Improvements In Moderate-to-vigorous Physical Activity Research Articles

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 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 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 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 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 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 months, respectively.ConclusionsPEP4PA achieved increases in MVPA and PQoL in low-income older adults, over 2 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.

Physical activity telephone coaching intervention for insufficiently physically active ambulatory hospital patients: Economic evaluation of the Healthy 4U-2 randomised controlled trial.

The Healthy 4U-2 randomised controlled trial demonstrated that a physical activity (PA) telephone coaching intervention was effective for improving objectively-measured PA and health-related outcomes. The current study reports on an economic evaluation performed alongside the trial to determine whether this effective intervention is also cost-effective from a healthcare funder perspective. Participants (N = 120) were insufficiently physically active adults recruited from an ambulatory care clinic in a public hospital in regional Australia. The primary outcome was change in moderate-to-vigorous physical activity (MVPA) measured using accelerometers. Changes in quality-adjusted life-years (QALYs) were derived from the 12-Item Short Form Health Survey Questionnaire (SF-12). Incremental cost-effectiveness ratios (ICERs) were calculated for each outcome. Uncertainty of cost-effectiveness results were estimated using non-parametric bootstrapping techniques and sensitivity analyses. The mean intervention cost was $132 per person. The control group incurred higher overall costs compared to intervention ($2,465 vs. $1,743, respectively). Relative to control, the intervention resulted in incremental improvements in MVPA and QALYs and was deemed cost-effective. Probabilistic sensitivity analysis indicated that compared to control, the intervention would be cost-effective for improving MVPA and QALYs at very low willingness to pay thresholds. Sensitivity analyses indicated that results were robust to varied assumptions. This study shows that PA telephone coaching was a low-cost strategy for increasing MVPA and QALYs in insufficiently active ambulatory hospital patients. Findings of health benefits and overall cost-savings are uncommon and PA telephone coaching offers a potentially cost-effective investment to produce important public health outcomes.

Improvements in motor competence skills are associated with improvements in executive function and math problem-solving skills in early childhood.

Efforts to increase moderate-to-vigorous physical activity (MVPA) in school-age children are associated with improved health, cognitive, and academic outcomes. However, questions remain about whether similar benefits are observed in early childhood. We hypothesized that motor competence, not MVPA, would be related to improved cognitive and academic skill development in early childhood. For this study, 283 children were recruited from 13 community-based preschools (55% female; M = 4.2 years old, SD = .6; 41% non-Hispanic White, 37% non-Hispanic Black; 10% Hispanic, 10% mixed race, 2% Asian, 1% American Indian). Children's physical activity, motor competence, executive function (EF), and math problem-solving skills were measured using the same protocol in three assessments in a single academic year (i.e., fall, winter, spring). Although motor competence was strongly correlated with contemporaneous measures of EF and math problem-solving skills (rs = .51-.63), MVPA was weakly correlated with EF and math problem-solving skills (rs = .03-.18). Mixed linear models demonstrated that improvements in children's motor competence were related to improvements in their EF and math problem-solving skills (ps < .001), their improvements in MVPA were not statistically significant related to any of the outcomes. These within-child associations provide a stronger basis of inference by controlling for all time-invariant confounders. The results of this study suggest that efforts to improve motor competence skills in young children may improve EF and math problem-solving skills, though experimental studies are required to rigorously test this idea. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Preliminary Efficacy of an Emotion Regulation Intervention on Physical Activity and Depressive and Anxious Symptoms in Individuals in Cardiac Rehabilitation.

