Web-based interventions to promote physical activity by older adults: promising perspectives for a public health challenge

Regular physical activity is associated with a wide range of health benefits. As population age, promotion of physical activity should specifically target older adults, an expanding group involving potential higher health care costs in the near future. Innovative interventions focusing on physical activity behaviors of senior adults exposed promising results, most recently through the use of the Internet. If seniors and Internet are generally considered as two opposite concepts, arguments in favour of bringing them together in a public health perspective have been identified by the recent literature. Older adults are the fastest growing group of Internet users and are more prone than younger to use it for health-related subjects. Web-based interventions are effective in many health promotion sectors, including physical activity. This is particularly true when interventions target the environmental determinants of each senior citizen and are specifically designed for this population. Those early research findings must clearly be extended, particularly regarding to the long term effects of Web-based physical activity interventions. Solutions that will reduce the high dropout rate recorded in the existing literature must also be considered as a priority in order to ensure the development of this forward-looking field of research.     

心理学因素对高血压患者运动行为的影响

目的 了解高血压患者运动行为的社会心理学影响因素,为发展有效的运动干预计划提供依据。方法 利用社区高血压患者运动干预项目基线调查数据。该项目采取多阶段分层随机抽样方法,选择武汉市6个城区12个社区586例高血压患者作为研究对象。通过面对面采访,有559例完成问卷调查,应答率为95.4%。采用描述性分析和Cronbach信度检验测试因子的信度,采用层次回归分析研究运动行为与社会心理学因素之间的关系。结果 运动相关心理量表具有较好的信度,Cronbach''sα值为0.7~0.9。高血压患者所处的运动阶段越高,各心理学因子得分越高。广义线性模型结果显示自我效能（β=0.379）和运动快乐（β=0.234）与运动行为显著相关（P＜0.05）;行为过程（β=0.069）和家庭支持（β=0.163）略有增加运动行为（P＜0.10）。结论 高血压运动干预项目应增加自我效能和运动愉悦感,同时提供家庭支持和发展适当的运动形式,促进运动行为的变化。     

Effects of virtual Reality-Based Training and aerobic training on gaming disorder,physical activity,physical fitness,and anxiety: A randomized,controlled trial

Background and aimThe effects of physical activity and exercise on gaming disorder severity in individuals with gaming disorder are unknown. The present study aimed to address the empirical gap in the current literature by comparing the effects of virtual reality-based training (VRT) and aerobic training (AT) exercise programs on gaming disorder severity, physical activity, physical fitness, and anxiety versus control group.Materials and methodsForty-four young male adults (18–28 years) with gaming disorder and a sedentary lifestyle were included in the study. The primary outcomes of the study were changes in gaming disorder severity and physical activity, and secondary outcomes included changes in physical fitness and anxiety levels. The participants were randomly assigned to VRT (n = 15), AT (n = 14) and control (n = 15) groups. Training sessions were performed at 50–70% of the maximal heart rate. Exercise programs consisted of 6 weeks of training 3 times a week for 30 min.ResultsThere was a decrease in the severity of gaming disorder as well as an increase in the level of physical activity in the VRT and AT exercise groups compared to the control group. In addition, a reduction was observed in the gaming time and sedentary time in both exercise groups versus control group. VRT group experienced greater improvements in physical fitness parameters than the AT group.ConclusionVRT and AT were effective in reducing gaming time and the severity of gaming disorder in individuals with gaming disorder. The therapeutic effects of VRT and AT can be used for reducing the severity of gaming disorder.     

Environmental interventions for eating and physical activity: a randomized controlled trial in middle schools

