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Effectiveness of YouRAction, an intervention to promote adolescent physical activity using personal and environmental feedback: a cluster RCT.

ABSTRACT: BACKGROUND:In this study the one and six months effects of the computer-tailored YouRAction (targeting individual level determinants) and YouRAction+e (targeting in addition perceived environmental determinants) on compliance with the moderate-to-vigorous physical activity (MVPA) guideline and weight status are examined. In addition the use and appreciation of both interventions are studied. METHODS:A three-armed cluster randomized trial was conducted in 2009-2010 with measurements at baseline, one and six months post intervention. School classes were assigned to one of the study arms (YouRaction, YouRAction+e and Generic Information (GI) control group). MVPA was derived from self-reports at baseline, one and six months post intervention. Body Mass Index and waist circumference were measured at baseline and six months post intervention in a random sub-sample of the population. Use of the interventions was measured by webserver logs and appreciation by self-reports. Multilevel regression analyses were conducted to study the effects of the intervention against the GI control group. ANOVA's and chi-square tests were used to describe differences in use and appreciation between study arms. RESULTS:There were no statistically significant intervention effects on compliance with the MVPA guideline, overweight or WC. Access to the full intervention was significantly lower for YouRAction (24.0%) and YouRAction+e (21.7%) compared to the GI (54.4%). CONCLUSION:This study could not demonstrate that the YouRAction and YouRAction+e interventions were effective in promoting MVPA or improve anthropometric outcomes among adolescents, compared to generic information. Insufficient use and exposure to the intervention content may be an explanation for the lack of effects. TRIAL REGISTRATION:TrialRegister.nl NTR1923.

SUBMITTER: Prins RG

PROVIDER: S-EPMC3293840 | biostudies-literature | 2012

REPOSITORIES: biostudies-literature

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Effectiveness of YouRAction, an intervention to promote adolescent physical activity using personal and environmental feedback: a cluster RCT.

Prins Richard Geuchien RG Brug Johannes J van Empelen Pepijn P Oenema Anke A

PloS one 20120305 3

<h4>Background</h4>In this study the one and six months effects of the computer-tailored YouRAction (targeting individual level determinants) and YouRAction+e (targeting in addition perceived environmental determinants) on compliance with the moderate-to-vigorous physical activity (MVPA) guideline and weight status are examined. In addition the use and appreciation of both interventions are studied.<h4>Methods</h4>A three-armed cluster randomized trial was conducted in 2009-2010 with measurement ...[more]

PMID: 22403695

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Project description:BackgroundPhysical activity is associated with improved health. Girls are less active than boys. Pilot work showed that a peer-led physical activity intervention called PLAN-A was a promising method of increasing physical activity in secondary school age girls. This study examined the effectiveness and cost-effectiveness of the PLAN-A intervention.MethodsWe conducted a cluster randomised controlled trial with Year 9 (13-14 year old) girls recruited from 20 secondary schools. Schools were randomly assigned to the PLAN-A intervention or a non-intervention control group after baseline data collection. Girls nominated students to be peer leaders. The top 18 % of girls nominated by their peers in intervention schools received three days of training designed to prepare them to support physical activity. Data were collected at two time points, baseline (T0) and 5-6 months post-intervention (T1). Participants wore an accelerometer for seven days to assess the primary outcome of mean weekday minutes of moderate-to-vigorous physical activity (MVPA). Multivariable mixed effects linear regression was used to estimate differences in the primary outcome between the two arms on an Intention-to-Treat (ITT) basis. Resource use and quality of life were measured and a within trial economic evaluation from a public sector perspective was conducted.ResultsA total of 1558 girls were recruited to the study. At T0, girls in both arms engaged in an average of 51 min of MVPA per weekday. The adjusted mean difference in weekday MVPA at T1 was - 2.84 min per day (95 % CI = -5.94 to 0.25) indicating a slightly larger decline in weekday MVPA in the intervention group. Results were broadly consistent when repeated using a multiple imputation approach and for pre-specified secondary outcomes and sub-groups. The mean cost of the PLAN-A intervention was £2817 per school, equivalent to £31 per girl. Economic analyses indicated that PLAN-A did not lead to demonstrable cost-effectiveness in terms of cost per unit change in QALY.ConclusionsThis study has shown that the PLAN-A intervention did not result in higher levels of weekday MVPA or associated secondary outcomes among Year 9 girls. The PLAN-A intervention should not be disseminated as a public health strategy.Trial registrationISRCTN14539759 -31 May, 2018.