For the 720 000 Americans expected to experience a new acute cardiac event this year, cardiac rehabilitation is an important part of recovery. Symptoms of depression and anxiety undermine recovery efforts, leaving recovering patients at risk for diminished functional capacity and heightened risk of mortality. Poor emotion regulation can worsen symptoms of depression and anxiety and hinder recovery efforts. The purpose of this randomized controlled trial was to evaluate the early efficacy testing of a theoretically based emotion regulation treatment (Regulating Emotions to Improve Self-management of Nutrition, Exercise, and Stress [RENEwS]) designed to assist survivors of an acute cardiac event in cardiac rehabilitation to optimize recovery. Survivors of an acute cardiac event in cardiac rehabilitation (n = 30, 83% men) were randomized to five 1-hour in-person group sessions of RENEwS or a phone-based attention-control group. Participants completed measures of depression and anxiety symptoms at 3 time points. Moderate to vigorous physical activity (MVPA) was objectively measured for 7 days at each time point using waist-worn actigraphy monitors. Between-group differences were calculated using analysis of variance with Cohen f effect sizes calculated to evaluate initial efficacy. There was no statistically significant difference in depression, anxiety, or MVPA over time based on group assignment (all P > .05). Compared with attention control participants, in RENEwS participants, preliminary effects showed greater reductions in depression (Cohen f = 0.34) and anxiety (Cohen f = 0.40) symptoms but only modest improvements in MVPA from baseline to 5 months (Cohen f = 0.08). Findings show that RENEwS is a promising emotion regulation intervention to enhance cardiac rehabilitation and potentially decrease symptoms of depression and anxiety.

Emotion Regulation Training May Improve Stress, Depression, Anxiety, and Physical Activity

The purpose of this two-arm randomized controlled pilot study was to assess initial efficacy of the theoretically-based RENEwS intervention, designed to improve emotion regulation and thereby decrease depression and anxiety and increase moderate to vigorous physical activity (MVPA) following a cardiac event. Participants (n=30, 83% men) recruited from cardiac rehabilitation were randomized to five weekly 1-hour sessions of RENEwS intervention or active control. Although this trial was not powered for confirmatory efficacy (p’s > .02, but many greater than .05), RENEwS participants evidenced an advantage over Control participants in terms of reductions in stress (Cohen’s f = .47), depression symptoms (Cohen’s f = .34), anxiety symptoms (Cohen’s f = .40) but only modest improvements in MVPA from baseline to 5 months (Cohen’s f = .08). Findings support potential efficacy and testing RENEwS in a larger sample.

A Controlled Evaluation of a CBPR Intervention's Effects on Physical Activity and the Related Psychosocial Constructs Among Minority Children in an Underserved Community.

Effective physical activity interventions are needed for children because health behaviors track into adulthood, and risk factors for diseases begin early in life. No study has determined whether an intervention designed using a Community-Based Participatory Research approach can improve moderate to vigorous physical activity (MVPA) and the related psychosocial constructs in underserved children. This study determined whether improvements in MVPA and related psychosocial constructs (self-efficacy, knowledge, beliefs, attitudes, and skills) occurred following a Community-Based Participatory Research intervention in underserved, rural children. It was then determined if these constructs were mediators of MVPA. Two fifth-grade classes at a school (n = 19 and n = 20) were randomly assigned to an intervention or comparison group. The intervention group participated in a 4-week intervention designed to improve MVPA (wGT3X-BT accelerometer; ActiGraph, Pensacola, FL) and the related psychosocial constructs (written survey). Groups were assessed prior to and immediately following the intervention. There were no differences at baseline between groups. MVPA (30.0 [4.4]min), knowledge, and skill scores were significantly higher in the intervention group compared with the comparison group at follow-up (P < .05). Knowledge and skills were mediating variables of MVPA. Priority should be placed on research that determines the sustained impact of similar Community-Based Participatory Research interventions.

Peer support for physical activity adoption among breast cancer survivors: Do the helped resemble the helpers?

Interventions offering peer mentoring programmes promoting moderate-to-vigorous physical activity (MVPA) have shown improvements in MVPA and well-being from baseline; however, research is limited. The purpose of this study was to compare the physical activity (PA) levels and psychosocial well-being of coaches and participants at baseline and following a 12-week intervention. Breast cancer survivors (<5years) were recruited and randomised into either exercise (Reach-to-Recovery (RTR)+PA) or control (RTR Control). Participants in both groups were individually assigned one of the 18 available coaches who delivered either the MVPA intervention or the control condition via telephone. PA (7-Day PA Recall), psychosocial well-being, fatigue and mood were assessed at baseline and intervention completion. Seventy-six breast cancer survivors (average age=55.62 (±9.55)) were randomised. At baseline, all participants showed significantly lower MVPA (p=.001) and well-being (p<.05) as compared to coaches. However, post-intervention showed significant improvement in PA and well-being in RTR+PA, so that they were no longer significantly different from the coaches. Post-intervention, MVPA (p<.01), quality of life (p<.05) and fatigue (p<.05) remained significantly lower in RTR Controls compared to coaches. Future interventions should consider the behavioural patterns not only of the participants, but also of those who deliver the interventions.

