Tailored multicomponent intervention for remote physical activity promotion in inactive adults

Fischer, Xenia. Tailored multicomponent intervention for remote physical activity promotion in inactive adults. 2019, Doctoral Thesis, University of Basel, Faculty of Medicine.

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Official URL: http://edoc.unibas.ch/diss/DissB_13491

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Background: The health benefits of physical activity are well established and widely recognized. Nevertheless, one third of adults worldwide as well as in Switzerland do not achieve the minimum of 150 minutes of at least moderate physical activity per week. The main reasons for this are a lack of time and a lack of motivation. With regard to individual and societal health consequences, effective programs to promote physical activity are therefore needed.
Interventions to promote physical activity without face-to-face contact seem particularly suitable to reach inactive adults. Telephone coaching as well as regular messages (prompts) or internet-based programs have been shown to result in short-term health-relevant behavior changes. Thereby, individually tailored interventions, as well as the implementation of certain behavior change techniques (e.g. self-monitoring, action planning, barrier management) were found most effective in increasing physical activity. Existing studies mainly assessed the effect on self-reported physical activity. Objectively measured physical activity, long-term effects but also mechanisms of action leading to a change in physical activity behavior have rarely been investigated. Additionally, it remains unknown, which delivery modes are most effective and can best be translated into practice.
Aim: This PhD project aimed to develop a physical activity promotion program and to evaluate different versions to communicate it. The short- and long-term effects of telephone coaching and short message services (SMS) prompting on self-reported and objectively assessed physical activity were investigated. A further objective was to examine, whether psychosocial determinants (e.g. outcome expectations, action planning) of physical activity mediate the effect of the intervention.
Methods: The "Movingcall" study is a three-armed randomized controlled trial with a six-month intervention and a six-month no-contact follow-up period. Two hundred and eighty-eight insufficiently active adults, aged 20 to 65 years, were assigned to three different versions of a physical activity promotion program. A “coaching group” received 12 biweekly telephone coaching sessions. In a “coaching and SMS group” the coaching was extended by four SMS prompts among each coaching session (48 SMS in total). The "control group" received a minimal credible interven-tion consisting of a single written recommendation. All participants were additionally asked to plan and self-monitor their physical activity behavior on a personal web application. The intervention consisted of evidence-based behavior change techniques and training recommendations in all three study-arms. The intervention content was individually tailored to the preferences and needs of the participants.
Outcome measures were assessed at baseline, after the intervention (6 months) and after the follow-up period (12 months). Self-reported moderate-to-vigorous physical activity (MVPA) in one week was assessed using a standardized interview based on the Simple Physical Activity Question-naire. Additionally, a wrist-worn accelerometer was applied to measure physical activity behavior of the same week objectively. Psychosocial determinants of physical activity as well as participants’ acceptance of the program were assessed via online questionnaires. Between group differences and changes over time in physical activity behavior were computed using linear mixed models. The mediating influences of psychosocial determinants were calculated in structural equation models.
Results: The study population comprised two-thirds women, had a mean age of 42 years (SD = 11) and at baseline the self-reported MVPA was 108 minutes/week (SD = 142). After the six-month intervention, self-reported physical activity increased by 173 minutes/week (95% CI 95 to 252) in the coaching group and by 165 minutes/week (95% CI 84 to 246) in the coaching and SMS group compared to the control group. The increased level of self-reported physical activity was main-tained after the follow-up period and the observed group differences persisted. Via accelerometer assessed physical activity, increases of 32 minutes/week (95% CI 0 to 63) in the coaching and 34 minutes/week (95% CI 2 to 66) in the coaching and SMS group compared to the control group were observed. The objectively assessed physical activity of the two intervention groups returned to the baseline-levels after the follow-up period. Group differences persisted in the long-term, as the control group decreased its objectively assessed physical activity level below baseline values. Additional SMS prompts did not lead to a further increase in physical activity at either of the measurement points.
The analysis of the psychosocial determinants of physical activity behavior revealed that the coaching resulted in a sustainable improvement of planning and barrier management. Right after the coaching interventions, there were also positive effects on self-efficacy, outcome expectations as well as on intention. An improvement in these determinants was, however, only weakly associated with increased physical activity. A mediation was only observed for increased objectively assessed physical activity after six months through increases in barrier management.
The telephone coaching was well accepted and rated positively. More than 80% of the coaching as well as the coaching and SMS group and 19% of the control group reported that they were satisfied with the program.
Conclusion: Telephone coaching led to higher physical activity levels in the short and long-term compared to a single written recommendation. The two intervention groups showed a relevant and sustainable increase in self-reported physical activity. However, the maintenance of achieved behavior change needs to be interpreted cautiously, as increases in objectively assessed physical activity returned to baseline after the follow-up period. Additional SMS prompts did not increase the efficacy of the coaching intervention. In accordance with theory and previous literature, the promotion of evidence-based behavior change techniques resulted in positive changes in psychosocial determinants of physical activity. Nevertheless, the intervention’s mechanisms of action remain largely unknown, as there was almost no mediation of physical activity by these determinants. Overall, telephone coaching can be considered an effective and well-accepted tool to support adults in adopting a physically active lifestyle.
Advisors:Pühse, Uwe and Zahner, Lukas and Gerber, Markus and Suggs, Suzanne and Donath, Lars
Faculties and Departments:03 Faculty of Medicine > Departement Sport, Bewegung und Gesundheit > Bereich Sportwissenschaft > Sportwissenschaften (Pühse)
UniBasel Contributors:Pühse, Uwe and Zahner, Lukas and Gerber, Markus and Donath, Lars
Item Type:Thesis
Thesis Subtype:Doctoral Thesis
Thesis no:13491
Thesis status:Complete
Number of Pages:1 Online-Ressource (1 Band)
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Last Modified:15 Feb 2020 05:30
Deposited On:14 Feb 2020 08:53

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