Physical activity and sedentary behavior are modifiable risk factors for non-communicable disease and healthy ageing, however the majority of older adults remain insufficiently active. Digital ...behavior change interventions (DBCI) have the potential to reach many older adults to promote physical activity and reduce sedentary time. This study aims to assess the efficacy of DBCI interventions in older adults (≥50 years) on physical activity and sedentary behavior.
A systematic review of major databases from inception to 03/2018 was undertaken. Randomized controlled trials (RCT) or pre-post interventions assessing effects of DBCI on physical activity and/or sedentary behavior in older adults (≥50 years) were included. Random effects meta-analyses were carried out.
Twenty-two studies were included, including 1757 older adults (mean age = 67 years, %male = 41), 68% showed moderate-high risk of bias. Meta-analyses suggested that DBCI increased total physical activity among RCT studies (n = 8) (SMD = 0.28; 95%CI 0.01, 0.56; p = 0.04) and pre-post studies (n = 6) (SMD = 0.25; 95%CI 0.09, 0.41; p = 0.002), increased moderate-to-vigorous physical activity (SMD = 0.47; 95%CI 0.32, 0.62, p < 0.001; MD = 52 min/week) and reduced sedentary time (SMD = −0.45; 95%CI −0.69, −0.19; p < 0.001; MD = 58 min/day). Reductions in systolic blood pressure (−11 bpm; p = 0.04) and improvements in physical functioning (p = 0.03) were also observed.
DBCI may increase physical activity and physical functioning, and reduce sedentary time and systolic blood pressure in older adults, however more high-quality studies are required.
•Digital behavior change interventions have potential to increase physical activity and reduce sedentary time in older adults•Digital behavior change interventions may improve physical functioning and reduce systolic blood pressure•The most common behavior change techniques found in the interventions were social support, goal setting and feedback•A minimum of 3 behavior change technique clusters were required for significant effects on physical activity
Physical activity (PA) is associated with a variety of physical and psychosocial health benefits, but levels of moderate-to-vigorous intensity PA remain low worldwide. Virtual reality (VR) gaming ...systems involving movement (VR exergames) could be used to engage people in more PA.
This study aimed to synthesize public reviews of popular VR exergames to identify common features that players liked or disliked to inform future VR exergame design.
We conducted a thematic analysis of 498 reviews of the 29 most popular exergames sold in the top 3 VR marketplaces: Steam (Valve Corporation), Viveport (Valve Corporation), and Oculus (Oculus VR). We categorized reviews as positive and negative as they appeared in the marketplaces and identified the most common themes using an inductive thematic analysis.
The reviews were often mixed, reporting a wide variety of expectations, preferences, and gaming experiences. Players preferred highly realistic games (eg, closely simulated real-world sport), games that were intuitive (in terms of body movement and controls), and games that provided gradual increases in skill acquisition. Players reported feeling that they reached a high level of exertion when playing and that the immersion distracted them from the intensity of the exercise. Some preferred features included music and social aspects of the games, with multiplayer options to include friends or receive help from experienced players. There were 3 main themes in negative reviews. The first concerned bugs that rendered games frustrating. Second, the quality of graphics had a particularly strong impact on perceived enjoyment. Finally, reviewers disliked when games had overly complex controls and display functions that evoked motion sickness.
Exergames prove to be a stimulating avenue for players to engage in PA and distract themselves from the negative perceptions of performing exercise. The common negative aspects of VR exergames should be addressed for increased uptake and continued engagement.
