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Pedometers and Text Messaging to Increase Physical Activity Randomized controlled trial of adolescents with type 1 diabetes

Authors:
Kirsty H Newton at Capital & Coast District Health Board
Kirsty H Newton
Esko Wiltshire at University of Otago
Esko Wiltshire
Carolyn Raina Elley at University of Auckland
Carolyn Raina Elley
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Abstract

To assess whether pedometers and text messaging increase physical activity in adolescents with type 1 diabetes. A 12-week randomized controlled trial was conducted. A total of 78 subjects participated in the trial (mean +/- SD age 14.4 +/- 2.37 years, 36 [47%] male). Intervention participants wore an open pedometer and received regular motivational text messages. Control participants received usual care. Primary outcomes were daily step count (4-day closed pedometer) and physical activity questionnaire. Baseline median step count was 11,063 steps/day (range 1,541-20,158). At 12 weeks, mean daily step count reduced by 840 (95% CI -1,947 to 266) in the control group and by 22 (-1,407 to 1,364) in the intervention group (P = 0.4). Mean self-reported moderate or vigorous physical activity increased by 38.5 min/week in the control group and by 48.4 in the intervention group (P = 0.9). A 12-week intervention using pedometers and text messaging as motivational tools in adolescents with type 1 diabetes did not increase physical activity.
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Pedometers and Text Messaging to
Increase Physical Activity
Randomized controlled trial of adolescents with type 1 diabetes
KIRSTY H. NEWTON,
MPHC
1
ESKO J. WILTSHIRE,
MD, FRACP
2
C. RAINA ELLEY,
MBCHB, FRNZCGP, PHD
3
OBJECTIVE — To assess whether pedometers and text messaging increase physical activity
in adolescents with type 1 diabetes.
RESEARCH DESIGN AND METHODS — A 12-week randomized controlled trial was
conducted. A total of 78 subjects participated in the trial (mean ⫾SD age 14.4 ⫾2.37 years, 36
[47%] male). Intervention participants wore an open pedometer and received regular motiva-
tional text messages. Control participants received usual care. Primary outcomes were daily step
count (4-day closed pedometer) and physical activity questionnaire.
RESULTS — Baseline median step count was 11,063 steps/day (range 1,541–20,158). At 12
weeks, mean daily step count reduced by 840 (95% CI ⫺1,947 to 266) in the control group and
by 22 (⫺1,407 to 1,364) in the intervention group (P⫽0.4). Mean self-reported moderate or
vigorous physical activity increased by 38.5 min/week in the control group and by 48.4 in the
intervention group (P⫽0.9).
CONCLUSIONS — A 12-week intervention using pedometers and text messaging as moti-
vational tools in adolescents with type 1 diabetes did not increase physical activity.
Diabetes Care 32:813–815, 2009
A
dolescents with type 1 diabetes re-
quire ongoing care and support to
manage diabetes (1,2). Physical
activity is an important contributor to
glycemic control (3), has multiple ef-
fects on blood glucose, insulin sensitiv-
ity, weight management, mental health,
social development (4,5), and subse-
quent cardiovascular disease risk (6),
but may not be seen as a priority by
adolescents. Physical activity often de-
clines during adolescence because
physical education at school is no
longer compulsory; adolescents may
stop playing weekend sports, receive a
driver’s license, participate in after-
school programs, or receive weekend
jobs (7,8).
RESEARCH DESIGN AND
METHODS — A 12-week randomized
controlled trial was conducted in an out-
patient setting from four regional adoles-
cent diabetes services in New Zealand.
Participants were aged 11–18 years. In-
formed consent, enrollment information,
and baseline measurements were com-
pleted before randomization. Assessors
were blinded at follow-up.
Participants randomized to the inter-
vention group wore an open pedometer
every day for 12 weeks, with a goal of at
least 10,000 steps/day. A pedometer can
be opened by a participant to monitor and
record the number of steps taken. Steps
per day were recorded on a chart. Each
week, participants received a motiva-
tional text message reminding them to
wear a pedometer and be active. Individ-
uals randomized to the control group re-
ceived standard care.
Primary outcome measures were
change in physical activity measured by a
4-day step count from a closed pedometer
and self-reported physical activity over 7
days measured by a validated question-
naire (9,10). The pedometer was taped
shut so participants did not know the step
count. Secondary outcome measures in-
cluded A1C, blood pressure, BMI Zscore,
and quality of life (11). Adherence was
monitored in the intervention group by
weekly text messages and daily step total
charts, which were collected at follow-up.
It was estimated that 84 participants
would be required to detect, as statisti-
cally significant, a difference between the
groups of 2,000 steps/day or 1.5 h/week
of physical activity (␣⫽0.05; P⫽0.8)
(12). Baseline analyses were undertaken
using SPSS 15.0 statistical software. Lin-
ear regression was performed to assess fi-
nal differences between groups using
STATA 9.0. An intention-to-treat analysis
was conducted assuming participants
with missing follow-up data had no
change over 12 weeks. Where variables
were missing at baseline, these individu-
als were not included in final analyses for
those variables.
