No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
MobileMums: A Randomized Controlled Trial of an SMS-Based Physical Activity Intervention
Abstract
Postnatal women (<12 months postpartum) are at increased risk of physical inactivity.
To evaluate the efficacy and feasibility of a theory-based physical activity (PA) intervention delivered to postnatal women primarily via mobile telephone short message service (SMS).
Eighty-eight women were randomized to the intervention (n = 45) or minimal contact control (n = 43) condition. The 12-week intervention consisted of a face-to-face PA goal-setting consultation, a goal-setting magnet, three to five personally tailored SMS/week and a nominated support person who received two SMS per week. SMS content targeted constructs of social cognitive theory. Frequency (days/week) and duration (min/week) of PA participation and walking for exercise were assessed via self-report at baseline, 6 and 13 weeks.
Intervention participants increased PA frequency by 1.82 days/week (SE +/- 0.18) by 13 weeks (F ((2,85)) = 4.46, p = 0.038) and walking for exercise frequency by 1.08 days/week (SE +/- 0.24) by 13 weeks (F ((2,85)) = 5.38, p = 0.02). Positive trends were observed for duration (min/week) of PA and walking for exercise.
Intervention exposure resulted in increased frequency of PA and walking for exercise in postnatal women.
... This conjoint risk [24] suggests the need for directing health interventions at both parties [25]. Digital technology, e.g., text messages, seems to increase retention, acceptability, and health behavior outcomes of interventions among postpartum women [26,27] and women with prior GDM [28]. Still, a knowledge gap exists on how health promotion interventions influence motivation for health behaviors among women with prior GDM and their partners. ...
... A recent review highlighted personalized goal setting and video coaching as highly acceptable features of digital health technology among women with prior GDM [28]. In the feasible MobileMums intervention, mothers reported that a personal connection to the intervention deliverer was facilitated by using first names, SMS texts, and possibly an initial face-to-face meeting [26]. Thus, our findings seem to be only partly consistent with the literature on digital interventions for postpartum mothers. ...
... Though partner support seems vital to increasing physical activity among mothers with small children [57], digital coaching may be more effective if offered to the woman and partner separately. For example, mothers in MobileMums indicated that they were satisfied with the sole focus on themselves as mothers [26]. Future studies should investigate how acceptability and adoption may be increased among women with prior GDM and their partners. ...
Promoting diet and physical activity is important for women with recent gestational diabetes mellitus (GDM) and their partners to reduce the risk of future type 2 diabetes (T2D). The study aimed to understand how motivation for changing diet and physical activity behaviors among women with recent GDM and their partners was experienced after participation in the Danish Face-it intervention. Fourteen couples’ interviews were conducted. Data analysis followed a reflexive thematic analysis. Guided by self-determination theory and interdependence theory, we identified four themes affecting couples’ motivation for health behavior change: (1) The need to feel understood after delivery; (2) adjusting health expectations; (3) individual and mutual preferences for health behaviors; and (4) the health threat of future T2D as a cue to action. We found that couples in general perceived the Face-it intervention as useful and motivating. Using couple interviews increased our understanding of how the women and partners influenced each other’s perspectives after a GDM-affected pregnancy and thus how targeting couples as opposed to women alone may motivate health behavior change.
... Specifically, beginning with text messages, although their use in health and wellness settings is not new (Grimstvedt et al., 2010;Mutsuddi & Connelly, 2012), previous studies have generally neither isolated the effects of motivational messages nor examined them in field settings. Our study differs from studies of textual messages embedded in interventions such as goalsetting and shared message boards (Fjeldsoe et al., 2010;Fukuoka et al., 2010;Hurling et al., 2007;Lee et al., 2011) in that we isolate the effect of motivational messages and separate them from their role in these broader interventions. The effect of motivational messages in real-life wellness programs warrants investigating them separately for at least two reasons. ...
... Although previously studied, existing research on motivational messages is limited in two key ways. First, the research generally conflates the effects of motivational messages (e.g., sending messages about exercise benefits and behavioral and cognitive strategies to overcome barriers of behavior change) with other interventions such as goal setting and shared message boards (Fjeldsoe et al., 2010;Fukuoka et al., 2010;Hurling et al., 2007;Lee et al., 2011). This amalgamation of the various interventions makes it impossible to isolate the effects of motivational messages alone on physical activity. ...
... The effect of this one-time intervention was monitored over one week. More generally, prior studies have predominantly examined the effect of motivational messaging on the initial period of an exercise regimen over a short time frame (15 weeks or less) (Cheung et al., 2008;Fjeldsoe et al., 2010;Fukuoka et al., 2010;Hurling et al., 2007;Lee et al., 2011;Wilbur et al., 2005). While this short-term effect of messages has received academic attention, their impact over a sustained period continues to be little understood. ...
We investigate how two digitally delivered nudges, namely light social support (nonverbal cues such as kudos or likes) and motivational messaging, affect employees’ self-reported physical activity in an online, corporate wellness program. Within this unique field setting, using data from several years, we found evidence that both types of nudges provide benefits beyond the effect of cash incentives. However, the effects vary by individual, depending on whether the employee is actively engaging in physical activity, and by time, depending on how long the employee has been in the wellness program. We found light social support to be less effective over time, while motivational messages were found to be more effective with the duration in the program and generally more effective for physically inactive users. Our findings have implications for the design of wellness systems, suggesting different approaches depending on an employee’s current activity level and tenure in the program
... Recruitment rate was compared to the 42% average recruitment rate of other feasibility randomized trials of PA interventions for mothers (Fjeldsoe, Miller, and Marshall 2010;Lipscombe et al. 2019;Mailey et al. 2014;Taveras et al. 2011;Teychenne et al. 2018); thus, we deemed a recruitment rate of >40 % to be successful. A 80-100 % retention rate was identified as a strong trial (Jackson and Waters 2005). ...
... The objectives of this study were to examine the feasibility and usability of a web-based intervention that integrates the M-PAC framework for promoting PA in mothers. As hypothesized, the recruitment rate was successful based on a range deemed suitable from prior PA feasibility studies with mothers (Fjeldsoe, Miller, and Marshall 2010;Lipscombe et al. 2019;Mailey et al. 2014;Taveras et al. 2011;Teychenne et al. 2018) and the retention rate represented a strong trial (Jackson and Waters 2005). Quantitative measures of satisfaction and usability were also favorable, given their scores were above our criteria. ...
... Interestingly, mothers in another PA promotion feasibility RCT reported high use of a goal-setting fridge magnet (Fjeldsoe, Miller, and Marshall 2010), whereas in the present study, according to the interviews, some participants weren't overly keen on writing down and planning their goals. This act of planning may not be as important for PA behavior in mothers (Grant, Lithopoulos, and Rhodes 2021) due to the many competing demands for time (Rhodes et al. 2020). ...
... Recruitment rate was compared to the 42% average recruitment rate of other feasibility randomized trials of PA interventions for mothers (Fjeldsoe, Miller, and Marshall 2010;Lipscombe et al. 2019;Mailey et al. 2014;Taveras et al. 2011;Teychenne et al. 2018); thus, we deemed a recruitment rate of >40 % to be successful. A 80-100 % retention rate was identified as a strong trial (Jackson and Waters 2005). ...
... The objectives of this study were to examine the feasibility and usability of a web-based intervention that integrates the M-PAC framework for promoting PA in mothers. As hypothesized, the recruitment rate was successful based on a range deemed suitable from prior PA feasibility studies with mothers (Fjeldsoe, Miller, and Marshall 2010;Lipscombe et al. 2019;Mailey et al. 2014;Taveras et al. 2011;Teychenne et al. 2018) and the retention rate represented a strong trial (Jackson and Waters 2005). Quantitative measures of satisfaction and usability were also favorable, given their scores were above our criteria. ...
... Interestingly, mothers in another PA promotion feasibility RCT reported high use of a goal-setting fridge magnet (Fjeldsoe, Miller, and Marshall 2010), whereas in the present study, according to the interviews, some participants weren't overly keen on writing down and planning their goals. This act of planning may not be as important for PA behavior in mothers (Grant, Lithopoulos, and Rhodes 2021) due to the many competing demands for time (Rhodes et al. 2020). ...
The onset of motherhood is associated with a decline in moderate- to vigorous-physical activity (MVPA) and this deficit can remain for years to come. This study explored the feasibility of a web-based intervention, informed by the multi-process action control (M-PAC) framework, to promote PA in mothers. Forty-one inactive mothers of children <16 were randomized to a 10-week web-intervention (n = 20) or wait-list control (n = 21). Primary outcomes of recruitment and retention were measured with frequency counts; usability and satisfaction were measured via self-report questionnaires and qualitative interviews; secondary outcomes of MVPA and M-PAC constructs were assessed via self-report. Recruitment was 41%, retention was 88%, and satisfaction and usability were high. Participants logged in 7.94 (SD = 3.87) times and spent 37.71 (SD = 20.21) minutes per week on the web-intervention. Suggestions for intervention improvement included additional content targeting mothers, reminders, and optimized navigation. Intervention participants trended toward improved MVPA and M-PAC constructs, particularly action control processes of habit, self-identity, and behavioral regulation. The high feasibility ratings of recruitment, retention, satisfaction, and usability demonstrated that the study can be extended to a full-scale RCT with minor additions to the intervention such as content targeting mothers, reminders, and optimized navigation.
... Interestingly, existing postpartum interventions have largely utilised flexible delivery methods that facilitate women's engagement in PA on their own (e.g. SMS [27,28], telephone [29], website [30], apps [31], home-based [32]). These were generally adopted following formative research expressing a preference for minimal face-to-face contact, no interest in or inability to join group-based PA programs, and to reduce costs of paying exercise providers [27]. ...
... SMS [27,28], telephone [29], website [30], apps [31], home-based [32]). These were generally adopted following formative research expressing a preference for minimal face-to-face contact, no interest in or inability to join group-based PA programs, and to reduce costs of paying exercise providers [27]. However, this current research study suggests that faceto-face sessions, convenient locations, appropriate timing, group contexts, catering for babies and child(ren), reasonable ongoing costs, and a welcoming and supportive ethos make group-based PA programs a preferred option. ...
... To our knowledge, this is the first study to explore mothers with young children's sustainable participation in groupbased PA programs. Most previous studies have confirmed the positive effect of social support in enabling MVPA and the findings of this study builds upon that other work [9,27]. However, in this study, the role of partner support was acknowledged but not as imperative for facilitating and sustaining PA participation mainly due to partners' work commitments. ...
Background
Many mothers with young children often do not achieve recommendations of at least 150-min moderate-to-vigorous physical activity (MVPA) each week. Previous qualitative work has generally focused on getting inactive mothers with young children to be active, so the characteristics of women who are active during early postpartum period are not well understood. This research set out to capture the characteristics of mothers with young children who engage in MVPA and how these women manage barriers and harness enablers to sustain in engagement in physical activity (PA) over an extended period.
Method
Thirty-two participants ranging in age from 27 to 42 years (35.2 ± 4.8), with age of their youngest child ranging from 6 weeks old to 5 years, participated in semi-structured interviews.
Results
Inductive thematic analysis revealed three overarching themes and fourteen sub-themes relating to the characteristics of active mothers with young children and the engagement and maintenance factors that recruit and sustain these women in group-based physical activity programs. Specifically, mothers with young children relish a welcoming and supportive environment that accommodates babies and young children, is affordable and convenient, focuses on building strength and functionality, and is non-judgmental.
Conclusion
These findings advance knowledge by providing considerations and recommendations that support intervention and program designers to be able to develop group-based physical activity programs for mothers with young children.
... Text messaging is a "push" technology with minimum efforts on the receivers' side (Gerber, Stolley, Thompson, Sharp, & Fitzgibbon, 2009, p. 22;Klasnja & Pratt, 2012). It has been widely used for sending reminders (Gold et al., 2011) and educational content (Chuang & Tsao, 2013;Lim et al., 2012), and for maintaining users' awareness of their health goals (Fjeldsoe, Miller, & Marshall, 2010). Cameras are usually used to collect health-related information such as food consumption, a condition, or a contextual factor. ...
... From the perspective of modality, mobile health promotion programs take different forms, including short message service (SMS) for reminders or delivery of educational material delivery (Armstrong et al., 2009;Chuang & Tsao, 2013;Fjeldsoe et al., 2010;Gold et al., 2011), mobile games (Grimes, Kantroo, & Grinter, 2010;Lee et al., 2010), mobile applications (Gerber et al., 2009;Haapala et al., 2009;Patrick et al., 2009;Reid et al., 2011), as well as mixed methods including using emails, websites, printed materials, pedometers, or group sections as complements (Joo & Kim, 2007;Kristjansdottir et al., 2013;Lim et al., 2012 Among various modalities, the majority of mobile programs take advantages of "push" technology through short message service (SMS) (Krishna, Boren, & Balas, 2009). Webb, Joseph, Yardley, and Michie (2010) indicate that text messages have been used in several ways, such as promoting interaction with interventions, sending motivational messages, challenging dysfunctional beliefs, or providing cues to action. ...
... Feedback was another evidence-based strategy used in mobile health programs, including content-tailored, time-tailored, or general feedback sent via SMS to participants. Content-tailored messages in the mobile interventions were either created through working with participants at the onset of interventions (Fjeldsoe et al., 2010;Gerber et al., 2009), generated by computer using a default algorithm (Free et al., 2013;Haapala et al., 2009), or written by researchers, therapists, or physicians (Kristjansdottir et al., 2013). Time-tailored messages were prearranged by researchers according to participants' preference in receiving messages. ...
This project seeks to explore self-guided mobile self-tracking for weight
management through an integrated theoretical lens. It looks at the correlational and causal relationships between a set of psycho-social variables, as well as the effects of mobile self-tracking by integrating classic communication and social psychology theories (i.e., social cognitive theory, theory of planned behavior) and emerging health behavior theories (i.e., self-determination theory, social action theory) into a new model of mobile self-tracking. Findings have shown that, among several underlying predictors, vigilance coping, self-efficacy, and normative beliefs significantly predicted an individual’s autonomous motivation for mobile self-tracking. More importantly, mobile self-trackers were found to have better health outcomes than non-mobile self-trackers after controlling for confounding factors. In addition, confirming theoretical perspectives, self- determination was shown to be an important component that not only can be reinforced through self-guided mobile self-tracking, but also can mediate the effects of mobile self- tracking on health outcomes. Ecological momentary intervention was validated as a significant moderator of the effects of mobile self-tracking engagement on healthy eating. In addition, results revealed that social influence takes forms of network exposure, tie strength, relation type, and role modeling in affecting individuals’ mobile self-tracking adoption. Lastly, structural equation modeling was performed to validate the research model. Contributions to the field of mobile health and implications for future health interventions and health research are discussed.