BACKGROUND: Our objective was to evaluate the effects of environmental, policy, and social marketing interventions on physical activity and fat intake of middle school students on campus. DESIGN: Twenty-four middle schools were randomly assigned to intervention or control conditions. Baseline measures were collected in spring 1997, and interventions were conducted during the 1997-1998 and 1998-1999 school years SETTING/PARTICIPATION: The schools had mean enrollments of 1109, with 44.5% nonwhite students.Over 2 years, physical activity interventions were designed to increase physical activity in physical education classes and throughout the school day. Nutrition interventions were designed to provide and market low-fat foods at all school food sources, including cafeteria breakfasts and lunches, a la carte sources, school stores, and bag lunches. School staff and students were engaged in policy change efforts, but there was no classroom health education. MAIN OUTCOMES MEASURES: Primary outcomes were measured by direct observation and existing records. RESULTS: Randomized regression models (N =24 schools) revealed a significant intervention effect for physical activity for the total group (p <0.009) and boys (p <0.001), but not girls (p <0.40). The intervention was not effective for total fat (p <0.91) or saturated fat (p <0.79). Survey data indicated that the interventions reduced reported body mass index for boys (p <0.05). CONCLUSIONS: Environmental and policy interventions were effective in increasing physical activity at school among boys but not girls. The interventions were not effective in reducing fat intake at school. School environmental and policy interventions have the potential to improve health behavior of the student population, but barriers to full implementation need to be better understood and overcome.     

Pilot randomized trial of a telephone-delivered physical activity and weight management intervention for individuals with lower extremity amputation

Background

Obesity and inactivity are common and burdensome for people with lower extremity amputation (LEA). The extent to which home-based physical activity/weight management programs are effective and safe for people with LEA is unknown. Translating effective interventions for understudied disability groups is needed.

The effect of physical activity on quality of life and parenting stress in children with attention-deficit/hyperactivity disorder: A randomized controlled trial

BackgroundPoorer quality of life (QoL) is commonly observed in children with Attention-deficit/Hyperactivity Disorder (ADHD). Parents of children with ADHD also perceived elevated levels of parenting stress. Previous research has documented the positive effects of physical activity (PA) on managing ADHD symptoms. It is critical to implement ADHD management with broader functioning from both children's and parents' perspectives.ObjectiveThis study aimed to examine whether PA would exert an influence on the QoL of children with ADHD and parenting stress of their parents.MethodsForty-three children with ADHD (6–12 years) were randomly assigned to the PA intervention and waitlist control groups. Children in the intervention group participated in a 12-week PA program. Parent-reported QoL and parenting stress were assessed before and immediately after the intervention. Analysis of covariance with a mixed factorial design of 2 (time: before vs. after intervention) × 2 (group: PA intervention vs. waitlist control) was conducted to examine changes in QoL and parenting stress over the 12 weeks.ResultsCompared to the control group, parents of children in the intervention group reported significant reduced overall parenting stress (p = .021, η² = 0.142) and child domain of parenting stress (p = .024, η² = 0.138) after the intervention. No significant improvement in QoL was documented in either group.ConclusionsThe participation of PA intervention positively impacts parenting stress perceived by parents of children with ADHD, which provides further evidence of the family-wide benefits of the PA intervention.     

A randomized controlled trial of continuous activity, short bouts, and a 10,000 step guideline in inactive adults

Objective

Although several studies have examined the effect of accumulated bouts on health outcomes, the impact of recommending short bouts on activity-related behavior in health promotion efforts has received minimal investigation.

Method

During this 5-week study in 2007-2008, 43 university employees (8 male, 35 female) in the Southeastern United States were randomly assigned to a group recommended to achieve (a) 10,000 steps (10 K), (b) 30-minutes (30 min) of continuous physical activity, or (c) 30-minutes of activity in bouts of at least 10 minutes (bouts).

Results and conclusions

Repeated measures ANOVA revealed that the 10 K group showed the largest increase in step counts whereas the bouts group showed the smallest change over the intervention period, p = 0.01. Condition differences were most pronounced on days in which participants met their activity recommendation. Accelerometer results revealed that the 10 K (d = 1.1) and 30 min groups (d = 0.89) showed large increases in minutes of moderate to vigorous activity (MVPA), whereas the bouts group showed minimal change (d = 0.11). Although activity recommendations did not differentially affect self-efficacy, participants from all conditions showed decreased self-efficacy across the intervention (p = 0.02), highlighting the need to develop strategies to increase self-efficacy in activity promotion efforts.     