The trial was approved by the New
Zealand Central Regional Ethics Com-
mittee (CEN/05/08/058) and registered
with the Australian New Zealand Clini-
cal Trials Registry (clinical trial reg. no.
ACTRN012605000339651).
RESULTS — Of the 154 potentially eli-
gible participants at the clinics, 100 (65%)
were assed for eligibility and 78 (78%)
agreed to participate (Figure A1, available in
an online appendix at http://care.diabetes
journals.org/cgi/content/full/dc08-1974/
DC1). Forty subjects were randomized to
the control group and 38 to the intervention
group. Step counts were collected on all
participants at baseline. All 38 participants
allocated to the intervention group received
an open pedometer to wear for 12 weeks.
Three participants from the intervention
●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●
From the
1
Department of Primary Health Care and General Practice, University of Otago Wellington,
Wellington, New Zealand; the
2
Department of Pediatrics, University of Otago Wellington, Wellington,
New Zealand; and the
3
Department of Primary Health Care and General Practice, University of Auckland,
Auckland, New Zealand.
Corresponding author: Kirsty H. Newton, kirsty.newton@ccdhb.org.nz.
Received 3 November 2008 and accepted 10 February 2009.
Published ahead of print at http://care.diabetesjournals.org on 19 February 2009. DOI: 10.2337/dc08-1974.
Clinical trial reg. no. ACTRN012605000339651, actr.org.au.
© 2009 by the American Diabetes Association. Readers may use this article as long as the work is properly
cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.
org/licenses/by-nc-nd/3.0/ for details.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby
marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
Clinical Care/Education/Nutrition/Psychosocial Research
BRIEF REPORT
DIABETES CARE,VOLUME 32, NUMBER 5, MAY 2009 813
group and one from the control group
dropped out before the follow-up (5% attri-
tion rate).
At baseline, participants had a me-
dian step count of 11,063 steps/day
(range 1,541–20,158). Quality-of-life
scores were below the normative range of
60–80% Scale Maximum, suggesting a
lower quality of life in this group of ado-
lescents compared with that in others of
their age (13). Boys were significantly
more active than girls, with higher
mean ⫾SD daily step counts (12,420 ⫾
4,919 vs. 10,461 ⫾3,071 steps/day, re-
spectively; P⫽0.04), higher New Zea-
land Physical Activity Questionnaire
(NZPAQ) scores (837 ⫾522 vs. 580 ⫾
333 min/week; P⫽0.02), and lower BMI
Zscores (0.36 ⫾0.9 vs. 0.74 ⫾0.57; P⫽
0.03).
Table 1 presents baseline characteris-
tics and final results. At 12 weeks, there
was no significant difference in change in
activity measures between the groups.
Daily step count as measured by closed
pedometers decreased to a median (inter-
quartile range) of 10,159 steps/day
(8,014–14,109) in the intervention
group and 9,982 (8,090–12,465) in the
control group (P⫽0.2). Differences in
secondary outcomes were also not signif-
icant at 12 weeks for A1C, BMI Zscore,
quality of life, and blood pressure. There
was a trend toward lower quality of life in
the intervention group.
All 38 participants in the intervention
group were sent weekly text messages
over the 12-week intervention period un-
less they notified the principal researcher
that they had stopped wearing a pedom-
eter. Seventeen subjects (45%) lost their
pedometers, but they were all replaced.
Fourteen subjects (37%) stopped wearing
pedometers before the follow-up, al-
though eleven of these agreed to wear
4-day closed pedometers at follow-up
assessment.
CONCLUSIONS — Pedometers and
weekly text messaging as motivational
tools did not increase physical activity in
adolescents with type 1 diabetes over a
12-week period. Adherence to pedometer
use waned in the intervention group, with
37% discontinuing the intervention be-
fore the 12-week end measurements. Al-
though pedometers have a gadget appeal
among adolescents, the appeal was short
lived. More support in addition to a
weekly text message may be needed to
sustain interest.