... The booklet was informed by previous intervention research, primarily on the basis of the TPB, with mothers and couple-based health interventions (Appendix Table 1, available online). 15,20,21,23,41,42 The booklet consisted of 2 main sections. The first section focused on the benefits of postpartum PA on immune function, a good night's sleep, increase in energy levels, control of food cravings, reduced pain, and prevention and treatment of postpartum depression. ...
... The overall null findings add to increasing literature on PA interventions after new parenthood, which have shown difficulty in sustaining MVPA improvements past very early gains. 15,[20][21][22][23][26][27][28]30 Tertiary analyses of a measured self-regulatory planning construct showed that the EP intervention did increase self-regulation behavior compared with the EC intervention, particularly during the phase of intervention delivery (i.e., baseline to 3 months). Thus, an increase in the use of selfregulatory tactics, using an extended TPB, was not sufficient to provide an overall impact on MVPA. ...
Introduction:
The demands of parenthood may limit the pursuit of moderate-to-vigorous intensity physical activity (MVPA), establish inactivity patterns into middle age, and lead to long-term poorer health and well-being. The purpose of this study was to examine the efficacy of a couple-based planning skills intervention to support MVPA from baseline (~2 months after birth) up to 6 months later in first-time parents.
Design:
Randomized trial.
Participants:
264 parents (132 couples) at the 2-month point of parenting their first child.
Intervention:
Couples were randomized to either an education control (n=58 couples) or an education plus planning condition (n=74 couples).
Main outcome measures:
MVPA was assessed via accelerometry and self-report at baseline, 6 weeks, 3 months, and 6 months. Health-related fitness (aerobic fitness, muscular strength, flexibility) and BMI tests were conducted at baseline and 6 months. Rolling recruitment was between 2014 and 2017.
Results:
The accelerometry results had large amounts of missing data that were not missing at random, so only self-reported MVPA was analyzed. Dyadic multilevel modeling conducted in 2020 showed that mothers' MVPA had a significant quadratic pattern over time that was similar for both conditions, and BMI decreased while strength and flexibility increased. Fathers did not have significant outcomes. Participants who were not meeting MVPA guidelines at baseline responded to the education plus planning condition with increased MVPA (father B=1.31, mother B=1.14, p<0.05) compared with those who initially met those guidelines.
Conclusions:
Mothers may be more responsive than fathers to MVPA interventions in early parenthood. Already active parents likely have little to be gained from additional intervention. Future research is needed to effectively promote MVPA during fatherhood and identify novel ways to sustain PA past the early response to an intervention.
Accessible at: http://hdl.handle.net/1828/15251
Trial registration:
This study is registered at www.clinicaltrials.gov NCT02290808.
... Effective antecedent interventions for increasing physical activity include self-monitoring and prompts (Thompson et al., 2016). Text-message prompts, in which a reminder is sent to participants regarding specific goals, have been effective for physical activity (Evans et al., 2012;Fjeldsoe et al., 2010;Green et al., 2016;Swartz et al., 2014;Thompson et al., 2016;Wong et al., 2015) and weight loss interventions (Gerber et al., 2009). Text-message prompts can be sent with automated text-message services to send messages at specified times during the day (Gerber et al., 2009;Thompson et al., 2016;Wong et al., 2015). ...
... Across all interventions and participants, they rated the use of the Fitbit, syncing, receiving text messages, and the effectiveness of the intervention highly. These findings align with past research suggesting that participants are receptive of receiving text-message prompts throughout the day (Evans et al., 2012;Fjeldsoe et al., 2010;Swartz et al., 2014;Thompson et al., 2016;Wong et al., 2015). The lowest satisfaction rating was in receiving money for meeting their physical activity goals, which may be because some participants did not receive money contingent on their goals (Prompts þ Feedback or constant-baseline). ...
Research suggests that meeting the Center for Disease Control guidelines for weekly physical activity cannot negate the health effects of sitting for more than 10 hours per day. Therefore, office workers would benefit from interventions to decrease sitting and increase physical activity. Sixteen university office workers were randomly assigned to a prompts+feedback, incentives+feedback, or incentives+prompts+feedback intervention. In baseline, participants wore Fitbits during work hours. In the prompts+feedback condition, Fitbits vibrated, and participants received a text-message prompt instructing them to walk 400 steps every hour. In the incentives+feedback condition, participants received monetary reinforcement according to an escalating schedule starting at $0.25 per hour. The incentives+prompts+feedback condition combined the other two treatments. Prompts+feedback was the most effective intervention, with an increase in intervals active for 2 out of 3 participants. Hourly intervals may be a more efficient way of affecting both sitting time and stepping behavior. Reinforcement characteristics may have reduced the effectiveness of the incentives including magnitude and immediacy.
... [20] Another previous study conducted in South Korean adults demonstrated that text messages about health behavior modification, diet, and physical activity (PA) could promote the weight loss during 12 weeks. [22] Web-based interventions showed positive effects in promoting PA [23] and healthy eating [24] among adolescents. ...
... Consistent with these findings, another study found an average 2% decrease in the body fat of participants who received tailored PA SMS, but no significant difference in BMI. [22] A community-based intervention with counseling calls and E-mails had no effect on weight loss, improvement in diet or PA. [32] Given that, in the present study, BMI or adiposity and PA did not change, suggest the need for more and comprehensive intervention, for example, adding PA classes for overweight children and family-based behavioral interventions. ...
Background and aim:
Little information is available on the use of text messages through mobile phones to address overweight/obesity in children. This study aims to evaluate the impact of a text message-based intervention for weight control and health-promoting lifestyle behaviors of overweight/obese children.
Materials and methods:
This quasi-experimental study was conducted among overweight/obese school students. Data on sociodemographic, dietary intake, sleep, sedentary behavior, physical activity (PA), and anthropometry were collected before and after the intervention. Weight and height were examined according to the standard protocols. The intervention was consisted of tailored messages for weight control and healthy lifestyle, including diet, PA, sedentary behavior, and sleep. Child attitude and his practice were asked before and after the intervention. The paired t-test was performed to compare means of continuous variables before and after the intervention for normal distribution data. The Wilcoxon test was also used for nonnormal data.
Results:
A total of 71 boy students were included in the study (62% obese). The mean age was 10.07 years. The means of attitude score for PA, nutrition, and sleep after intervention were greater than before it, but it was significant only for PA. The mean of nighttime sleep duration of students after the intervention was significantly less. Furthermore, unhealthy score decreases after the intervention.
Conclusion:
Three-month lifestyle intervention as text messages had positive effects on the nutritional intake of obese children and their attitudes toward PA, but no effect on child body mass index.
... A self-administered, web-based questionnaire was used in this cross-sectional, correlational study. An online questionnaire was used as mothers with young children express a desire to participate in studies with a flexible mode of delivery and minimal face-to-face contact (Fjeldsoe, Miller, and Marshall 2010). Online surveys also offer a convenient and easy way for people to participate who might otherwise not have the time to travel or spend in a face-to-face session, such as mothers with young children (Wright 2005). ...
... Due to the open accessibility of the internet, it was difficult to determine that each participant was a mother and whether each participant considered each question before answering (Evans and Mathur 2005). However, for mothers with young children, online studies offer a convenient and realistic way to participate in studies (Fjeldsoe, Miller, and Marshall 2010). Additionally, the selfselected nature of this sample and the lack of availability of access to computers and the internet, which is related to socioeconomic status (Harris, Straker, and Pollock 2017), further limits the representativeness of the sample and thus the generalizability of results. ...
We explored whether the guilt mothers of young children feel about engaging in health behaviors mediates the relationship between self-compassion and self-reported engagement in health-promoting behaviors such as physical activity, eating a healthy diet and getting enough sleep. In this online, cross-sectional study, 143 mothers of young children completed measures of self-compassion, guilt about taking time to engage in health-promoting behaviors, trait guilt, health-promoting behaviors, self-esteem, and demographics. Mediation analysis, using Hayes’ PROCESS macro showed that mother guilt mediated the relationship between self-compassion and health-promoting behaviors, ß = .05, Bca CI (.0014, .1133) with a bootstrapped standard error of .03 and a 95% confidence interval. Self-compassion may offer mothers a positive way to deal with guilty feelings about looking after their health.
... The postpartum phase for recruitment ranged from 3 weeks to 12 months. 24,[28][29][30][31] Twelve studies recruited participants with overweight or obesity at baseline (i.e., in the postpartum period), 28,[31][32][33][34][35][36][37][38][39][40][41] five studies recruited women with overweight or obesity according to prepregnancy BMI, 40,[42][43][44][45] one study recruited women with excessive gestational weight gain of more than 6Á8 kg, 46 three recruited only those with postnatal depression, 24,47,48 four recruited only women with a history of gestational diabetes, 27,39,41,49 and one recruited only those with type 2 diabetes. 50 The remaining studies recruited from the general postpartum population. ...
... and highest at 86%. 47,53 Most studies had a participation rate ranging between 20% to 40%. 29,32,43,49 The study with the highest participation rate recruited from parents groups. 53 Figure S1 . ...
The established efficacy in postpartum lifestyle interventions has not been translated into better outcomes. This systematic review and meta‐analysis assess the penetration (the proportion of women invited within the target population), implementation (fidelity), participation (the proportion of those invited who enrolled), and effect (weight loss compared to controls) (PIPE) of randomized controlled trials of lifestyle interventions in postpartum women (within two years after birth). MEDLINE, EMBASE, Pubmed, and other databases and clinical trial registries were searched up to the 3rd of May 2019. Data was extracted from published reports and missing data was obtained from study authors. The quality of the studies was appraised using the Cochrane Risk of Bias tool (2·0). Main outcomes were the PIPE impact metrics and changes in body weight. Thirty‐six trials (49 publications) were included (n=5,315 women). One study provided sufficient information to calculate the population penetration rate (2·5%). All studies provided implementation (fidelity) information, but over half had low program fidelity. The participation rate was calculated for nine studies (0·94% to 86%). There was significant change in body weight (mean difference (MD) (95% confidence interval, CI) of ‐2·33 (‐3·10 to ‐1·56). This highlights the inadequacy of conventional RCTs to inform implementation. Future research should broaden methods to pragmatic trials.
... Several meta-analysis and systematic reviews have established that digital motivational interventions (SMS, app, web-page, or email) can motivate to a healthy behaviour [12][13][14]. Studies specifically investigating change in physical activity level achieved by digital motivation in different patient groups have found an overall low to moderate effect [15][16][17][18][19][20][21][22][23][24][25]. However, a systematic review investigating the effect of education, exercise, or web-based interventions designed to increase the physical activity level in patients with chronic musculoskeletal pain found little to no overall change [26]. ...
... The text messages contained information and general advice about the importance of performing daily physical activity. The intervention was based on previous experience with web-based digital motivation for hip and knee OA [33], and the proven effectiveness of weekly text messages for decreasing sedentary behaviour [17,21]. The content of the text messages was developed based on recommendation and advice from the Danish Health Authority about the importance of regular daily physical activity. ...
Background:
One of the big contributors to physical inactivity in the elderly population is osteoarthritis (OA) of the knee. Digital motivation seems to have a positive effect on individual physical inactivity level, but limited evidence exists on the effects of digital motivation on patients with knee OA.
Objective:
To investigate if motivational text messages reduce time spent physically inactive in patients with knee OA.
Method:
This study was designed as an unblinded pilot randomised controlled trial, randomising participants equally (1:1) to an intervention group (motivational text messages) or control group (no intervention). Participants were recruited from six physical therapy clinics in Denmark. Inclusion criteria were age ≥ 18, diagnosed with knee OA, owner of a smartphone or tablet, and participating or commencing participation in the GLA:D® program. The primary outcome was time spent physically inactive, measured with a tri-axial accelerometer mounted on the lateral side of the thigh. Data on OA symptoms were obtained using the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire.
Results:
A total of 49 participants were screened, and 38 participants were included and randomised to either the intervention group (n = 19) or the control group (n = 19). No statistically significant difference between the two groups was found in average change of time spent physically inactive (mean difference 13.2 min/day [95% CI - 41.0 to 67.3]; P = 0.63), time spent standing (mean difference 3.0 min/day [95% CI - 22.7 to 28.7]; P = 0.81), or time spent moving (mean difference - 20.4 min/day [95% CI - 63.0 to 22.3]; P = 0.34) nor was there any difference in change between the two groups on KOOS.
Conclusion:
Motivational text messages have seemed to have no effect on overall time spent physically inactive.
Trial registration:
clinicaltrials.gov, NCT03339011. Registered 9 November 2017.
... Yet, evidence on the effectiveness of multiple-round interventions over time is mixed. Some studies have found that the impact of multiple-round interventions diminishes over time, such that later rounds have little to no impact [13][14][15]. Other studies have observed positive incremental effects for later rounds of intervention [16][17][18]. ...
For information interventions to be effective, recipients must first engage with them. We show that engagement with repeated digital information interventions is shaped by subtle and strategically controllable signals of the information’s value. In particular, recipients’ expectations are shaped by signals from the “envelope” that surrounds a message in an information intervention. The envelope conveys clues about the message but does not reveal the message itself. When people expect the message to be valuable, delivering it in a consistent and recognizable envelope over time increases engagement relative to varying the envelope. Conversely, when people expect the message to be of little value, delivering it in a consistent and recognizable envelope decreases engagement relative to varying the envelope. We show this with two field experiments involving massive open online courses and one online survey experiment (all pre-registered, N = 439,150).
... Another study with 125 overweight individuals showed that the group with phone intervention lost a significant amount of weight in comparison to the control group (20). A study conducted with women after they gave birth stated that those women in the SMS intervention group showed a significant increase in physical exercise time (21). ...
