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Workplace pedometer interventions for increasing physical activity.
Freak-Poli, R, Cumpston, M, Albarqouni, L, Clemes, SA, Peeters, A
The Cochrane database of systematic reviews. 2020;(7):CD009209
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Abstract
BACKGROUND The World Health Organization (WHO) recommends undertaking 150 minutes of moderate-intensity physical activity per week, but most people do not. Workplaces present opportunities to influence behaviour and encourage physical activity, as well as other aspects of a healthy lifestyle. A pedometer is an inexpensive device that encourages physical activity by providing feedback on daily steps, although pedometers are now being largely replaced by more sophisticated devices such as accelerometers and Smartphone apps. For this reason, this is the final update of this review. OBJECTIVES To assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving long-term health outcomes. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Occupational Safety and Health (OSH) UPDATE, Web of Science, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform from the earliest record to December 2016. We also consulted the reference lists of included studies and contacted study authors to identify additional records. We updated this search in May 2019, but these results have not yet been incorporated. One more study, previously identified as an ongoing study, was placed in 'Studies awaiting classification'. SELECTION CRITERIA We included randomised controlled trials (RCTs) of workplace interventions with a pedometer component for employed adults, compared to no or minimal interventions, or to alternative physical activity interventions. We excluded athletes and interventions using accelerometers. The primary outcome was physical activity. Studies were excluded if physical activity was not measured. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. When studies presented more than one physical activity measure, we used a pre-specified list of preferred measures to select one measure and up to three time points for analysis. When possible, follow-up measures were taken after completion of the intervention to identify lasting effects once the intervention had ceased. Given the diversity of measures found, we used ratios of means (RoMs) as standardised effect measures for physical activity. MAIN RESULTS We included 14 studies, recruiting a total of 4762 participants. These studies were conducted in various high-income countries and in diverse workplaces (from offices to physical workplaces). Participants included both healthy populations and those at risk of chronic disease (e.g. through inactivity or overweight), with a mean age of 41 years. All studies used multi-component health promotion interventions. Eleven studies used minimal intervention controls, and four used alternative physical activity interventions. Intervention duration ranged from one week to two years, and follow-up after completion of the intervention ranged from three to ten months. Most studies and outcomes were rated at overall unclear or high risk of bias, and only one study was rated at low risk of bias. The most frequent concerns were absence of blinding and high rates of attrition. When pedometer interventions are compared to minimal interventions at follow-up points at least one month after completion of the intervention, pedometers may have no effect on physical activity (6 studies; very low-certainty evidence; no meta-analysis due to very high heterogeneity), but the effect is very uncertain. Pedometers may have effects on sedentary behaviour and on quality of life (mental health component), but these effects were very uncertain (1 study; very low-certainty evidence). Pedometer interventions may slightly reduce anthropometry (body mass index (BMI) -0.64, 95% confidence interval (CI) -1.45 to 0.18; 3 studies; low-certainty evidence). Pedometer interventions probably had little to no effect on blood pressure (systolic: -0.08 mmHg, 95% CI -3.26 to 3.11; 2 studies; moderate-certainty evidence) and may have reduced adverse effects (such as injuries; from 24 to 10 per 100 people in populations experiencing relatively frequent events; odds ratio (OR) 0.50, 95% CI 0.30 to 0.84; low-certainty evidence). No studies compared biochemical measures or disease risk scores at follow-up after completion of the intervention versus a minimal intervention. Comparison of pedometer interventions to alternative physical activity interventions at follow-up points at least one month after completion of the intervention revealed that pedometers may have an effect on physical activity, but the effect is very uncertain (1 study; very low-certainty evidence). Sedentary behaviour, anthropometry (BMI or waist circumference), blood pressure (systolic or diastolic), biochemistry (low-density lipoprotein (LDL) cholesterol, total cholesterol, or triglycerides), disease risk scores, quality of life (mental or physical health components), and adverse effects at follow-up after completion of the intervention were not compared to an alternative physical activity intervention. Some positive effects were observed immediately at completion of the intervention periods, but these effects were not consistent, and overall certainty of evidence was insufficient to assess the effectiveness of workplace pedometer interventions. AUTHORS' CONCLUSIONS Exercise interventions can have positive effects on employee physical activity and health, although current evidence is insufficient to suggest that a pedometer-based intervention would be more effective than other options. It is important to note that over the past decade, technological advancement in accelerometers as commercial products, often freely available in Smartphones, has in many ways rendered the use of pedometers outdated. Future studies aiming to test the impact of either pedometers or accelerometers would likely find any control arm highly contaminated. Decision-makers considering allocating resources to large-scale programmes of this kind should be cautious about the expected benefits of incorporating a pedometer and should note that these effects may not be sustained over the longer term. Future studies should be designed to identify the effective components of multi-component interventions, although pedometers may not be given the highest priority (especially considering the increased availability of accelerometers). Approaches to increase the sustainability of intervention effects and behaviours over a longer term should be considered, as should more consistent measures of physical activity and health outcomes.
