Effects of a Multi-Component Workplace Intervention Program with Environmental Changes on Physical Activity among Japanese White-Collar Employees: a Cluster-Randomized Controlled Trial

Purpose

This study aimed to investigate effects of a flexible multi-component workplace intervention program for improving physical activity among Japanese white-collar employees in a cluster randomized controlled trial design.

Methods

A total of 208 worksites and nested employees were approached. Any worksite interested in a 3-month physical activity promotion intervention and white-collar workers aged 18 years or older were eligible. The worksites were randomly assigned to an intervention or a control, stratified by worksite size. The intervention worksites were offered an intervention program that allows these worksites to select intervention components from a set of options, including environmental changes. The control worksites were offered feedback and basic occupational health services. Physical activity level was measured using a self-reported questionnaire at baseline and at 3 and 6 months of follow-up.

Results

Three worksites (92 employees) were allocated to the intervention and five worksites (98 employees) to the control worksites. The overall physical activity level in the intervention worksites significantly increased compared with the control worksites (Coeff?=?0.45, SE?=?0.19, p?=?0.018). For subgroup analyses, the intervention effect on the overall physical activity level was significant among medium- and large-sized worksites but not among small-sized worksites.

Conclusion

This trial showed a significant and positive effect of the intervention program on physical activity. The program is unique because of its flexibility and feasibility. However, small worksites might receive less benefit from the program, indicating a need for further support and/or new technologies.

Trial Registration

UMIN Clinical Trials Registry (ID=UMIN000024069).

     

Depressive Symptoms Among Older Adults: Long-Term Reduction After a Physical Activity Intervention

We examined the effects of two physical activity modes on depressive symptoms over a 5-year period among older adults and change in physical self-esteem as a mediator of changes in depressive symptoms. Formerly sedentary, older adults (N = 174) were randomly assigned into 6-month conditions of either walking or low-intensity resistance/flexibility training. Depressive symptoms and physical self-esteem were measured before and after the 6-month intervention, and 12 and 60 months after intervention initiation. Depressive symptoms scores were decreased immediately after the intervention, followed by a sustained reduction for 12 and 60 months after intervention initiation; there was no differential pattern of change between the physical activity modes. Change in physical self-esteem predicted change in depressive symptoms. This study supports the effectiveness of an exercise intervention for the sustained reduction of depressive symptoms among sedentary older adults and physical self-esteem as a potential mediator of this effect.     

The effects of a lifestyle physical activity counseling program with feedback of a pedometer during pulmonary rehabilitation in patients with COPD: a pilot study

OBJECTIVE: To study the effects of a lifestyle physical activity counseling program with feedback of a pedometer during pulmonary rehabilitation. METHODS: Twenty-one chronic obstructive pulmonary disease (COPD) patients were randomized to an experimental group that followed a regular rehabilitation program plus the counseling intervention or to a control group that only followed rehabilitation. The primary outcome was daily physical activity assessed by pedometers. Secondary outcomes were physical fitness, health-related quality of life, activities of daily living, depression and self-efficacy. RESULTS: The experimental group showed an increase of 1,430 steps/day (+69% from baseline), whereas the control group showed an increase of 455 steps/day (+19%) (p = 0.11 for group x time interaction). The secondary outcomes showed no differences. CONCLUSION AND PRACTICE IMPLICATIONS: This study showed that the use of the pedometer, in combination with exercise counseling and the stimulation of lifestyle physical activity, is a feasible addition to pulmonary rehabilitation which may improve outcome and maintenance of rehabilitation results.     

Daily differences in patterns of physical activity among overweight/obese children engaged in a physical activity program.

The aim of this study was to compare the physical activity of overweight/obese children during days when they attended a physical activity program, and days when they did not. This is a cross-sectional intervention study of daily physical activity. The participants were referred by family, doctors, or hospital pediatricians to take part in a 10-month interdisciplinary, outpatient obesity intervention program for children. The subjects included 41 overweight and obese children aged 8-16 years, 19 boys (46%) and 22 girls (54%); BMI: 25.7 + 3.3 kg m(-2). The MTI Actigraph was used as an objective measure of daily physical activity over seven consecutive days. Physical activity program days presented a significantly higher percentage of time (4.68%) spent in moderate-to-vigorous activity compared with no physical activity program days (3.16%) and weekend (2.7%). The results of this study suggest that a physical activity program can help increasing daily physical activity in obese children, with a special focus on MVPA level. Our data point that obese children are less active at weekend than during weekdays.     

