Acceptability and Feasibility of a Sedentary Behavior Reduction Program during Pregnancy: A Semi-Experimental Study.
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ABSTRACT:
SUBMITTER: Kawajiri M
PROVIDER: S-EPMC7712505 | biostudies-literature | 2020 Oct
REPOSITORIES: biostudies-literature
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Acceptability and Feasibility of a Sedentary Behavior Reduction Program during Pregnancy: A Semi-Experimental Study.
Kawajiri Maiko M Nakamura Yasuka Y Yoshida Mikako M Takeishi Yoko Y Masaki Ai A Iwasaki Yuki Y Sato Satomi S Kodera Yuri Y Chiba Kazumi K Yoshizawa Toyoko T
Healthcare (Basel, Switzerland) 20201029 4
Physical activity (PA) during pregnancy is associated with maternal benefits. Therefore, innovative strategies that promote PA are needed. This study investigated the acceptability and feasibility of a sedentary behavior (SB) reduction program during pregnancy. The study employed a semi-experimental research design using historical control subjects. The intervention group program consisted of individual face-to-face guidance, automatic alerts during SB from wearable devices, and self-monitoring ...[more]
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Project description:ObjectivesThis study reports on the feasibility of the SitLess with MS trial, an intervention targeting sedentary behavior in individuals with multiple sclerosis (MS).DesignSingle group, pre-post intervention design.SettingCommunity.ParticipantsParticipants (N=41) with mild to moderate disability from MS.InterventionThe intervention was 15 weeks, with a 7-week follow-up, and included 2 stages: SitLess and MoveMore. During the SitLess stage, participants were encouraged to break up prolonged sitting bouts over a 7-week period, whereas the MoveMore stage promoted increased steps per day and interrupting sitting over a 7-week period. The intervention was delivered through weekly one-on-one coaching sessions via telerehabilitation and an accompanying newsletter based on social-cognitive theory. Activity was monitored throughout the program using a Fitbit.Main outcome measuresProcess (eg, recruitment) and resource and management (eg, personnel requirements) metrics were assessed, along with efficacy outcomes (eg, effect). Progression criteria were set a priori and were related to safety, fatigue, satisfaction, and attrition. Sedentary behavior, measured using the ActivPal, was reported pre- and postintervention, as well as 7 weeks postintervention. Effect sizes (pre to post, pre to 7 weeks post) were calculated for the sedentary behavior outcomes (eg, time sitting, transitions from sitting to standing, number of long sitting bouts). Experiences with the intervention were explored through an online survey.ResultsForty-one participants enrolled, 39 of whom completed the intervention. All participants but 1 were satisfied with the experience. Pre-post intervention effect sizes for change in total sedentary time, number of transitions from sit to stand, and number of long (>30 min) sedentary bouts were 0.34, 0.02, and 0.39 respectively. All a priori progression criteria were met.ConclusionsThe SitLess with MS program, a novel intervention that emphasized and facilitated sitting less and moving more, was feasible and resulted in small changes in sedentary behavior in individuals with MS.
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Project description:Importance: Reducing poststroke sedentary behavior is important for reducing recurrent stroke risk, yet interventions to achieve this are scant.Objective: To assess the feasibility of, and estimate change in sedentary behavior over time associated with, a behavioral intervention.Design: Single-arm delayed baseline with postintervention and 8-wk follow-up assessment.Setting: Community based.Participants: Ambulatory, community-dwelling people with chronic stroke and reported ?6 hr daily sitting time (N = 21).Intervention: Activating Behavior for Lasting Engagement (ABLE) was delivered by an occupational therapist 3×/wk for 4 wk. ABLE involves activity monitoring, activity scheduling, self-assessment, and collaborative problem solving.Outcomes and measures: Feasibility (participant safety, adherence, satisfaction, and reliable intervention delivery) was assessed against preestablished benchmarks. Changes over time in sedentary behavior (assessed with an ActivPAL micro3 device) and participation (Stroke Impact Scale-Participation subscale) were described.Results: ABLE was safe (0 serious adverse events), adhered to (11.95 sessions/participant), and reliably delivered (90.00%-97.50% adherence). Participant satisfaction was unmet (Client Satisfaction Questionnaire-8, M = 28.75, SD = 3.84). ABLE was associated with a mean group reduction in prolonged sitting of 54.95 min (SD = 81.10) at postintervention and 14.08 (SD = 58.95) at follow-up. ABLE was associated with a negligible mean group increase over time in participation at postintervention (M = 1.48%, SD = 8.52) and follow-up (M = 1.33%, SD = 15.38).Conclusions and relevance: The ABLE intervention is feasible and may be associated with within-group reduction in sedentary behavior over time. Further refinement is indicated.What this article adds: The ABLE intervention uses engagement in meaningful daily activities to reduce sedentary behavior after stroke. These findings suggest that ABLE can be delivered safely and consistently. Further research is required to enhance participant satisfaction and determine the effects of ABLE on stroke survivors' sedentary behavior.