Project description:INTRODUCTION:Increasing children's cycling to school and physical activity are national health goals. The objective was to conduct an RCT of a bicycle train program to assess impact on students' school travel mode and moderate-to-vigorous physical activity (MVPA). STUDY DESIGN:Pilot cluster RCT with randomization at the school level and N=54 participants. SETTING/PARTICIPANTS:Fourth-fifth graders from four public schools serving low-income families in Seattle, WA in 2014 with analyses in 2015-2016. All participants were provided and fitted with bicycles, safety equipment (helmets, locks, and lights), and a 2- to 3-hour bicycle safety course. INTERVENTION:The intervention was a bicycle train offered daily (i.e., students volunteered to cycle with study staff to and from school). MAIN OUTCOME MEASURES:Time 1 assessments occurred prior to randomization. Time 2 assessments occurred after 3-5 weeks of the intervention (i.e., during Weeks 4-6 of the intervention period). The primary outcome was the percentage of daily commutes to school by cycling measured by validated survey. MVPA, measured by accelerometry and GPS units and processed by machine learning algorithms, was a secondary outcome. RESULTS:For two separate adjusted repeated measures linear mixed effects models in which students (N=54) were nested within schools (N=4), intervention participants had: (1) an absolute increase in mean percentage of daily commutes by cycling of 44.9%, (95% CI=26.8, 63.0) and (2) an increase in mean MVPA of 21.6 minutes/day, (95% CI=8.7, 34.6) from Time 1 to Time 2 compared with controls. CONCLUSIONS:A pilot bicycle train intervention increased cycling to school and daily MVPA in the short term among diverse, inner-city elementary school students. The bicycle train intervention appears promising and warrants further experimental trials among large, diverse samples with longer follow-up. TRIAL REGISTRATION:This study is registered at www.clinicaltrials.gov NCT02006186.

Project description:BackgroundMost adolescents do not meet the recommendations for physical activity (PA) of at least 1 h per day. Individual planning (IP) interventions, including forming plans for when, where and how (action planning) to engage in a behavior, as well as the planning for how to deal with arising barriers (coping planning), are effective to enhance PA in adults. Collaborative planning (CP) is conjoint planning of two individuals regarding a behavior which is performed together. It is assumed that CP stimulates social exchange processes between the planning partners. However, it remains unclear whether planning interventions of PA in adolescents are successful and which planning intervention is more effective. Thus, this cluster randomized controlled trial (RCT) examines changes in daily moderate-to-vigorous PA in adolescents' friendship dyads resulting from planning. Individual self-regulating mechanism and social exchange processes are proposed as mediating mechanisms of the effects of planning for health behavior change.MethodsA single-blind four-arm parallel-group cluster-RCT is used. The sample consists of 400 friendship dyads between 14 and 18 years of age. As the recruitment takes place in schools, a cluster randomization of the schools is used to enroll dyads to (a) an IP intervention, (b) a CP intervention or (c) one of the two no-planning control conditions. Devise-measured and self-reported PA as the primary outcomes, self-regulatory strategies, and social exchange processes as secondary outcomes are assessed at three or four time points. After baseline measurement, the baseline ecological momentary assessment of the main variables takes place for 8 days followed by the intervention and a 7-days diary phase. Follow-ups are 1 month and 6 months later. Subsequent to the six-month follow-up, another 7-days diary phase takes place.DiscussionThis is the first study examining IP in comparison to CP in adolescents applying a single-blind cluster RCT. Consequently, the study allows for understanding the efficacy of individual and collaborative planning and the underlying mechanisms in adolescent dyads.Trial registrationThis RCT was funded by the Swiss National Science Foundation (100019_169781/1) and was registered on 18/06/2018 at ClinicalTrials.gov : NCT03575559 .

Project description:BackgroundMulticomponent school-based interventions have the potential to reduce the age-related decline in adolescents' physical activity (PA), yet there is not consistent evidence to guide non-curricular and school environment interventions. The aim of this study was to assess the effectiveness of a multicomponent environmental school-based intervention, designed to reduce the age-related decline in PA among adolescents.MethodsA cluster randomized controlled trial was conducted with 7 intervention and 7 control schools. Baseline measurements were carried out in spring 2010 with 2 years of follow-up. A total of 1,348 students (11-13 years, in grade 5 and 6) enrolled in the study at baseline. The 14 schools included in the study were located in the Region of Southern Denmark. The intervention consisted of organizational and physical changes in the school environment with a total of 11 intervention components. The primary outcome measure was overall PA (cpm, counts per minute) and was supported by analyses of time spent in MVPA, and time spent sedentary. Furthermore, a secondary outcome measure was PA in school time and during recess. PA was measured using accelerometer (Actigraph GT3X).ResultsA total of 797 students completed the trial and had valid accelerometer data. No significant difference was found for overall PA with an adjusted difference of -19.1 cpm (95% CI: -93, 53) or for school time activity with an adjusted difference of 6 cpm (95% CI: -73, 85). A sensitivity analysis revealed a positive significant intervention effect of PA in recess with an adjusted difference of 95 cpm.ConclusionsNo evidence was found of the overall effect of a non-curricular multicomponent school-based intervention on PA among Danish adolescents. The intervention was positively associated with PA during school time and recess, however, with small estimates. Lack of effect on overall PA could be due to both program theory and different degrees of implementation.Trial registrationwww.Controlled-Trials.com ISRCTN79122411.