Table 1—Baseline characteristics and mean changes in primary and secondary outcomes over 12 weeks
Baseline characteristics Mean change between baseline and follow-up*
Control† Intervention† Control‡ Intervention‡
Difference between
groups‡ P
n40 38
Primary outcome measures
Daily step count 10,900 (8,324–13,240) 11,242 (8,380–13,537) ⫺840 (⫺1,947 to 266) ⫺22 (⫺1,407 to 1,364) 819 (⫺916 to 2,554) 0.4
Moderate and vigorous physical
activity (min/week)§ 645 (298–895) 712 (420–1,000) 38.5 (⫺95 to 172) 48.4 (⫺89 to 185) 9.9 (⫺178 to 198) 0.9
Secondary outcome measures
A1C (%) 8.50 (7.55–9.3) 7.95 (7.3–9.1) ⫺0.02 (⫺0.38 to 0.34) 0.35 (⫺0.12 to 0.83) 0.38 (⫺0.21 to 0.96) 0.2
Systolic blood pressure (mmHg) 114 (104–123) 115 (106–126) ⫺2.1 (⫺9.1 to 4.8) ⫺0.0 (⫺8.8 to 8.8) 2.1 (⫺8.9 to 13.1) 0.7
Diastolic blood pressure (mmHg) 67 (60–72) 65 (60–67) ⫺2.0 (⫺6.8 to 2.8) ⫺0.7 (⫺6.2 to 4.9) 1.3 (⫺5.8 to 8.5) 0.7
BMI Zscore 0.64 (0.05–0.98) 0.62 (0.25–1.17) 0.016 (⫺0.08 to 0.11) 0.006 (⫺0.07 to 0.09) ⫺0.009 (⫺0.13 to 0.12) 0.9
Quality of life (SQOL) 54.9 (53.8–55.8) 55.0 (54.1–56.4) 0.21 (⫺0.18 to 0.61) ⫺0.71 (⫺1.59 to 0.17) ⫺0.93 (⫺1.86 to 0.00) 0.06
Other measures
Insulin total daily dose (units/kg) 1.1 (1–1.4) 1.2 (0.9–1.6) 0.013 (⫺0.023 to 0.12) 0.015 (⫺0.016 to 0.136) 0.002 (0.006–0.01) 0.6
*Intention-to-treat analysis assumed that in subjects whose follow-up data were missing (n⫽4关5%兴) there was no change in outcome variable between baseline and follow-up. †Median (interquartile range); ‡(95%
CI); §self-reported from the physical activity questionnaire (NZPAQ). SQOL, subjective quality of life (13).
Pedometers and text messaging
814 DIABETES CARE,VOLUME 32, NUMBER 5, MAY 2009
Because of the limited number of ad-
olescents with type 1 diabetes in the re-
gions of the study and the business of the
clinics, the sample size did not reach the
target of 84. Even with 84 participants,
the study would have been underpow-
ered to detect as statistically significant
the difference of 819 steps/day, instead of
2,000 estimated. Although participation
(78%) and study retention (95%) rates
were high, adherence to the intervention
was low (37% stopped wearing the
pedometer).
There were also potential biases in
self-report of physical activity (reliability
and overestimation of both physical activ-
ity and adherence to pedometers). In ad-
dition, participants could not be blinded
to allocation of the intervention, and the
motivating effect of the closed pedometer
(with reminder texts) at baseline and fol-
low-up may have inflated physical activity
estimates in both groups.
There is no consensus about an ap-
propriate target number of steps for ado-
lescents (14,15). Even so, involving
regular physical activity as part of their
management remains clinically important
and warrants further investigation as to
the best method of motivating adoles-
cents to be more physically active.
Acknowledgments— This study was funded
by the Wellington Medical Research Founda-
tion and Sport & Recreation New Zealand.
This study was funded in part by Novo Nor-
disk. No other potential conflicts of interest
relevant to this article were reported.
Parts of this study were presented in ab-
stract form at the annual scientific meeting of
the Australasian Paediatric Endocrine Group,
Broome, Australia, 15–18 October 2007.
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Newton, Wiltshire, and Elley
DIABETES CARE,VOLUME 32, NUMBER 5, MAY 2009 815
... The pooled MD for counts per minute (Figure 2 [34,37,41,45,47]) was −16.11 counts per minute (95% CI −122.76 to 90.53), with the number of trials (k=3) and number of participants (n=402) favoring control. For steps per day (Figure 2), MD was 593.46 steps (95% CI −2102.27 to 3289.19; k=2; n=152; favoring intervention [FI]). ...
... The trial by Shapiro et al [48] was excluded from the steps per day analysis owing to its lack of a control group for this parameter. The pooled MD for MVPA (Figure 3 [33,34,36,39,40,43,45,47,49,50,53,54,56,57]) was −1.99 minute per day (95% CI −8.95 to 4.96; k=14; n=2336; favoring control). After extracting data for the analysis, 1 study [43] showed log transformed data for MVPA and was consequently excluded from the analysis. ...