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Sedentary Time and Physical Activity in Older Women Undergoing Exercise Training.
Wang, X, Breneman, CB, Sparks, JR, Blair, SN
Medicine and science in sports and exercise. 2020;(12):2590-2598
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Abstract
UNLABELLED Older adults have low rates meeting the physical activity (PA) guidelines and high sedentary time. Low PA and excessive sedentary time have been linked to adverse health outcomes. Less is known about whether exercise training influences sedentary time and PA in various intensities. PURPOSE This study aimed to examine the effects of a 16-wk aerobic exercise training on time spent being sedentary and on light-intensity PA (LPA) and moderate- to vigorous-intensity PA (MVPA) and step numbers in older women. METHODS Inactive women (n = 61; age = 65.5 ± 4.3 yr) participated in moderate-intensity walking of either a low or a moderate dose (33.6 and 58.8 kJ·kg body weight per week, respectively). They wore a SenseWear Mini Armband at baseline and at end intervention to determine sedentary, LPA, and MVPA time and step numbers. RESULTS Time being sedentary, or spent on LPA and MVPA, did not change differently by exercise groups with different doses (all P values for group-time interaction >0.580). Overall, time being sedentary reduced from baseline to end intervention by approximately 39 min·d (P < 0.001), and LPA increased by 19 min·d (P = 0.003). MVPA time increased (P < 0.001), which was primarily accounted for by the supervised exercise. Interestingly, daily steps increased more in the moderate-dose than the low-dose group (P = 0.023 for group-time interaction; 33.6% and 19.8% median increase in moderate- and low-dose groups, respectively). Also, there were individual differences in these changes. CONCLUSION Results indicated that, on average, older women did not reduce time of LPA or MVPA outside the exercise program or increase sedentary time as a result of participating in the exercise program.
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Investigating the Use of an Electronic Activity Monitor System as a Component of Physical Activity and Weight-Loss Interventions in Nonclinical Populations: A Systematic Review.
Sypes, EE, Newton, G, Lewis, ZH
Journal of physical activity & health. 2019;(4):294-302
Abstract
BACKGROUND Electronic activity monitor systems (EAMSs) have been readily incorporated into physical activity (PA) and weight-loss interventions to facilitate self-monitoring PA behavior. A comprehensive review is required to better understand their utility as intervention modalities in nonclinical populations. METHODS Medscape, MEDLINE, PsycINFO, and Cochrane databases were searched in February 2017, with a search update in April 2017. Citation screening, risk of bias assessment, and an intensity evaluation were conducted in duplicate by 2 investigators. RESULTS The search returned 409 unique citations. Of which, 22 citations met the inclusion criteria. Seven studies found significant between-group differences: 3 in weight loss, 3 in PA levels, and 1 in both weight loss and PA levels. Effective interventions lasted 6 weeks to 12 months. Positive health outcomes were demonstrated when users interacted with multiple features of the EAMS and had access to other services, such as personal coaching or environmental reinforcement. CONCLUSIONS When control and intervention groups have access to the same components, such as counseling or group interaction, the addition of an EAMS for self-monitoring within the intervention group may not confer more favorable results. Risk of performance bias and low sample sizes should be addressed in future trials to generate more reliable findings.
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Examining adherence to activity monitoring devices to improve physical activity in adults with cardiovascular disease: A systematic review.