Background: Nowadays, as in all health branches, health communication technologies are used in diabetes to develop positive health behaviors and the self-efficacy of patients. The aim of this study was to evaluate the effect of SMS-intervention on disease perception, health behavior, and improvement initiatives for treatment compliance in diabetic patients. Methods: This intervention type study was conducted at Afyon Kocatepe University, Ahmet Necdet Sezer Research and Application Hospital in Turkey. Diabetic patients (n=136) were randomly assigned to three groups. These were “Control”, “Reminder”, “Information and Motivation”. The “Reminder” and “Information and Motivation” groups received regular SMS for one year. Results: In our study, there was a significant increase for health beliefs and treatment compliance in “Reminder” and “Information and Motivation” groups after the intervention. However, there was no significant difference in “Control” group. The SMS sent to diabetes patients positively affected their health belief and treatment compliance. Especially in the “Information and Motivation” group, differences were found in all parameters of the Health Belief Model Scale. Conclusions: SMS interventions are easy and effective interventions that can be used to improve positive health behaviors and positive health perception in individuals. Such interventions, especially for common diseases such as diabetes, will make a significant contribution to the control and treatment of the disease.
... Studies have identified the mobile platform as an effective means for promoting physical activity behavior (Huang & Hung, 2016;Rayward et al., 2018). Short Message Service (SMS, that is, texting), as an intervention tool, presents the advantages of low cost, no spatial or temporal limitations, and a high subscription rate, and it has been demonstrated to be effective in increasing physical activity in school children (Lau et al., 2015) and postnatal women (Fjeldsoe et al., 2010). However, this approach is still in its infancy and requires the incorporation of more components. ...
Background
Occupational health nurses in workplaces aim to offer evidence-based interventions to increase physical activity among employees to promote health. Mobile health (m-health) interventions have demonstrated effectiveness in increasing physical activity, and the application of m-health solutions in workplaces warrants investigation. We examined the effectiveness of a cell phone/smart device and web-based (m-health) intervention in motivating the employees at financial enterprise firms to increase physical activity.
Methods
This study included employees from 16 banks ( n = 194) who were randomly assigned to either (a) an experimental group (6 banks, n = 89), which received an intervention that integrated the Theory of Planned Behavior (TPB)-based tailored Short Message Service (SMS) with web-based knowledge or (b) a comparison group (10 banks, n = 105), which received web-based messages alone. Outcomes included psychosocial variables (attitude toward physical activity, normative beliefs, and control beliefs) and the level of physical activity. Data were collected at baseline, immediately after the intervention, and 3 months after the intervention.
Findings
The level of physical activity significantly increased in the experimental group ( p < .05). TPB variables such as perceived social norms ( p < .01) and behavioral control ( p < .05) also significantly improved in the experimental group. However, all the effects had a small size (=.05) and diminished in 12 weeks.
Conclusions
In addition to internet-based information, the use of mobile phones/smart devices to encourage employees to exercise for 8 weeks effectively increased employees’ physical activity level. More research, specifically addressing workplace culture, is warranted to establish methods for sustaining healthy behaviors to increase physical activity.
... The mean number of antenatal care visits was 2.54, with 71.6% making at least one visit (Mendoza et al, 2013). Similarly, a randomised controlled trial found text messages with health information improved the level of postnatal exercise among women (Fjeldsoe et al, 2010). ...
... Text messaging is more practical due to the wider accessibility of people to mobile phones with short message service (SMS) than smartphones (9). There is a growing body of research supporting the use of text messagebased interventional systems and instructional videos for increasing physical activities and self-managed exercises (10)(11)(12)(13)(14)(15)(16). ...
Object: Post-operative rehabilitation for patients with flexor tendon injuries is necessary for full recovery. This paper thus describes the study design of a randomized controlled trial assessing the effectiveness of a text message-based rehabilitation program (TextRehab) on the improvement rate of hand rehabilitation in patients with flexor tendon injuries after repair.
Methods: This study is designed as a randomized, three-month, single-center, two-arm, parallel controlled trial. A total of 40 patients will be randomly classified as either the control or intervention group; both groups receive usual care. However, the intervention group is also asked to perform the designed rehabilitation activities through TextRehab. The activity instructions are sent to patients step by step at least once a day. All outcomes will be assessed at 6 and 12 weeks after discharge and include self-reported Patient Rated Wrist Evaluation (PRWE) as the primary outcome and self-reported Quick-Disability of Arm, Shoulder, and Hand (Quick-DASH), Visual Analogue Scale (VAS), physician reported Mayo checklist and grip strength as secondary outcomes.
Results: The development of message scheduling system is completed. This trial was approved by the Medical Ethics Committee of Mashhad University of Medical Sciences. Study results are expected to be available in mid-2021.
Conclusions: The TextRehab program is developed to provide advice, motivation, information, and care for patients with hand flexor tendon injuries after repair. This trial provides evidence of the effectiveness of sending text messages on persuading patients to perform home-based rehabilitation activities.
... The mean number of antenatal care visits was 2.54, with 71.6% making at least one visit (Mendoza et al, 2013). Similarly, a randomised controlled trial found text messages with health information improved the level of postnatal exercise among women (Fjeldsoe et al, 2010). ...
Background/aims
The short message service is a part of mobile health, which is defined as medical and public health practices that are supported by mobile devices, such as mobile phones, personal digital assistants, and other wireless devices. Mobile health has documented positive outcomes on other health services, including focused antenatal care. The focused antenatal care model emphasises quality of care rather than quantity of antenatal visits, and the World Health Organization recommends a minimum of four targeted antenatal visits. This study examines the influence of short message service reminders on utilisation of focused antenatal care in rural Kenya.
Methods
This was a randomised controlled trial with 118 respondents in each of two study arms, intervention and control, conducted in Tharaka Nithi, Kenya. The study group were pregnant women attending their first antenatal care visit in Tharaka sub-county health facilities. The intervention was three short message service reminders a week before the scheduled visit. Structured questionnaires were used to collect baseline and exit interviews. The chi-square test and logistic regression were used to check associations between uptake of antenatal care and participant characteristics at 5% significance level.
Results
Three quarters (75%) of the respondents in the intervention group completed the four targeted antenatal visits, whereas only 10% of respondents attended the required four visits in the control group. None of the sociodemographic variables were found to have any association or influence on focused antenatal care attendance. Short message reminders increased the chances of attending the recommended visits by 27 times (P<0.001).
Conclusions
Short message service reminders have a positive influence on utilisation of focused antenatal care. This research paper recommends that policymakers and health managers use short message service reminders to increase the uptake of focused antenatal care.
... Walking was the most reported outcome measure (77/117, 65.8%) [41,43,44,48,[50][51][52][53][54][58][59][60][63][64][65][67][68][69], followed by MVPA (62/117, 53.0%) [42,44,46,47,49,[51][52][53][54][55]57,59,[61][62][63][64]68,[70][71][72][73][74][75][76][78][79][80]82,[84][85][86][87][89][90][91]94,98,104,107,109,112,114,117,125,126,[131][132][133][134][135][136][137][138][139][140][141][142][143][144][145][146][147], TPA (33/117, 28.2%) [44,45,50,52,54,56,64,66,72,74,[76][77][78]84,85,89,96,[110][111][112]114,118,131,135,146,[148][149][150][151][152][153][154]157], and EE (5/117, 4.3%) [61,103,137,155,156]. Most RCTs were conducted in at-risk ( [61] reported long-term follow-up effects for EE, which were not statistically significant. ...
Background
Mobile health (mHealth) interventions can increase physical activity (PA); however, their long-term impact is not well understood.
Objective
The primary aim of this study is to understand the immediate and long-term effects of mHealth interventions on PA. The secondary aim is to explore potential effect moderators.
Methods
We performed this study according to the Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched PubMed, the Cochrane Library, SCOPUS, and PsycINFO in July 2020. Eligible studies included randomized controlled trials of mHealth interventions targeting PA as a primary outcome in adults. Eligible outcome measures were walking, moderate-to-vigorous physical activity (MVPA), total physical activity (TPA), and energy expenditure. Where reported, we extracted data for 3 time points (ie, end of intervention, follow-up ≤6 months, and follow-up >6 months). To explore effect moderators, we performed subgroup analyses by population, intervention design, and control group type. Results were summarized using random effects meta-analysis. Risk of bias was assessed using the Cochrane Collaboration tool.
ResultsOf the 2828 identified studies, 117 were included. These studies reported on 21,118 participants with a mean age of 52.03 (SD 14.14) years, of whom 58.99% (n=12,459) were female. mHealth interventions significantly increased PA across all the 4 outcome measures at the end of intervention (walking standardized mean difference [SMD] 0.46, 95% CI 0.36-0.55; P
... Addressing occasional treatment unfairness in health care, improving access to health information, reducing health system failures and remodeling primary health care, all depend on the enormous potential that the use of mobile health technologies offers nowadays [4]. These mHealth apps potentially involve reaching a wider scope with equal accessibility while keeping it a low-cost way to deliver a healthcare service, which makes these apps a vigorous public health solutions [5]. These apps are widespread, however, in-depth research addressing the effectiveness and acceptability of these apps is lacking [6]. ...
Contraception Mobile Personal Health Records (mPHRs) are efficient mobile health applications (apps) to increase awareness about fertility and contraception and to allow women to access, track, manage, and share their health data with healthcare providers. This paper aims to develop a requirements catalog, according to standards, guidelines, and relevant literature to e-health technology and psychology. The requirements covered by this catalog are Acceptability, Usability, Sustainability, and Internationalization (i18n). This catalog can be very useful for developing, evaluating, and auditing contraceptive apps, as well as helping stakeholders and developers identify potential requirements for their mPHRs to improve them.
... Tremendous efforts have been made to identify creative strategies to promote and sustain PA for the sake of better public health. Numerous studies regarding the effect of the text-message intervention on health behavior have been conducted to examine the effectiveness of social support on health promotion and indicated improved PA with text-messaging [14,[26][27][28][29][30]. The effects of self-monitoring on PA promotion have also been studied and indicate a significant increase in PA with self-monitoring [15,16,[31][32][33][34]. ...
Wearable activity trackers have gained popularity among individuals who want to track their physical activity (PA). The features of wearable tracking technology that are known to facilitate positive behavior changes such as self-monitoring and social connectedness) are well documented; yet, the existing evidence is not conclusive in the literature requiring further investigation. This study was an 8-week pilot randomized controlled study examining the effectiveness of PA intervention incorporating a wearable activity tracker’s online connectivity feature. Forty participants were equally randomized into either an individual-based (n = 20) or a connected group (n = 20). A Jawbone UP24 tracker was provided to all participants in both groups as a means of self-monitoring PA for eight weeks, but the connected group was additionally instructed to share their PA levels with the others using the accompanying smartphone application. Participants’ weekly step counts were evaluated each week to examine the change in PA. Participants’ biometric variables such as body weight, body mass index, waist circumference, blood pressure, and psychological status, including self-efficacy (SE) and exercise motivation (EM), were measured from both groups before and after the intervention period. Additionally, the social support questionnaire (SSQ) was measured among the connected group. The statistical significance level was set at
... Most studies had a high overall risk of bias, mostly due to bias resulting from deviations from intended interventions. The risk of bias from missing outcome data was reduced through the intention-to-treat analysis reported in ten studies [29,33,36,37,[41][42][43]52,53,56,63]. Two studies [38,[44][45][46] reported higher drop-out rates in the intervention group, which could have been related to the true outcome, and these studies consequently received a rating of high risk of bias from missing outcome data. ...
Background:
Postpartum weight retention is a significant contributor to obesity in women, adverse perinatal events in subsequent pregnancies, and chronic disease risk. Health literacy is known to impact health behaviors. The study aimed to identify the health literacy domains utilized in postpartum weight management interventions and to determine their impact on weight, diet and physical activity in postpartum women.
Methods:
We searched MEDLINE, CINAHL, EMBASE, PSYCINFO, and EBM databases. We included random control trials of lifestyle intervention in postpartum women (within two years post-delivery) published up to 3 May 2019. Subgroup analyses were performed to determine the effect of health literacy domains on outcomes.
Results:
Out of 5000 studies, 33 studies (n = 3905) were included in the systematic review and meta-analysis. The health literacy domain self-care (skills and knowledge) was associated with a significant reduction in body weight (mean difference (MD) -2.46 kg; 95% confidence interval (CI) from -3.65 to -1.27) and increase in physical activity (standardized mean difference (SMD) 0.61; 95% CI 0.20 to 1.02). No other health literacy domain was associated with significant outcomes in weight, energy intake, or physical activity.
Conclusions:
Health literacy skills such as knowledge of self-care are effective in improving weight and in increasing physical activity in postpartum women. The efficacy of other health domains was not supported.
... Health-behavior theory plays a crucial role in mHealth apps [55,56]. Similar to previous studies [15,57], the constructs of social cognitive theory (ie, knowledge, goal setting, and self-efficacy) were the most common theoretical constructs found in commercial dialysis diet apps. ...
Background
With the unprecedented growth of mobile technology, a plethora of dialysis diet apps have been developed to promote patient dietary self-management. Nevertheless, the utility of such apps remains questionable.
Objective
This study aimed to evaluate the content, features, and quality of commercial dialysis diet apps for adult dialysis patients.
Methods
This study consisted of a quantitative content analysis of commercial dialysis diet apps downloaded from Google Play and the Apple App Store available in the Asian marketplace, searched for using the following keywords in English: dialysis diet and diet for kidney disease. Free and paid apps available in English that provide nutrition information for adult dialysis patients were included. Apps that were not relevant to the dialysis diet, not meant for patient self-management, or redundant were excluded. Apps were evaluated for language medium (subscore=1), credibility (subscore=1), food database (subscore=1), valuable features (subscore=12), health-behavior theory constructs (subscore=60), and technical quality (subscore=25). The relationships among the variables of interest were determined by Pearson correlation. Stepwise multiple linear regression analysis was performed to identify the features that contribute to greater technical quality of dialysis diet apps. Statistical significance was defined as P
... Their findings show that such feedback predicts positive outcomes for athletes. A few studies focus on short message service-based interventions to improve PA (e.g., [37,54,59]). Unfortunately, these studies do not isolate the effect of messages alone, do not include follow-up periods, and lack a clear theoretical underpinning. ...