Effectiveness of eHealth Interventions Promoting Physical Activity in Children and Adolescents: Systematic Review and Meta-Analysis (Preprint)
Preprint
  • Aug 2022
BACKGROUND eHealth interventions have been postulated as a feasible, acceptable, and possibly effective tool to promote physical activity (PA) among children and adolescents; however, a comprehensive quantitative analysis of the effects of eHealth interventions promoting PA is lacking. OBJECTIVE This study aims to conduct a systematic review and meta-analysis on experimental studies reporting the effects of eHealth interventions aimed at promoting PA on PA parameters and sedentary behavior parameters in children and adolescents. METHODS The CENTRAL, MEDLINE, Embase, and Web of Science databases were searched from inception to February 2022 for randomized controlled trials that analyzed the effects of eHealth interventions aimed at promoting PA on PA and sedentary parameters in children and adolescents. The Hartung-Knapp-Sidik-Jonkman random effects method was used to determine the mean differences (MDs) with their respective 95% CIs. The risk of bias was assessed using the Risk of Bias 2 (RoB2; Cochrane) tool and its extension for cluster randomized controlled trials. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. RESULTS A total of 20 trials reporting the effects of different eHealth interventions aimed at promoting PA were included. Results for each parameter were as follows: counts per minute (MD −16.11 counts, 95% CI −122.76 to 90.53; k =3; n=402; I <sup>2</sup>=69%; favoring control), steps per day (MD 593.46 steps, 95% CI −2102.27 to 3289.19; k =2; n=152; I <sup>2</sup>=0%; favoring intervention [FI]), moderate to vigorous PA (MD −1.99 min/d, 95% CI −8.95 to 4.96; k =14; n=2336; I <sup>2</sup>=86%; favoring control), light PA (MD 3.28 min/d, 95% CI −15.48 to 22.04; k =5; n=355; I <sup>2</sup>=67%; FI), screen time (MD −31.48 min/d, 95% CI −68.62 to 5.65; k =5; n=904; I <sup>2</sup>=0%; FI), and sedentary time (MD −33.12 min/d, 95% CI −57.27 to −8.97; k =8; n=819; I <sup>2</sup>=75%; FI). Our results should be interpreted cautiously because of important limitations such as the scarcity of evidence, overall risk of bias, and low to very low certainty of evidence. CONCLUSIONS We did not find conclusive evidence regarding the impact of PA-targeted eHealth interventions on PA parameters, but the very low certainty of evidence suggests that eHealth interventions may reduce sedentary time in children and adolescents. Our results may have important scientific implications as they highlight that the rapid development of eHealth interventions to promote PA lacks robust supporting evidence. CLINICALTRIAL PROSPERO CRD42020211020; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=211020
View
... The pooled MD for counts per minute (Figure 2 [34,37,41,45,47]) was −16.11 counts per minute (95% CI −122.76 to 90.53), with the number of trials (k=3) and number of participants (n=402) favoring control. For steps per day (Figure 2), MD was 593.46 steps (95% CI −2102.27 to 3289.19; k=2; n=152; favoring intervention [FI]). ...
... The trial by Shapiro et al [48] was excluded from the steps per day analysis owing to its lack of a control group for this parameter. The pooled MD for MVPA (Figure 3 [33,34,36,39,40,43,45,47,49,50,53,54,56,57]) was −1.99 minute per day (95% CI −8.95 to 4.96; k=14; n=2336; favoring control). After extracting data for the analysis, 1 study [43] showed log transformed data for MVPA and was consequently excluded from the analysis. ...
Effectiveness of eHealth Interventions Promoting Physical Activity in Children and Adolescents: Systematic Review and Meta-Analysis
Article
Full-text available
  • Feb 2024
  • J MED INTERNET RES
Background eHealth interventions have been postulated as a feasible, acceptable, and possibly effective tool to promote physical activity (PA) among children and adolescents; however, a comprehensive quantitative analysis of the effects of eHealth interventions promoting PA is lacking. Objective This study aims to conduct a systematic review and meta-analysis on experimental studies reporting the effects of eHealth interventions aimed at promoting PA on PA parameters and sedentary behavior parameters in children and adolescents. Methods The CENTRAL, MEDLINE, Embase, and Web of Science databases were searched from inception to February 2022 for randomized controlled trials that analyzed the effects of eHealth interventions aimed at promoting PA on PA and sedentary parameters in children and adolescents. The Hartung-Knapp-Sidik-Jonkman random effects method was used to determine the mean differences (MDs) with their respective 95% CIs. The risk of bias was assessed using the Risk of Bias 2 (RoB2; Cochrane) tool and its extension for cluster randomized controlled trials. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. Results A total of 20 trials reporting the effects of different eHealth interventions aimed at promoting PA were included. Results for each parameter were as follows: counts per minute (MD −16.11 counts, 95% CI −122.76 to 90.53; k=3; n=402; I2=69%; favoring control), steps per day (MD 593.46 steps, 95% CI −2102.27 to 3289.19; k=2; n=152; I2=0%; favoring intervention [FI]), moderate to vigorous PA (MD −1.99 min/d, 95% CI −8.95 to 4.96; k=14; n=2336; I2=86%; favoring control), light PA (MD 3.28 min/d, 95% CI −15.48 to 22.04; k=5; n=355; I2=67%; FI), screen time (MD −31.48 min/d, 95% CI −68.62 to 5.65; k=5; n=904; I2=0%; FI), and sedentary time (MD −33.12 min/d, 95% CI −57.27 to −8.97; k=8; n=819; I2=75%; FI). Our results should be interpreted cautiously because of important limitations such as the scarcity of evidence, overall risk of bias, and low to very low certainty of evidence. Conclusions We did not find conclusive evidence regarding the impact of PA-targeted eHealth interventions on PA parameters, but the very low certainty of evidence suggests that eHealth interventions may reduce sedentary time in children and adolescents. Our results may have important scientific implications as they highlight that the rapid development of eHealth interventions to promote PA lacks robust supporting evidence. Trial Registration PROSPERO CRD42020211020; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=211020
View
... The pooled MD for counts per minute (Figure 2 [34,37,41,45,47]) was −16.11 counts per minute (95% CI −122.76 to 90.53), with the number of trials (k=3) and number of participants (n=402) favoring control. For steps per day (Figure 2), MD was 593.46 steps (95% CI −2102.27 to 3289.19; k=2; n=152; favoring intervention [FI]). ...
