activity, assessed via validated self-report measures supported by accelerometry, and physical function and well-being variables. Additional intervention impacts are assessed at 24 months. Potential mediators and moderators of intervention success will be explored to better determine which subgroups do best with which type of intervention. Here we present the study design and methods, including recruitment strategies and yields. Trial registrationclinicaltrial.gov Identifier = NCT03041415

Testing the feasibility and acceptability of a culturally adapted physical activity intervention for adult Somali women.

Despite growing numbers in the USA, immigrant populations are underrepresented in existing physical activity (PA) research, in particular Muslim immigrant women. The current study is a pilot evaluation of a culturally adapted evidence-based PA intervention for adult Somali women. Stratified randomization was used to assign participants from a sample of 27 Somali women, aged 18 to 65, to a PA group or a waitlist control group. Bicultural Somali community research team members delivered a 12-week culturally adapted intervention available in English and Somali in a community-based setting. Process and outcome evaluation assessed changes in PA, self-efficacy for PA, access to PA resources, and wellbeing as well as feasibility and satisfaction with the program. Participants in the PA group increased their moderate to vigorous PA significantly more than those from the waitlist group from baseline to post-intervention (2 (SD = 15) to 100 (SD = 53) vs 12 (SD = 21) to 32 (SD = 44) minutes per week). Participants in the PA group had significantly greater scores in wellbeing at post-intervention compared to the waitlist group though there was no significant change from pre- to post-intervention for either group. Participants reported a high level of satisfaction with the program and preliminary evidence supports the general feasibility and acceptability of the program. Findings show that a culturally adapted intervention increased engagement in PA and was feasible and acceptable within a pilot sample of Somali women.

The Use of Mobile Apps to Increase Physical Activity Level: A Systematic Review

Background: About 82% of the U.S. adult population owns a smartphone. More than half of that population downloaded a fitness or health app to increase the physical activity level. The current review included studies that have utilized mobile apps in conjunction with other intervention strategies to increase physical activity levels. Methods: The search was conducted in five electronic databases. Studies were included if they were randomized controlled trials, utilized mobile apps, physical activity was the primary outcome, written in English, and conducted between the years of 2007 and 2019. Results: Thirteen studies were included in the final review. Results indicated that multi-component interventions reported significant improvements in physical activity across all age groups. The most substantial behavior change effects were observed in interventions that combined apps with health coaching, individualized text messages, and self-monitoring component. The overall results indicated that 8 out of 13 included studies reported statistically significant improvement in physical activity level with mobile app utilization in multi-component interventions. Conclusion: This review suggests that mobile apps have the potential to effectively deliver physical activity interventions, by providing tailored-based approach, unlimited accessibility, and monitoring. Therefore, future studies must focus on the effective delivery of evidence-based physical activity interventions through mobile apps in various populations.

What Diet, Physical Activity and Behavioral Strategies Are Used by Women with Polycystic Ovary Syndrome and Where Are They Sourced From?

ObjectivesPolycystic ovary syndrome (PCOS) is a complex endocrine disorder affecting 13% of reproductive-aged women. Lifestyle management is the first-line treatment for improving reproductive, metabolic and psychological complications in PCOS, however women experience challenges with implementing behavioral change. This indicates a clear need to better understand how women with PCOS engage with evidence-based dietary and physical activity (PA) interventions. The primary aim of this study was to identify the types and sources of dietary and PA interventions implemented by women with PCOS. A secondary aim was to understand how they use behavioral and cognitive self-management strategies to support behavioral change. MethodsIn this cross-sectional study an online questionnaire was disseminated via the PCOS Nutrition Centre (a consumer-based website) between May 2015-May 2016. Women (n = 1167) were aged 18–45 years, primarily born within the United States (70%) and self-reported a PCOS diagnosis. ResultsWhile only 33% and 16% of women reported following formal nutrition or PA guidelines (respectively), 57% had implemented a ‘special diet’ to help manage their PCOS. Many of these diets were not supported by evidence-based PCOS practice. Participants also displayed a low level of engagement with important self-management behaviors, including goal setting and positive self-talk. The internet was the primary source of nutrition (36%) and PA (32%) information, with few turning to health professionals including doctors (nutrition 16%; PA 13%) and dietitians (nutrition 4.8%; PA 2.4%). ConclusionsThese findings suggest that online information may promote inaccurate non-evidence-based lifestyle advice, and indicates a need to increase engagement with qualified health professionals. As current lifestyle advice for PCOS management utilized by health professionals are based on generic national guidelines, it is possible that this one-size-fits-all approach does not satisfy their desire for more personalized recommendations. It is also likely that health professionals will need to diversify their mode of communication through the delivery of online lifestyle education. Funding SourcesThis research received funding from the National Heart Foundation of Australia and the National Health and Medical Research Council.