People do not exercise as much and as regularly as they should. To support users in adopting healthy exercise routines, app designers integrate persuasive techniques in their apps. In this study, we focus on two of these techniques, i.e., offering tangible rewards and sending motivational messages to users. Past research has demonstrated the effects of these techniques in nudging recipients to increase their physical activity levels. However, the effect of these interventions on the intrinsic motivation of the participants has not yet been studied. We conducted a 10-month study involving 208 participants; this research consisted of a 3-month baseline (pre-phase), a 4-month experiment and a 3-month follow-up (post-phase). The participants were randomly assigned to one of the following three interventions: either they receive money ((i.) through a fixed incentive or (ii.) a lottery), or (iii.) informative messages. Their daily goal was to walk 10K steps. Through their smart phones, we recorded how many steps they walked every day. These interventions had no effect on the main outcome variable (i.e., the number of steps). However, the manipulations produced a detrimental effect on the intrinsic motivation of the participants, measured through a standardized questionnaire. This negative effect extended into the follow-up period. Our study reveals that tangible rewards and motivational messages decrease the intrinsic motivation of the participants, hence their connected physical activity. In our findings, we highlight the importance of intrinsic motivation in setting up healthy exercise routines that will be carried on autonomously by the participants after the period of the intervention. Finally, we present implications for the design of persuasive apps.
... 17,18 Data regarding improved physical activity in pregnancy were mixed. [19][20][21] Postpartum weight retention seemed to improve in the short term (6 months) however no significant difference persists when patients were followed to 12 months. [22][23][24][25] Notable findings included Gilmore et al, 22 which found significant reduction in body weight in five patients with the highest adherence to their platform, and Choi et al, 21 which found decreased perceived barrier to being active in the app plus Fitbit intervention group. ...
Objective:
To systematically review the effectiveness of telehealth interventions for improving obstetric and gynecologic health outcomes.
Data sources:
We conducted a comprehensive search for primary literature in ClinicalTrials.gov, Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE.
Methods of study selection:
Qualifying primary studies had a comparison group, were conducted in countries ranked very high on the United Nations Human Development Index, published in English, and evaluated obstetric and gynecologic health outcomes. Cochrane Collaboration's tool and ROBINS-I tool were used for assessing risk of bias. Summary of evidence tables were created using the United States Preventive Services Task Force Summary of Evidence Table for Evidence Reviews.
Tabulation, integration, results:
Of the 3,926 published abstracts identified, 47 met criteria for inclusion and included 31,967 participants. Telehealth interventions overall improved obstetric outcomes related to smoking cessation and breastfeeding. Telehealth interventions decreased the need for high-risk obstetric monitoring office visits while maintaining maternal and fetal outcomes. One study found reductions in diagnosed preeclampsia among women with gestational hypertension. Telehealth interventions were effective for continuation of oral and injectable contraception; one text-based study found increased oral contraception rates at 6 months. Telehealth provision of medication abortion services had similar clinical outcomes compared with in-person care and improved access to early abortion. Few studies suggested utility for telehealth to improve notification of sexually transmitted infection test results and app-based intervention to improve urinary incontinence symptoms.
Conclusion:
Telehealth interventions were associated with improvements in obstetric outcomes, perinatal smoking cessation, breastfeeding, early access to medical abortion services, and schedule optimization for high-risk obstetrics. Further well-designed studies are needed to examine these interventions and others to generate evidence that can inform decisions about implementation of newer telehealth technologies into obstetrics and gynecology practice.
... The overall high risk of bias was primarily due to deviations from intended interventions. Ten studies reported intention-to-treat analyses [26,[34][35][36][37][38][39][40][41][42][43], which reduces the risk of bias from missing outcome data. Two studies [44][45][46][47] were evaluated to have a high risk of bias for missing outcome data due to a higher dropout rate in the intervention group, which could be related to the true outcome. ...
Successful implementation of postpartum lifestyle interventions first requires the identification of effective core components, such as strategies for behavioural change. This systematic review and meta-analysis aimed to describe the associations between behavioural strategies and changes in weight, diet, and physical activity in postpartum women. Databases MEDLINE, CINAHL, EMBASE, and PsycINFO were searched for randomised controlled trials of lifestyle interventions in postpartum women (within 2 years post-delivery). Strategies were categorised according to the Behaviour Change Technique Taxonomy (v1). Forty-six articles were included (n = 3905 women, age 23–36 years). Meta-analysis showed that postpartum lifestyle interventions significantly improved weight (mean difference −2.46 kg, 95%CI −3.65 to −1.27) and physical activity (standardised mean difference 0.61, 95%CI 0.20 to 1.02) but not in energy intake. No individual strategy was significantly associated with weight or physical activity outcomes. On meta-regression, strategies such as problem solving (β = −1.74, P = 0.045), goal setting of outcome (β = −1.91, P = 0.046), reviewing outcome goal (β = −3.94, P = 0.007), feedback on behaviour (β = −2.81, P = 0.002), self-monitoring of behaviour (β = −3.20, P = 0.003), behavioural substitution (β = −3.20, P = 0.003), and credible source (β = −1.72, P = 0.033) were associated with greater reduction in energy intake. Behavioural strategies relating to self-regulation are associated with greater reduction in energy intake.
... Hingegen sind die positiven Wirkungen von Unterstützungsbotschaften (sog. Supportive Messages), die dem Empfänger Hilfsbereitschaft der Botschaftssenders signalisieren, im Bereich der interpersonalen Kommunikation (im Rahmen von mHealth, Onlineforen oder persönlichen Gesprächen) bereits intensiv untersucht worden (siehe u. a. Bodie und Burleson 2008;Fjeldsoe et al. 2010). ...
Soziale Appelle beziehen sich im Gegensatz zu Gesundheitsappellen auf die sozialen Konsequenzen eines gesundheitsrelevanten Verhaltens und nicht auf die körperlichen und mentalen Risiken. Insbesondere für Bevölkerungsgruppen, denen soziale Ziele wichtiger als Gesundheit (d. h. ihre biophysiologische Unversehrtheit) sind, kann diese Botschaftsstrategie zielführend sein, um sie zu erreichen und ihre Gesundheit zu verbessern. Der Beitrag stellt verschiedene Formen sozialer Appelle und den entsprechenden Forschungsstand dar.
... The authors described how they pretested messages, which involved getting feedback from the target audience about messages throughout the development process. Participant satisfaction was reportedly high regarding message content (Fjeldsoe, Miller & Marshall 2010;. Two stakeholder groups were involved in testing the appropriateness and acceptability of the messages in a study which aimed to improve access to quality sexual health and reproduction (SHR) information for youth (Gonsalves et al. 2015). ...
The Parenting Premmies Support Program: developing and piloting a mobile health intervention for mothers of preterm infants. The study presented in this thesis aimed to investigate the use of contemporary mobile health technology as a vehicle to support and promote the health and wellbeing of mothers of preterm infants during the transitional time following their infant’s discharge from hospital. An exploratory, mixed methods approach with a three phase design was used to understand maternal experience, challenges and issues in this context, develop an mHealth protocol that formed the program, and finally, pilot the program.
... These screen-based activities have traditionally been considered sedentary pursuits [2,3]. However, because modern smartphones are portable and provide the user access to physical activity monitoring software, software applications (i.e., "apps") designed to promote physical activity, and because these devices can be used effectively as part of interventions to prompt participants to increase physical activity (i.e., mobile health or mHealth), smartphone use does not have to be a sedentary activity [4][5][6][7][8][9][10][11]. ...
Underserved populations, including racial/ethnic minorities, individuals with low socioeconomic status, and individuals with physical disabilities, are less likely to engage in sufficient moderate to vigorous physical activity (MVPA) and are thus at increased risk of morbidity and mortality. These populations face unique challenges to engaging in MVPA. Learning how to overcome these challenges is a necessary first step in achieving health equity through health promotion research. In this review of the literature, we discuss issues and strategies that have been used to promote MVPA among individuals from underserved populations, focusing on recruitment, intervention delivery, and the use of technology in interventions. Physical activity promotion research among these vulnerable populations is scarce. Nevertheless, there is preliminary evidence of efficacy in the use of certain recruitment and intervention strategies including tailoring, cultural adaptation, incorporation of new technologies, and multilevel and community-based approaches for physical activity promotion among different underserved populations.
Postpartum women are one of the least physically active vulnerable populations globally and telehealth has been proposed as a potential method of delivering effective exercise interventions for this population. However, clinical practice guidelines are based upon the recommendations for the general population and therefore, the most efficacious exercise dose and the delivery method for this population is unclear. This quantitative systematic review will examine the implementation and outcomes of telehealth exercise interventions in the postpartum population to synthesise the degree to which these outcomes have been assessed and evaluated. Five databases were searched from January 2001 to March 2022. Studies implementing synchronous telehealth exercise interventions for postpartum women were included. Interventions were examined against the Template for Intervention Description and Replication (TIDieR) checklist that assesses intervention reporting completeness and replicability. Of the 1036 records identified, 16 studies progressed to data extraction. Six interventions provided individualised exercise prescription, and only four were delivered by university-level exercise practitioners. Physical activity participation was well reported, however health-related outcomes (i.e., muscular strength and aerobic capacity) were very minimally assessed. Only one intervention utilised modern video conferencing as the primary telehealth communication method. With the minimal assessment of health-related outcomes, there is limited scope to assess the effectiveness of these interventions for postpartum women. Future research interventions need to be reported according to a validated trial reporting system and focus on relevant health related outcomes including postpartum depressive symptoms, quality of life, cardiovascular fitness, muscular strength and body composition.
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.
Importance:
Hypertensive disorders of pregnancy are associated with increased risk of cardiovascular disease, yet few interventions have targeted this population to decrease long-term risk.
Objective:
To determine whether a digital health intervention improves physical activity in postpartum individuals with hypertensive disorders of pregnancy.
Design, setting, and participants:
This 12-week randomized clinical trial enrolled postpartum individuals who delivered at the University of Pennsylvania and had a hypertensive disorder of pregnancy between October 2019 and June 2020. Analysis was intention to treat.
Interventions:
All participants received a wearable activity tracker, established a baseline step count, selected a step goal greater than baseline, and were randomly assigned to control or intervention. Participants in the control arm received daily feedback on goal attainment. Participants in the intervention arm were placed on virtual teams and enrolled in a game with points and levels for daily step goal achievement and informed by principles of behavioral economics.
Main outcomes and measures:
The primary outcome was change in mean daily step count from baseline to 12-week follow-up. Secondary outcome was proportion of participant-days that step goal was achieved.
Results:
A total of 127 participants were randomized (64 in the control group and 63 in the intervention group) and were enrolled a mean of 7.9 weeks post partum. Participants had a mean (SD) age of 32.3 (5.6) years, 70 (55.1%) were Black, and 52 (41.9%) had Medicaid insurance. The mean (SD) baseline step count was similar in the control and intervention arms (6042 [2270] vs 6175 [1920] steps, respectively). After adjustment for baseline steps and calendar month, participants in the intervention arm had a significantly greater increase in mean daily step steps from baseline compared with the control arm (647 steps; 95% CI, 169-1124 steps; P = .009). Compared with the control arm, participants in the intervention arm achieved their steps goals on a greater proportion of participant-days during the intervention period (0.47 vs 0.38; adjusted difference 0.11; 95% CI, 0.04-0.19; P = .003).
Conclusions and relevance:
In this study, a digital health intervention using remote monitoring, gamification, and social incentives among postpartum individuals at elevated cardiovascular risk significantly increased physical activity throughout 12 weeks.
Trial registration:
ClinicalTrials.gov Identifier: NCT03311230.
Issue addressed
Many postpartum women often do not achieve recommendations of at least 150 minutes moderate-to-vigorous physical activity (MVPA) each week. Previous qualitative work has focused on postpartum women’s barriers and challenges to being active, with recent research starting to explore the characteristics of PA programs and women who are active during the postpartum period. As yet, little research has focused on the characteristics of key stakeholders and community organisations that support women to sustain their PA engagement during the postpartum period.
Methods
This research generates practice-based evidence to provide essential insights for effective implementation, strategies and actions of community group-based PA programs that recruit and retain postpartum women to ensure future interventions are scalable and sustainable. Ten participants (90% female), ranging in age from 34 to 40 years, were recruited from nine community organisations/businesses. The ten participants engaged in semi-structured interviews for an average length of 31 minutes.
Results
Inductive thematic analysis revealed four overarching themes (1. effective practitioners have a history of, and passion for women’s health and PA; 2. low-cost, connected approaches attract postpartum women into community group-based PA programs; 3. inclusive, flexible, varied, and holistic approaches sustain postpartum women’s participation; and 4. utilise connections to overcome barriers to community group-based PA programs). These four themes were informed by twelve sub-themes relating to the background of stakeholders and practitioners and the approaches that they use to attract and sustain postpartum women in community group-based PA programs.
Conclusions
Practice-based findings should inform future practices and the development of future real-world group-based PA interventions for postpartum women.
So what?
Specifically, interventions will need to be designed and implemented by practitioners who have a history of, and passion for women’s health and PA, be low-cost, connected approaches, that are inclusive, flexible, varied, and holistic that prioritise physical, emotional, and social wellbeing.
Biases introduced in early-stage studies can lead to inflated early discoveries. The risk of generalizability biases (RGBs) identifies key features of feasibility studies that, when present, lead to reduced impact in a larger trial. This meta-study examined the influence of RGBs in adult obesity interventions. Behavioral interventions with a published feasibility study and a larger scale trial of the same intervention (e.g., pairs) were identified. Each pair was coded for the presence of RGBs. Quantitative outcomes were extracted. Multilevel meta-regression models were used to examine the impact of RGBs on the difference in the effect size (ES, standardized mean difference) from pilot to larger scale trial. A total of 114 pairs, representing 230 studies, were identified. Overall, 75% of the pairs had at least one RGB present. The four most prevalent RGBs were duration (33%), delivery agent (30%), implementation support (23%), and target audience (22%) bias. The largest reductions in the ES were observed in pairs where an RGB was present in the pilot and removed in the larger scale trial (average reduction ES −0.41, range −1.06 to 0.01), compared with pairs without an RGB (average reduction ES −0.15, range −0.18 to −0.14). Eliminating RGBs during early-stage testing may result in improved evidence.
Background
Addiction to opiates and synthetic opioids poses a major threat to public health worldwide, with pharmaceutical opioids prescribed to manage pain constituting the main problem. To counteract this threat, suitable pain management strategies should be implemented in health care. Monitoring pain management seems to be feasible using telemedicine with a certain degree of resource intensity and digitization. As a communication channel for this type of monitoring, SMS appears to be a valid alternative.
