Piloting a behavioral intervention delivered through interactive voice response telephone messages to promote weight loss in a pre-diabetic population

OBJECTIVE: To pilot test the feasibility and effectiveness of interactive voice response (IVR) calls targeting physical activity and healthful eating as strategies for weight loss for patients with pre-diabetes. METHODS: Participants (N=77) who engaged in a 90-min diabetes prevention class were randomly assigned to receive IVR support targeting physical activity and nutrition weight loss strategies or to a no-contact control. Physical activity, dietary intake, and body weight were assessed prior to and following the 3-month intervention. RESULTS: Eighty-five percent of the intervention participants completed at least half of the intervention. Participants assigned to receive the intervention lost an average of 2.6% of body weight during the 3 months while control participants lost an average of 1.6%. To determine the effect of the calls when used we found that those who used the system lost approximately 3% of body weight which approached significance when compared to controls (p<.06). CONCLUSION: IVR holds promise for follow-up encounters with patients with pre-diabetes. PRACTICE IMPLICATIONS: IVR can be used to provide physical activity and nutrition counseling that can enhance the potential reach and effectiveness of health professionals working with patients who have diabetes while placing a minimal burden on financial resources and staff time.     

Prediction of physical activity level in adulthood by physical characteristics,physical performance and physical activity in adolescence: an 11-year follow-up study

The purpose of the study was to investigate to what extent the physical activity pattern in adulthood can be predicted by physical characteristics, performance and activity in adolescence. A group of 62 men and 43 women completed a questionnaire concerning physical activity during their leisure time at the ages of 16 and 27 years. An activity index produced from the questionnaire. At the age of 16 years, the subjects were also tested for strength (strength test battery) and running performance (9-min run). Maximal oxygen uptake ( ) was estimated from a submaximal test and a muscle biopsy specimen was taken and analysed for fibre types (percentages of types I, IIA, 1113). The proportion of subjects engaged in some kind of physical activity during their leisure time was approximately 70% among the women and 80% among the men at both ages. The time spent on physical activity (minutes per week) decreased with age for the men but not for the women. The women devoted less time. to physical activity than the men both at age 16 and 27 years. The attitude to endurance activities had changed to a more positive attitude among the women and to a less positive attitude among the men at age 27 years. The aerobic potential ( and percentage of type I fibre), running performance, strength performance, physical activity and marks in physical education at age 16 years explained 82% of the physical activity level in adulthood for the women and 47% for the men. The aerobic potential at age 16 years alone explained 31% of the adult physical activity level in the women and 24% in the men. Strength performance, physical activity and marks in physical education at age 16 years further increased the predictive value for the physical activity level in adulthood for the women but not for the men. It is suggested that the major portion of the variation in physical activity level in adult women, but not in the adult men, could be predicted from physical characteristics, physical performance, and the activity level in adolescence.     

Effects of a daily school based physical activity intervention program on muscle development in prepubertal girls

This 12-month prospective controlled intervention evaluated the effect of a general school based physical activity program on muscle strength, physical performance and body composition in prepubertal girls. Fifty-three girls aged 7–9 years involved in a school based exercise program [40 min/day of general physical activity per school day (200 min/week)] were compared with 50 age-matched girls who participated in the general Swedish physical education curriculum (mean 60 min/week). Body composition (DXA), isokinetic peak torque (PT) of the knee extensors and flexors at 60 and 180°/s, and vertical jump height (VJH) were assessed at baseline and 12 months. The annual gain in weight was similar between the groups, but there was a greater increase in total body and regional lean mass (P < 0.05) and fat mass (P < 0.01) in the exercise group. Mean gains in knee extensor PT at 60 and 180°/s were 7.0–7.6% greater in the exercise group (P ranging <0.05–<0.001). No significant differences were detected in VJH. In conclusion, increasing school based physical education to at least 3 h/week provides a feasible strategy to enhance the development of muscle strength and lean mass in prepubertal girls.     

Randomised controlled trial of a pedometer-based telephone intervention to increase physical activity among cardiac patients not attending cardiac rehabilitation

Objective

To determine the effectiveness of a pedometer-based telephone intervention on the physical activity levels of cardiac patients who did not attend a CRP.

Methods

A randomised controlled trial was conducted with 215 patients referred to a CRP but who could not or chose not to attend. The 6-week intervention included self-monitoring of physical activity using a pedometer and step calendar; and behavioural counselling and goal setting sessions. Data were collected at baseline, 6 weeks and 6 months.