Physical activity for individuals living with a physical disability in Quebec: Issues and opportunities of access

BackgroundIndividuals living with a physical disability have reported difficulty in meeting their healthy living and leisure needs which could be a result of poor accessibility.ObjectiveThis qualitative study aimed to understand the relative accessibility of physical activity from the perspective of individuals living with a physical disability in Quebec, Canada.MethodsTwenty semi-structured interviews were conducted with current, past, non-members, and staff members of an adapted physical activity program. A qualitative approach with an inductive thematic analysis was used to interpret the data.ResultsWe identified five overarching themes focusing on participants’ experiences related to access: (i) physical activity opportunities; (ii) social interactions; (iii) relationships; (iv) infrastructure; (v) policies and public services. Participants highlighted that access to physical activity programming is shaped by a complex interaction of these overarching themes and their sub-themes.ConclusionsAccess to physical activity opportunities for individuals living with a physical disability cannot be understood in isolation from the broader public policies, infrastructure, social interactions, and relationships that shape their experiences. Policy makers and other health and recreational professionals must consider these broader factors when recommending or creating physical activity opportunities for individuals with physical disabilities.     

Park-based physical activity interventions for persons with disabilities: A mixed-methods systematic review

Background

Park-based physical activity (PA) interventions improve health in the general population, but it is unknown if the evidence can be translated to persons with disabilities.

The effectiveness of physical activity interventions in socio-economically disadvantaged communities: a systematic review

Objective

Interventions to increase levels of physical activity (PA) in socio-economically disadvantaged communities are needed but little is known about their effectiveness. This review examines the effectiveness of interventions designed to increase PA in these communities and the theoretical frameworks and components used.

Methods

Five databases were searched for papers published in English between January 2000 and December 2010 that reported outcomes of PA interventions in socio-economically disadvantaged communities. Studies targeting individuals with pre-existing disease and not reporting a measure of free-living PA were excluded. Two reviewers independently extracted data and evaluated quality of evidence against pre-defined criteria.

Results

Of 478 publications identified, 27 were included. We found that group-based interventions were effective for adults but not for children; evidence for the effectiveness of interventions targeting individuals was insufficient; limited evidence suggested that community-wide interventions produced small changes in PA. Interventions underpinned by any theoretical framework, compared to none, were more likely to be effective. Several effective interventions included education, PA and social support components.

Conclusion

Compared to other approaches, multi-component adult group-based interventions with theoretical frameworks are most effective in increasing PA in socio-economically disadvantaged communities. More robust evaluations of interventions targeting individuals in these ‘hard-to-reach’ communities are required.     

Effects of a physical activity and nutrition program for seniors on body mass index and waist-to-hip ratio: a randomised controlled trial

Objective

To investigate whether a home-based program, physical activity and nutrition for seniors (PANS), made positive changes to central obesity, measured by body mass index (BMI) and waist-to-hip ratio (WHR).

Methods

A 6-month randomised controlled trial was conducted targeting overweight and sedentary older adults aged 60 to 70 years residing in low to medium socio-economic suburbs within metropolitan Perth. Intervention participants (n = 248) received mailed materials and telephone/email support to improve nutrition and physical activity levels. Controls (n = 230) received small incentives to complete baseline and post-intervention questionnaires. Both groups reported anthropometric measures following specific written instructions. Generalised estimating equation models were used to assess repeated outcomes of BMI and WHR over both time points.

Results

176 intervention and 199 controls (response rate 78.5%) with complete data were available for analysis. After controlling for demographic and other confounding factors, the intervention group demonstrated a small (0.02) but significant reduction in WHR (p = 0.03) compared to controls, no apparent change in BMI was evident for both groups. The 0.02 reduction in mean WHR corresponded to a 2.11 cm decrease in waist circumference for a typical hip circumference.

Conclusion

PANS appears to improve the WHR of participants. Changes in BMI might require a longer term intervention to take effect, and/or a follow-up study to confirm its sustainability.     

