First isolation and genotyping of pathogenic Leptospira spp. from Austria.

Leptospirosis is a globally distributed zoonotic disease. The standard serological test, known as Microscopic Agglutination Test (MAT), requires the use of live Leptospira strains. To enhance its sensitivity and specificity, the usage of locally circulating strains is recommended. However, to date, no local strain is available from Austria. This study aimed to isolate circulating Leptospira strains from cattle in Austria to enhance the performances of the routine serological test for both humans and animals. We used a statistical approach combined with a comprehensive literature search to profile cattle with greater risk of leptospirosis infection and implemented a targeted sampling between November 2021 and October 2022. Urine and/or kidney tissue were sampled from 410 cattle considered at higher risk of infection. Samples were inoculated into EMJH-STAFF culture media within 2-6 h and a real-time PCR targeting the lipL32 gene was used to confirm the presence/absence of pathogenic Leptospira in each sample. Isolates were further characterised by core genome multilocus sequence typing (cgMLST). Nine out of 429 samples tested positive by PCR, from which three isolates were successfully cultured and identified as Leptospira borgpetersenii serogroup Sejroe serovar Hardjobovis, cgMLST cluster 40. This is the first report on the isolation and genotyping of local zoonotic Leptospira in Austria, which holds the potential for a significant improvement in diagnostic performance in the country. Although the local strain was identified as a cattle-adapted serovar, it possesses significant zoonotic implications. Furthermore, this study contributes to a better understanding of the epidemiology of leptospirosis in Europe.

Effects of a Web-Based Lifestyle Intervention on Physical Fitness and Health in Physically Inactive Adults: A Randomized Controlled Trial.

Web-based lifestyle interventions are a new area of health research. This randomized controlled trial evaluated the effectiveness of an interactive web-based health program on physical fitness and health. N = 189 healthy adults participated in a 12-week interactive (intervention) or non-interactive (control) web-based health program. The intervention provided a web-based lifestyle intervention to promote physical activity and fitness through individualized activities as part of a fully automated, multimodal health program. The control intervention included health information. Cardiorespiratory fitness measured as maximum oxygen uptake (VO2max) was the primary outcome, while musculoskeletal fitness, physical activity and dietary behavior, and physiological health outcomes were assessed as secondary outcomes (t0: 0 months, t1: 3 months, t2: 9 months, t3: 15 months). Statistical analysis was performed with robust linear mixed models. There were significant time effects in the primary outcome (VO2max) (t0-t1: p = 0.018) and individual secondary outcomes for the interactive web-based health program, but no significant interaction effects in any of the outcomes between the interactive and non-interactive web-based health program. This study did not demonstrate the effectiveness of an interactive compared with a non-interactive web-based health program in physically inactive adults. Future research should further develop the evidence on web-based lifestyle interventions.

Network analysis of pig movement data as an epidemiological tool: an Austrian case study.

Animal movements represent a major risk for the spread of infectious diseases in the domestic swine population. In this study, we adopted methods from social network analysis to explore pig trades in Austria. We used a dataset of daily records of swine movements covering the period 2015-2021. We analyzed the topology of the network and its structural changes over time, including seasonal and long-term variations in the pig production activities. Finally, we studied the temporal dynamics of the network community structure. Our findings show that the Austrian pig production was dominated by small-sized farms while spatial farm density was heterogeneous. The network exhibited a scale-free topology but was very sparse, suggesting a moderate impact of infectious disease outbreaks. However, two regions (Upper Austria and Styria) may present a higher structural vulnerability. The network also showed very high assortativity between holdings from the same federal state. Dynamic community detection revealed a stable behavior of the clusters. Yet trade communities did not correspond to sub-national administrative divisions and may be an alternative zoning approach to managing infectious diseases. Knowledge about the topology, contact patterns, and temporal dynamics of the pig trade network can support optimized risk-based disease control and surveillance strategies.

Effects of a Web-Based Lifestyle Intervention on Weight Loss and Cardiometabolic Risk Factors in Adults With Overweight and Obesity: Randomized Controlled Clinical Trial.