Marin, TS, Kourbelis, C, Foote, J, Newman, P, Brown, A, Daniel, M, Coffee, NT, Nicholls, SJ, Ganesan, A, Versace, VL, et al
European journal of preventive cardiology. 2019;(4):382-397
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BACKGROUND Activity monitoring devices are currently being used to facilitate and monitor physical activity. No prior review has examined adherence to the use of activity monitoring devices amongst adults with cardiovascular disease. METHODS Literature from June 2012 to October 2017 was evaluated to examine the extent of adherence to any activity monitoring device used to collect objective physical activity data. Randomized control trials comparing usual care against the use of an activity monitoring device, in a community intervention for adults from any cardiovascular diagnostic group, were included. A systematic search of databases and clinical trials registers was conducted using Joanna Briggs Institute methodology. RESULTS Of 10 eligible studies, two studies reported pedometer use and eight accelerometer use. Six studies addressed the primary outcome. Mean adherence was 59.1% (range 39.6% to 85.7%) at last follow-up. Studies lacked equal representation by gender (28.6% female) and age (range 42 to 82 years). CONCLUSION This review indicates that current research on activity monitoring devices may be overstated due to the variability in adherence. Results showed that physical activity tracking in women and in young adults have been understudied.
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Can activity monitors predict outcomes in patients with heart failure? A systematic review.
Tan, MKH, Wong, JKL, Bakrania, K, Abdullahi, Y, Harling, L, Casula, R, Rowlands, AV, Athanasiou, T, Jarral, OA
European heart journal. Quality of care & clinical outcomes. 2019;(1):11-21
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Actigraphy is increasingly incorporated into clinical practice to monitor intervention effectiveness and patient health in congestive heart failure (CHF). We explored the prognostic impact of actigraphy-quantified physical activity (AQPA) on CHF outcomes. PubMed and Medline databases were systematically searched for cross-sectional studies, cohort studies or randomised controlled trials from January 2007 to December 2017. We included studies that used validated actigraphs to predict outcomes in adult HF patients. Study selection and data extraction were performed by two independent reviewers. A total of 17 studies (15 cohort, 1 cross-sectional, 1 randomised controlled trial) were included, reporting on 2,759 CHF patients (22-89 years, 27.7% female). Overall, AQPA showed a strong inverse relationship with mortality and predictive utility when combined with established risk scores, and prognostic roles in morbidity, predicting cognitive function, New York Heart Association functional class and intercurrent events (e.g. hospitalisation), but weak relationships with health-related quality of life scores. Studies lacked consensus regarding device choice, time points and thresholds of PA measurement, which rendered quantitative comparisons between studies difficult. AQPA has a strong prognostic role in CHF. Multiple sampling time points would allow calculation of AQPA changes for incorporation into risk models. Consensus is needed regarding device choice and AQPA thresholds, while data management strategies are required to fully utilise generated data. Big data and machine learning strategies will potentially yield better predictive value of AQPA in CHF patients.
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Feasibility, acceptability and efficacy of a text message-enhanced clinical exercise rehabilitation intervention for increasing 'whole-of-day' activity in people living with and beyond cancer.
Gomersall, SR, Skinner, TL, Winkler, E, Healy, GN, Eakin, E, Fjeldsoe, B
BMC public health. 2019;(Suppl 2):542
Abstract
BACKGROUND Exercise interventions are typically delivered to people with cancer and survivors via supervised clinical rehabilitation. However, motivating and maintaining activity changes outside of the clinic setting remains challenging. This study investigated the feasibility, acceptability and efficacy of an individually-tailored, text message-enhanced intervention that focused on increasing whole-of-day activity both during and beyond a 4-week, supervised clinical exercise rehabilitation program for people with cancer and survivors. METHODS Participants (n = 36; mean ± SD age 64.8 ± 9.6 years; 44.1 ± 30.8 months since treatment) were randomized 1:1 to receive the text message-enhanced clinical exercise rehabilitation program, or the standard clinical exercise rehabilitation program