Abstract This study aimed to examine whether psychological distress was cross-sectionally associated with meeting World Cancer Research Fund (WCRF) recommendations in people living with and beyond ...cancer. Participants were adults living with and beyond breast, prostate and colorectal cancer, participating in the baseline wave of the Advancing Survivorship after Cancer Outcomes Trial (ASCOT). Anxiety/depression was assessed using the EQ-5D-5L and dichotomised into any/no problems. WCRF recommendations were assessed via pedometers, 24-h dietary recalls, self-reported alcohol intake (AUDIT-C), and self-reported smoking status. Participants were categorised as meeting WCRF recommendations using the following cut-offs: average daily steps (≥ 10,000/day), average weekly aerobic steps (≥ 15,000/day), fruit and vegetables (≥ 400 g/day), fibre (≥ 30 g/day), red meat (< 500 g/week), processed meat (0 g/day), high calorie food (fat ≤ 33% of total daily energy intake and free sugar ≤ 5% of total daily energy intake), alcohol (≤ 14 units/week) and smoking (non-smoking). A composite health behaviour risk index (CHBRI) was calculated by summing the number of WCRF recommendations met (range: 0–9). Among 1348 participants (mean age = 64 years (SD = 11.4)), 41.5% reported anxiety/depression problems. The mean CHBRI score was 4.4 (SD = 1.4). Anxiety/depression problems were associated with lower odds of meeting WCRF recommendations for average daily steps (odds ratio (OR) = 0.73; 95% CI 0.55, 0.97), but not for any other health behaviour. Psychological distress is associated with lower adherence to WCRF recommendations for physical activity in people living with and beyond cancer. Physical activity may be a mechanism linking psychological distress and poorer outcomes among people living with and beyond cancer, and this should be explored in longitudinal studies.
A cancer diagnosis and its treatment may be an especially isolating experience. Despite evidence that positive health behaviours can improve outcomes for people living with and beyond cancer (LWBC), ...no studies have examined associations between loneliness and different health behaviours in this population. This study aimed to describe the prevalence of loneliness in a large sample of UK adults LWBC and to explore whether loneliness was associated with multiple health behaviours.
Participants were adults (aged ≥ 18 years) diagnosed with breast, prostate or colorectal cancer who completed the Health and Lifestyle After Cancer Survey. Loneliness was reported using the UCLA loneliness score, dichotomised into higher (≥ 6) versus lower (< 6) loneliness. Engagement in moderate-to-vigorous physical activity, dietary intake, smoking status, alcohol use, and self-reported height and weight were recorded. Behaviours were coded to reflect meeting or not meeting the World Cancer Research Fund recommendations for people LWBC. Logistic regression analyses explored associations between loneliness and health behaviours. Covariates were age, sex, ethnicity, education, marital status, living situation, cancer type, spread and treatment, time since treatment, time since diagnosis and number of comorbid conditions. Multiple imputation was used to account for missing data.
5835 participants, mean age 67.4 (standard deviation = 11.8) years, completed the survey. 56% were female (n = 3266) and 44% (n = 2553) male, and 48% (n = 2786) were living with or beyond breast cancer, 32% (n = 1839) prostate, and 21% (n = 1210) colorectal. Of 5485 who completed the loneliness scale, 81% (n = 4423) of participants reported lower and 19% (n = 1035) higher loneliness. After adjustment for confounders, those reporting higher levels of loneliness had lower odds of meeting the WCRF recommendations for moderate-to-vigorous physical activity (Odds Ratio OR 0.78, 95% Confidence Internal CI, 0.67, 0.97, p =.028), fruit and vegetable intake (OR 0.81, CI 0.67, 1.00, p =.046), and smoking (OR 0.62, 0.46, 0.84, p =.003). No association was observed between loneliness and the other dietary behaviours, alcohol, or body mass index.
Loneliness is relatively common in people LWBC and may represent an unmet need. People LWBC who experience higher levels of loneliness may need additional support to improve their health behaviours.
Neighbourhood cohesion is increasingly recognised as a key determinant of health and health-related behaviours. Positive association between social support and physical activity have been ...demonstrated on an interpersonal level, there is less evidence at group-level. This study aimed to examine the association between neighbourhood cohesion and physical activity trajectories during the COVID-19 pandemic. Hypothesizing that higher neighbourhood cohesion was a protective factor against reduced physical activity during the pandemic. Data from Understand Society (wave 9, Jan 2017–Dec 2019), and the COVID-19 sub-study (waves 1, 5, 7) was used. Participants (N = 14,475) had baseline data and at least one Covid physical activity measure. We used linear mixed models with a random intercept and slope at the individual level and an unstructured correlation matrix to examine the association between neighbourhoodcohesion and physical activity during the follow-up period.We found a significant reduction in physical activity (-441 MET-min/wk, (CI 374.51 – 507.65, p < 0.001) through the COVID-19 pandemic, and that higher neighbourhood cohesion was related to higher physical activity after control for covariates. There was a significant difference between neighbourhood cohesion categories and change seen in PA during the 39-month follow-up period (difference in change between lowest and highest neighbourhood cohesion categories = 373 MET-min/wk, p = 0.036), higher neighbourhood cohesion had a protective effect. Strong relationships between public health and urban planning sectors are needed to build communities with structures in place to support a sense of community, social interaction and attraction to the neighbourhood. This will help long-term neighbourhood cohesion and support increased physical activity.