BACKGROUND: The high proportion of people with overweight and obesity has become a worldwide problem in recent decades, mainly due to health consequences, such as cardiovascular diseases, neoplasia, and type 2 diabetes mellitus. Regarding effective countermeasures, the digitization of health services offers numerous potentials, which, however, have not yet been sufficiently evaluated. Web-based health programs are becoming increasingly interactive and can provide individuals with effective long-term weight management support. OBJECTIVE: The purpose of this randomized controlled clinical trial was to evaluate the effectiveness of an interactive web-based weight loss program on anthropometric, cardiometabolic, and behavioral variables and to compare it with a noninteractive web-based weight loss program. METHODS: The randomized controlled trial included people who were aged between 18 and 65 years (mean 48.92, SD 11.17 years) and had a BMI of 27.5 to 34.9 kg/m2 (mean 30.71, SD 2.13 kg/m2). Participants (n=153) were assigned to either (1) an interactive and fully automated web-based health program (intervention) or (2) a noninteractive web-based health program (control). The intervention program focused on dietary energy density and allowed for dietary documentation with appropriate feedback on energy density and nutrients. The control group only received information on weight loss and energy density, but the website did not contain interactive content. Examinations were performed at baseline (t0), at the end of the 12-week intervention (t1), and at 6 months (t2) and 12 months (t3) thereafter. The primary outcome was body weight. The secondary outcomes were cardiometabolic variables as well as dietary and physical activity behaviors. Robust linear mixed models were used to evaluate the primary and secondary outcomes. RESULTS: The intervention group showed significant improvements in anthropometric variables, such as body weight (P=.004), waist circumference (P=.002), and fat mass (P=.02), compared with the control group over the course of the study. The mean weight loss after the 12-month follow-up was 4.18 kg (4.7%) in the intervention group versus 1.29 kg (1.5%) in the control group compared with the initial weight. The results of the nutritional analysis showed that the energy density concept was significantly better implemented in the intervention group. Significant differences in cardiometabolic variables were not detected between the 2 groups. CONCLUSIONS: The interactive web-based health program was effective in reducing body weight and improving body composition in adults with overweight and obesity. However, these improvements were not associated with relevant changes in cardiometabolic variables, although it should be noted that the study population was predominantly metabolically healthy. TRIAL REGISTRATION: German Clinical Trials Register DRKS00020249; https://drks.de/search/en/trial/DRKS00020249. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.3390/ijerph19031393.

Evaluation of an Interactive Web-Based Health Program for Weight Loss-A Randomized Controlled Trial.

Personal behavior patterns, such as unhealthy diet and lack of physical activity, lead to the development of overweight and obesity. These are associated with other comorbidities, reduced quality of life, premature frailty and increased mortality. Personalized web-based interventions are promising in inducing behavioral change leading to effective reductions in body weight at relatively low costs. However, the long-term effects have not been thoroughly investigated. This work evaluates the effectiveness of web-based interactive weight loss coaching and compares it to a non-interactive web-based health program. Therefore, a randomized controlled trial (RCT) was implemented, measuring primary and secondary outcomes at four time points (program start; end of the 12-week-program; 6 months after program end, 12 months after program end). The net sample covered 1499 subjects in the intervention group and 1492 in the control group. On average, the IG was 43 years old (±13.6), 80.1% male, and had 86.4 kg body weight (±16.1) at baseline. The CG was 42.7 years old (±13.9), 79.5% male and had a mean body weight of 86.1 (±15.7). Multilevel analyses with fixed effects were carried out both from the perspective of an intention-to-treat (ITT) and a complete cases approach (CCA). In sum, our adjusted models suggest a weight loss of 0.4 kg per time point. At the end of the program, significant differences in weight loss in % to baseline (delta M = 1.8 in the CCA) were observed in favor of the intervention group. From a long-term perspective, no superiority of the intervention group in comparison to the control group could be found. More intensive use of the program was not statistically associated with higher weight loss.

Hyalomma spp. in Austria-The Tick, the Climate, the Diseases and the Risk for Humans and Animals.

Recently, ticks of Hyalomma spp. have been found more often in areas previously lacking this tick species. Due to their important role as a vector of different diseases, such as Crimean-Congo-hemorrhagic fever (CCHF), the occurrence and potential spread of this tick species is of major concern. So far, eight Hyalomma sp. ticks were found between 2018 and 2021 in Austria. A serological investigation on antibodies against the CCHF virus in 897 cattle as indicator animals displayed no positive case. During observation of climatic factors, especially in the period from April to September, the year 2018 displayed an extraordinary event in terms of higher temperature and dryness. To estimate the risk for humans to come in contact with Hyalomma sp. in Austria, many parameters have to be considered, such as the resting place of birds, availability of large livestock hosts, climate, density of human population, etc.