Mediators of Increased Physical Activity and Change in Subjective Well-being: Results from the Activity Counseling Trial (ACT)

The purpose of this study was to examine whether change in satisfaction with physical function (SF), satisfaction with physical appearance (SA), and self-efficacy (SE) mediate the effects that increased physical activity has on change in subjective well-being (SWB). Participants in this investigation consisted of 854 men (n = 471) and women (n = 383) who took part in the Activity Counseling Trial (ACT). ACT was a 24-month multicenter, randomized controlled trial to evaluate the effectiveness of interventions to promote physical activity in the primary care setting. Participants were assigned to one of three treatments: standard care control, staff-assisted intervention, or staff-counseling intervention. Results revealed that, irrespective of treatment arm, change in physical activity was related to change in SBW and to change in all mediators of interest. A statistical test of mediation revealed that the influence of change in physical activity on SWB was due to change in all three mediators with change in SF making the greatest contribution to the model.     

Dietary behavior and type 2 diabetes care

OBJECTIVE: To explore risk factors modification, as well as barriers and facilitators for behavioral change in Mexican type 2 diabetics and their families. METHODS: Risk assessment and impact evaluation included measurements on anthropometrics, diet, physical activity, nutrition knowledge, and HbA(1c.) The intervention included discussion groups and promoted behavioral change on dietary risk, physical exercise, and basic diabetic knowledge of 48 urban diabetic patients and 38 relatives. The educational method consisted of cognitive reframing and situational problem solving during five meetings over an 8-month period. RESULTS: Diabetics were older and less educated than their participating relatives (55.8+/-11 and 34.7+/-13.7 years old, and 4.5+/-3.4 and 7.8+/-3.7 years of schooling, respectively). Factors such as diet, degree of obesity, physical activity and HbA(1c), reflected that 92% of diabetic patients and 83% of their relatives were at high health risk. After the intervention, nutritional knowledge and diet-health awareness increased (p=.013 and .001 respectively); however, no significant health-risks reduction was observed. DISCUSSION: Focus group analysis suggested that lack of support from family and health services, low income, neighborhood insecurity and misleading "popular knowledge" and advice are key barriers to behavioral change. PRACTICE IMPLICATIONS: The study supports the understanding of constrains to health promotion campaigns and better health provider-patient interactions in Mexican population. Additionally, the study contributes to the general knowledge of ethnic socio-cultural environment influences over health care issues, primarily to diet modifications.     

Prevention for Preschoolers at High Risk for Conduct Problems: Immediate Outcomes on Parenting Practices and Child Social Competence

This study investigated the immediate impact of an 8-month center- and home-based prevention program for preschoolers at high risk for conduct problems. We report immediate program effects on observed and self-rated parenting practices and observed child behavior with peers. Ninety-nine preschool-age siblings of adjudicated youths and their families were randomly assigned to an enhanced version of the Incredible Years Series (Webster-Stratton, 1989; n = 50) or to a no-intervention control condition (n = 49). In an intent-to-treat design, the intervention yielded significant effects on negative parenting, parental stimulation for learning, and child social competence with peers. Improvements in negative parenting, stimulation for learning, and child social competence support the potential of the intervention to prevent later conduct problems in high-risk children.     

The effects of a moderate physical activity program on thermoregulatory responses in a warm environment in men.

Moderate intensity training induces health benefits, but its influence on thermoregulatory responses during exercise in a warm environment is unclear. Twelve inactive men (mean age 24.0 +/- 6.5 yrs) underwent exercise heat tests, and peak VO2 tests, before and after a moderate training program (n= 8) or no training intervention (n = 4). Assignment to groups was random. All subjects were initially below the guidelines for physical activity set forth by Health Canada, the Canadian Society for Exercise Physiology (CSEP), and the U.S. Surgeon General. Those in the 12-week training program participated in activities such as cycling, walking, and recreational sports. Subjects were instructed to train at 50% VO2 reserve, and to gradually increase energy expenditure beyond the above mentioned recommendations. In the training group, peak VO2 increased 13%, p < 0.01, and resting peripheral blood flow during heat stress increased, p < 0.01, indicating some initial thermoregulatory benefits. No significant differences were observed in esophageal temperature or sweating threshold. Health benefits associated with thermoregulatory adaptations to exercise in a warm environment may require more vigorous exercise than recommended by current physical activity guidelines.     