Project description:BackgroundPhysical inactivity is a major risk factor for many chronic diseases including diabetes, cardiovascular diseases and some cancers. It is estimated that, in Australia, physical inactivity contributes to 13,500 annual deaths and incurs an annual cost of AU$ 21 billion to the health care system. The cost of physical inactivity to the Western Australian (WA) economy is estimated to be about AU$ 2.1 billion. Increased burden of physical inactivity has motivated health professionals to seek cost effective intervention to promote physical activity. One such strategy is encouraging general practitioners (GPs) to advocate physical activity to the patients who are at high risk of developing chronic diseases associated with physical inactivity. This study intends to investigate the cost-effectiveness of a subsidy program for GP advice to promote physical activity.MethodologyThe percentage of population that could potentially move from insufficiently active to sufficiently active, on GP advice was drawn from the Western Australian (WA) Premier's Physical Activity Taskforce (PATF) survey in 2006. Population impact fractions (PIF) for diseases attributable to physical inactivity together with disability adjusted life years (DALYs) and health care expenditure were used to estimate the net cost of intervention for varying subsidies. Cost-effectiveness of subsidy programs were evaluated in terms of cost per DALY saved at different compliance rates.ResultsWith a 50% adherence to GP advice, an annual health care cost of AU$ 24 million could be potentially saved to the WA economy. A DALY can be saved at a cost of AU $ 11,000 with a AU$ 25 subsidy at a 50% compliance rate. Cost effectiveness of such a subsidy program decreases at higher subsidy and lower compliance rates.ConclusionImplementing a subsidy for GP advice could potentially reduce the burden of physical inactivity. However, the cost-effectiveness of a subsidy program for GP advice depends on the percentage of population who comply with GP advice.

Project description:PurposeThis study aimed to evaluate the effects of sit-to-stand and treadmill desks on sedentary behavior during a 12-month, cluster-randomized multicomponent intervention with an intent-to-treat design in overweight office workers.MethodsSixty-six office workers were cluster-randomized into a control (n = 21; 8 clusters), sit-to-stand desk (n = 23; 9 clusters), or treadmill desk (n = 22; 7 clusters) group. Participants wore an activPAL™ accelerometer for 7 d at baseline, month 3, month 6, and month 12 and received periodic feedback on their physical behaviors. The primary outcome was total daily sedentary time. Exploratory outcomes included total daily and workplace sedentary, standing and stepping time, and the number of total daily and workplace sedentary, standing, and stepping bouts. Intervention effects were analyzed using random-intercept mixed linear models accounting for repeated measures and clustering effects.ResultsTotal daily sedentary time did not significantly differ between or within groups after 12 months. Month 3 gains were observed in total daily and workplace standing time in both intervention groups (sit-to-stand desk: mean Δ ± SD, 1.03 ± 1.9 h·d-1 and 1.10 ± 1.87 h at work; treadmill desk: mean Δ ± SD, 1.23 ± 2.25 h·d-1 and 1.44 ± 2.54 h at work). At month 3, the treadmill desk users stepped more at the workplace than the control group (mean Δ ± SD, 0.69 ± 0.87 h). Month 6 gains in total daily stepping were observed within the sit-to-stand desk group (mean Δ ± SD, 0.82 ± 1.62 h·d-1), and month 3 gains in stepping at the workplace were observed for the treadmill desk group (mean Δ ± SD, 0.77 ± 0.83 h). These trends were sustained through month 12 in only the sit-to-stand desk group.ConclusionsActive-workstation interventions may cause short-term improvements in daily standing and stepping. Treadmill desk users engaged in fewer sedentary bouts, but sit-to-stand desks resulted in more frequent transitions to upright physical behaviors.