Adoption and maintenance of physical activity: Mediation analysis of a psychological intervention.

OBJECTIVE: To analyze the cognitive mediation processes of an effective psychological group-based intervention promoting physical activity (based on motivational and volitional theories; MoVo-LISA) and to test for different underlying intervention mechanisms in the adoption and maintenance phase of physical activity behavior change. METHOD: In an RCT, N = 202 patients with coronary heart disease were randomly allocated to the group-based MoVo-LISA intervention or a control group (treatment-as-usual). Primary outcome was physical activity (in minutes per week, significant group differences: posttreatment: d = 1.03; 12-months follow-up: d = .57). Potential mediator variables were self-efficacy, outcome expectations, intention strength, self-concordance, action planning and barrier management. A mediation analysis of longitudinal data in SPSS AMOS v.24 was conducted. RESULTS: The intervention was successful in modifying most of the examined cognitive variables in the adoption and/or the maintenance phase, with exception of self-concordance. Intention strength and self-concordance were significant predictors of behavior change in both phases. Findings suggest that the observed intervention effects on physical activity behavior were only partially mediated through the motivational variables self-efficacy and outcome expectation. CONCLUSIONS: The results contribute to opening "the black box" of processes behind an intervention and show that intervention effects of MoVo-LISA are partially mediated through the specified cognitive variables. The relevance of motivational variables (intention strength and self-concordance) in the adoption and maintenance phases is highlighted in this study and leads to relevant intervention design implications. Nevertheless, the differentiation of the two phases might help to improve intervention programs through a stronger focus on those cognitive parameters that are critical at a certain point in the behavior change process. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Blended Care Interventions to Promote Physical Activity: A Systematic Review of Randomized Controlled Trials.

BACKGROUND: Blended care interventions combine therapeutic guidance with digital care. Current research results show the promising role of the blended care approach in clinical care. This new way of delivering health care could have the potential to effectively promote physical activity in different public health settings. OBJECTIVE: The aim of the systematic review is to investigate the varieties of intervention characteristics of blended care interventions to promote physical activity in terms of structure, behavior change goals, behavior change techniques, and effectiveness of blended care interventions compared to a control group. METHODS: We searched for randomized controlled trials published from 2000 to March 2021 in MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, SPORTDiscus, PsycINFO, and Web of Science according to the PRISMA guidelines. Risk of bias was assessed using the Cochrane Collaboration tool. Study characteristics, intervention characteristics, and outcome data were extracted. Furthermore, the effect size on the outcome of physical activity was examined or calculated. RESULTS: In total, the number of reports identified from the database searches was 4828. Of these, 25 studies were included in the review, with a total of 5923 study participants. Results indicated that the characteristics of blended care interventions showed a high heterogeneity. The combinations of therapist-guided interventions and digital interventions allowed the identification of specific subgroups, but they varied in length (range 8-52 weeks, SD 16.6), intensity, and the combination of the components. The most used combination of blended care interventions to promote physical activity was the combination of one-on-one meetings via telephone and Web-based interventions. Motivational models of behavior change were used most frequently as underlying theoretical foundations. Certain behavior change techniques were used consistently across the individual components, e.g., "problem solving" in the therapist-guided component and "feedback on behavior" in the digital component. Considering the effect size of blended care interventions compared with control groups, most studies showed a small effect. CONCLUSIONS: It can be concluded that blended care interventions have potential to promote physical activity. In the future, further high-quality studies should investigate which type of blended care intervention is effective for which target group. Additionally, insights are required on which intervention characteristics are most effective, taking into account new evidence on behavior change. Registration This systematic literature review was registered in PROSPERO ( CRD42020188556 ).

Automated 3D thorax model generation using handheld video-footage.