alone. Activity was assessed at baseline, 4-weeks (end of the standard program) and 12-weeks (end of enhanced program) using both device (activPAL accelerometer; sitting, standing, light-stepping, moderate-stepping) and self-report [Multimedia Activity Recall for Children and Adults (MARCA); sedentary, light, moderate-to-vigorous physical activity (MVPA)] methods. The MARCA also assessed time use domains to provide context to activity changes. Changes and intervention effects were evaluated using linear mixed models, adjusting for baseline values and potential confounders. RESULTS The study had high retention (86%) and participants reported high levels of satisfaction [4.3/5 (±0.8)] with the intervention. Over the first 4 weeks, MARCA-assessed MVPA increased [+ 53.2 (95%CI: 2.9, 103.5) min/d] between groups, favoring the text message-enhanced program, but there were no significant intervention effects on sedentary behavior. By 12 weeks, relative to the standard group, participants in the text message-enhanced group sat less [activPAL overall sitting: - 48.2 (- 89.9, - 5.6) min/16 h awake; MARCA -80.1 (- 156.5, - 3.8) min/d] and were participating in more physical activity [activPAL light stepping: + 7.0 (0.4, 13.6: min/16 h awake; MARCA MVPA + 67.3 (24.0, 110.6) min/d]. The time-use domains of Quiet Time [- 63.3 (- 110.5, - 16.0) min/d] and Screen Time [- 62.0 (- 109.7, - 14.2) min/d] differed significantly between groups. CONCLUSIONS Results demonstrate feasibility, acceptability and efficacy of a novel, text message-enhanced clinical exercise rehabilitation program to support changes in whole-of-day activity, including both physical activity and sedentary behavior. Changes were largely seen at 12-week follow-up, indicating potential for the intervention to result in continued improvement and maintenance of behavior change following a supervised exercise intervention. TRIAL REGISTRATION This trial is registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12616000641493 ; date registered 17/5/16).
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24-hour accelerometry in COPD: Exploring physical activity, sedentary behavior, sleep and clinical characteristics.
Orme, MW, Steiner, MC, Morgan, MD, Kingsnorth, AP, Esliger, DW, Singh, SJ, Sherar, LB
International journal of chronic obstructive pulmonary disease. 2019;:419-430
Abstract
BACKGROUND The constructs and interdependency of physical behaviors are not well described and the complexity of physical activity (PA) data analysis remains unexplored in COPD. This study examined the interrelationships of 24-hour physical behaviors and investigated their associations with participant characteristics for individuals with mild-moderate airflow obstruction and healthy control subjects. PATIENTS AND METHODS Vigorous PA (VPA), moderate-to-vigorous PA (MVPA), light PA (LPA), stationary time (ST), average movement intensity (vector magnitude counts per minute), and sleep duration for 109 individuals with COPD and 135 healthy controls were obtained by wrist-worn accelerometry. Principal components analysis (PCA) examined interrelationships of physical behaviors to identify distinct behavioral constructs. Using the PCA component loadings, linear regressions examined associations with participant (+, positive correlation; -, negative correlation), and were compared between COPD and healthy control groups. RESULTS For both groups PCA revealed ST, LPA, and average movement intensity as distinct behavioral constructs to MVPA and VPA, labeled "low-intensity movement" and "high-intensity movement," respectively. Sleep was also found to be its own distinct behavioral construct. Results from linear regressions supported the identification of distinct behavioral constructs from PCA. In COPD, low-intensity movement was associated with limitations with mobility (-), daily activities (-), health status (+), and body mass index (BMI) (-) independent of high-intensity movement and sleep. High-intensity movement was associated with age (-) and self-care limitations (-) independent of low-intensity movement and sleep. Sleep was associated with gender (0= female, 1= male; [-]), lung function (-), and percentage body fat (+) independent of low-intensity and high-intensity movement. CONCLUSION Distinct behavioral constructs comprising the 24-hour day were identified as "low-intensity movement," "high-intensity movement," and "sleep" with each construct independently associated with different participant characteristics. Future research should determine whether modifying these behaviors improves health outcomes in COPD.
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A short history of time use research; implications for public health.