... The trial by Shapiro et al [48] was excluded from the steps per day analysis owing to its lack of a control group for this parameter. The pooled MD for MVPA (Figure 3 [33,34,36,39,40,43,45,47,49,50,53,54,56,57]) was −1.99 minute per day (95% CI −8.95 to 4.96; k=14; n=2336; favoring control). After extracting data for the analysis, 1 study [43] showed log transformed data for MVPA and was consequently excluded from the analysis. ...
View
... Outcome results from a randomized controlled trial to evaluate the effectiveness of text messaging to increase physical activity in adolescents with type I diabetes also reflected inconsequential influence. 13 The 12-week study compared results of a control group who received usual diabetic care with the intervention group who received text messages reminding them to engage in activity and wear a provided pedometer so researchers could measure activity levels. Adherence was low, with 37% of participants not wearing their pedometer by the end of the 12 weeks, and there was decreased activity at follow-up (though not significant) in both groups. ...
... Additionally, there were no significant improvements in glycemic control or other outcome measures, such as quality of life, blood pressure, or BMI. 13 Research findings by Miloh et al 14 in pediatric transplant patients showed that SMS improved adherence and outcomes. This small (n = 41) prospective research project aimed to improve therapy adherence among pediatric and young adult liver transplant patients using text messaging. ...
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  • Jan 2023
Unhealthy and risky behaviors among adolescents and young adults, such as poor nutrition, lack of physical activity, smoking, and sexual practices, can lead to long-term negative health outcomes. Individuals with chronic diseases in these age groups are also more prone to nonad-herence in the management of their diseases. Positively influencing the voluntary aspect of unhealthy behaviors in adolescents and young adults is an important public health topic. Recent research on cell phone text messaging has emerged as a potentially efficient, real-time intervention portal to prompt healthy behaviors in these populations. The purpose of this article is to review the current state of research evaluating the effectiveness of text messaging as a health intervention for adolescents and young adults.
View
... Other studies have also reported a desire among adolescents for emojis and media [36,61] and have found that the use of these in SMS text messages can increase participant engagement [62,63]. Engagement is an important consideration, given that previous SMS text message-based interventions in other high-risk, hard-to-reach populations has been very high [64]. There is little information in the literature about the timing and frequency of SMS text messages [10]; however, input from adolescents revealed that 2 to 3 SMS text messages per day were acceptable and should be sent before (8 AM) and after (4 PM) school to adhere to parent and school rules about phone use. ...
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Article
  • Aug 2023
Background: SMS text message-based interventions are a promising approach for reaching and engaging high-risk youths, such as Hispanic adolescents with obesity, in health promotion and disease prevention opportunities. This is particularly relevant, given that SMS text messaging is widely accessible and available and that adolescents are frequent texters. Including youths in the development of SMS text message content can lead to more acceptable and relevant messaging; however, few studies include this group as cocollaborators. Objective: This study aimed to use a co-design process to inform the development of SMS text messages that promote healthy physical activity (PA) and sleep behaviors among Hispanic adolescents with obesity. Methods: The co-design framework uses multiple methods across several phases. Self-determination theory and a literature review of SMS text message-based interventions guided the background and research phases. In the co-design phase, Hispanic adolescents (n=20) completed in-depth interviews to identify barriers and facilitators of PA and sleep, preferences for ways to emphasize key self-determination theory constructs (autonomy, competence, and relatedness), and suggestions for making SMS text message content engaging. In the design and content phase, interview findings were used to develop initial SMS text messages, which were then evaluated in the early evaluation phase by experts (n=6) and adolescents (n=6). Feedback from these panels was integrated into the SMS text message content during refinement. Results: The background phase revealed that few SMS text message-based interventions have included Hispanic adolescents. Common barriers and facilitators of activity and sleep as well as preferences for ways in which SMS text messages could provide autonomy, competence, and relatedness support were identified in the co-design phase. The youths also wanted feedback about goal attainment. Suggestions to make SMS text messages more engaging included using emojis, GIFs, and media. This information informed an initial bank of SMS text messages (N=116). Expert review indicated that all (116/116, 100%) SMS text messages were age and culturally appropriate; however, some (21/116, 18.1%) did not adequately address youth-identified barriers and facilitators of PA and sleep, whereas others (30/116, 25.9%) were not theoretically adherent. Adolescents reported that SMS text messages were easy to understand (116/116, 100%), provided the support needed for behavior change (103/116, 88.8%), and used mostly acceptable language (84/116, 72.4%). Feedback was used to refine and develop the final bank of 125 unique text messages. Conclusions: Using a co-design process, a theoretically grounded, appealing, and relevant bank of SMS text messages promoting healthy PA and sleep behaviors to adolescents was developed. The SMS text messages will be further evaluated in a pilot study to assess feasibility, acceptability, and preliminary efficacy. The co-design process used in this study provides a framework for future studies aimed at developing SMS text message-based strategies among high-risk adolescents. International registered report identifier (irrid): RR2-10.1016/j.cct.2023.107117.