PURPOSE: For the visualization of pulmonary ventilation with Electrical Impedance Tomography (EIT) most devices use standard reconstruction models, featuring common thorax dimensions and predetermined electrode locations. Any discrepancies between the available model and the patient in terms of body shape and electrode position lead to incorrectly displayed impedance distributions. This work addresses that problem by presenting and evaluating a method for 3D model generation of the thorax and any affixed electrodes based on handheld video-footage. METHODS: Therefore, a process was developed, providing users with the ability to capture a patient's chest and the attached electrodes via smartphone. Once data is collected, extracted images are used to generate a 3D model with a structure from motion approach and locate electrodes with ArUco markers. For the evaluation of the developed method, multiple tests were performed in laboratory environments, which were compared with manually created reference models and differences quantified based on mean distance, standard deviation, and maximum distance. RESULTS: The implemented workflow allows for automated model reconstruction based on videos or selected images captured with a handheld device. It generates sparse point clouds from which a surface mesh is reconstructed and returns relative coordinates of any identified ArUco marker. The average value for the mean distance error of two model generations was 5.4 mm while the mean standard deviation was 6.0 mm. The average runtime of twelve reconstructions was 5:17 min, with a minimal runtime of 3:22 min and a maximal runtime of 7:29 min. CONCLUSION: The presented methods and results show that model reconstruction of a patient's thorax and applied electrodes at an emergency site is feasible with already available devices. This is a first step toward the automated generation of patient-specific reconstruction models for Electrical Impedance Tomography based on images recorded with handheld devices.

A system for real-time multivariate feature combination of endoscopic mitral valve simulator training data.

PURPOSE: For an in-depth analysis of the learning benefits that a stereoscopic view presents during endoscopic training, surgeons required a custom surgical evaluation system enabling simulator independent evaluation of endoscopic skills. Automated surgical skill assessment is in dire need since supervised training sessions and video analysis of recorded endoscope data are very time-consuming. This paper presents a first step towards a multimodal training evaluation system, which is not restricted to certain training setups and fixed evaluation metrics. METHODS: With our system we performed data fusion of motion and muscle-action measurements during multiple endoscopic exercises. The exercises were performed by medical experts with different surgical skill levels, using either two or three-dimensional endoscopic imaging. Based on the multi-modal measurements, training features were calculated and their significance assessed by distance and variance analysis. Finally, the features were used automatic classification of the used endoscope modes. RESULTS: During the study, 324 datasets from 12 participating volunteers were recorded, consisting of spatial information from the participants' joint and right forearm electromyographic information. Feature significance analysis showed distinctive significance differences, with amplitude-related muscle information and velocity information from hand and wrist being among the most significant ones. The analyzed and generated classification models exceeded a correct prediction rate of used endoscope type accuracy rate of 90%. CONCLUSION: The results support the validity of our setup and feature calculation, while their analysis shows significant distinctions and can be used to identify the used endoscopic view mode, something not apparent when analyzing time tables of each exercise attempt. The presented work is therefore a first step toward future developments, with which multivariate feature vectors can be classified automatically in real-time to evaluate endoscopic training and track learning progress.

National Monitoring of Veterinary-Dispensed Antimicrobials for Use on Pig Farms in Austria: 2015-2020.

Antimicrobial use in livestock production systems is increasingly scrutinised by consumers, stakeholders, and the veterinary profession. In Austria, veterinarians dispensing antimicrobials for use in food-producing animals have been required to report these drugs since 2015. Here, we describe the national monitoring systems and the results obtained for Austrian pig production over a six-year period. Antimicrobial dispensing is described using the mass-based metric, milligrams per population correction unit (mg/PCU) and the dose-based metric, Defined Daily Dose (DDDvet) per year and divided into the European Medicines Agency's prudent use categories. Pig production was divided into breeding units, fattening farms, farrow-to-finish farms, and piglet-rearing systems. Over all six years and all pig production systems, the mean amount of antimicrobials dispensed was 71.6 mg/PCU or 2.2 DDDvet per year. Piglet-rearing systems were found to have the highest levels of antimicrobial dispensing in DDDvet, as well as the largest proportion of Category B antimicrobials, including polymyxins. Although progress has been made in promoting a more prudent use of antimicrobials in veterinary medicine in Austria, further steps need to be taken to proactively improve animal health and prevent disease to reduce the need for antimicrobials, particularly those critically important for human medicine, in the future.

Health Effects of a 12-Week Web-Based Lifestyle Intervention for Physically Inactive and Overweight or Obese Adults: Study Protocol of Two Randomized Controlled Clinical Trials.