Prevention for preschoolers at high risk for conduct problems: immediate outcomes on parenting practices and child social competence.

This study investigated the immediate impact of an 8-month center- and home-based prevention program for preschoolers at high risk for conduct problems. We report immediate program effects on observed and self-rated parenting practices and observed child behavior with peers. Ninety-nine preschool-age siblings of adjudicated youths and their families were randomly assigned to an enhanced version of the Incredible Years Series (Webster-Stratton, 1989; n = 50) or to a no-intervention control condition (n = 49). In an intent-to-treat design, the intervention yielded significant effects on negative parenting, parental stimulation for learning, and child social competence with peers. Improvements in negative parenting, stimulation for learning, and child social competence support the potential of the intervention to prevent later conduct problems in high-risk children.     

Psychotherapy for the spouses of lung cancer patients: assessment of an intervention

This study was a randomized prospective clinical trial to test the effect of a professionally provided program of social support counselling on newly diagnosed lung cancer patients and their families. Over the 6 months of the intervention there was no differential change by experimental status for either the patients or their principal support in outcome measures of emotional, social, or physical function. This paper reviews methodological issues which must be considered before accepting these negative findings. Further, it discusses important design considerations relevant for any psychotherapy intervention study in medical patients.     

Six-month effects of the Groningen active living model (GALM) on physical activity, health and fitness outcomes in sedentary and underactive older adults aged 55-65

OBJECTIVE: To determine the effects on energy expenditure, health and fitness outcomes in sedentary older adults aged 55-65 after 6-month participation in the GALM program. METHODS: In three Dutch communities, subjects from matched neighbourhoods were assigned to an intervention (n = 79) or a waiting-list control group (n = 102). The GALM program consisted of fifteen 60 min sessions once a week emphasising moderate-intensity recreational sports activities. RESULTS: The intervention group showed significant increases in energy expenditure for recreational sports activities, other leisure-time physical activity, health indicators, and perceived and performance-based fitness. Contrary to our expectations, the same increases were found for the control group. Consequently, only significant between-group differences, favouring the intervention group, were obtained for sleep, diastolic blood pressure, perceived fitness score and grip strength. CONCLUSION: The increases in energy expenditure for physical activity from the GALM program, especially for the more intensive recreational sports activities, look promising and are in line with the expected amounts necessary to improve health. Further research is needed to evaluate long-term effects of participation in the GALM program. PRACTICE IMPLICATIONS: These results underline that GALM can be considered successful in stimulating leisure-time physical activity and improving health and fitness in older adults.     

Development and validation of a computerized exercise intervention program for patients with type 2 diabetes mellitus in Korea

This study was designed to develop and validate a computerized exercise intervention program using the transtheoretical model (TTM) for Korean patients with type 2 diabetes mellitus (DM). This computerized program was web-based and developed by designing a flow chart. An expert group (n=24), who validated the content of the computerized program, produced a mean score for the evaluation scale of 4.25 (SD.56). Of the patients (n=28) with type 2 DM who participated in clinical validity testing of the program, the mean score for the satisfaction scale was 4.82 (SD.12). In the validation of the program, significant differences between baseline and after-intervention were observed in the stage of readiness for exercise (Z=-3.78, p < 0.001), physical activity (Z=-2.33, p < 0.05), blood glucose profiles [FBS (Z=-2.84, p < 0.01), pc 2 hr. glucose (Z=-2.33, p < 0.05), HbA1c (Z=-2.77, p < 0.01)], and VO2max (Z=-2.52, p < 0.01). The study confirmed that the computerized program could be used to construct a database and continue to provide follow-up intervention for patients in all stages.     