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Project description:BackgroundPhysical activity in pregnancy and postpartum is beneficial to mothers and infants. To advance knowledge of objective physical activity measurement during these periods, this study compares hip to wrist accelerometer compliance; assesses convergent validity (correlation) between hip- and wrist-worn accelerometry; and assesses change in physical activity from pregnancy to postpartum.MethodsWe recruited women during pregnancy (n?=?100; 2014-2015), asking them to wear hip and wrist accelerometers for 7?days during Trimester 2 (T2), Trimester 3 (T3), and 3-, 6-, 9- and 12-months postpartum. We assessed average wear-time and correlations (axis-specific counts/minute, vector magnitude counts/day and step counts/day) at T2, T3, and postpartum.ResultsCompliance was higher for wrist-worn accelerometers. Hip and wrist accelerometers showed moderate to high correlations (Pearson's r 0.59 to 0.84). Hip-measured sedentary and active time differed little between T2 and T3. Moderate-to-vigorous physical activity decreased at T3 and remained low postpartum. Light physical activity increased and sedentary time decreased throughout the postpartum period.ConclusionsWrist accelerometers may be preferable during pregnancy and appear comparable to hip accelerometers. As physical activity declines during later pregnancy and may not rebound post birth, support for re-engaging in physical activity earlier in the postpartum period may benefit women.
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Project description:BackgroundCardiac rehabilitation participants are encouraged to meet physical activity guidelines to reduce the risk of repeat cardiac events. However, previous studies have found that physical activity levels are low and sedentary behavior is high, both during and after cardiac rehabilitation. There is potential for smartphone apps to be effective in reducing sedentary behavior, although among the few studies that have investigated smartphone apps in cardiac rehabilitation, none targeted sedentary behavior.ObjectiveThis study aims to evaluate the feasibility of a behavioral smartphone app (Vire) and a web-based behavior change program (ToDo-CR) to decrease sedentary behavior in cardiac rehabilitation participants.MethodsUsing a single-center, pre-post design, participants were recruited by nursing staff on admission to cardiac rehabilitation. All eligible participants installed the Vire app, were given a Fitbit Flex, and received the 6-week ToDo-CR program while attending cardiac rehabilitation. The ToDo-CR program uses personalized analytics to interpret important behavioral aspects (physical activity, variety, and social opportunity) and real-time information for generating and suggesting context-specific actionable microbehavioral alternatives (Do's). Do's were delivered via the app, with participants receiving 14 to 19 Do's during the 6-week intervention period. Outcome measures were collected at 0, 6, and 16 weeks. The assessors were not blinded. Feasibility outcomes included recruitment and follow-up rates, resource requirements, app usability (Unified Theory of Acceptance and Use of Technology 2 [UTAUT2] questionnaire), and objectively measured daily minutes of sedentary behavior (ActiGraph) for sample size estimation. Secondary outcomes included functional aerobic capacity (6-min walk test), quality of life (MacNew Heart Disease Health-Related Quality of Life Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale questionnaire), BMI, waist circumference, waist-to-hip ratio, and blood pressure.ResultsBetween January and May 2019, 20 participants were recruited consecutively. One-third of people who commenced cardiac rehabilitation were eligible to participate. Other than declining to take part in the study (15/40, 38%), not having a smartphone was a major reason for exclusion (11/40, 28%). Those excluded without a smartphone were significantly older than participants with a smartphone (mean difference 20 [SD 5] years; P<.001). Participants were, on average, aged 54 (SD 13) years, mostly male (17/20, 85%), and working (12/20, 67%). At 6 weeks, 95% (19/20) of participants were assessed, and 60% (12/20) of participants were assessed at 16 weeks. Participants were relatively satisfied with the usability of the app (UTAUT2 questionnaire). Overall, participants spent 11 to 12 hours per day sitting. There was a medium effect size (Cohen d=0.54) for the reduction in sedentary behavior (minutes per day) over 16 weeks.ConclusionsThe use of a behavioral smartphone app to decrease sitting time appears to be feasible in cardiac rehabilitation. A larger randomized controlled trial is warranted to determine the effectiveness of the app.