Results

Study groups did not differ significantly at baseline. After 6 weeks, improvements in total physical activity time (p = 0.027), total physical activity sessions (p = 0.003), walking time (p = 0.013) and walking sessions (p = 0.002) in the intervention group were significantly greater than the control group after adjusting for baseline differences, and remained significant at 6 months.

Conclusion

The findings that the pedometer-based telephone intervention was successful in increasing physical activity levels in cardiac patients who did not attend a CRP could result in major health benefits for this group of people.

Practical implications

The pedometer-based telephone intervention could be offered as an effective and accessible option for patients not attending a CRP to increase and maintain their physical activity levels after hospitalisation.     

Beliefs about exercise and physical activity among pregnant women

Objective

The objective of this study was to document self-reported beliefs about physical activity and exercise among pregnant women.

Methods

The Pregnancy, Infection, and Nutrition (PIN3) Study asked 1306 pregnant women about beliefs regarding physical activity and exercise at 27–30 weeks’ gestation.

Results

While 78% of women agreed that most women can continue their regular exercise during pregnancy, fewer (68%) agreed that most women who never exercised could begin an exercise program during pregnancy. Most (89%) agreed that regular exercise was better than irregular exercise during pregnancy. While almost all women agreed with the benefits of light activity (98%), fewer agreed that there were benefits with moderate (73%) or vigorous exercise (13%). Differences in beliefs were most notable by educational level, race/ethnicity, and whether they participated in regular exercise during pregnancy.

Conclusion

Future studies can better elucidate the reasons behind the differences in beliefs, to explore whether cultural reasons are contributing to these differences and whether tailored messages would be more effective than general educational approaches.

Practice Implications

This study provides information to create more successful interventions to help women understand concepts regarding the safety and benefits of physical activity during pregnancy.     

Physical activity counseling intervention at a federally qualified health center: Improves autonomy-supportiveness,but not patients’ perceived competence

Objective

To assess the effect of a pilot intervention to promote clinician–patient communication about physical activity on patient ratings of their perceived competence for physical activity and their clinicians’ autonomy-supportiveness.

Methods

Family medicine clinicians (n = 13) at two urban community health centers were randomized to early or delayed (8 months later) communication training groups. The goal of the training was to teach the 5As (Ask, Advise, Agree, Assist, Arrange) for physical activity counseling. Outcome measures were changes in patient perceptions of autonomy support (modified Health Care Climate Questionnaire, mHCCQ) and perceived competence (Perceived Competence Scale for physical activity, PCS) completed via surveys at baseline, post-intervention and six-month follow-up.

Results

Patients (n = 326) were mostly female (70%) and low income. Using a generalized estimating equations model (GEE) with patients nested within clinician, patient perceived autonomy support increased at post-intervention compared to baseline (mean HCCQ scores 3.68–4.06, p = 0.03). There was no significant change in patient perceived competence for physical activity.

Conclusions

A clinician-directed intervention increased patient perceptions of clinician autonomy support but not patient perceived competence for physical activity.

Practice implications

Clinicians working with underserved populations can be taught to improve their autonomy supportiveness, according to patient assessments of their clinicians.     

Acceptability,feasibility and effectiveness of a computer-tailored physical activity intervention in adolescents

Objective

To evaluate acceptability, feasibility and effectiveness of computer-tailored physical activity education among adolescents.

Methods

Two classes of 7th graders from 10 randomly selected schools were assigned to the intervention (computer-tailored intervention, n = 139) or control (no-intervention, n = 142) condition. Questionnaires were completed 1 week before and 3 months after the intervention. The computer-tailored intervention was completed during classes.

Results

Students had few problems with the diagnostic questions and with the use of a computer. About half of the students evaluated the advice as interesting and easy to understand and about 40% as personally relevant, easy to use and credible. Half of students evaluated the advice as too long and only 33% reported to have used the advice. The computer-tailored intervention was effective for increasing school related physical activity levels with on average 25 min per week (F = 3.4, P ≤ .05), but not for increasing total physical activity or leisure time physical activity.

Conclusions

A 1-h computer-tailored intervention offered during class-time has the potential to increase school related physical activity.

Practice implications

Although favourable effects of large scale implementation may be expected, some adaptations that might increase effectiveness should be investigated in the future.     