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... However, the effectiveness of SMS is also controversial. Some studies have found that SMS can be effective in managing weight loss (Bauer et al., 2010;Fukuoka et al., 2010), but other studies found no increase in motivation or willingness to exercise or significant effect on weight loss among people who receive exercise text messages (Newton et al., 2009). Similarly, in smoking cessation programs, SMS may have been effective because the participants were mostly light or moderate smokers who did not need a great deal of support to quit (Chalela et al., 2020). ...
Texting in a crisis—using SMS for information and emotional support during COVID-19: A mixed methods research study
Article
Full-text available
  • Nov 2022
In the era of new media, short message service (SMS) is no longer seen as advantageous and it is no longer used very much by the Chinese public. However, as a traditional media, local governments managing public health crises used SMS as a way of meeting the public's need for emotional support during the COVID-19 pandemic. Our study examined 108 SMS texts pushed to phones in Chongqing between January and December 2020, and carried out in-depth interviews with ten interviewees. This mixed research method of descriptive and grounded theory analysis was designed to investigate how SMS was used to communicate prevention guidelines and give emotional support during COVID-19. The results show that Chongqing Municipal Health and Health Commission gained the public's attention with SMS messages consisting of neutral, objective advice, and guidance to reduce people's anxiety and panic. However, with the stabilization of COVID-19, SMS has once again been discarded by users, including the public health sector. The study found that the emotional support offered by SMS was limited to the elderly, a subset of the population considered to be weak users of the internet. SMS has been replaced by other technologies, but along with other media, such as official media and social media, it has shaped the media communication environment and served as an emotional support channel for the public. Undoubtedly,the use of SMS during COVID-19 presents a research opportunity for exploring its capacity for prevention, control and emotional support.
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Physical activity during COVID-19 pandemic and its impact on glycemic control in children with type 1 diabetes mellitus
Article
Full-text available
  • Mar 2023
Background: Physical activity is one of the important factors affecting glycemic control in type 1 diabetes mellitus (T1DM). During COVID-19 pandemic the government imposed restrictions to prevent the spread of COVID and physical activity of children was curtailed. We assessed the physical activity during COVID-19 pandemic restrictions (from September 2020 to September 2021) and its association with their glycemic control. Methods: 48 children with T1DM receiving treatment in paediatric endocrinology outpatient department (OPD), AIIMS, New Delhi were enrolled. Socio-clinical data were collected using pre-validated and tested self-structured tool, physical activity was assessed using global physical activity questionnaire and glycemic control was assessed by glycated haemoglobin (HbA1C) and compared to baseline level before the onset of pandemic. Results: Among 48 children (11.2±3.7 years, 25 M: 23 F), 79.2% fulfilled the 60 minutes’ requirement of physical activity/day. Moderate negative correlation was found in recommended physical activity duration and HbA1c during COVID-19 pandemic. However, there was a significant increase in the HbA1C level from 7.6±1.5 to 8.5±1.8 during COVID-19 pandemic. Conclusions: There was a moderate negative correlation between duration of physical activity and HbA1c of children. In spite of restrictions imposed by the government, children who were physically active were able to maintain good glycemic control. Although there was significant increase in the mean HbA1c of children during COVID-19 pandemic but the percentage of hyperglycemic events was significantly lower among the children who had walked/rode bicycle for going from one place to another and who had more rooms to play at home had good glycemic control.
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Factors Associated with Intention of Sustainable Use in Players of the Wii Fit or Smartphone-Based Fitness Applications
Article
  • Nov 2022
The Wii Fit (Nintendo, Kyoto, Japan) is the most commonly used exergame platform for balance training. We explored diverse factors associated intention of sustainable use of either the Wii Fit or smartphone-based fitness applications. Then, we analyzed differences in such factors between users of the Wii Fit and those of smartphone-based fitness applications. We selected followers of the Instagram, Facebook and Twitter of the Wii Fit or smartphone-based fitness applications as the subjects for the current questionnaire survey that was performed between September and November 2020. For the current study, we used four concepts: presence, enjoyment, flow and intention of sustainable use. Then, we proposed the following five hypotheses: “Presence might have a significant positive effect on flow,” “Presence might have a significant positive effect on enjoyment,” “Enjoyment might have a significant positive effect on flow,” “Enjoyment might have a significant positive effect on intention of sustainable use” and “Flow might have a significant positive effect on intention of sustainable use.” The current questionnaire study includes a total of 301 subjects, who comprise 188 men (62.5%) and 113 women (37.5%). Moreover, the subjects are composed of 167 (55.5%) users of the Wii Fit and 134 users (44.5%) of smartphone-based fitness applications. We found that all the five hypotheses were accepted for users of the Wii Fit. We also found, however, that the following three hypotheses were accepted for users of smartphone-based fitness applications: “Presence might have a significant positive effect on flow.,” “Presence might have a significant positive effect on enjoyment.” and “Enjoyment might have a significant positive effect on intention of sustainable use.” Based on our results, it can be concluded not only that flow has a significant effect in mediating between presence, or enjoyment, and intention of sustainable use in users of the Wii Fit. Our results also indicate, however, that enjoyment has a significant effect in mediating between presence and intention of sustainable use in users of smartphone-based fitness applications.