Bauman, A, Bittman, M, Gershuny, J
BMC public health. 2019;(Suppl 2):607
Abstract
BACKGROUND This section defined time use (TU) research, illustrating its relevance for public health. TUR in the health context is the study of health-enhancing and health-compromising behaviours that are assessed across a 24 h day. The central measurement is the use of Time Use Diaries, which capture 24-48 h, typically asking about behaviour in each 15-min period. TUR is used for understanding correlates of health behaviours, and as a form of population surveillance, assessing behavioural trends over time. MAIN BODY This paper is a narrative review examining the history of time use research, and the potential uses of TU data for public health research. The history of TUR started in studies of the labour force and patterns of work in the late 19th and early twentieth century, but has more recently been applied to examining health issues. Initial studies had a more economic purpose but over recent decades, TU data have been used to describe the distribution and correlates of health-enhancing patterns of human time use. These studies require large multi-country population data sets, such as the harmonised Multinational Time Use Study hosted at the University of Oxford. TU data are used in physical activity research, as they provide information across the 24-h day, that can be examined as time spent sleeping, sitting/standing/light activity, and time spent in moderate-vigorous activities. TU data are also used for sleep research, examining eating and dietary patterns, exploring geographic distributions in time use behaviours, examining mental health and subjective wellbeing, and examining these data over time. The key methodological challenge has been the development of harmonised methods, so population TU data sets can be compared within and between-countries and over time. CONCLUSIONS TUR provides new methods for examining public health research questions where a temporal dimension is important. These time use surveys have provided unique data over decades and in many countries that can be compared. They can be used for examining the effects of some large public health interventions or policies within and between countries.
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Counting Steps: A New Way to Monitor Patients with Pulmonary Arterial Hypertension.
Sehgal, S, Chowdhury, A, Rabih, F, Gadre, A, Park, MM, Li, M, Wang, X, Highland, KB, ,
Lung. 2019;(4):501-508
Abstract
RATIONALE Activity levels in patients with pulmonary arterial hypertension (PAH) have correlated with surrogate markers of disease severity. It is not known whether physical activity measures are useful in monitoring patients with PAH. OBJECTIVES This pilot study aimed to evaluate whether change in physical activity measured by an accelerometer correlates with changes in six-minute walk distance (6MWD), echocardiographic parameters, NT-proBNP, or health-related quality-of-life measures (HRQOL). METHODS The study design was a prospective, observational study in subjects with prevalent PAH. Subjects wore a wrist-worn accelerometer (Fitbit Charge HR®) between two outpatient visits. Daily step count and activity levels were recorded, and the change over time was correlated with changes in 6MWD, echocardiographic parameters, HRQOL, and NT-proBNP. MEASUREMENTS AND MAIN RESULTS 30 subjects were enrolled, of which 20 patients had adequate accelerometer data to be analyzed over the study duration. The mean duration of follow-up was 136.4 ( ± 47.3) days. The change in daily step count correlated with a change in 6MWD (r 0.43, p 0.05). Changes in duration spent in moderately active (r 0.52, p 0.02), lightly active (r 0.48, p 0.05), and sedentary activity levels (r - 0.54, p 0.02) correlated with a change in HRQOL. Changes in activity levels did not correlate with echocardiographic measures or NT-pro BNP. CONCLUSIONS Changes in daily step count and time spent at fairly active, lightly active, and sedentary activity levels correlate with changes in 6MWD, and HRQOL in subjects with PAH suggesting that accelerometry may be a useful monitoring tool.
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Gamifying Accelerometer Use Increases Physical Activity Levels of Sedentary Office Workers.
Gremaud, AL, Carr, LJ, Simmering, JE, Evans, NJ, Cremer, JF, Segre, AM, Polgreen, LA, Polgreen, PM
Journal of the American Heart Association. 2018;(13)
Abstract
BACKGROUND Sedentary work is hazardous. Over 80% of all US jobs are predominantly sedentary, placing full-time office workers at increased risk for cardiovascular and metabolic morbidity and mortality. Thus, there is a critical need for effective workplace physical activity interventions. MapTrek is a mobile health platform that gamifies Fitbit use for the purpose of promoting physical activity. The purpose of this study was to test the efficacy of MapTrek for increasing daily steps and moderate-intensity steps over 10 weeks in a sample of sedentary office workers. METHODS AND RESULTS Participants included 146 full-time sedentary office workers aged 21 to 65 who reported sitting at least 75% of their workday. Each participant received a Fitbit Zip to wear daily throughout the intervention. Participants were randomized to either a: (1) Fitbit-only group or 2) Fitbit + MapTrek group. Physical activity outcomes and intervention compliance were measured with the Fitbit activity monitor. The Fitbit + MapTrek group significantly increased daily steps (+2092 steps per day) and active minutes (+11.2 min/day) compared to the Fitbit-only arm, but, on average, participants' steps declined during the study period. CONCLUSIONS MapTrek is an effective approach for increasing physical activity at a clinically meaningful level in sedentary office workers, but as with accelerometer use alone, the effect decreases over time. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT03109535.