A systematic framework to classify physical activity research for individuals with spina bifida

BackgroundIdentifying the types of research conducted in the area of physical activity (PA) for the spina bifida (SB) population is important in order to move research forward to increase PA behaviors and improve health. The Behavioral Epidemiological Framework is a one way to systematically classify PA and SB literature by organizing research into one of five phases: phase 1 research links behaviors to health, phase 2 includes research focused on developing methods for measuring behavior, phase 3 research identifies factors that influence behavior, phase 4 research evaluates interventions to change the behavior, and phase 5 studies translates research into practice.ObjectiveTo systematically classify PA research for individuals with SB by using the Behavioral Epidemiologic Framework and to identify where the research has focused.MethodAn audit of the literature was conducted using search engines and keywords related to PA and SB. Inter-rater reliability was established between the research team coding articles based on established inclusion criteria. Finally, literature was categorized into one of the five phases.ResultsSeventy-seven articles met the inclusion criteria and were categorized. Forty three percent of the articles were categorized in phase 1, 21% in phase 2, 32% in phase 3, 4% in phase 4, and zero in phase 5.ConclusionThe majority of articles are in phase 1, indicating that PA and SB research is still in early stages of development. Future research needs to move beyond phase 1 to examine factors that affect PA behaviors and ways to increase PA behaviors in the SB population.     

Spousal support and self-determined physical activity in individuals with multiple sclerosis: A theory-informed qualitative exploration

BackgroundIndividuals with multiple sclerosis (MS) tend to exhibit high levels of sedentary behavior which contributes to increased disability and comorbidity. Understanding what factors underlie the motivation to be physically active in this group is therefore important.ObjectiveThis theory-informed qualitative study explored spousal support and behavior in fostering self-determined physical activity engagement of adults with MS.MethodsEight couples were interviewed using a semi-structured interview guide derived from Self-Determination Theory.ResultsAnalysis of transcribed audio recordings revealed that supportive and empathetic spousal communication, encouragement and expectations regarding physical activity, and bonding through co-participation increased feelings of relatedness. In addition, co-planning and problem-solving around physical activity and serving as a behavioral model facilitated perceptions of competency, while spouses who valued their partners’ independence and offered choice enhanced autonomous motivation for physical activity.ConclusionsInsight into the marital context that supports self-determined physical activity decisions of individuals with MS may better inform family-oriented health promotion approaches in this group.     

Home-based exercise for middle-aged Chinese at diabetic risk: a randomized controlled trial

Objective

To evaluate short- (3 months) and long-term (9 months) effects of home-based exercise on adiponectin, exercise behavior and metabolic risk factors in middle-aged adults at diabetic risk.

Methods

One hundred and thirty-five middle-aged adults (38 men, 97 women) with at least one diabetic risk factor were randomly assigned to either a home-based exercise group (Ex-group) or a usual care group (C-group). Outcome measures included plasma adiponectin, exercise self-efficacy, physical activity, and metabolic risk factors, as follows: insulin levels, insulin resistance by homeostasis model assessment (HOMA-IR), physical fitness, and components of metabolic syndrome. This study was conducted in metropolitan Taipei from 2004 to 2005.

Results

The Ex-group had improvements in exercise self-efficacy (+ 2.5, p = 0.01), body mass index (BMI) (− 0.6 kg/m², p < 0.001) and flexibility (+ 2.4 cm, p < 0.001) at 3-month follow-up and maintained BMI and flexibility at 9-month follow-up. The Ex-group exhibited significantly increased physical activity while the C-group exhibited decreased physical activity at 9-month follow-up (p < 0.001). No intervention effect was found on adiponectin (p = 0.64) or other outcome measures over time.

Conclusions

Home-based exercise did not improve adiponectin levels, but significantly improved exercise behavior, and certain metabolic risk factors, with the effects maintained for 9-months in subjects with type 2 diabetic risk.     

Parental perceptions on childrens out-of-school physical activity and family-based physical activity

This study explored parents’ physical activity (PA) knowledge and perceptions of children’s out-of-school PA to formatively contribute to a family-based intervention design. Eleven telephone interviews were conducted with parents of children aged 10–11 years. Child and parent data were triangulated and family case studies were written. Most parents were unaware of the UK child PA guidelines and whether their child achieved the guidelines daily. PA for many parents was attributed to healthy weight status, and the neighbourhood environment was perceived as unconducive to children’s outdoor play which consequently increased the attractiveness of adult supervised organized activities. Consulting with parents in a formative sense prior to familial PA intervention facilitates intervention content to be aligned with family-specific perceptions and needs, and offers opportunities to communicate the relevance of programs to parents. This may aid subsequent intervention recruitment and engagement.