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Exploring Opportunities to Improve Physical Activity in Individuals with Spinal Cord Injury Using Context-Aware Messaging
Article
  • Nov 2022
Spinal cord injury (SCI) affects the mobility of 250,000 people per year worldwide. Physical activity (PA) in individuals with SCI is positively associated with improved mental and physical health outcomes. Mobile technologies have been developed to motivate individuals with SCI to increase PA using activity tracking and real-time feedback. We conducted semi-structured interviews and participatory design sessions with 15 manual wheelchair users with SCI and eight of their family members/friends to investigate user impressions of future technologies that might use computer-mediated, sensor-triggered communication to motivate PA. We assessed barriers to PA and how context-aware communication could help overcome them. Participants with SCI expressed that PA tracking and communication technologies must be tailored to their specific needs. Further analysis revealed that context-aware messaging could help participants with SCI connect with others to initiate timely conversations about overcoming PA barriers, and to provide encouragement to meet their PA goals. We discuss opportunities to empower individuals with SCI with regards to PA using tailored, context-aware communication.
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Improving diabetes control in adolescents
Article
Full-text available
  • Dec 1999
  • DIABETES CARE
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Interest and participation in selected sports among New Zealand adolescents
Article
Full-text available
  • Jul 2004
  • N Z Med J
The current study aims to describe participation and interest in 18 selected popular sports among a large sample of New Zealand adolescents with the goal of identifying opportunities for increasing youth participation in physical activity. Multi-stage cluster sampling was used to select 82 secondary schools and classes of Year 10 and 12 students within schools from six geographical regions throughout New Zealand. Students completed self-administered written questionnaires. The school response rate was 58%, with physical activity data available for 1730 females and 1704 males, including 637 students who self-identified as Maori. The greatest gaps between expressed interest and actual participation were reported for rugby union, rugby league, basketball, soccer and surfing (among both sexes); dance and volleyball (among females); and skateboarding (among males). When diversity of participation was modelled, increased diversity was associated with being male, having an income from part-time work, and having greater diversity of interest in the selected sports. For several sports there are substantial groups of young people who express interest but do not participate. The challenge for public health is to turn this interest into increased participation in health-promoting physical activity--by providing appropriate opportunities and support for participation.
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Adolescent obesity and physical inactivity
Article
Full-text available
  • Jan 2005
  • N Z Med J
Globally, obesity and physical inactivity are two health issues affecting young people. In New Zealand, the most current statistics indicate that 33.6% of 11 to 14 year olds, and 27% of 15 to 18 year olds, are considered overweight or obese.1,2 Despite these high prevalence levels, only 38% of young people aged 13 to 17 years in New Zealand are considered physically inactive.3 Future effort needs to be directed towards enhancing the existing national surveys to ensure a comprehensive and valid surveillance system of adolescent obesity and inactivity is conducted on a regular basis. This would involve the development of age, sex, and ethnic specific body mass index cut-off thresholds to define overweight and obesity, validation of an adolescent questionnaire that examines physical activity from a broad perspective, and development of physical activity recommendations for youth based on international best practice. Although the main focus of this paper is on obesity and physical inactivity, diet is also a key determinant of obesity. Therefore, to provide an accurate assessment of factors associated with youth obesity in New Zealand, surveillance of diet must occur concurrently with that of obesity and physical activity. The development of accurate measurement tools is critical for (1) determining obesity and inactivity trends, (2) identifying at-risk groups, (3) tracking progress toward national health priorities, and (4) evaluating the efficacy of interventions targeting obesity and physical inactivity. Furthermore, attention needs to be directed towards identifying correlates of inactivity and obesity to help inform the development of comprehensive multisectorial, multisetting, prevention, and management initiatives.
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Incidence and trends of childhood Type 1 diabetes worldwide 1990-1999
Article
  • Aug 2006
Aims To examine incidence and trends of Type 1 diabetes worldwide for the period 1990–1999. Methods The incidence of Type 1 diabetes (per 100 000/year) was analysed in children aged ≤ 14 years from 114 populations in 112 centres in 57 countries. Trends in the incidence of Type 1 diabetes were analysed by fitting Poisson regression models to the dataset. Results A total of 43 013 cases were diagnosed in the study populations of 84 million children. The age‐adjusted incidence of Type 1 diabetes among 112 centres (114 populations) varied from 0.1 per 100 000/year in China and Venezuela to 40.9 per 100 000/year in Finland. The average annual increase in incidence calculated from 103 centres was 2.8% (95% CI 2.4–3.2%). During the years 1990–1994, this increase was 2.4% (95% CI 1.3–3.4%) and during the second study period of 1995–1999 it was slightly higher at 3.4% (95% CI 2.7–4.3%). The trends estimated for continents showed statistically significant increases all over the world (4.0% in Asia, 3.2% in Europe and 5.3% in North America), except in Central America and the West Indies where the trend was a decrease of 3.6%. Only among the European populations did the trend in incidence diminish with age. Conclusions The rising incidence of Type 1 diabetes globally suggests the need for continuous monitoring of incidence by using standardized methods in order to plan or assess prevention strategies.