Objective
The aim of this systematic literature review was to (1) provide information on the state of research regarding postoperative pain management via SMS, (2) establish a basic understanding of SMS-based pain management, and (3) provide insight into the feasibility of these management strategies. The research question was as follows: Is postoperative pain management feasible and effective utilizing SMS?
MethodsA systematic literature review was performed mainly following the PRISMA guidelines and another guide on performing a systematic literature review for information systems–related research. A search string was developed based on the objectives and research question, and eight databases were searched.
ResultsThe initial search resulted in 2083 records, which could be narrowed down by applying various exclusion criteria. Thereby, 11 articles were identified as relevant, which were accordingly analyzed and evaluated by full-text screening. In all articles, pain management interventions were performed using SMS communication between health care professionals and patients or their legal guardians. A prospective approach was predominantly chosen as the study design (91%) with the leading research objective of determining the intervention’s feasibility (73%). The primary reason for sending SMS messages was to monitor patients (64%). Overall, the use of SMS improved adherence, acceptance, and satisfaction regarding postoperative pain management. With an average response rate of approximately 89.5% (SD 3.8%), the reliability of SMS as a communication and monitoring tool was further emphasized. This response rate is significantly higher than that for email interventions (66.63%, P
This article describes the development of the Parenting Premmies Support Program, a mobile health intervention designed to support mothers during the transitional time following their preterm infant’s discharge from hospital. Examples of how research teams give voice to the target population throughout the development and design of mHealth programs is largely missing from the literature. A detailed description of the steps taken in the development of the mHealth intervention that formed the support program is the intention of this paper. An exploratory, sequential, mixed-methods approach with a three-phase design was conducted. In each phase, the experience and perspectives of mothers of preterm infants were acknowledged and included. Phase one sought women’s accounts of their experience collected in semi-structured interviews (n = 9) and subject to a descriptive content analysis. In the second phase, a collaborative, stakeholder interrogation of issues was conducted to develop content of the mHealth protocol. In this phase, two interdependent procedures were used with two participant panels; a stakeholder panel (n = 10) undertook a series of face-to-face meetings, and a user group panel (n = 18) of women who had birthed a preterm infant up to 12 months before undertook an online Delphi survey. In phase three a pilot implementation of the program was undertaken with women whose preterm infants were being discharged home from hospital. The outcome was an mHealth protocol, a resource designed to support women by giving them information to understand and normalise their experience with their preterm infants, and to help them make decisions which may enhance responsive mothering. Collaborative research integrating user feedback in partnership with experts in the field increases the likelihood the final product will be of value and prove supportive and useful to the target audience.
Telemedicine is an important modality of care delivery in the twenty-first century and has many applications for the obstetric population. Existing research has shown the clinical efficacy and improved patient satisfaction of many telemedicine platforms in obstetrics. Telemedicine has the potential to reduce racial and geographic disparities in pregnancy care, but more research is necessary to inform best practices. Developing cost-effective telemedicine programs and establishing health care policy that standardizes insurance reimbursement are some of the most important steps toward scaling up telemedicine offerings for obstetric patients in the United States.
This phenomenological study explored the lived experiences of pregnant women using VeedaMom, a mobile app created to screen for and manage symptoms of perinatal depression. Participants were required to complete the in-app Edinburgh Postnatal Depression Scale weekly, watch psycho-educational videos featured in the app, and practice mindfulness exercises offered through the app as audio recordings. Individual interviews were conducted with six pregnant women attending a maternal-fetal clinic in South Texas. Three of these participants also took part in a focus group. The findings of this study provide a deeper understanding of pregnant women’s experiences while using the VeedaMom app. Some interesting findings refer to the role social media and social pressure play in their motherhood experience, and how an electronic intervention can help as treatment companion.
Despite the vast number of mobile fitness applications (apps) and their potential advantages in promoting physical activity, many existing apps lack behavior-change features and are not able to maintain behavior change motivation. This paper describes a novel fitness app called CalFit, which implements important behavior-change features like dynamic goal setting and self-monitoring. CalFit uses a reinforcement learning algorithm to generate personalized daily step goals that are challenging but attainable. We conducted the Mobile Student Activity Reinforcement (mSTAR) study with 13 college students to evaluate the efficacy of the CalFit app. The control group (receiving goals of 10,000 steps/day) had a decrease in daily step count of 1,520 (SD ± 740) between baseline and 10-weeks, compared to an increase of 700 (SD ± 830) in the intervention group (receiving personalized step goals). The difference in daily steps between the two groups was 2,220, with a statistically significant p = 0.039.
Introduction
Clear and accurate communication is paramount in delivering high quality surgical care. Through the development of a mobile application, we provided patients with a source of education and instruction throughout the peri-operative period.
Methods
Patients >18 years old with a smart-phone undergoing elective general surgery procedures were eligible. Patients received perioperative educational materials and text message reminders of time-sensitive events via the application. A System Usability Scale and survey was administered.
Results
100 patients were enrolled; 51% completed the survey. The average SUS score was 86, correlating with >90th percentile usability. 86% of patients felt that the application improved their surgical experience, 96% said the application provided essential reminders, and 90% felt that application clarified information. 84% of patients did not identify any inconsistency between the application and surgeon.
Conclusion
Utilizing patient's smart phones to aid in perioperative education is feasible and improves patient satisfaction. This application has a high usability score, indicating ease of use.
Purpose:
Understanding theoretically derived social and behavioral mediators of long-term increases in physical activity (PA) in a vulnerable population at risk for being underactive is needed to inform future research, clinical applications, and public health efforts. This is an analysis of potential mediators of an intervention that increased long-term (12-month) moderate-to-vigorous physical activity (MVPA) in postpartum (2-12months) women in a randomized trial, using a longitudinal analysis.
Methods:
Healthy, underactive (i.e., not meeting national guidelines for MVPA) women (n = 311; mean age = 32 ± 5.6 years, 85% minorities) with infants (mean age: 5.7 ± 2.8 months) were randomly assigned to either a tailored eHealth condition consisting of personalized telephone counseling plus access to a website tailored to new mothers' MVPA issues or to a standard MVPA materials-only website. MVPA was assessed via surveys completed at baseline, then 6 and 12 months later. Theoretically derived mediators included social support for MVPA, self-efficacy to increase MVPA, barriers to increasing MVPA, and benefits of increasing MVPA.
Results:
All mediators, except benefits, improved over the 12 months in the tailored eHealth condition. The tailored condition's effect on increasing MVPA from 6 months to 12 months was mediated by an increase in social support from baseline to six months. No other hypothesized mediators were significant.
Conclusion:
Our results demonstrated that learning strategies to increase social support for MVPA was instrumental in new mothers' increase in MVPA over a 12 month intervention. During this brief but impactful life-stage, where the focus can understandably be on her baby, being able to elicit support from friends and family may facilitate women's efforts to focus on their own needs with respect to MVPA.
Trial registration:
ClinicalTrials.gov number.
Context:
Despite clear health benefits, many individuals fail to achieve the recommended levels of physical activity. Text message interventions to promote physical activity hold promise owing to the ubiquity of cell phones and the low expense of text message delivery.
Evidence acquisition:
A systematic review and meta-analysis were performed to examine the impact of text message interventions on physical activity. Searches of PubMed, PsycINFO, Scopus, Cochrane, and ClinicalTrials.gov databases from inception to December 2017 were performed to identify studies investigating one-way text message interventionss to promote physical activity. A subset of RCTs, including an objective (accelerometer-based) physical activity outcome, were included in random-effects meta-analyses in 2018.
Evidence synthesis:
The systematic search revealed 944 articles. Of these, 59 were included in the systematic review (12 1-arm trials and 47 controlled trials; n=8,742; mean age, 42.2 years; 56.2% female). In meta-analyses of 13 studies (n=1,346), text message interventionss led to significantly greater objectively measured postintervention steps/day (Cohen's d=0.38, 95% CI=0.19, 0.58, n=10 studies). Analysis of postintervention moderate-to-vigorous physical activity found a similar but not statistically significant effect (Cohen's d=0.31, 95% CI= -0.01, 0.63, n=5 studies). Interventions with more components, tailored content, and interventions in medical populations led to nonsignificantly larger effect sizes compared with text message interventions without these features.
Conclusions:
Text message interventions lead to higher objectively measured postintervention physical activity compared with control groups. More extensive, well-controlled studies are needed to examine this relationship further and identify characteristics of effective text message interventions.
Objectives: To establish which Social Cognitive Theory constructs mediated effects of the MobileMums (MMP) program on increased duration and frequency of moderate-vigorous physical activity (MVPA) in women with young children (<5 years). Methods: This secondary data analysis is from a community-based randomised controlled trial. Over 12 weeks, intervention participants received a minimum of 52 individually tailored text messages, one face-to-face and one telephone-delivered session with a trained behavioural counsellor. Participants identified a support person who also received 12 weeks of individually tailored text messages. Control participants received minimal intervention contact. Data were collected pre- and post-program. Five potential mediators were assessed: barrier self-efficacy, goal setting skills, outcome expectancies, perceived environmental opportunity for physical activity and social support for physical activity. Results: Improvements in MVPA frequency were mediated by improvements in barrier self-efficacy, goal setting skills, outcome expectancies and perceived social support. Improvements in MVPA duration resulting from the MMP were mediated by improvements in women’s barrier self-efficacy and goal setting skills. Conclusions: MMP improved targeted theoretical constructs and this led to changes in women’s MVPA. These findings are valuable for refinement and translation of the MMP and for further research to create theory- and evidence-based physical activity behaviour change programs for women with young children.
Purpose:
Despite cure, adolescents and young adults (AYA) who complete cancer treatment remain at risk for numerous physical and psychological late effects. However, engagement in recommended follow-up care, knowledge of cancer treatment history and risks, and adoption of health promoting behaviors are often suboptimal. The pilot randomized controlled trial assessed the feasibility and acceptability of a text messaging intervention (THRIVE; Texting Health Resources to Inform, motiVate, and Engage) designed to promote well-being, and health knowledge and behaviors.
Methods:
Sixty-one AYA who recently completed cancer therapy enrolled and were randomized to receive THRIVE (n=31) or an AYA survivor handbook (n=30). Participants from both groups completed baseline measures and follow-up surveys 16 weeks later. AYA randomized to THRIVE received 1-2 health-related text messages per day over 16 weeks.
Results:
THRIVE demonstrated a high level of acceptability and feasibility. Exploratory analyses highlighted promising improvements in knowledge, fruit/vegetable intake, and perceptions of health vulnerability.
Conclusions:
Text messaging is an acceptable and feasible intervention approach for improving well-being and health of AYA survivors. Future research is needed to test the impact of text messaging in a larger trial, including whether or not such an intervention can improve clinical outcomes, such as survivors' engagement in follow-up care.
Background
Behavioral treatment strategies improve adherence to lifestyle intervention for adults with obesity, but can be time and resource intensive when delivered via traditional face-to-face care. This study aimed to investigate the efficacy and optimal timing of using telephone calls and text message as adjunctive tools to support a community-based obesity management program.
Method
This 8-month randomized controlled crossover trial recruited 61 adults with class III obesity (BMI > 40 kg/m²) enrolled in a publicly funded obesity management service (OMS). Participants were randomly assigned to receive telephone and text message support in addition to standard OMS care, or standard OMS care alone. After 4 months, participants crossed over to the alternative sequence. The technological support was based on self-determination theory. Outcome measures included diet, physical activity, anthropometry, self-efficacy, and treatment self-regulation.
Results
Telephone and text message support improved lifestyle intervention adherence and clinical outcomes when compared with standard care. Participants who received the intervention in the first 4-month period lost 4.87 kg, compared with no weight loss (+ 0.38 kg) in the standard care only group. There was no evidence to indicate an optimal timing of the intervention, with both groups achieving significant results by the end of the intervention.
Conclusion
These results suggest a high degree of promise for the incorporation of telephone and text message support into community-based obesity management services. The findings have the potential to improve existing practices and reduce the burden on the health care system by demonstrating a resource-effective improvement to obesity management service delivery.
Engaging in physical activity and breastfeeding are 2 of the healthiest behaviors a new mother can participate in, yet a majority of mothers are not achieving physical activity or breastfeeding recommendations. Breastfeeding mothers may experience additional barriers to physical activity; however, more research is needed. Therefore, the purpose of this cross-sectional study was to determine the physical activity levels of breastfeeding women as well as to better understand their motivation and barriers for engaging in physical activity. A total of 633 breastfeeding mothers completed a 30-question survey developed under the constructs of self-determination theory. Findings indicate the majority of breastfeeding mothers are engaging in light activity (eg, walking) regularly; nevertheless, 1 in 5 mothers is predominantly sedentary and only 1 in 20 mothers is engaging in heavy exercise (eg, running) regularly. Furthermore, mothers appear motivated by extrinsic factors related to improving fitness and appearance. Finally, physical discomfort due to breastfeeding and concerns for reduction in milk supply were found to be substantial barriers to physical activity. These findings suggest breastfeeding women may need additional support for engaging in physical activity and further education and resource development is needed.
Using data from a supplement to the 1995 National Health Interview Survey, this article examines the relationship among three major work and family roles—marriage, parenthood, and employment—and time spent on exercise among American men and women ages 18 to 64 (N = 13,496). As the time availability perspective suggests, work and family roles curtail time for exercise. Married adults spend less time on exercising than unmarried adults. Although the number of children is not related to time spent on exercising, having children under age 5 is negatively associated with exercising. Long hours of employment are also related to less time spent on exercising, although the effect is small. Across the board, women spend less time on exercising than men, but the negative association of work and family roles, especially the role of spouse, with time for exercise is greater for men than for women.
This article provides a critical analysis of the growing use of social marketing in the field of health promotion. In response
to a recent article by A. Hastings and G. Haywood (Health Promotion International, 6, 135–134), three questions are asked about each of the proposed tenets of social marketing: are these ideas new? are they
more effective than current health promotion practices? and do they raise any particular ethical concerns? On each of these
counts, the analysis suggests that the purported benefits of social marketing might not be as great as proponents claim. There
are also some problematic unintended consequences that arise from the use of social marketing methods. The narrow focus on
individual behavior change and the potentially manipulative techniques for inducing behavior change are of particular concern.