上海市3城区1～6岁饮食行为问题儿童交互式干预体格生长评价

目的对存在不良饮食行为问题的1～6岁儿童进行交互式干预,评价干预后体格生长指标改善情况。方法选择上海市长宁区、卢湾区和虹口区1～6岁存在饮食行为问题的常住户籍儿童为研究对象,随机分为干预组和对照组。干预组在基线（T0）调查后给予交互式干预,并于入组后的1、3、6和9个月（T1～T4）分别进行随访评估,测量身高和体重;对照组T0调查后不予交互式干预,于T4时点随访。比较干预组和对照组体重和身高的增长量[△（T4-T0）],评价干预组体重/身高的改变趋势。结果共纳入存在不良饮食行为问题的儿童490例,失访25例（5.1%）。465例完成随访,其中干预组248例,对照组217例。两组基线水平具可比性。①至T4时点干预组1～4岁亚组体重增长量均显著高于对照组;干预组2～3岁亚组男、女性体重增长量均显著高于对照组。②至T4时点干预组和对照组身高增长量均呈现随年龄增长而降低的趋势,干预组2～3岁亚组身高增长量均显著高于对照组;干预组2岁亚组男性及2～3岁亚组女性身高增长量均显著高于对照组。③T0～T4时点干预组男、女性的体重/身高增长均呈现赶超P50曲线的趋势,对照组T0及T4时点均在P50曲线以下,干预组男性体重/身高增长幅度低于女性。结论交互式干预对饮食行为问题儿童的体格生长具有正向促进作用。     

Regional brain activation and affective response to physical activity among healthy adolescents

Research has shown that frontal brain activation, assessed via electroencephalographic (EEG) asymmetry, predicts the post-exercise affective response to exercise among adults. Building on this evidence, the present study investigates the utility of resting cortical asymmetry for explaining variance in the affective response both during and after exercise at two different intensities among healthy adolescents. Resting EEG was obtained from 98 adolescents (55% male), who also completed two 30-min exercise tasks on a cycle ergometer at a moderate and hard intensity. Affect (as measured by the Feeling Scale) was assessed prior to exercise, every 10 min during exercise, immediately post-exercise, and 10 min post-exercise. When moderate exercise was performed first, resting frontal cortical asymmetry was related to the affective response to moderate exercise, such that left-dominant adolescents reported more positive affect compared to right-dominant adolescents. When hard exercise was performed first, the association was not significant. The results are interpreted in light of current theory related to affect in response to exercise.     

常运动对大学生Wingate无氧运动能力的影响

目的为研究有规律的运动对大学生无氧运动能力的影响,采用Wingate功率自行车测试比较常运动和久坐大学生的无氧做功能力,并用表面肌电信号分析下肢主要肌群无氧疲劳特征。方法募集38名男大学生,分为常运动和久坐大学生两组,每组各19名。常运动组的质控标准是每周每次运动超过30min、每周运动次数≥4次;0~3次则为久坐组。采用日本COMBI公司PowerMax Ⅶ功率自行车进行Wingate无氧功率测试,比较两组学生最大功率输出(peak power output,PP)、平均功率(mean power output,MP)和无氧疲劳指数(anaerobic fatigue index,AFI)的差异。同时采集了Wingate运动过程中下肢股直肌、股外侧肌、股内侧肌和股二头肌的表面肌电信号,利用自主构建的非线性小波对表面肌电信号的强度和平均功率频率(mean power frequency,MPF)进行分析,检测肌肉纤维的募集与肌肉无氧疲劳状况。结果常运动大学生功率自行车PP和MP显著高于久坐大学生(P0.05),AFI明显小于久坐大学生。肌电信号MPF随着疲劳的产生而持续下降,常运动组的下降趋势比久坐组显著。肌电信号的强度两组也呈现不同的趋势。结论常运动组大学生的无氧运动能力显著高于久坐组。无氧运动能力与快肌纤维密切相关,结合功率输出和肌电信号分析,大学生进行有规律的运动对于增加快肌纤维的比例和面积,并进一步增加肌肉的爆发力和速度有积极的影响。     

Prospective associations between intervention components and website engagement in a publicly available physical activity website: the case of 10,000 Steps Australia

Background

Effectiveness of and engagement with website-delivered physical activity interventions is moderate at best. Increased exposure to Internet interventions is reported to increase their effectiveness; however, there is a lack of knowledge about which specific intervention elements are able to maintain website engagement.

Objective

To prospectively study the associations of website engagement and exposure to intervention components for a publicly available physical activity website (10,000 Steps Australia).

Methods

Between June and July 2006 a total of 348 members of 10,000 Steps completed a Web-based survey to collect demographic characteristics. Website engagement was subsequently assessed over a 2-year period and included engagement data on website components; individual challenges, team challenges, and virtual walking buddies; and indicators of website engagement (average steps logged, days logging steps, and active users).