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Measuring physical activity in primary health care research
Article
Objectives To assess the effectiveness of physical activity interven- tions in primary health care, measurement tools are needed that are appropriate and valid for use within pri- mary care amongst less-active people. This study assesses the validity of two physical activity recall questionnaires within a primary care setting.
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Quality of Life in Adolescence: The Role of Perceived Control, Parenting Style, and Social Support
Article
  • Sep 2000
Adult levels of subjective quality of life (SQOL) are remarkably stable on a population basis. This has been explained through the operation of a homeostatic system that acts to maintain each individual's SQOL within a narrow range. However, there are good reasons to expect this homeostatic system to come under severe challenge during adolescence. Many of the variables thought to be involved in the homeostatic process are undergoing marked change during this period, including the balance between primary and secondary control, perceived social support, and interaction with parents. In order to test the stability of SQOL and the influence of these other variables, a sample of 279 adolescents between the ages of 12 to 17 years were recruited. It was found that the SQOL of the older adolescents lay below the predicted range for adults, thereby supporting the idea of a strong challenge to homeostasis during this period. A new scale to measure perceived control was found to possess a useful two-factor structure of primary and secondary control. Moreover, both of these factors, together with social support, predicted levels of SQOL, even though the levels of primary control decreased with age. Finally, adolescents who perceived an authoritarian parenting style experienced a higher SQOL than those who perceived an unengaged style. These findings contribute to our understanding of SQOL homeostasis.
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Motivation for Physical Activity Among Children and Adolescents
Article
  • Feb 1998
Assisting children and adolescents in adopting physically active lifestyles is an integral part of the health education and health promotion services provide by nurses in school, family, community, and primary care settings. In order to effectively engage in physical activity counseling, the determinants of physical activity must be understood and integrated into effective interventions for youths. This review of research literature includes a critique of intervention studies aimed at helping children and adolescents adopt active lifestyles that will be sustained throughout life. Social cognitive theory provided the theoretical basis for most of the studies reviewed but specification of how theory concepts were operationalized in the interventions was often unclear. Suggestions for increasing the rigor of theoretically based intervention studies aimed at promoting physical activity are proposed. Models and variables are identified that need further testing to determine their relevance to the promotion of physical activity during childhood and adolescence.
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Methodological Considerations for Researchers and Practitioners Using Pedometers to Measure Physical (Ambulatory) Activity
Article
  • Apr 2001
Researchers and practitioners require guidelines for using electronic pedometers to objectively quantify physical activity (specifically ambulatory activity) for research and surveillance as well as clinical and program applications. Methodological considerations include choice of metric and length of monitoring frame as well as different data recording and collection procedures. A systematic review of 32 empirical studies suggests we can expect 12,000-16,000 steps/day for 8-10-year-old children (lower for girls than boys); 7,000-13,000 steps/day for relatively healthy, younger adults (lower for women than men); 6,000-8,500 steps/day for healthy older adults; and 3,500-5,500 steps/day for individuals living with disabilities and chronic illnesses. These preliminary recommendations should be modified and refined, as evidence and experience using pedometers accumulates.
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BMI-referenced standards for recommended pedometer-determined step/day in children
Article
  • Jul 2004
Recommended levels of youth physical activity (PA) should emerge from data related to important health outcomes. The purpose of the present study was to establish criterion-referenced standards for PA (using pedometer-assessed steps/day) related to healthy body composition. This is a secondary analysis of an existing data set (including pedometer-assessed PA and objectively measured BMI) of 1,954 children (995 girls, 959 boys; ages 6-12 years) from the USA, Australia, and Sweden. The contrasting groups method [M.J. Sarif, Introduction to Measurement in Physical Education and Exercise Science, St. Louis, MO: Mosby College Publishing; 1986] for establishing criterion-referenced cut points was used to identify optimal age- and sex-specific standards for steps/day related to international BMI cut points for normal weight and overweight/obesity. The selected cut points for steps/day for 6-12 year olds were 12,000 steps/day for girls and 15,000 steps/day for boys. The analytical process undertaken in this study illuminated the difference in previously used norm-referenced standards vs. criterion-referenced standards based on BMI categories. The steps/day cut points established herein, using an international sample, are higher than previously suggested normative standards but are not inconsistent with recent advances in our understanding of PA needs in youth. This analysis provides the foundation for cross-validation and evaluation of these BMI-referenced steps/day cut points in independent samples and with longitudinal study designs.
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