Understanding the environmental determinants of physical activity in populations at high risk of inactivity could contribute to the development of effective interventions. Socioecological models of ...activity propose that environmental factors have independent and interactive effects of physical activity but there is a lack of research into interactive effects.
This study aimed to explore independent and interactive effects of social and physical environmental factors on self-reported physical activity in income-deprived communities.
Participants were 5,923 adults in Glasgow, United Kingdom. Features of the social environment were self-reported. Quality of the physical environment was objectively-measured. Neighbourhood walking and participation in moderate physical activity MPA on ≥5 days/week was self-reported. Multilevel multivariate logistic regression models tested independent and interactive effects of environmental factors on activity.
'Social support' (walking: OR:1.22,95%CI = 1.06-1.41,p<0.01; MPA: OR:0.79,95%CI = 0.67-0.94,p<0.01), 'social interaction' (walking: OR:1.25,95%CI = 1.10-1.42,p<0.01; MPA: OR:6.16,95%CI = 5.14-7.37,p<0.001) and 'cohesion and safety' (walking: OR:1.78,95%CI = 1.56-2.03,p<0.001; MPA: OR:1.93,95%CI = 1.65-2.27,p<0.001), but not 'trust and empowerment', had independent effects on physical activity. 'Aesthetics of built form' (OR:1.47,95%CI = 1.22-1.77,p<0.001) and 'aesthetics and maintenance of open space' (OR:1.32, 95%CI = 1.13-1.54,p<0.01) were related to walking. 'Physical disorder' (OR:1.63,95%CI = 1.31-2.03,p<0.001) had an independent effect on MPA. Interactive effects of social and physical factors on walking and MPA were revealed.
Findings suggest that intervening to create activity-supportive environments in deprived communities may be most effective when simultaneously targeting the social and physical neighbourhood environment.
Ecological models of physical activity posit that social and physical environmental features exert independent and interactive influences on physical activity, but previous research has focussed on ...independent influences. This systematic review aimed to synthesise the literature investigating how features of neighbourhood physical and social environments are associated with physical activity when both levels of influence are simultaneously considered, and to assess progress in the exploration of interactive effects of social and physical environmental correlates on physical activity.
A systematic literature search was conducted in February 2016. Articles were included if they used an adult (≥15 years) sample, simultaneously considered at least one physical and one social environmental characteristic in a single statistical model, used self-reported or objectively-measured physical activity as a primary outcome, reported findings from quantitative, observational analyses and were published in a peer-reviewed journal. Combined measures including social and physical environment items were excluded as they didn't permit investigation of independent and interactive social and physical effects. Forty-six studies were identified.
An inconsistent evidence base for independent environmental correlates of physical activity was revealed, with some support for specific physical and social environment correlates. Most studies found significant associations between physical activity and both physical and social environmental variables. There was preliminary evidence that physical and social environmental variables had interactive effects on activity, although only 4 studies examined interactive effects.
Inconsistent evidence of independent associations between environmental variables and physical activity could be partly due to unmeasured effect modification (e.g. interactive effects) creating unaccounted variance in relationships between the environment and activity. Results supported multiple levels of environmental influence on physical activity. It is recommended that further research uses simultaneous or interaction analyses to gain insight into complex relationships between neighbourhood social and physical environments and physical activity, as there is currently limited research in this area.
Background
Many people living with and beyond cancer (LWBC) do not meet dietary recommendations. To implement a healthier diet, people LWBC must perceive a need to improve their diet.
Methods
...Participants included people diagnosed with breast, prostate or colorectal cancer in the UK. Two binary logistic regression models were conducted with perceived need for dietary change as the outcome (need to improve vs. no need). Predictor variables included demographic and clinical characteristics, receipt of dietary advice, and either body mass index (BMI) or adherence to seven relevant World Cancer Research Fund (WCRF) dietary recommendations.