The paper concludes with a call for further discussion about the limits and potential iatrogenic side-effects of using social
marketing strategies for health promotion.
The continued rise in obesity rates in most countries suggests that current programs and initiatives designed to combat obesity have not been successful in reversing the obesity epidemic. Obesity rates are increasing because of a gradual weight gain in most populations. There has been little long-term success in treating established obesity through lifestyle change, perhaps because of the large permanent changes in diet and physical activity required to keep weight off. An alternative strategy to address the obesity epidemic involves not focusing on weight loss but promoting small changes in diet and physical activity to initially prevent further weight gain. With the use of this strategy, obesity rates could first be stabilized in most populations and then, over time, decrease gradually. Supporting data show that small reductions in conscious energy intake and increases in physical activity can reduce excessive weight gain. The opportunity exists to use the small-changes approach to bring different stakeholders together to create a national initiative to address the global epidemic of obesity. The Joint Task Force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council believe that a small-changes framework, aimed at helping people make conscious small changes in lifestyle behaviors, in combination with efforts by the private sector to gradually "ratchet down" some of the environmental factors that have contributed to excessive energy intake and the declining rates of physical activity, can be successful in reducing obesity rates. Such an initiative would benefit from the support of educational and social marketing campaigns developed with governmental input and support.
Beneficial Effects of Physical Activity: The Panel concludes that a large body of evidence supports the contention that physical activity produces a number of major health benefits. Regular physical activity is associated with a reduction in all-cause mortality, fatal and nonfatal total cardiovascular disease, and coronary heart disease. It is also associated with a reduction in the incidence of obesity and type 2 diabetes mellitus, and an improvement in the metabolic control of individuals with established type 2 diabetes. Furthermore, physical activity is associated with a reduction in the incidence of colon cancer and osteoporosis. Further benefits of regular physical activity include improved physical function and independent living in the elderly. Individuals with high levels of physical activity are less likely than those with lower levels to develop depressive illness. Moreover in those with mild-to-moderate depression and anxiety, prescribed physical activity is associated with an improvement in symptoms. The Panel also recognizes the favorable impact of physical activity on several cardiovascular risk factors, including a reduction in blood pressure, improvement in the plasma lipid profile, and alterations in coagulation and hemostatic factors. Dose-Response Relationship of Physical Activity to Health Outcomes: There is an inverse and generally linear relationships for the rates of all-cause mortality, total CVD, and coronary heart disease incidence and for the incidence of type 2 diabetes mellitus. It is more difficult to determine a dose-response relationship for other health outcomes. Ther are several reasons for this diffulty: 1) the absence of studies defining a dose-responce; 2)lack of field methods sensitive and acurate enough to determine the dose of physical activity on some outcomes; 4) uncontrolled confounding factiors such as genetic variability; and 5) simultaneous changes in body weight and composition that accompanies physical activity. The Panel suggests that where a dose-response relationship cannot be proven, it may be sufficient to discover a level of physical activity for fitness that results in a beneficial effect. The greater the intensity and volume of exercise, the greater the risk of injury and harm, especially muskculoskeletal for most individuals and cardiovascular for those with underlying disease. When attempting to establish an optimal dose of physical activity for health, intensity is especially induced medical complications. The Panel suggests that, when assessing dose-response, consideration be given not only to that dose that indues the greatest health benefit but also to the potential risk in a particular population. Research Recommendations: Although the field of physical activity is rich in high-quality observation data and studies of physiology, there are a limited number of RCT on the quantitative effect or dose relationship of physical activity and health outcomes. If the results of RCT on the benefits of physical activity are to be convincing, they must be based on precise and reproducible methodology. To better evaluate the dose-response relationship, attention needs to be paid to the following: Study design: 1) development of a gold standard for precise field measurement of physical activity; 2) evaluation of the health effects of multiple levels of physical activity, volume, intensity, and fitness; 3) application of innovative statistical procedures; 4) asessment of potential adverse effects of physical activity; and 5) study polulations being representative of all ages, both sexes, ethnic groups, and those with a variety of health states. Study evaluation: 1) strict adherence to regimens of physical activity in future studies must be promoted and carefully monitored; 2) importance of defining a minimum effective dose of physical activity for health benefit and attention being paid to any additional benefits that accrue from increased levels of activity; and 3) in the design and analysis of future studies, attention to the newly recognized interindividual variability in the response to physical activity and its genetic basis. Consideration should be given to the development of large, multicenter randomized controlled trials on the effect of multiple levels and patterns of physical activity on a range of health outcomes and risks. The Panel recognizes the challenge that would be presented by such studies but observes that such studies have been done and are underway for other important preventive and therapeutic interventions. If the full benefits of current and future knowledge about the benefits of physical activity are to be realized, substantial and sustained effeort will be needed to ensure the practical application of this knowledge into clinical settings and for entire populations.
To assess the impact of a national campaign on awareness of the campaign, change in knowledge of physical activity recommendations and self reported physical activity.
three year prospective longitudinal survey using a multi-stage, cluster random probability design to select participants.
England.
A nationally representative sample of 3189 adults aged 16-74 years.
Awareness of the advertising element of the campaign, changes in knowledge of physical activity recommendations for health and self reported physical activity.
38% of participants were aware of the main advertising images, assessed six to eight months after the main television advertisement. The proportion of participants knowledgeable about moderate physical activity recommendations increased by 3.0% (95% CI: 1.4%, 4.5%) between waves 1 and 2 and 3.7% (95% CI: 2.1%, 5.3%) between waves 1 and 3. The change in proportion of active people between baseline and waves 1 and 2 was -0.02 (95% CI: -2.0 to +1.7) and between waves 1 and 3 was -9.8 (-7.9 to -11.7).
The proportion of participants who were knowledgeable about the new recommendations, increased significantly after the campaign. There was however, no significant difference in knowledge by awareness of the main campaign advertisement. There is no evidence that ACTIVE for LIFE improved physical activity, either overall or in any subgroup.
Epidemiological studies suggest that childbearing may contribute to the development of obesity. In the past 12 years, several cross-sectional and randomized trials have addressed the effect of postpartum exercise on weight loss and/or energy balance in mostly lactating women. These studies suggest that moderate exercise without specific calorie restriction does not promote greater weight or fat loss. This may be because exercise may promote greater energy intake and/or reduced energy expenditure from nonexercise physical activity (thus preventing negative energy balance), but further research is needed. Regular exercise, however, is likely to have other important health benefits after childbirth. A few published studies suggest that postpartum exercise improves aerobic fitness, high-density lipoprotein-cholesterol levels, and insulin sensitivity. Exercise may also enhance psychological well-being, but controlled clinical studies are needed. Although two published studies have addressed whether exercise training attenuates lactation-induced bone loss, better controlled studies are needed to determine whether postpartum weight-bearing exercise can improve bone mineral density in lactating and nonlactating women alike. In lactating women, several studies have collectively determined that neither acute nor regular exercise has adverse effects on a mother's ability to successfully breast-feed. It needs to be determined whether a woman's participation in regular exercise after childbirth will improve her ability to mother or instill lifetime habits of regular physical activity in either herself or her offspring. Overall, published studies have established the importance of regular exercise during the postpartum period. More research, however, is needed in this important area.
Physical inactivity is associated with increased risk of mortality and chronic diseases, yet trend information is lacking in most countries. This investigation examines physical activity levels of Canadian adults aged 18 years and older.
Data were collected in six national surveys between 1981 and 2000. Sample sizes ranged from 2,500 to 18,000. Prevalences were tested using Chi-square and Student's t-tests. Socio-demographic correlates were examined using odds ratios adjusted for age, sex, education and income.
Physical activity increased in the 1980s and 1990s among men and women and for all age, education and income groups (p<0.01). Although education differentials narrowed over the period, age differentials widened and income differentials emerged.
The positive trend in Canada is consistent with Finland, but contrary to recent trends for Australia, England and the United States. Despite increases, sedentary living remains a public health issue particularly among women, older adults and lower income groups.
Background:
We compared the responsiveness to change (prepost intervention) of 3 commonly-used self-report measures of physical activity.
Methods:
In a cluster-randomized trial of a telephone-delivered intervention with primary care patients, physical activity was assessed at baseline and 4 months (n = 381) using the 31-item CHAMPS questionnaire; the 6-item Active Australia Questionnaire (AAQ); and, 2 walking for exercise items from the US National Health Interview Survey (USNHIS). Responsiveness to change was calculated for frequency (sessions/week) and duration (MET·minutes/week) of walking and moderate-to-vigorous intensity physical activity.
Results:
The greatest responsiveness for walking frequency was found with the USNHIS (0.45, 95% CI: 0.19, 0.72) and AAQ (0.43, 95% CI: 0.19, 0.67), and for walking duration with the USNHIS (0.27, 95%CI 0.13, 0.41) and CHAMPS (0.24, 95% CI: 0.12, 0.36). For moderate-to-vigorous activity, responsiveness for frequency was slightly higher for the AAQ (0.50, 95% CI: 0.30, 0.69); for duration it was slightly higher for CHAMPS (0.32, 95% CI: 0.17, 0.47).
Conclusions:
In broad-reach trials, brief self-report measures (USNHIS and AAQ) are useful for their comparability to population physical activity estimates and low respondent burden. These measures can be used without a loss in responsiveness to change relative to a more detailed self-report measure (CHAMPS).
This study uses time diary and telephone survey data from a nonrandom sample of 310 US public, elementary school teachers in 46 schools and four school districts to analyze the sources of time for employed parents to devote to their children in the US. Comparing parent and nonparent teachers for a 24-hour working day reveals that American parents spend significantly less time on work, personal time, passive leisure, and exercise, and significantly more time on child care and housework. Even so, the parent workday is far longer than the employment contract stipulates. Mild evidence suggests that supportive supervisors, shorter contractual hours, and low levels of student poverty are linked to increased parental time for children among the teachers. Evidence is found for a time transfer of work from parents to nonparents in schools with higher proportions of women teachers. Less direct evidence suggests this time transfer is voluntary.
Background: For research on physical activity interventions to progress systematically, the mechanisms of action must be studied. In doing so, the research methods and their associated concepts and terminology become more complex. It is particularly important to clearly distinguish among determinants, correlates, mediators, moderators, and confounder variables used in physical activity research. This article examines the factors that are correlated with and that may have a causal relationship to physical activity.Methods and Results: We propose that the term “correlate” be used, instead of “determinant,” to describe statistical associations or correlations between measured variables and physical activity. Studies of the correlates of physical activity are reviewed. The findings of these studies can help to critique existing theories of health behavior change and can provide hypotheses to be tested in intervention studies from which it is possible to draw causal inferences. Mediator, moderator, and confounder variables can act to influence measured changes in physical activity. Intervening causal variables that are necessary to complete a cause-effect pathway between an intervention and physical activity are termed “mediators.” The relationship between an intervention and physical activity behaviors may vary for different groups; the strata by which they vary are levels of “moderators” of the relationship. Other factors may distort or affect the observed relationships between program exposure and physical activity, and are known as “confounders.”Conclusions: Consistent use of terms and additional research on mediators and moderators of intervention effects will improve our ability to understand and influence physical activity.
Fidelity refers to the demonstration that an experimental manipulation is conducted as planned. In outcome research, an intervention can be said to satisfy fidelity requirements if it can be shown that each of its components is delivered in a comparable manner to all participants and is true to the theory and goals underlying the research. Demonstrating the fidelity of an intervention is a key methodologic requirement of any sound prevention trial. This paper summarizes key conceptual and methodologic issues associated with intervention fidelity, and describes the steps taken to promote fidelity in EARLY ALLIANCE, a large-scale prevention trial currently testing the effectiveness of family, peer, and school interventions to promote competence and reduce risk for conduct disorder, substance abuse, and school failure. The paper presents preliminary results (Trial Year 1) that demonstrate content and process fidelity for two of these interventions, and discusses how the EARLY ALLIANCE methodology may be generalized to address fidelity issues in other prevention studies.
Forty-four pregnant women participated in water aerobics 2 times per week for a period of 6 weeks, with each session lasting approximately 45 min. The hypothesis that participants would report greater feelings of positive well-being and less psychological distress and fatigue during the 6-week program as compared to preprogram reports was supported. Also supporting our hypothesis, similar improvements were noted following a single bout of exercise during each week of the program. Taken together, the results of the present study suggest that regular engagement in an aquatic exercise program is associated with improvements in positive feeling states and reductions in negative feeling states and fatigue for women during pregnancy.
(1) Hydrotherapy is an effective, alternative intervention that can be used by care providers to provide a nonpharmacological method to assist low risk, laboring women cope with labor. This article provides a synthesis of the state of the science on the effects of hydrotherapy with labor and delivery. The indications, physiologic mechanism, benefits, practice implications, and needed research are discussed. The data-based articles support numerous benefits such as increased relaxation, increased satisfaction, lower blood pressure, and increased diuresis with women who bathe during labor. These studies found that there was no difference in maternal and neonatal morbidity such as infections between bathers and nonbathers. Additionally, there was no difference in maternal and neonatal infection rates between women with intact or ruptured membranes. The use of hydrotherapy during established labor increases cervical dilation while bathing although there is no difference in the total length of labor between bathers and nonbathers. Researchers conclude that hydrotherapy is a safe, nonpharmacological alternative for women to use during labor and delivery.
The purpose of the research project was to examine the effects of exercise, social support and depression on postnatal women who reported experiencing postnatal depression. A 12-week randomized, controlled trial was conducted investigating the effects of an exercise intervention group (a pram-walking programme for mothers and their babies ) compared to a social support group (non-structured sessions, similar to a playgroup). Participants in both groups had given birth in the past 12 months. Pretest data of physical fitness and structured questionnaires were compared to post-test effects. The primary outcomes were to reduce the depressive symptomatology and improve fitness levels of participants in the pram-walking group. Secondary outcomes were to improve the social support levels of the participants in both groups and explore women's views about the programmes. It was hypothesized that the pram-walking group participants would improve their feelings of depression and fitness levels compared to the social support group, but that both groups would improve their perceived levels of social support. The results showed that mothers in the pram-walking intervention group improved their fitness levels and reduced their level of depressive symptomatology significantly more than the social support group. There were no significant changes to social support levels for both groups. Therefore, a direct association between improvement in fitness was related to improvement in depression for the pram-walking group. However, it is also suggested that other factors in combination with improvements in fitness influenced improvements in depression levels. It is recommended that pram-walking programmes for mothers with postnatal depression be implemented as pilot research into existing available services.