Results

On average participants logged steps on 169 (SD 228.25) days. Over a 2-year period this equated to an average of 1.6 logons per week. Binary logistic regression showed that individuals who participated in individual challenges were more likely to achieve an average of 10,000 steps per day (odds ratio [OR] = 2.80, 95% confidence interval [CI] 1.45–5.40), log steps on a higher than average number of days (OR = 6.81, 95% CI 2.87–13.31), and remain an active user (OR = 4.36, 95% CI 2.17–8.71). Additionally, those using virtual walking buddies (OR = 5.83, 95% CI 1.27–26.80) and of older age logged steps on a higher than average number of days. No significant associations were found for team challenges.

Conclusions

Overall engagement with the 10,000 Steps website was high, and the results demonstrate the relative effectiveness of interactive components to enhance website engagement. However, only exposure to the interactive individual challenge feature was positively associated with all website engagement indicators. More research is needed to examine the influence of intervention components on website engagement, as well as the relationship between website engagement and physical activity change.     

Effectiveness of a computer tailored physical activity intervention in adolescents compared to a generic advice

Objective

To investigate the differences in effects of a computer tailored physical activity advice as compared to generic information in adolescents.

Methods

Students (mean age, 14.6 ± 1.2) out of 90 classes from six different Flemish schools were randomly assigned to the tailored intervention (n = 563) or the generic non-tailored intervention (n = 608) condition. Both interventions included information on public health recommendations and tips on becoming more active. Participants in both groups received their assessment and feedback at baseline, at 4 weeks and at 3 months during school hours. Physical activity levels were determined using an adolescent adaptation of the International Physical Activity Questionnaire (IPAQ).

Results

After 4 weeks, almost all physical activity scores increased over time in both the generic and the tailored intervention group. No differences between groups were found (all F ≤ 0.07). After 3 months, the generic intervention was more effective for increasing ‘walking in leisure time’ among students not complying with recommendations. For all other physical activity scores, no differences between groups were found (all F ≤ 2.3).

Conclusions

In contrast to the expectations, changes in physical activity scores did not differ between the tailored and the non-tailored intervention group. For most of the physical activity scores increases were found in both groups.     

Relationship between self-efficacy and physical activity among patients with type 2 diabetes

Introduction  While previous studies indicate a significant relationship between self-efficacy and physical activity, less research has focused on this relationship among patients with type 2 diabetes. The purpose of this investigation was to examine whether self-efficacy mediated the relationship between participation in a 1-month, print-based physical activity intervention and improvements in activity levels. Methods  Participants (N = 85; mean age = 57; 73% Caucasian; 69% female) were recruited from a community diabetes center. The intervention was individually-tailored based on theoretical constructs, including self-efficacy. Results  After controlling for age, baseline activity, and baseline self-efficacy, the tailored intervention was associated with significant improvements in physical activity, 95% CI [23.01, 271.68] as well as self-efficacy, CI [0.02, 3.48]. There was an indirect effect of treatment on physical activity through self-efficacy, CI [0.77, 73.11], and the direct effect of treatment on physical activity was no longer significant, CI [−7.33, 253.40], after the influences of self-efficacy change were accounted for in the model. Discussion  Results supported a mediation effect, such that the treatment effect on physical activity was completely mediated by changes in self-efficacy. Although replication is needed, results support the theoretical rationale for targeting self-efficacy to promote physical activity among patients with type 2 diabetes.     

Heart rate as an indicator of the intensity of physical activity in human adolescents

The aims of this study were, in a group of adolescents, firstly to identify the absolute heart rates (HR) and the percentages of maximal heart rates (HR_max) corresponding to 40%, 60% and 80% of peak oxygen uptake ( ), secondly to identify absolute and relative ( ) oxygen uptakes ( ) corresponding to HR of 120, 140 and 160 beats·min^–1, and thirdly to examine a possible effect of fatness and fitness on the relationship between HR and . The subjects were 127 (60 boys, 67 girls) adolescents with a mean age of 14.8 (SD 0.3) years. The HR and were measured by means of an incremental exercise test to exhaustion. Linear regressions were performed for the and relationships using absolute and relative (%HR_max, ) data for each individual. From these regressions, target HR and were computed. Average target HR corresponding to 40%, 60% and 80% of were: 119 (SD 9), 145 (SD 9), 171 (SD 8), and 120 (SD 10), 146 (SD 8), 172 (SD 8) beats·min^–1 for boys and girls, respectively. Average corresponding to HR of 120, 140 and 160 beats·min^–1 were: 22 (SD 5), 30 (SD 5), 38 (SD 6) and 18 (SD 4), 24 (SD 4), 31 (SD 4) mlO₂·kg^–1·min^–1for boys and girls, respectively. An analysis of covariance showed a significant fitness effect (P<0.001) for predicted at all HR studied. The results suggest that the use of absolute HR to define exercise intensity levels when assessing young people's physical activity using HR monitoring detracts from the validity of the interpretation of the data. Electronic Publication     