Web-based lifestyle interventions have attracted considerable research interest. Available evidence on such interventions suggests health-promoting effects, but further research is needed. Therefore, this study aims to investigate short-, medium-, and long-term health effects of a web-based health program ("TK-HealthCoach", TK-HC) offered by a national statutory health insurance fund (Techniker Krankenkasse, TK). The study comprises two randomized controlled clinical trials to evaluate the health goals "Increasing Fitness" (Fclin) and "Losing and Maintaining Weight" (Wclin). A total of n = 186 physically inactive (Fclin) and n = 150 overweight or obese (Wclin) adults will be randomly assigned to a 12-week interactive (TK-HC) or non-interactive web-based health program using permuted block randomization with a 1:1 allocation ratio. Primary outcomes include cardiorespiratory fitness (Fclin) and body weight (Wclin). Secondary outcomes comprise musculoskeletal fitness (Fclin), physical activity and dietary behavior, anthropometry, blood pressure, blood levels, and vascular health (Fclin, Wclin). All outcomes will be measured before and after the 12-week intervention and after a 6- and 12-month follow-up. Additionally, usage behavior data on the health programs will be assessed. Linear mixed models (LMMs) will be used for statistical analysis. Findings of this study will expand the available evidence on web-based lifestyle interventions.

A questionnaire to assess eating behavior: Structure, validity and responsiveness of a new German eating behavior scale (SEV).

Numerous weight-loss interventions promoting healthy and weight-reducing eating behavior have been developed over the past years. To evaluate the effectiveness of such interventions for eating behavior change, short, validated and sensitive instruments are needed. In this study series, we developed and validated a new outcome measure to assess health-conscious and weight-controlling eating behavior for the evaluation of weight-loss interventions. The preliminary version of the German eating behavior scale (Skala zumErnährungsverhalten [SEV]) included 40 items. Three studies were conducted to (a) reduce the preliminary item pool, (b) investigate structural validity and internal consistency using exploratory and confirmatory factor analyses (EFA, CFA), as well as McDonald's ω, and (c) test construct validity with physiological and behavioral parameters. Responsiveness to change was also assessed after a 12-week weight-loss intervention. EFA indicated a two-factor solution with health-conscious (hc-EB) and weight-controlling eating behavior (wc-EB) as subscales, CFA confirmed the two-factor solution with acceptable model fit. Internal consistencies of both subscales were also acceptable to good (hc-EB: ω = 0.88; wc-EB: ω = 0.78). Significantly small to moderate correlations to the Healthy Eating Index (r = 0.51) as well as blood glucose (r = 0.31), blood lipids (r = 0.23), and vascular age (r = 0.31) were found, supporting the construct validity of the SEV and its subscales. Both subscales detected intervention-related changes in eating behavior among subjects of a weight-loss intervention with Standardized Response Means of 0.52 and 0.67, indicating good responsiveness of the SEV. In sum, findings provide evidence that the SEV is a valid and responsive measure to assess health-conscious and weight-controlling eating behavior.

Interprofessional education in medical and physiotherapy studies for future collaboration.

BACKGROUND: Interprofessional education (IPE) for medical and healthcare professions is highly relevant. It increases knowledge and skills, but also helps to foster the development of collaboration, which is essential for optimal patient care. One important aspect of IPE is to better understand profession's individual attitudes and perceptions towards interprofessionalism and the expected roles and skills for future collaboration in the context of patient care. METHODS: We offered IPE workshops using a peer assisted learning approach, with the focus on anatomy in the area of the lower back and hip. The workshops were attended by medical and physiotherapy students and consisted of three consecutive training sessions with the topics anatomical prosections, anatomy in vivo and orthopedics testing. We focused on student's attitudes and perceptions regarding the relevance of IPE and their expected skills in interprofessionalism. An established questionnaire was used as an instrument for self-assessment before and after the interprofessional experience. To evaluate for significance, analysis was carried out for all groups on pre- and post-course item mean differences. RESULTS: Pre-post score comparison for all groups combined demonstrated significant increase in terms of perceptions and attitudes for several items related to interprofessionalism and interprofessional skills. Medical and physiotherapy students rated themselves significantly higher for different questionnaire items. Students, who had obtained a professional qualification prior to their current studies, rated themselves significantly higher on certain items compared to those who had not. CONCLUSIONS: The results from this brief interprofessional anatomy experience are encouraging. The course led to meaningful improvements in competencies that are highly relevant for effective interprofessional collaboration in the future. Furthermore, identification of differences in professional group perceptions can be useful for development of future IPE workshops.