1) The mechanisms that underlie successful initiation and adherence to physical activity regimens are not well understood. Few theoretical models have used consistent explanatory variables that are theory‐driven and many findings that use extant models are equivocal. Social Cognitive Theory (SCT) as presented by Bandura (1986 [4], 1997 [5]) appears to have strong promise as a guide to understanding physical activity behaviors and developing clinically relevant interventions to promote the initiation and maintenance of physical activity. This critical systematic review of research using SCT was completed to determine the predictive ability of model constructs in explaining physical activity behavior and in identifying key intervention components found to enhance physical activity initiation and maintenance. Following review for quality and adequacy, published research during the years 1990‐1998 contained 27 studies that examined the relationship between the construct of SCT, self‐efficacy, and physical activity. All of the descriptive studies found a statistically significant relationship between self‐efficacy and exercise behavior. Intervention studies demonstrated that participation in an exercise program promoted self‐efficacy, and that programs designed to increase outcome expectations and self‐efficacy significantly increased exercise behavior.
(2) Due to the centrality of self‐efficacy in many of the social psychological theories that help explain the attitude‐intention‐behavior triad, a strong need remains to design interventions to maximize its usefulness. Clear, generalizable, systematic and theoretically comprehensive, randomized, controlled studies are needed to understand the usefulness of the construct.
The health benefits of physical activity are well documented, but mothers of young children experience significant barriers
to exercise. A 10-week minimal-intervention exercise program, involving a weekly meeting at which child care was provided,
and guidance in establishing independent exercise was developed on the basis of previous research with this population group.
Thirty-two women with children under age 5, and in the contemplation or preparation stages of exercise behavior change, were
recruited from Australian play groups. Postprogram measures showed small but significant decreases in body mass index, resting
heart rate, and diastolic blood pressure. Three months later, 41% of participants were still active. Family-related constraints
were highly disruptive to these participants. This study is limited by its small sample size, lack of controls, and potential
biases in recruitment and assessment, but it does suggest that hard-to-reach groups, such as mothers of young children, may
be mobilized to exercise if programs explicitly address social contexts and the constraints on individual choice.
Objective:
To evaluate the use of a local neighborhood environment-focused physical activity website and its effects on walking and overall physical activity in middle-aged adults.
Method:
One-hundred and six (72% women) inactive adults aged 52+/-4.6 years were randomly allocated to receive access to a neighborhood environment-focused website, (Neighborhood group, n=52) or a motivational-information website (Comparison group n=54). Participants also received eleven emails over the 26 weeks. Study outcomes were objectively-monitored website use, and self-reported total walking (min/wk), total physical activity (min/wk) and neighborhood walking (min/wk) collected at baseline, 12 and 26 weeks. The study was conducted between August 2005 and February 2006 in Brisbane, Australia.
Results:
Website use was significantly greater among Neighborhood participants (p=0.01). Statistically significant increases in walking and total physical activity were observed in both groups. There was also a statistically significant interaction effect for total physical activity, with Neighborhood group participants maintaining more of their initial increase in physical activity at week-26 (p<0.05). Further, those in the Neighborhood group who used the website more often reported significantly more walking along the community trail at week-26 (p=0.05) compared with those who did not.
Conclusions:
A local neighborhood-environment focused physical activity website was more effective at engaging participants than a motivational-information website. Moreover, its use resulted in meaningful increases in physical activity relative to the comparison website.
Results from a national representative telephone survey of Americans in 2000 show that Internet and mobile phone usage was very similar, and that several digital divides exist with respect to both Internet and mobile phone usage. The study identifies and analyzes three kinds of digital divides for both the Internet and mobile phones—users/nonuser, veteran/recent, and continuing/dropout—and similarities and differences among those digital divides based on demographic variables. The gap between Internet users and nonusers is associated with income and age, but no longer with gender and race, once other variables are controlled. The gap between mobile phone users and nonusers is associated with income, work status, and marital status. The veteran/recent Internet gap is predicted by income, age, education, phone user, membership in community religious organizations, having children, and gender; for mobile phones, age, work status and marital status are predictors. The gap between continuing and dropout users is predicted by education for Internet usage and income for mobile phone usage. Finally, cross-categorization of Internet and mobile phone usage/nonusage is distinguished (significantly though weakly) primarily by income and education. Thus, there are several digital divides, each predicted by somewhat different variables; and while Internet and mobile phone usage levels in 2000 were about the same, their users overlap but do not constitute completely equivalent populations.
To describe the prevalence of maternal physical and emotional health problems six to seven months after birth.
Statewide postal survey, incorporating the Edinburgh Postnatal Depression Scale, distributed to women six to seven months after childbirth.
All women who gave birth in a two-week period in Victoria, Australia in September 1993 except those who had a stillbirth or known neonatal death.
The response rate was 62.5% (n = 1336). Respondents were representative of the total sample in terms of mode of delivery, parity and infant birthweight; young women, single women and women of nonEnglish speaking background were under-represented. One or more health problems in the first six postnatal months were reported by 94% of the women; a quarter had not talked to a health professional about their own health since the birth. Of women reporting health problems, 49% would have liked more help or advice. The most common health problems were tiredness (69%), backache (43.5%), sexual problems (26.3%), haemorrhoids (24.6%) and perineal pain (21%); 16.9% of women scored as depressed. Compared with spontaneous vaginal births, women having forceps or ventouse extraction had increased odds for perineal pain (OR 4.69 [95% CI 3.2-6.8]), sexual problems (OR 2.06 [95% CI 1.4-3.0]), and urinary incontinence (OR 1.81 [95% CI 1.1-2.9]). These differences remained significant after adjusting for infant birthweight, length of labour and degree of perineal trauma.
Physical and emotional health problems are common after childbirth, and are frequently not reported to health professionals despite the fact that many women would like more advice and assistance in dealing with them.
We compared the responsiveness to change (prepost intervention) of 3 commonly-used self-report measures of physical activity.
In a cluster-randomized trial of a telephone-delivered intervention with primary care patients, physical activity was assessed at baseline and 4 months (n = 381) using the 31-item CHAMPS questionnaire; the 6-item Active Australia Questionnaire (AAQ); and, 2 walking for exercise items from the US National Health Interview Survey (USNHIS). Responsiveness to change was calculated for frequency (sessions/week) and duration (MET x minutes/week) of walking and moderate-to-vigorous intensity physical activity.
The greatest responsiveness for walking frequency was found with the USNHIS (0.45, 95% CI: 0.19, 0.72) and AAQ (0.43, 95% CI: 0.19, 0.67), and for walking duration with the USNHIS (0.27, 95% CI 0.13, 0.41) and CHAMPS (0.24, 95% CI: 0.12, 0.36). For moderate-to-vigorous activity, responsiveness for frequency was slightly higher for the AAQ (0.50, 95% CI: 0.30, 0.69); for duration it was slightly higher for CHAMPS (0.32, 95% CI: 0.17, 0.47).
In broad-reach trials, brief self-report measures (USNHIS and AAQ) are useful for their comparability to population physical activity estimates and low respondent burden. These measures can be used without a loss in responsiveness to change relative to a more detailed self-report measure (CHAMPS).
The Australian Women's Activity Survey (AWAS) was developed based on a systematic review and qualitative research on how to measure activity patterns of women with young children (WYC). AWAS assesses activity performed across five domains (planned activities, employment, child care, domestic responsibilities, and transport) and intensity levels (sitting, light intensity, brisk walking, moderate intensity, and vigorous intensity) in a typical week in the past month. The purpose of this study was to assess the test-retest reliability and criterion validity of the AWAS.
WYC completed the AWAS on two occasions 7 d apart (test-retest reliability protocol) and/or wore a Manufacturing Technology Inc. (MTI) ActiGraph accelerometer for 7 d in between (validity protocol). Forty WYC (mean age 35 +/- 5 yr) completed the test-retest reliability protocol and 75 WYC (mean age 33 +/- 5 yr) completed the validity protocol. Interclass correlation coefficients (ICC) between AWAS administrations and Spearman's correlation coefficients (rs) between AWAS and MTI data were calculated.
AWAS showed good test-retest reliability (ICC = 0.80 (0.65-0.89)) and acceptable criterion validity (rs = 0.28, P = 0.01) for measuring weekly health-enhancing physical activity. AWAS also provided repeatable and valid estimates of sitting time (test-retest reliability, ICC = 0.42 (0.13-0.64); criterion validity, rs = 0.32, (P = 0.006)).
The measurement properties of the AWAS are comparable to those reported for existing self-report measures of physical activity. However, AWAS offers a more comprehensive and flexible alternative for accurately assessing different domains and intensities of activity relevant to WYC. Future research should investigate whether the AWAS is a suitable measure of intervention efficacy by examining its sensitivity to change.
This study uses time diary and telephone survey data from a nonrandom sample of 310 US public, elementary school teachers in 46 schools and four school districts to analyze the sources of time for employed parents to devote to their children in the US. Comparing parent and nonparent teachers for a 24-hour working day reveals that American parents spend significantly less time on work, personal time, passive leisure, and exercise, and significantly more time on child care and housework. Even so, the parent workday is far longer than the employment contract stipulates. Mild evidence suggests that supportive supervisors, shorter contractual hours, and low levels of student poverty are linked to increased parental time for children among the teachers. Evidence is found for a time transfer of work from parents to nonparents in schools with higher proportions of women teachers. Less direct evidence suggests this time transfer is voluntary.
The expansion and adoption of new methods of communication provide new opportunities for delivering health behavior change interventions. This paper reviews the current research examining mobile telephone short-message service (SMS) for delivering health behavior change interventions via text messages. This service has wide population reach, can be individually tailored, and allows instant delivery with asynchronous receipt, suggesting potential as a delivery channel for health behavior interventions.
An electronic database search was conducted for studies published between January 1990 and March 2008. Studies were included in the review if they (1) evaluated an intervention delivered primarily via SMS, (2) assessed change in health behavior using pre-post assessment, and (3) were published in English in a peer-reviewed scientific journal.
Of 33 studies identified, 14 met the inclusion criteria. Four of the 14 studies reviewed targeted preventive health behaviors (e.g., smoking cessation), and ten focused on clinical care (e.g., diabetes self-management). Positive behavior change outcomes were observed in 13 of the 14 reviewed studies. Intervention initiation (researcher or participant), SMS dialogue initiation, tailoring of SMS content, and interactivity were found to be important features of SMS-delivered interventions. Methodologic issues with current SMS research were also identified.
This review suggests that SMS-delivered interventions have positive short-term behavioral outcomes. Further research is required to evaluate interventions for preventive health behaviors that incorporate features found to affect behavioral outcomes and participant acceptance. The quality of studies in this emerging field of research needs to improve to allow the full potential of this medium to be explored.
How women's social roles such as parenthood, marital status and employment status affect their exercise participation, is important for the rational planning of suitable and effective exercise programs for women in different social contexts. A secondary analysis of a large data-base of urban women aged 20-49 (n = 5939) was carried out to determine if social roles, their characteristics and their combinations were related to women's exercise participation. Parenthood and marital status were significantly related to whether women exercise, and among those exercising, all three roles were significantly related to the amount of exercise. Statistical modelling, including all three roles and their interactions, controlling for age and education, showed that with respect to whether women exercise, parenthood affected exercise participation most and that its effect was dependent on age. Of the role characteristics only the number of children and overall satisfaction with daily activities improved the prediction of exercising. With respect to how much women exercise, the effect of parenthood interacted with marital status. Married parents were least likely to exercise very much. Of the role characteristics only overall satisfaction with daily activities improved the prediction of the amount of exercise.
'The Stockholm Pregnancy and Weight Development Study' was conducted to identify risk factors for postpartum weight retention, such as dietary habits, physical activity and socio-demographic factors. The body weight development of 1423 pregnant women was studied prospectively from the beginning of the pregnancy until 1 year postpartum. Data were collected from routine pregnancy records and from questionnaires 6 and 12 months postpartum. Mean weight retention 1 year postpartum was 0.5 kg compared with the prepregnancy body weight. A 'trend method' was constructed to identify a number of pre-defined major patterns of behaviour. The weight retention 1 year postpartum was greater in women who (a) increased their energy intake during and after pregnancy, (b) increased their snack eating after pregnancy to three or more snacks/d, and (c) decreased their lunch frequency starting during or after the pregnancy. Women who had retained > or = 5 kg 1 year postpartum were more seldom physically active in their leisure time throughout the study period compared with women with a smaller weight gain. Postpartum weight retention correlated negatively with the degree of physical activity in the second half year postpartum. These results indicate that postpartum weight retention is more affected by a change in lifestyle during, and above all after, pregnancy than by factors before pregnancy.
National policy for increasing leisure physical activity in the United States is impeded by a poor understanding of interventions that can be implemented by community and clinical medicine. To clarify the literature in this area, we conducted a quantitative, meta analysis of 127 studies that examined the efficacy of interventions for increasing physical activity among approximately 131,000 subjects in community, worksite, school, home, and health care settings; 445 effects were expressed as a Pearson correlation coefficient (r) and examined as they varied according to moderating variables important for community and clinical intervention. The mean effect was moderately large, r = 0.34, approximating three-fourths of a standard deviation or an increase in binomial success rate from 50% to 67%. The estimated population effect weighted by sample size was larger, r = 0.75, approximating 2 standard deviations or increased success to 88%. Contrasts between levels of independent moderating variables indicated that effects weighted by sample size were larger when the interventions: 1) employed the principles of behavior modification, 2) used a mediated delivery, 3) targeted groups, 4) of combined ages, 5) sampled apparently healthy people, or 6) measured active leisure, of 7) low intensity, 8) by observation. Independently of sample size, effects were larger when interventions 1) used behavior modification, 2) employed a preor quasi-experimental design, or 3) were of short duration, regardless of features of the people, setting, or physical activity. Our results show that physical activity can be increased by intervention. The optimal ways for selecting intervention components, settings, and population segments to maintain increases in physical activity and the relative contributions by community and clinical medicine toward successful physical activity intervention require experimental confirmation, warranting accelerated attention in clinical trials.