An internet-supported school physical activity intervention in low socioeconomic status communities: results from the Activity and Motivation in Physical Education (AMPED) cluster randomised controlled trial

ObjectiveQuality physical education (PE) is the cornerstone of comprehensive school physical activity (PA) promotion programmes. We tested the efficacy of a teacher professional learning intervention, delivered partially via the internet,...

Impact of a male‐only weight loss maintenance programme on social–cognitive determinants of physical activity and healthy eating: A randomized controlled trial

To examine the effect of a gender-tailored, Social Cognitive Theory (SCT)-based weight loss maintenance (WLM) intervention on men's physical activity and healthy eating cognitions and behaviours in the 12 months after completing a weight loss programme. A two-phase, assessor-blinded, randomized controlled trial. Ninety-two overweight/obese men (mean [SD] age: 49.2 years [10.1], BMI: 30.7 [3.3] kg/m(2) ) who lost at least 4 kg after completing the 3-month SCT-based SHED-IT Weight Loss Program were randomly allocated to receive (1) the SCT-based SHED-IT WLM Program; or (2) no additional resources (self-help control group). The 6-month gender-tailored SHED-IT WLM Program was completely self-administered and operationalized SCT behaviour change principles to assist men to increase moderate-to-vigorous physical activity (MVPA) and decrease energy-dense, nutrient-poor (discretionary) food consumption after initial weight loss. After randomization (WLM baseline), men were reassessed at 6 months (WLM post-test) and 12 months (6-month WLM follow-up). SCT cognitions (e.g., self-efficacy, goal setting), MVPA, and discretionary food consumption were assessed with validated measures. Following significant improvements in cognitions, MVPA and discretionary food consumption during the weight loss phase, intention-to-treat, linear mixed models revealed no significant group-by-time differences in cognitions or behaviours during the WLM phase. Initial improvements in MVPA and some cognitions (e.g., goal setting, planning, and social support) were largely maintained by both groups at the end of the study. Dietary effects were not as strongly maintained, with the intervention and control groups maintaining 57% and 75% of the Phase I improvements in discretionary food intake, respectively. An additional SCT-based WLM programme did not elicit further improvements over a self-help control in the cognitions or behaviours for MVPA or discretionary food intake of men who had lost weight with a SCT-based weight loss programme. Statement of contribution What is already known on this subject?Weight regain after weight loss (WL) is common. As successful weight loss maintenance (WLM) requires sustained improvements in cognitions and behaviours, health psychology can contribute to intervention development. However, little research has examined the utility of psychological theory in the context of a WLM randomised controlled trial. What does this study add? A theory-based WL program improved men's physical activity and dietary behaviours and cognitions. Men who also received a theory-based WLM program did not show further improvements in physical activity or dietary cognitions and behaviours compared to those that did not.

Long-term physical activity outcomes of home-based lifestyle interventions among breast and prostate cancer survivors

Few studies have investigated long-term effects of physical activity (PA) interventions. The goal of this study was to evaluate whether or not increased levels of moderate to vigorous physical activity (MVPA) were maintained by cancer survivors 1 year after receipt of two home-based interventions. The FRESH START trial randomized 543 breast and prostate cancer survivors to 1-of-2 mailed print diet and exercise interventions: sequentially-tailored vs. standardized (attention control). Each arm received eight mailings over a 1-year period, with follow-up at 1 and 2 years. This analysis focuses solely on the 400 participants who had suboptimal levels of MVPA at baseline (measured by the 7-Day Physical Activity Recall) and who completed the 2-year study. Median minutes of MVPA at baseline, 1-year and 2-year follow-up in the tailored intervention arm were as follows: 0, 90, and 60 min/week, respectively. The corresponding values in the attention control group were 0, 30, and 30 min/week. Significant improvements in MVPA from baseline to 2-year follow-up were observed in both study arms (p < 0.01). While significant between-arm differences were observed at 1-year follow-up (p < 0.01), there was only the suggestion of a trend (p = 0.08) at 2-year follow-up. This study provides evidence that mailed-print exercise interventions result in significant and sustainable improvements in MVPA among newly diagnosed cancer survivors that are observed well after the intervention is complete. While tailored interventions, as compared to standardized materials, appear to produce superior improvements in MVPA initially, these differences diminish over time.