Physical activity intervention for rural middle-aged and older Australian adults: a pilot implementation study of the ecofit program delivered in a real-world setting

Backgroundecofit is an evidence-based multi-component physical activity intervention that integrates smartphone technology, the outdoor environment, and social support. In a previous efficacy trial, significant improvements were found across several clinical, fitness, and mental health outcomes among adults at risk of (or with) type 2 diabetes.MethodsThe aim of the present pilot study was to evaluate a number of patient-centered and feasibility outcomes of the ecofit intervention in a “real-world” setting, using a scalable implementation model. ecofit was adapted and implemented by a rural municipal council in the Upper Hunter Shire, New South Wales, Australia, and evaluated using a single-group pre-post design. Inactive middle-aged and older adults (N=59) were recruited and assessed at 6 (primary time-point) and 20 weeks (follow-up).ResultsImprovements were found in this predominantly overweight and obese sample for aerobic fitness, functional mobility, upper and lower body muscular fitness, systolic blood pressure, and waist circumference at 6 weeks. At 20 weeks, effects were found for aerobic fitness, functional mobility, upper and lower body muscular fitness, and systolic blood pressure. Overall, participants were satisfied with the ecofit program. Participants attended the 6-week primary time-point (66.1%) and follow-up at 20 weeks (41.6%).ConclusionsOur findings support the preliminary effectiveness and feasibility of the ecofit intervention delivered by municipal council staff following a brief training from the research team. This study provides valuable preliminary evidence to support a larger implementation trial.

\u201cIt makes me feel not so alone\u201d: features of the Choose to Move physical activity intervention that reduce loneliness in older adults

BackgroundDespite the well-known health benefits of physical activity (PA), older adults are the least active citizens. Older adults are also at risk for loneliness. Given that lonely individuals are at risk for accelerated loss of physical functioning and health with age, PA interventions that aim to enhance social connectedness may decrease loneliness and increase long-term PA participation. The objectives of this mixed-method study are to: (1) evaluate whether an evidence-based PA intervention (Choose to Move; CTM) influenced PA and loneliness differently among self-identified ‘lonely’ versus ‘not lonely’ older adults and (2) to describe factors within CTM components most likely to promote social connectedness/reduce loneliness.MethodsCTM is a flexible, scalable, community-based health promoting physical activity intervention for older adults. Two community delivery partner organizations delivered 56 CTM programs in 26 urban locations across British Columbia. We collected survey data from participants (n = 458 at baseline) at 0 (baseline), 3 (mid-intervention) and 6 (post-intervention) months. We conducted in depth interviews with a subset of older adults to understand how CTM facilitated or impeded their PA and social connectedness.ResultsPA increased significantly from baseline to 3 months in lonely and not lonely participants. PA decreased significantly from 3 to 6 months in lonely participants; however, PA at 6 months remained significantly above baseline levels in both groups. Loneliness decreased significantly from baseline to 3 and 6 months in participants identifying as lonely at baseline. Factors within CTM components that promote social connectedness/reduce loneliness include: Activity coach characteristics/personality traits and approaches; opportunity to share information and experiences and learn from others; engagement with others who share similar/familiar experiences; increased opportunity for meaningful interaction; and accountability.ConclusionHealth promoting interventions that focus on PA and social connectedness through group-based activities can effectively reduce social isolation and loneliness of older adults. Given the ‘epidemic of loneliness’ that plagues many countries currently, these kinds of interventions are timely and important. Research that further delineates mechanisms (e.g., sharing experiences vs. lectures), that modify the effect of an intervention on social connectedness outcomes for older adults engaged in community-based PA programs would be a welcome addition to the literature.

Implementation and Effects of Information Technology-Based and Print-Based Interventions to Promote Physical Activity Among Community-Dwelling Older Adults: Protocol for a Randomized Crossover Trial.