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Project description:Background: Prenatal posttraumatic stress disorder (PTSD) is a significant complication of pregnancy linked to increased risk of adverse perinatal outcomes. Although 1 in 5 pregnant trauma-exposed individuals have PTSD, most PTSD treatment trials exclude participants who are pregnant, and none focus on treatment specifically during pregnancy. Moreover, access to mental health treatment is particularly challenging in low-resource settings with high rates of trauma. This study examined implementation of Narrative Exposure Therapy (NET), a short-term evidence-based PTSD treatment, in an urban prenatal care setting. Partial telehealth delivery was used to increase accessibility. Study aims were to examine (a) feasibility, (b) acceptability, and (c) case-based treatment outcomes associated with NET participation.Method: Eight pregnant participants (median age?=?27, median gestational week in pregnancy?=?22.5) received up to six sessions of NET with partial telehealth delivery. PTSD and depression symptoms were assessed at pre-treatment intake (T1), at each session (T2), and 1-week post-treatment (T3). A multiple case study approach was used to examine recruitment and engagement, retention, treatment completion, treatment barriers, use of telehealth, participants' experiences of treatment, and PTSD and depression symptoms.Results: Nine of the 16 participants (56%) who were invited to participate engaged in treatment, and one dropped out after the first session. Eight participants completed the minimum "dose" of 4 NET sessions (N?=?8/9, 89%). Seven participants gave the highest ratings of treatment acceptability. The most frequently reported barriers to treatment were competing priorities of work and caring for other children. Pre-post treatment symptom measures revealed clinically meaningful change in PTSD severity for nearly all participants (7/8, 88%).Conclusions: Results suggest that a brief exposure therapy PTSD treatment can be successfully implemented during pregnancy, suggesting promising results for conducting a larger-scale investigation. Trial registration ClinicalTrials.gov, NCT04525469. Registered 20 August 2020-Retrospectively registered, https://register.clinicaltrials.gov/prs/app/template/EditRecord.vm?epmode=View&listmode=Edit&uid=U00058T2&ts=3&sid=S000A59A&cx=-w1vnvn.
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Project description:BACKGROUND:Sedentary behavior (SED) is a potential risk factor for poor pregnancy outcomes. We evaluated the validity of several common and one new method to assess SED across three trimesters of pregnancy. METHODS:This cohort study of pregnant women measured objective and self-reported SED each trimester via thigh-worn activPAL3 micro (criterion), waist-worn Actigraph GT3X, and self-report from the Pregnancy Physical Activity Questionnaire (PPAQ) and the de novo Sedentary Behavior Two Domain Questionnaire (SB2D). SED (hours per day) and percent time in SED (SED%) from activPAL were compared to GT3X, SB2D, and PPAQ using Pearson's r, ICC, Bland-Altman analysis, and comparison of criterion SED and SED% across tertiles of alternative methods. RESULTS:Fifty-eight women (mean age 31.5 ± 4.8 years; pre-pregnancy BMI 25.1 ± 5.6 kg/m2; 76% white) provided three trimesters of valid activPAL data. Compared to activPAL, GT3X had agreement ranging from r = 0.54-0.66 and ICC = 0.52-0.65. Bland-Altman plots revealed small mean differences and unpatterned errors, but wide limits of agreement (greater than ±2 h and ± 15%). The SB2D and PPAQ had r < 0.5 and ICC < 0.3 vs. activPAL SED, with lower agreement during the 2nd and 3rd trimesters, and performed poorly in Bland-Altman analyses. SED% from the modified SB2D performed best of the self-reported instruments with modest mean differences, r ranging from 0.55 to 0.60, and ICCs from 0.31-0.33; though, limits of agreement were greater than ±35%. Significant trends in activPAL SED were observed across increasing tertiles of SB2D SED in the 1st and 3rd trimesters (both p ≤ 0.001), but not the 2nd trimester (p = 0.425); and for PPAQ SED in the 1st and 2nd trimesters (both p < 0.05), but not the 3rd trimester (p = 0.158). AcitvPAL SED and SED% increased significantly across tertiles of GT3X SED and SED% as well as SB2D SED% (all p-for-trend ≤ 0.001). CONCLUSIONS:Compared to activPAL, waist-worn GT3X produced moderate agreement, though similar mean estimates of SED across pregnancy. Self-report questionnaires had large absolute error and wide limits of agreement for SED hr./day; SB2D measurement of SED% was the best self-report method. These data suggest activPAL be used to measure SED when possible, followed by GT3X, and - when necessary - SB2D assessing SED% in pregnancy. TRIAL REGISTRATION:www.clinicaltrials.gov NCT03084302 on 3/20/2017.