Peer Volunteers Improve Long-Term Maintenance of Physical Activity With Older Adults: A Randomized Controlled Trial.

Using peer volunteers as delivery agents may improve translation of evidence-based physical activity promotion programs for older adults. This study examined whether tailored support from older peer volunteers could improve initiation and long-term maintenance of physical activity behavior. Participants were randomized to 2 16-week, group-based programs: (1) peer-delivered, theory-based support for physical activity behavior change; or (2) an intervention typically available in community settings (basic education, gym membership, and pedometer for self-monitoring), attention-matched with health education. Moderate-to-vigorous physical activity (MVPA) was assessed via daily self-report logs at baseline, at the end of the intervention (16 weeks), and at follow-up (18 months), with accelerometry validation (RT3) in a random subsample. Seven peer volunteers and 81 sedentary adults were recruited. Retention at the end of the trial was 85% and follow-up at 18 months was 61%. Using intent-to-treat analyses, at 16 weeks, both groups had similar significant improvements in MVPA. At 18 months, the group supplemented with peer support had significantly more MVPA. Trained peer volunteers may enhance long-term maintenance of physical activity gains from a community-based intervention. This approach has great potential to be adapted and delivered inexpensively in community settings.

Effects of a physical education intervention to improve student activity levels

Background: School physical education is available to most young people and provides a structured context for physical activity participation. Regular physical activity during childhood can confer acute and long-term health benefits. From this health perspective one of the goals of physical education is for students to take part in appropriate amounts of physical activity during lesson time. However, the diverse aims of physical education (e.g., motor, cognitive, social development, etc.) may hinder achievement of this goal as they can contrast with participation in health-enhancing physical activity. Despite these constraints improving physical activity opportunities during lessons is a worthwhile aspiration and has been a research focus for some time. Purpose: To increase cardio respiratory health-enhancing physical activity levels during girls' gymnastics lessons by manipulating the lesson contexts and teacher behaviours, and to achieve this without compromising other planned lesson objectives Participants and setting: Two classes of 30–32 Year 7 girls (aged 11–12 years) from one co-educational high school in Merseyside, England participated in the study. Classes were randomly appointed to control (CON) and intervention (INT) conditions. Intervention: The key principle of the pedagogical intervention was that the INT teacher including enhanced physical activity levels as an additional planned lesson objective, alongside existing objectives from a gymnastics unit of work. The INT teacher used these slightly modified lesson objectives to underpin the lesson planning and delivery. Research design: The research incorporated a quasi-experimental design whereby both the CON and INT classes were taught gymnastics lessons based on the same unit of work over a six-week period. Following an initial baseline lesson, the CON class participated in lessons planned and taught in the regular way, while the INT class took part in lessons that employed the intervention principles integrated into the planning and delivery. Data collection: Student activity levels, lesson contexts and teacher behaviours were quantified over a six-lesson gymnastics unit using a validated direct observation instrument (SOFIT). After each lesson the CON and INT teachers completed evaluations indicating whether lesson objectives were met. Data analysis: The dependent variables reflected lesson length, student activity levels, lesson contexts and teacher behaviours. Student activity levels included proportions of the time spent at various activity levels and three summary measures of activity, which were, (a) the proportion of lesson time engaged in moderate-to-vigorous physical activity (MVPA), (b) estimated mean energy expenditure rate per child (EER), and (c) estimated total energy expenditure per child per lesson (TEE). Data were analysed between classes using independent t-tests. Findings: Both classes engaged in relatively low levels of MVPA, although the INT students took part in significantly more than the CON students (18.5% vs. 13.5% of lesson time, p < .05). EER was 8% greater among the INT class compared to the CON class (p = .07). TEE was similar between classes, even though CON lessons were 6.4 min longer. Furthermore, INT students had most opportunities for skill practice (43.1% vs. 34.7% of lesson time, p < .05). Both teachers indicated that their planned lesson objectives were achieved. Conclusions: Modest improvements in MVPA can be realised in gymnastics, whose goals and characteristics seemingly contrast with engagement in cardio-respiratory health-enhancing physical activity. Integrating increased MVPA as a lesson objective can optimise students' active participation in lessons.