Effects of a Web-Based Weight Loss Program on the Healthy Eating Index-NVS in Adults with Overweight or Obesity and the Association with Dietary, Anthropometric and Cardiometabolic Variables: A Randomized Controlled Clinical Trial.

This randomized, controlled clinical trial examined the impact of a web-based weight loss intervention on diet quality. Furthermore, it was investigated whether corresponding changes in diet quality were associated with changes in measures of cardiovascular risk profile. Individuals with a body mass index (BMI) of 27.5 to 34.9 kg/m2 and an age of 18 to 65 y were assigned to either an interactive and fully automated web-based weight loss program focusing on dietary energy density (intervention) or a non-interactive web-based weight loss program (control). Examinations were performed at baseline (t0), after the 12-week web-based intervention (t1), and after an additional 6 (t2) and 12 months (t3). Based on a dietary record, the Healthy Eating Index-NVS (HEI-NVS) was calculated and analyzed using a robust linear mixed model. In addition, bootstrapped correlations were performed independently of study group to examine associations between change in HEI-NVS and change in dietary, anthropometric, and cardiometabolic variables. A total of n = 153 participants with a mean BMI of 30.71 kg/m2 (SD 2.13) and an average age of 48.92 y (SD 11.17) were included in the study. HEI-NVS improved significantly in the intervention group from baseline (t0) to t2 (p = 0.003) and to t3 (p = 0.037), whereby the course was significantly different up to t2 (p = 0.013) and not significantly different up to t3 (p = 0.054) compared to the control group. Independent of study group, there was a significant negative association between change in HEI-NVS and dietary energy density. A higher total score in HEI-NVS did not correlate with improvements in cardiovascular risk profile. The interactive and fully automated web-based weight loss program improved diet quality. Independent of study group, changes in HEI-NVS correlated with changes in energy density, but there was no association between improvements in HEI-NVS and improvements in cardiovascular risk profile.

Effectiveness of an interactive web-based health program for adults: a study protocol for three concurrent controlled-randomized trials (EVA-TK-Coach).

BACKGROUND: A healthy lifestyle can help prevent diseases that impair quality of life and lead to premature death. The Techniker health insurance fund offers a comprehensive online health program to support users in achieving their health goals of Increasing Fitness, Losing and Maintaining Weight, or Smoking Cessation. METHODS: The aim of this study is to test the long-term effectiveness of the web-based TK-HealthCoach with regard to the primary outcomes of increased physical activity, sustainable weight reduction, and smoking abstinence. We are conducting three interconnected, randomized controlled trials (RCT), one for each health goal, within which participants are allocated to an intervention group (interactive online health program) or a control group (non-interactive online health program). The effects of the intervention groups compared to the control groups will be analyzed by multi-level models for change. Participants' data are captured via online questionnaires before the program starts (baseline t0), again when it ends (t1), and later at two follow-up surveys (t2 and t3); the latter 12 months after t1. We are documenting socio-demographic, health-related, and psychological variables as well as usage behavior data of the programs. According to our sample size calculation, we have to enroll 1114 participants in each Losing and Maintaining Weight and Increasing Fitness RCT and 339 participants in the Smoking Cessation RCT. Additionally, 15-20 participants in the interactive smoking-cessation program will be invited to qualitative telephone interviews with the aim to obtain detailed information concerning utilization, compliance, and satisfaction. The online RCTs' inclusion criteria are: adults of each gender regardless of whether they are insured with Techniker health insurance fund. Persons with impairments or pre-existing conditions require a medical assessment as to whether the program is suitable for them. Specific exclusion criteria apply to each program/RCT. DISCUSSION: We assume that study participants will improve their health behavior by using the offered online health programs and that each health goal's intervention group will reveal advantages regarding the outcome variables compared to the control groups. Study enrollment started on January 1, 2020. TRIAL REGISTRATION: German Clinical Trials Register, Universal Trial Number (UTN): U1111-1245-0273 . Registered on 11 December 2019.

Joint associations of regular exercise and healthy diet with psychobiological stress reactivity in a healthy male sample.