Project description:BackgroundThe nutrition and physical activity self-assessment for childcare (NAP SACC) intervention has demonstrated effectiveness in the USA. A feasibility randomised controlled trial was conducted in England to adapt the intervention to the UK context. An embedded process evaluation focused on three key questions. 1. Was it feasible and acceptable to implement the intervention as planned? 2. How did the intervention affect staff and parent mediators? 3. Were the trial design and methods acceptable?MethodsTwelve nurseries in south-west England were recruited and randomised to intervention or control. The intervention comprised: NAP SACC UK Partner (Health Visitor) support to nurseries to review practice and policies against best practice, and then set goals to improve physical activity, nutrition and oral health; two staff training workshops; and a web-based parent support element. The process evaluation comprised: observations of Partner training (n?=?1), Partner/manager meetings (n?=?5) and staff workshops (n?=?10); semi-structured interviews with Partners (n?=?4), managers (n?=?12), staff (n?=?4) and parents (n?=?20); analysis of self-assessment forms, goal setting forms and Partner logbooks; and assessment of staff and parent knowledge, motivation and self-efficacy mediators.ResultsOverall, NAP SACC UK was feasible to implement and acceptable to nursery staff, managers, Partners and parents. The intervention was implemented as planned in five of the six intervention nurseries. Partners and managers appreciated the opportunity to review and improve nursery practices and valued the relationship forged between them. Staff rated the training workshops highly, despite attending outside of working hours. Most goals set by nurseries were achieved. However, Partners raised concerns about Health Visitors' capacity to deliver the intervention in any subsequent roll out. Mediator scores improved in all but two areas in intervention staff and parents, with decreases or minimal changes in the control group. The web-based parent element was not well used and should be removed from any subsequent trial. The trial methods were acceptable to managers, staff, Partners and parents.ConclusionsImplementing and evaluating a physical activity and nutrition intervention in nursery settings is feasible and acceptable. A full RCT of NAP SACC UK (with appropriate modifications) is warranted.Trial registrationISRCTN16287377 (10 Apr 2015).

Project description:BACKGROUND:Less than 20% of adolescents globally meet recommended levels of physical activity, and not meeting these recommended levels is associated with social disadvantage and rising disease risk. The determinants of physical activity in adolescents are multilevel and poorly understood, but the school's social environment likely plays an important role. We conducted a cluster randomised controlled trial to assess the effectiveness of a school-based programme (GoActive) to increase moderate-to-vigorous physical activity (MVPA) among adolescents. METHODS AND FINDINGS:Non-fee-paying, co-educational schools including Year 9 students in the UK counties of Cambridgeshire and Essex were eligible for inclusion. Within participating schools (n = 16), all Year 9 students were eligible and invited to participate. Participants were 2,862 13- to 14-year-olds (84% of eligible students). After baseline assessment, schools were computer-randomised, stratified by school-level pupil premium funding (below/above county-specific median) and county (control: 8 schools, 1,319 participants, mean [SD] participants per school n = 165 [62]; intervention: 8 schools, 1,543 participants, n = 193 [43]). Measurement staff were blinded to allocation. The iteratively developed, feasibility-tested 12-week intervention, aligned with self-determination theory, trained older adolescent mentors and in-class peer-leaders to encourage classes to conduct 2 new weekly activities. Students and classes gained points and rewards for engaging in any activity in or out of school. The primary outcome was average daily minutes of accelerometer-assessed MVPA at 10-month follow-up; a mixed-methods process evaluation evaluated implementation. Of 2,862 recruited participants (52.1% male), 2,167 (76%) attended 10-month follow-up measurements; we analysed the primary outcome for 1,874 participants (65.5%). At 10 months, there was a mean (SD) decrease in MVPA of 8.3 (19.3) minutes in the control group and 10.4 (22.7) minutes in the intervention group (baseline-adjusted difference [95% confidence interval] -1.91 minutes [-5.53 to 1.70], p = 0.316). The programme cost £13 per student compared with control; it was not cost-effective. Overall, 62.9% of students and 87.3% of mentors reported that GoActive was fun. Teachers and mentors commented that their roles in programme delivery were unclear. Implementation fidelity was low. The main methodological limitation of this study was the relatively affluent and ethnically homogeneous sample. CONCLUSIONS:In this study, we observed that a rigorously developed school-based intervention was no more effective than standard school practice at preventing declines in adolescent physical activity. Interdisciplinary research is required to understand educational-setting-specific implementation challenges. School leaders and authorities should be realistic about expectations of the effect of school-based physical activity promotion strategies implemented at scale. TRIAL REGISTRATION:ISRCTN Registry ISRCTN31583496.

Dataset Information

Effectiveness of YouRAction, an intervention to promote adolescent physical activity using personal and environmental feedback: a cluster RCT.

Publications

Effectiveness of YouRAction, an intervention to promote adolescent physical activity using personal and environmental feedback: a cluster RCT.

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