Medium-Term Effectiveness of a Comprehensive Internet-Based and Patient-Specific Telerehabilitation Program With Text Messaging Support for Cardiac Patients: Randomized Controlled Trial

BackgroundCardiac telerehabilitation has been introduced as an adjunct or alternative to conventional center-based cardiac rehabilitation to increase its long-term effectiveness. However, before large-scale implementation and reimbursement in current health care systems is possible, well-designed studies on the effectiveness of this new additional treatment strategy are needed.ObjectiveThe aim of this trial was to assess the medium-term effectiveness of an Internet-based, comprehensive, and patient-tailored telerehabilitation program with short message service (SMS) texting support for cardiac patients.MethodsThis multicenter randomized controlled trial consisted of 140 cardiac rehabilitation patients randomized (1:1) to a 24-week telerehabilitation program in combination with conventional cardiac rehabilitation (intervention group; n=70) or to conventional cardiac rehabilitation alone (control group; n=70). In the telerehabilitation program, initiated 6 weeks after the start of ambulatory rehabilitation, patients were stimulated to increase physical activity levels. Based on registered activity data, they received semiautomatic telecoaching via email and SMS text message encouraging them to gradually achieve predefined exercise training goals. Patient-specific dietary and/or smoking cessation advice was also provided as part of the telecoaching. The primary endpoint was peak aerobic capacity (VO₂ peak). Secondary endpoints included accelerometer-recorded daily step counts, self-assessed physical activities by International Physical Activity Questionnaire (IPAQ), and health-related quality of life (HRQL) assessed by the HeartQol questionnaire at baseline and at 6 and 24 weeks.ResultsMean VO₂ peak increased significantly in intervention group patients (n=69) from baseline (mean 22.46, SD 0.78 mL/[min*kg]) to 24 weeks (mean 24.46, SD 1.00 mL/[min*kg], P<.01) versus control group patients (n=70), who did not change significantly (baseline: mean 22.72, SD 0.74 mL/[min*kg]; 24 weeks: mean 22.15, SD 0.77 mL/[min*kg], P=.09). Between-group analysis of aerobic capacity confirmed a significant difference between the intervention group and control group in favor of the intervention group (P<.001). At 24 weeks, self-reported physical activity improved more in the intervention group compared to the control group (P=.01) as did the global HRQL score (P=.01).ConclusionsThis study showed that an additional 6-month patient-specific, comprehensive telerehabilitation program can lead to a bigger improvement in both physical fitness (VO₂ peak) and associated HRQL compared to center-based cardiac rehabilitation alone. These results are supportive in view of possible future implementation in standard cardiac care.     

Pilot study of a family physical activity planning intervention among parents and their children

Physical activity interventions among youth have resulted in modest outcomes; thus, there is a need to increase the theoretical fidelity of interventions and hone pilot work before embarking on large scale trials. The purpose of this study was to examine the effect of a planning intervention in comparison to a standard condition on intergenerational physical activity in families with young children. Inactive families (N = 85) were randomized to either a standard condition (received physical activity guidelines and a local municipal healthy active living guide) or the intervention (physical activity guidelines, local municipal healthy active living guide + planning material) after completing a baseline questionnaire package. Sixty-five families (standard condition n = 34; intervention condition n = 31) completed the 4 week follow-up questionnaire package. Complete cases and intention to treat analyses showed that the planning intervention resulted in higher self-reported family physical activity compared to the standard condition and this was due to an increase in unstructured family activities over the 4 weeks. The results are promising and suggest that theoretical fidelity targeting parent regulation of family activity may be a helpful approach to increasing weekly energy expenditure.     

The Strong African American Families Program: a cluster-randomized prevention trial of long-term effects and a mediational model

The Strong African American Families Program, a universal preventive intervention to deter alcohol use among rural African American adolescents, was evaluated in a cluster-randomized prevention trial. This 7-week family skills training program is based on a contextual model in which intervention effects on youth protective factors lead to changes in alcohol use. African American 11-year-olds and their primary caregivers from 9 rural communities (N = 332 families) were randomly selected for study participation. Communities were randomized to prevention and control conditions. Intent-to-treat analyses indicated that fewer prevention than control adolescents initiated alcohol use; those who did evinced slower increases in use over time. Intervention-induced changes in youth protective factors mediated the effect of group assignment on long-term changes in use.     