This study examines the utility of three theoretical models--the stages of change model, self-efficacy theory, and the decisional balance model--in understanding exercise behavior among employed women.
Data for this cross-sectional study were collected as part of a routine follow-up of a worksite-based smoking and health risk appraisal study.
The study was conducted in three Rhode Island worksites, including one manufacturing company, one medical center, and one retail outlet.
Of a sample of 431 women who completed exercise questionnaires, 293 reported participation in a physical activity over the previous week. The average age of the sample was 41.1 years, and mean years of education was 12.8.
Previously validated measures to determine stage of exercise behavior, exercise self-efficacy, exercise decisional balance, and physical activity participation were administered. Additional demographic information was also obtained.
Frequency counts revealed that 39% of the population was sedentary, 34% were participating in irregular activity, and 27% were active. MANOVAs followed by one way ANOVAs revealed that women in Precontemplation scored the lowest and those in Maintenance scored the highest on the self-efficacy, pro, and decisional-balance indices, with the trend reversed on the con scale. A chi-square test revealed that women with one or more young children in the home were more likely to be in a lower stage of exercise adoption.
Most of the women in this cross-sectional study did not engage in regular activity. Presence of young children in the home was significantly related to decreased activity.(ABSTRACT TRUNCATED AT 250 WORDS)
The life course perspective offers a framework for understanding continuity and change in health and health practices. Body weight, and the diet and physical activity strategies used to manage weight in pregnancy and the postpartum period, are a focus of much study because of an association between parity and body weight. The motherhood transition offers an opportunity to study weight concerns and weight management strategies during a period of weight fluctuation that is part of a life transition for many women. Our aim was to develop an in-depth understanding of women's experiences of pregnancy and postpartum weight changes, the strategies that women used to deal with weight changes, and patterns in their attitudes and strategies across pregnancy and the postpartum period. A longitudinal design, using multiple, in-depth, qualitative interviews with 36 women from pregnancy through the postpartum period, was chosen for data collection. Prepregnancy orientations towards body weight emerged as the primary influence on women's pregnancy and postpartum attitudes towards weight, on patterns of physical activity and diet, and on postpartum weight outcomes among most study participants. Four different trajectories ("relaxed maintenance", "exercise", "determined", and "unhurried"), characterized by differences in women's orientations towards their body weight and their diet and physical activity patterns across pregnancy and the postpartum period, emerged from the data. Only a few women diverged from prepregnancy trajectories in weight orientation and diet and physical activity patterns postpartum. Delayed resumption of prepregnancy physical activity and dietary patterns contributed to postpartum weight retention for a subset of "exercisers". Stress and age- or role-related changes in perspective interrupted the continuity of weight orientations and behavioral patterns for three other women. These findings highlight the direction and momentum provided by trajectories in health attitudes and strategies as processes shaping responses to a life transition.
Physical inactivity is a recognized independent risk factor for the development of cardiovascular disease. However, a large proportion of the U.S. population does not participate in regular physical activity, and research has shown that without intervention, most people remain sedentary. Thus, an urgent need exists for developing effective interventions to promote physical-activity adoption and maintenance. Additionally, it is important that these interventions can be disseminated to the large population of sedentary individuals. To be disseminable, physical-activity interventions must move beyond reliance on strictly face-to-face modes and begin to more fully use newer technologies, such as the Internet. This article summarizes the progress made in promoting physical activity with interactive communications. We also delineate areas for future research.
This paper explores the association between moderate levels of physical activity (PA) and health benefits in well being and symptoms such as tiredness, back pain, and constipation. Participants in the Australian Longitudinal Study on Women's Health, 14,502 young women (ages 18-23 years), 13,609 middle-age women (45-50 years), and 11,421 older women (ages 70-75 years), answered questions about vigorous and less vigorous exercise (used to determine a physical activity score), well being (SF-36), symptoms, and medical conditions. There were significant associations between the PA score and SF-36 in each cohort. Odds ratios (OR) for a range of symptoms and conditions were lower for women who reported low to moderate activity than for sedentary women, for example, for young women or for constipation = 0.76 (CI, 0.65-0.89), for middle-age women or for tiredness = 0.70 (0.63-0.78). There was no threshold of PA at which health benefits increased significantly. Although cross-sectional, the findings suggest that low-to-moderate levels of exercise are associated with a range of health benefits for women of all ages. These preliminary findings will be followed up during the longitudinal study.
Fidelity refers to the demonstration that an experimental manipulation is conducted as planned. In outcome research, an intervention can be said to satisfy fidelity requirements if it can be shown that each of its components is delivered in a comparable manner to all participants and is true to the theory and goals underlying the research. Demonstrating the fidelity of an intervention is a key methodologic requirement of any sound prevention trial. This paper summarizes key conceptual and methodologic issues associated with intervention fidelity, and describes the steps taken to promote fidelity in EARLY ALLIANCE, a large-scale prevention trial currently testing the effectiveness of family, peer, and school interventions to promote competence and reduce risk for conduct disorder, substance abuse, and school failure. The paper presents preliminary results (Trial Year 1) that demonstrate content and process fidelity for two of these interventions, and discusses how the EARLY ALLIANCE methodology may be generalized to address fidelity issues in other prevention studies.
Rapid increases in access to the Internet have made it a viable mode for public health intervention. No controlled studies have evaluated this resource for weight loss.
To determine whether a structured Internet behavioral weight loss program produces greater initial weight loss and changes in waist circumference than a weight loss education Web site.
Randomized, controlled trial conducted from April to December 1999.
Ninety-one healthy, overweight adult hospital employees aged 18 to 60 years with a body mass index of 25 to 36 kg/m(2). Analyses were performed for the 65 who had complete follow-up data.
Participants were randomly assigned to a 6-month weight loss program of either Internet education (education; n = 32 with complete data) or Internet behavior therapy (behavior therapy; n = 33 with complete data). All participants were given 1 face-to-face group weight loss session and access to a Web site with organized links to Internet weight loss resources. Participants in the behavior therapy group received additional behavioral procedures, including a sequence of 24 weekly behavioral lessons via e-mail, weekly online submission of self-monitoring diaries with individualized therapist feedback via e-mail, and an online bulletin board.
Body weight and waist circumference, measured at 0, 3, and 6 months, compared the 2 intervention groups.
Repeated-measures analyses showed that the behavior therapy group lost more weight than the education group (P =.005). The behavior therapy group lost a mean (SD) of 4.0 (2.8) kg by 3 months and 4.1 (4.5) kg by 6 months. Weight loss in the education group was 1.7 (2.7) kg at 3 months and 1.6 (3.3) kg by 6 months. More participants in the behavior therapy than education group achieved the 5% weight loss goal (45% vs 22%; P =.05) by 6 months. Changes in waist circumference were also greater in the behavior therapy group than in the education group at both 3 months (P =.001) and 6 months (P =.005).
Participants who were given a structured behavioral treatment program with weekly contact and individualized feedback had better weight loss compared with those given links to educational Web sites. Thus, the Internet and e-mail appear to be viable methods for delivery of structured behavioral weight loss programs.
Women with children are less likely to engage in adequate physical activity (PA) than women without children. This study aimed to evaluate the efficacy of two strategies for promoting increased PA among mothers of preschool-aged children, and to explore the mediators of any resulting change in PA behavior.
Controlled intervention trial incorporating repeated data collection from 554 women, randomized to one of three experimental conditions. Intervention Group 1 served as a control, while women in Groups 2 and 3 were given print information about overcoming PA barriers. Women in Group 3 were also invited to discuss the development of local strategies for the promotion of PA among mothers of young children. The primary strategies included increasing partner support, social advocacy, and capacity building, and were implemented through collaboration among participants, researchers, and community organizations.
Adequate physical activity (PA), self-efficacy (SE) and partner support (PS).
Following the intervention, women in Group 3 were significantly more likely to meet guidelines for PA than controls (odds ratio [OR]=1.71, confidence interval [CI]=1.05-2.77)] after controlling for age and PA at baseline. After controlling for baseline PA, residualized change in SE (OR=1.86, CI=1.17-2.94) and PS (OR=2.29, CI=1.46-3.58) significantly predicted meeting guidelines. After controlling for residual change in PS and SE, the significant intervention effect was attenuated (Group 3 OR=1.40, CI=0.76-2.36), indicating that partner support and self-efficacy may be mediators of physical activity behavior change.
The findings indicate that community participation approaches that facilitate increased self-efficacy and partner support can be effective in increasing PA among mothers of young children.
For research on physical activity interventions to progress systematically, the mechanisms of action must be studied. In doing so, the research methods and their associated concepts and terminology become more complex. It is particularly important to clearly distinguish among determinants, correlates, mediators, moderators, and confounder variables used in physical activity research. This article examines the factors that are correlated with and that may have a causal relationship to physical activity.
We propose that the term "correlate" be used, instead of "determinant," to describe statistical associations or correlations between measured variables and physical activity. Studies of the correlates of physical activity are reviewed. The findings of these studies can help to critique existing theories of health behavior change and can provide hypotheses to be tested in intervention studies from which it is possible to draw causal inferences. Mediator, moderator, and confounder variables can act to influence measured changes in physical activity. Intervening causal variables that are necessary to complete a cause-effect pathway between an intervention and physical activity are termed "mediators." The relationship between an intervention and physical activity behaviors may vary for different groups; the strata by which they vary are levels of "moderators" of the relationship. Other factors may distort or affect the observed relationships between program exposure and physical activity, and are known as "confounders."
Consistent use of terms and additional research on mediators and moderators of intervention effects will improve our ability to understand and influence physical activity.
NAPOLITANO, M.A., and B.H. MARCUS. Targeting and tailoring physical activity information using print and information technologies. Exerc. Sport Sci. Rev., Vol. 30, No. 3, pp. 122–128, 2002. With the large numbers of physically inactive individuals, it is important that interventions reach a broad spectrum of the population. This paper focuses on targeting and tailoring physical activity information, and the use of mediated interventions, specifically those using print, and other information technologies for promoting physical activity.
A prerequisite to translating research findings into practice is information on consistency of implementation, maintenance of results, and generalization of effects. This follow-up report is one of the few experimental studies to provide such information on Internet-based health education.
We present follow-up data 10 months following randomization on the "Diabetes Network (D-Net)" Internet-based self-management project, a randomized trial evaluating the incremental effects of adding (1) tailored self-management training or (2) peer support components to a basic Internet-based, information-focused comparison intervention. Participants were 320 adult type 2 diabetes patients from participating primary care offices, mean age 59 (SD = 9.2), who were relatively novice Internet users.
All intervention components were consistently implemented by staff, but participant website usage decreased over time. All conditions were significantly improved from baseline on behavioral, psychosocial, and some biological outcomes; and there were few differences between conditions. Results were robust across on-line coaches, patient characteristics, and participating clinics.
The basic D-Net intervention was implemented well and improvements were observed across a variety of patients, interventionists, and clinics. There were, however, difficulties in maintaining usage over time and additions of tailored self-management and peer support components generally did not significantly improve results.
Stroll Your Way To Well Being is a community pramwalking program designed to increase access by mothers to sociable postnatal exercise. This study evaluated the program in terms of long-term adherence rates by mothers to walking, and the effectiveness of kits distributed to providers in assisting them to set up their own groups. Approximately one quarter of information kit recipients established a pramwalking group. Reasons for non-initiation included lack of time or a perceived lack of priority. Mothers reported program benefits to be the opportunity to exercise, socialize and share information about baby issues. 70% of mothers were still walking 16 months after the program's commencement. Reasons for mothers ceasing participation in pramwalking included lack of interest, no group leader available or their baby was too old. Future studies need to focus on the prevention and treatment of postnatal depression through exercise.
A 12-week randomized controlled trial was conducted (n = 20) investigating the effects of a multi-intervention programme of exercise and social support compared to a control group. Both groups had given birth in the past 12 months and were experiencing depressive symptomatology. Pretest data of physical fitness and structured questionnaires were compared to post-test data. The results from the study showed that mothers who were in the multi-intervention group improved their fitness levels and depressive symptomatology significantly more than the control group. However, there were no significant changes to either group's social support levels. These results are encouraging and suggest that a pram push walking intervention might be an effective treatment for mothers suffering postnatal distress.
Sedentary mothers are important to reach with physical activity promotion. Purpose: This study pilot tested "Moms on the Move," a Transtheoretical Model (TTM)-derived physical activity (PA) intervention for low-income mothers enrolled in the Women, Infants, and Children (WIC) program.
Sedentary mothers (N = 44) were randomized to (a). Moms on the Move (PA intervention) or (b). counseling on self-breast examination (control). Pre- and posttest measurement (baseline and 2 weeks after the 8-week interventions) included (a). stage of PA behavior change, (b). PA behavior, (c). selected TTM constructs, and (d). social support. Pre- and postdifference scores, chi-square, and one-way analyses of variance (ANOVAs) were used.
The experimental group progressed in stage of change more than control, chi2(1, N = 44) = 20.50, p <.001. The experimental group had greater PA behavior: weekly minutes of PA, F(1, 42) = 46.85, p <.001; daily energy expenditure (EE), F(1, 42) = 23.01, p <.001; and weekly moderate PA EE, F(1, 42) = 32.63, p <.001. Experimental subgroup (n = 11) step counts increased pre-post, t(10) = 6.16, p <.001. An ANOVA showed that the experimental group had greater improvements in all TTM constructs and social support, ps <.001.
WIC mothers are at risk for sedentary living and have not been targeted for PA behavior change using a provider-counseled approach. Although further testing is needed, Moms on the Move appears to be efficacious.
This article examines health promotion and disease prevention from the perspective of social cognitive theory. This theory posits a multifaceted causal structure in which self-efficacy beliefs operate together with goals, outcome expectations, and perceived environmental impediments and facilitators in the regulation of human motivation, behavior, and well-being. Belief in one's efficacy to exercise control is a common pathway through which psychosocial influences affect health functioning. This core belief affects each of the basic processes of personal change--whether people even consider changing their health habits, whether they mobilize the motivation and perseverance needed to succeed should they do so, their ability to recover from setbacks and relapses, and how well they maintain the habit changes they have achieved. Human health is a social matter, not just an individual one. A comprehensive approach to health promotion also requires changing the practices of social systems that have widespread effects on human health.