Results
The sample included 5835 responses. Only 31% perceived a need to improve their diet. Being younger (odds ratio OR 0.95, 95% confidence interval CI = 94–0.95), female (OR = 1.33, 95% CI = 1.15–1.53), not of white ethnicity (OR = 1.8, 95% CI = 1.48–2.27), not married/cohabiting (OR = 1.32, 95% CI = 1.16–1.52) and having received dietary advice (OR = 1.36, 95% CI = 1.43–1.86) was associated with an increased odds of perceiving a need to improve diet. This association was also seen for participants with two or more comorbidities (OR = 1.31, 95% CI = 1.09–1.57), those not meeting the recommendations for fruit and vegetables (OR = 0.47, 95% CI = 0.41–0.55), fat (OR = 0.67, 95% CI = 0.58–0.77), and sugar (OR = 0.86, 95% CI = 0.75–0.98) in the dietary components model and those who had a higher BMI (OR = 1.53, 95% CI = 1.32–1.77) in the BMI model.
Conclusions
Most of this sample of people LWBC did not perceive a need to improve their diet. More research is needed to understand the reasons for this and to target these reasons in dietary interventions.
Despite published dietary recommendations, we found that many people living with and beyond cancer do not follow a healthy diet and only 31% of our sample (n = 5835) perceived a need to improve their diet. Being younger, female, not of white ethnicity, not married/cohabiting, having more comorbidities, having a higher body mass index, and not meeting various dietary recommendations was associated with perceiving a need to improve diet.
Introduction
Increased moderate to vigorous physical activity (MVPA) can improve clinical and psychosocial outcomes for people living with and beyond cancer (LWBC). This study aimed to assess the ...feasibility and acceptability of trial procedures in a pilot randomised controlled trial (RCT) of a theory‐driven app‐based intervention with behavioural support focused on promoting brisk walking (a form of MVPA) in people LWBC (APPROACH).
Methods
Participants diagnosed with breast, prostate or colorectal cancer were recruited from a single UK hospital site. Assessments at baseline and 3 months included online questionnaires, device‐measured brisk walking (activPAL accelerometer) and self‐reported weight and height. Participants were randomised to intervention or control (care as usual). The intervention comprised a non‐cancer‐specific app to promote brisk walking (National Health Service ‘Active 10’) augmented with print information about habit formation, a walking planner and two behavioural support telephone calls. Feasibility and acceptability of trial procedures were explored. Initial estimates for physical activity informed a power calculation for a phase III RCT. A preliminary health economics analysis was conducted.
Results
Of those medically eligible, 369/577 (64%) were willing to answer further eligibility questions and 90/148 (61%) of those eligible were enrolled. Feasibility outcomes, including retention (97%), assessment completion rates (>86%) and app download rates in the intervention group (96%), suggest that the trial procedures are acceptable and that the intervention is feasible. The phase III RCT will require 472 participants to be randomised. As expected, the preliminary health economic analyses indicate a high level of uncertainty around the cost‐effectiveness of the intervention.
Conclusions
This pilot study demonstrates that a large trial of the brisk walking intervention with behavioural support is both feasible and acceptable to people LWBC. The results support progression onto a confirmatory phase III trial to determine the efficacy and cost‐effectiveness of the intervention.
Background
COVID-19 lockdown introduced substantial barriers to physical activity, providing a unique ‘natural experiment’ to understand the social factors associated with sustained physical ...activity. The objectives of this study were to identify the proportion of people who successfully sustained physical activity during lockdown and to explore whether social support, loneliness and social isolation were associated with maintenance of physical activity during COVID-19 lockdown.
Method
Longitudinal data from 16,980 participants, mean age 51.3 years (SD = 14.3) from the COVID-19 Social Study was used to identify a sample of participants who maintained their physical activity despite lockdown.
Results
Seventeen percent were consistently active whilst 42% were completely inactive. After adjustment for multiple confounders, high social support was associated with a 64% (95% CI 50–80%) increased odds of sustaining physical activity and medium social support was associated with 32% (95% CI 20–44%) increased odds. Associations between physical activity and loneliness and social isolation were not found.
Conclusion
This study supports previous research showing the importance of social support for the long-term maintenance of physical activity behaviour but shows that such effects extend to contexts of social restrictions.
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