| S-EPMC7014698 | biostudies-literature
Project description:Background and objectivesWe tested the feasibility of reducing sedentary behavior common in CKD.Design, setting, participants, & measurementsWe carried out a Sit Less, Interact, Move More intervention in a 24-week parallel-group, randomized controlled trial in patients with stages 2-5 CKD. In the intervention group (n=54), accelerometry performed at baseline and repeated every 4 weeks was used to develop and monitor adherence to individualized plans targeting sedentary and stepping durations. The control group (n=52) was provided national physical activity recommendations; accelerometry was performed at baseline and every 8 weeks. Between-groups changes from baseline to the average follow-up values at weeks 8, 16, and 24 of the sedentary and stepping durations were the coprimary end points.ResultsThe mean age was 69±13 years. Fourteen percent were on dialysis or received a kidney transplant. Eight percent of the control group and 17% of the intervention group were lost to follow-up. Sedentary and stepping durations did not change in the control group. Within the intervention group, the maximum decrease in sedentary duration (-43; 95% confidence interval, -69 to -17 min/d) and increase in stepping duration (16; 95% confidence interval, 7 to 24 min/d) and the number of steps per day (1265; 95% confidence interval, 518 to 2012) were seen at week 20. These attenuated at week 24. In mixed effects models, overall treatment effects between groups on sedentary (-17; 95% confidence interval, -43 to 8 min/d) and stepping (6; 95% confidence interval, -3 to 15 min/d) durations and the number of steps per day, a secondary end point (652; 95% confidence interval, -146 to 1449), were not significantly different. The intervention significantly reduced secondary end points of body mass index (-1.1; 95% confidence interval, -1.9 to -0.3 kg/m2) and body fat percentage (-2.1%; 95% confidence interval, -4.4% to -0.2%).ConclusionsIt is feasible to reduce sedentary duration and increase stepping duration in patients with CKD, but these were not sustained.Clinical trial registry name and registration numberNational Health and Nutrition Examination Survey (NHANES), NCT02970123.
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Project description:Background: Evidence suggests in utero exposures are related to lifespan health of the offspring. Whether maternal activity profile during pregnancy impacts offspring health remains unknown. Methods: This follow-up study recruited mothers with objectively measured sedentary behavior (SED) and moderate-to-vigorous intensity physical activity (MVPA) from a previous cohort study. Maternal activity was analyzed across pregnancy (trajectory groups) and continuously by trimester. Offspring anthropometrics up to 24 months were abstracted from medical records (n = 62). Outcomes included childhood growth rate (incremental rate of BMI z-score change up to 24 months) and rapid growth (increased BMI z-score >0.67 at 12 months). Associations of maternal activity with growth rate were examined using mixed linear models and rapid growth using generalized linear models. Results: Forty percent of participants were in the high SED and 20% in the high MVPA trajectories during pregnancy. Higher SED, across pregnancy [slope (95% confidence interval; CI): 0.080 (0.024-0.061) ΔBMI z-score/month] and in the first trimester [standardized beta; std β (95% CI): 0.017 (0.007-0.026)], was related to accelerated growth rate. Higher MVPA, in the second and third trimesters, was associated with accelerated growth rate [std β (95% CI): trimester 2: 0.013 (0.002-0.024) and trimester 3:0.011 (0.003-0.020)] and greater risk of rapid growth [risk ratio (95% CI): trimester 2: 1.25 (1.009-1.555) and trimester 3: 1.25 (1.056-1.475)]. Conclusions: These findings add to growing evidence on the deleterious effects of high SED during pregnancy. The increased risk for accelerated growth with higher MVPA elicits further investigation. Overall, maternal activity profile shows promise as a modifiable behavior to improve intergenerational health.
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Project description:BackgroundInternational guidelines recommend that following an early-pregnancy 'opt-out' referral for smoking cessation support, pregnant women who smoke should also be offered referrals at subsequent antenatal appointments ('opt-in' referrals). We assessed feasibility and acceptability of introducing 'opt-in' self-referral forms to stop smoking services (SSS) in antenatal clinics.MethodA 'before-after' service evaluation and qualitative interviews. 'Opt-in' self-referral forms were distributed by reception staff to women attending antenatal ultrasound appointments. We collected hospital/SSS data for the study period and a comparison period 12 months prior. Reception staff were interviewed and data analyzed thematically.ResultsOver 6500 women entered antenatal care in each period; ~15% smoked and ~50% of those who smoked were referred to SSS at their first appointment. In the study period, 17.4% of women completed 'opt-in' forms. Of these 17.3% smoked, and 23.1% of those who smoked requested a referral. The staff thought new procedures had minimal impact on workload, but were easy to forget. They believed the pathway would be better delivered by midwifery staff, with additional information/advice to improve engagement.Conclusions'Opt-in' referrals in later pregnancy result in significant numbers of women who smoke indicating interest in smoking cessation support. Additional training and support is necessary to motivate reception staff to oversee self-referral pen-and-paper procedures effectively.
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