The role of physical activity in rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory auto-immune disease, causing progressive damage to the musculoskeletal system. Many patients with RA also suffer from accelerated muscle loss or cachexia, which contributes to the loss of physical function and quality of life. Physical activity plays a central role in the management of the disease as it is essential to maintain muscle strength and endurance, range of motion and the ability to perform activities of daily life. On the other hand, given the nature of the disease, there is always an increased risk for injury. There is a large amount of literature investigating the effect of exercise interventions on muscle function and disease activity. These studies show that exercise clearly improves muscle function without affecting disease activity. Studies including radiographic evaluation of joint damage as an endpoint also show that there is no evidence that exercise, even high-intensity exercise, increases inflammation or joint damage, although care should be taken with patients with severe baseline damage. Regarding daily physical activity (exercise is only one component of physical activity) there is hardly any research done showing either that physical activity is indeed decreased in patients or whether or not there is a relation between daily physical activity and disease activity. The results from studies looking at the effect of exercise on muscle mass or the ability to prevent or reverse cachexia are somewhat contradictory, but it seems that when the training dose is sufficiently large, gains in muscle mass can be achieved.     

Web-based, computer-tailored, pedometer-based physical activity advice: development, dissemination through general practice, acceptability, and preliminary efficacy in a randomized controlled trial

Background

Computer tailoring is a relatively innovative and promising physical activity intervention approach. However, few computer-tailored physical activity interventions in adults have provided feedback based on pedometer use.

Objectives

To (1) describe the development of a Web-based, pedometer-based, computer-tailored step advice intervention, (2) report on the dissemination of this tool through general practice, (3) report on its perceived acceptability, and (4) evaluate the preliminary efficacy of this tool in comparison with a standard intervention.

Methods

We recruited 92 participants through general practitioners and randomly assigned them to a standard condition (receiving a pedometer-only intervention, n = 47) and a tailored condition (receiving a pedometer plus newly developed, automated, computer-tailored step advice intervention, n = 45). Step counts, self-reported data obtained via telephone interview on physical activity, time spent sitting, and body mass index were assessed at baseline and postintervention. The present sample was mostly female (54/92, 59%), highly educated (59/92, 64%), employed (65/92, 71%), and in good health (62/92, 67%).

Results

Recruitment through general practitioners was poor (n = 107, initial response rate 107/1737, 6.2%); however, the majority of participants (50/69, 73%) believed it is useful that general practitioners help patients find ways to increase physical activity. In the tailored condition, 30/43 (70%) participants requested the computer-tailored step advice and the majority found it understandable (21/21, 100%), credible (17/18, 94%), relevant (15/18, 83%), not too long (13/18, 72%), instructive (13/18, 72%), and encouraging to increase steps (16/24, 67%). Daily step counts increased from baseline (mean 9237, SD 3749 steps/day) to postintervention (mean 11,876, SD 4574 steps/day) in the total sample (change of 2639, 95% confidence interval 105–5172; F ₁ = 5.0, P = .04). No interaction or other time effects were found.

Conclusions

The majority of participants in the tailored condition accepted the step advice and indicated it was useful. However, in this selected sample of adults, the tailored condition did not show superior effects compared with the standard condition.     

Unsupervised detection and analysis of changes in everyday physical activity data

Sensor-based time series data can be utilized to monitor changes in human behavior as a person makes a significant lifestyle change, such as progress toward a fitness goal. Recently, wearable sensors have increased in popularity as people aspire to be more conscientious of their physical health. Automatically detecting and tracking behavior changes from wearable sensor-collected physical activity data can provide a valuable monitoring and motivating tool. In this paper, we formalize the problem of unsupervised physical activity change detection and address the problem with our Physical Activity Change Detection (PACD) approach. PACD is a framework that detects changes between time periods, determines significance of the detected changes, and analyzes the nature of the changes. We compare the abilities of three change detection algorithms from the literature and one proposed algorithm to capture different types of changes as part of PACD. We illustrate and evaluate PACD on synthetic data and using Fitbit data collected from older adults who participated in a health intervention study. Results indicate PACD detects several changes in both datasets. The proposed change algorithms and analysis methods are useful data mining techniques for unsupervised, window-based change detection with potential to track users’ physical activity and motivate progress toward their health goals.