BackgroundDespite the known health benefits of physical activity (PA), less than half and less than one-third of older adults in Germany reach the PA recommendations for endurance training and strength training, respectively, of the World Health Organization. The aim of this study is to investigate the implementation and effectiveness over the course of 9 months of two interventions (information technology [IT]-based vs print-based) for PA promotion among initially inactive older adults in a randomized, crossover trial. This study is part of a large research consortium (2015-2021) investigating different aspects of PA promotion. The IT-based intervention was previously developed and refined, while the print-based intervention was newly developed during this funding phase.ObjectiveWe aim to compare the effectiveness and examine the preferences of study participants regarding both delivery modes.MethodsOur target sample size was 390 initially inactive community-dwelling older adults aged ≥60 years at baseline (3-month follow-up [T1]: expected n=300; 9-month follow-up [T2]: expected n=240) who were randomized to one of two interventions for self-monitoring PA: IT-based (50%) or print-based (50%) intervention. In addition, 30% of the IT-based intervention group received a PA tracker. At T1, participants in both groups could choose whether they prefered to keep their assigned intervention or cross over to the other group for the following 6 months (T2). Participants’ intervention preferences at baseline were collected retrospectively to run a post hoc matched-mismatched analysis. During the initial 3-month intervention period, both intervention groups were offered weekly group sessions that were continued monthly between T1 and T2. A self-administered questionnaire and 3D accelerometers were employed to assess changes in PA between baseline, T1, and T2. Adherence to PA recommendations, attendance at group sessions, and acceptance of the interventions were also tracked.ResultsThe funding period started in February 2018 and ends in January 2021. We obtained institutional review board approval for the study from the Medical Association in Bremen on July 3, 2018. Data collection was completed on January 31, 2020, and data cleaning and analysis started in February 2020. We expect to publish the first results by the end of the funding period.ConclusionsStrategies to promote active aging are of particular relevance in Germany, as 29% of the population is projected to be ≥65 years old by 2030. Regular PA is a key contributor to healthy aging. This study will provide insights into the acceptance and effectiveness of IT-based vs print-based interventions to promote PA in initially inactive individuals aged ≥60 years. Results obtained in this study will improve the existing evidence base on the effectiveness of community-based PA interventions in Germany and will inform efforts to anchor evidence-based PA interventions in community structures and organizations via an allocation of permanent health insurance funds.Trial RegistrationGerman Registry of Clinical Trials DRKS00016073; https://tinyurl.com/y983586mInternational Registered Report Identifier (IRRID)DERR1-10.2196/15168

Involving the headteacher in the development of school-based health interventions: A mixed-methods outcome and process evaluation using the RE-AIM framework.

Although interventions delivered in school settings have the potential to improve children's health and well-being, the implementation of effective interventions in schools presents challenges. Previous research suggests facilitating greater autonomy for schools to select interventions aligned to their needs could improve implementation and maintenance. The aim of this mixed-methods outcome and process evaluation was to explore whether involving headteachers in the developmental stages of health interventions influenced adoption, effectiveness (e.g. pupil fitness and physical activity, assessed quantitatively), implementation and maintenance (assessed quantitatively and qualitatively). Three UK primary schools were provided with a choice of five evidence-based physical activity interventions: Playground scrapstore, daily classroom refreshers, alternative afterschool clubs, parent and child afterschool activities and an 'In the Zone' playground intervention. To evaluate the impact of this autonomous approach, semi-structured interviews with headteachers (n = 3), teachers (n = 3), and a private coach, and focus groups with pupils aged 9-11 (n = 6, 31 pupils, 15 boys), were undertaken. This was alongside an outcome and process evaluation, guided by the RE-AIM framework. This study assessed the impacts on adoption, implementation and maintenance of the autonomous approach and the effect on physical activity (seven day accelerometry-GENEActiv) and aerobic fitness (20m shuttle run). All three schools adopted different intervention components; alternative afterschool clubs, parent and child afterschool activities and daily classroom refreshers. Headteachers welcomed greater autonomy in developing school-based interventions and appreciated the more collaborative approach. Mixed results were reported for the effectiveness, implementation and maintenance of the interventions adopted. Allowing pupils choice and promoting a positive school environment were key factors for enhancing engagement. Moreover, promoting inclusive physical activity projects with a consideration of existing curriculum pressures aided implementation. This mixed-methods study provides valuable insights about autonomous approaches to inform further development, implementation and maintenance for future interventions.