Effect of a brief cognitive training programme in patients with long-lasting back pain evaluated as unfit for surgery

The aim of the study was to evaluate the effect of cognitive intervention (information and physical exercise), on patients with long-lasting back pain referred for surgical evaluation at an orthopaedic hospital, but evaluated as unfit for surgery. One hundred and fifty-two patients were randomized to a five days intervention or control. The intervention had no significant effects on pain. At three-month follow-up, the patients in the intervention group used significantly more active strategies to cope with the back pain compared to the control group. This effect seemed to increase over time, being more pronounced at one-year follow-up evaluation.     

Impact of management change and an intervention program on health care personnel

BACKGROUND: There has been a major shift in the organization and responsibility for the provision of geriatric care in Sweden. This was believed to be stressful. We therefore decided to launch a controlled intervention program on health care personnel aimed at enhancing their adaptation and ability to cope. The purpose of this study was to assess the impact of management change on psychosocial parameters of health care personnel and the effects, if any, of a structured intervention program. METHODS: Two separate wards were randomly allocated to be either intervention (I) or control (C) ward. The I-ward personnel were subjected to a psychologist's structured 10-session intervention program for 20 weeks. The program consisted of an initial educational part followed by a practical problem-solving discussion part. A structured questionnaire on psychosocial issues was answered by the participants before (0 weeks), immediately after (20 weeks), and 10 weeks after the intervention (30 weeks). RESULTS: There were no significant changes in the psychosocial parameters of the C-ward personnel. In the I-ward, however, there was a significant increase in work demand as well as in positive feelings about work, as compared to the C-ward at the 30-week follow-up. There was also significantly better work comfort in the I-ward. CONCLUSIONS: We did not find any anticipated negative psychosocial effects on health care personnel undergoing an organizational change. However, by offering a structured intervention program to one group of health care personnel, we found some positive psychosocial effects. Future research is needed to pinpoint which factor or factors in the intervention program were the most crucial for the effects to occur.     

A comparison of education methods and their impact on behavioral change in patients with hyperlipidemia

We sought to determine the efficacy of a hospital-based, professionally-taught program emphasizing cardiovascular health. Similar programs are in existence throughout the country without documentation of their long-term benefits. Thirty-six hyperlipidemic individuals were treated as a control group or participated in one of two intensive educational interventions. The educational program was based on information obtained from focus group methodology to elicit attitudes about dietary change and learning style preferences. Behavioral changes in smoking, dietary salt and saturated fat intake, stress and tension, physical activity, and departure from ideal body weight were documented using health questionnaires and Lifestyle Risk. Indices. At three months of follow-up, there was no change in serum lipids, total fat intake, or cardiovascular risk behavior in either the control or intervention group. We conclude that a one-day program, whether designed by the target population or experts, did not improve cardiovascular risk behaviors, suggesting that more innovative methods are required to address health behaviors in this high risk group.     

Making access to TV contingent on physical activity: effects on liking and relative reinforcing value of TV and physical activity in overweight and obese children

This study examined the effects of making access to television (TV) viewing contingent on physical activity on the liking and reinforcing value of TV and attitudes towards physical activity in overweight and obese children. Secondary data analysis from a randomized controlled trial designed to increase physical activity and reduce TV viewing in 30, 8–12 years old overweight or obese children by making access to TV contingent on physical activity (intervention) or free access to TV (control). Liking of TV and physical activity was measured by a 100 point visual analog scale, while the relative reinforcing value of TV in relation to physical activity was assessed using a questionnaire based on behavioural choice paradigm that provided children an opportunity to work (button presses) to gain access to TV or physical activity according to a progressive ratio schedule of reinforcement. Enjoyment, Adequacy, Predilection and Motivation for physical activity was assessed by self-report questionnaire. Making access to TV contingent on physical activity showed a trend that approached statistical significance towards increased enjoyment of physical activity and did not adversely affect change in the liking or the relative reinforcing value of TV viewing. Making access to TV contingent on physical activity had no adverse effects on the liking or reinforcing value of TV and even showed a suggestive effect of increased enjoyment of physical activity. Thus, given this intervention markedly increased physical activity and reduced TV viewing in overweight and obese children, long-term evaluations of this interventions to assess sustainability of these behavioral changes and associated health benefits are warranted.