Objectives: Engaging in physical activity and exercise have long been shown to have beneficial effects on (psychosocial) stress reactivity. Initial studies could reveal that these positive effects on stress reactivity also exist for a healthy diet. Aim of this study was to examine whether combining a healthy diet and regular exercise can provide additional benefits on psychobiological stress levels. Methods: Forty-two men self-identifying as non-exercisers or regular exercisers between 18 and 30 years were exposed to the Trier Social Stress Test for Groups. Salivary cortisol (sCort) and alpha-amylase (sAA) as biological stress markers, and self-reported momentary stress were repeatedly examined. Questionnaires on regular exercise and dietary intake were completed once. Results: Two-stage hierarchical multiple regressions predicting participants' stress reactivity, i.e. response and recovery, from diet quality, exercise as well as their interaction appeared inconsistent. sCort response was significantly predicted by regular exercise whereas greater sCort recovery was predicted by higher diet quality. In contrast, higher sAA reactivity was predicted by higher diet quality while participants eating less healthy and exercising more showed the most pronounced sAA recovery. None of the other outcome variables was predicted by the interaction. Subjective stress was unrelated to either health behavior. Conclusions: The present examination among an all-male sample emphasized the stress-buffering capabilities of regular exercise and provided initial evidence for a distinct link to healthy diet. Assumed synergistic benefits could, however, not be confirmed. Advances are needed to better understand how individuals profit the most from which behaviors as well as their interactive effects.

LAY SUMMARYThe present study among an all-male sample emphasized the stress-buffering capabilities of regular exercise. While the quality of the diet had a similar effect, assumed double benefits did not appear.

Effects of a workplace physical activity intervention on cognitive determinants of physical activity: a randomized controlled trial.

OBJECTIVE: The present randomized controlled trial evaluated if a workplace physical activity (PA) program that comprises both a PA component and a psychological coaching component (PA + C) is more effective in changing cognitive determinants of PA than a PA program without coaching component. Design:N = 213 employees were cluster-randomly assigned to two groups: the PA + C group received the MoVo-work intervention, combining a psychological coaching component and a PA component. The PA group received the PA component without psychological coaching. Main Outcome Measures: Strength of goal intention, self-efficacy, outcome expectations, action planning and barrier management were assessed at five time points (before and at the end of the intervention, as well as 6 weeks, 6 months and 12 months after the intervention). Results: After six weeks and one year, respectively, the PA + C group showed significantly higher goal intentions (p = .018) and self-efficacy beliefs (p = .006) than the PA group; and, at a descriptive level, a clear tendency towards better barrier management. Conclusions: The results indicate that a workplace PA program, including psychological coaching, may partially improve the effects of a pure PA program on critical motivational and volitional determinants of PA behavioural change among employees.

Effects of Incentives on Adherence to a Web-Based Intervention Promoting Physical Activity: Naturalistic Study.

BACKGROUND: Despite many advantages of web-based health behavior interventions such as wide accessibility or low costs, these interventions are often accompanied by high attrition rates, particularly in usage under real-life conditions. It would therefore be helpful to implement strategies such as the use of financial incentives to motivate program participation and increase adherence. OBJECTIVE: This naturalistic study examined real-life usage data of a 12-week web-based physical activity (PA) intervention (Fitness Coach) among insurants who participated in an additional incentive program (incentive group) and those who did not (nonincentive group). Users in the incentive group had the perspective of receiving €30 (about US $33) cash back at the end of the intervention. METHODS: Registration and real-life usage data as part of routine data management and evaluation of the Fitness Coach were analyzed between September 2016 and June 2018. Depending on the duration of use and the weekly recording of tasks, 4 adherence groups (low, occasional, strong, and complete adherence) were defined. Demographic characteristics were collected by a self-reported questionnaire at registration. We analyzed baseline predictors and moderators of complete adherence such as participation in the program, age, gender, and BMI using binary logistic regressions. RESULTS: A total of 18,613 eligible persons registered for the intervention. Of these, 15,482 users chose to participate in the incentive program (incentive group): mean age 42.4 (SD 14.4) years, mean BMI 24.5 (SD 4.0) kg/m2, median (IQR) BMI 23.8 (21.7-26.4) kg/m2; 65.12% (10,082/15,482) female; and 3131 users decided not to use the incentive program (nonincentive group): mean age 40.7 (SD 13.4) years, mean BMI 26.2 (SD 5.0) kg/m2, median BMI 25.3 (IQR 22.6-28.7) kg/m2; 72.18% (2260/3131) female. At the end of the intervention, participants in the incentive program group showed 4.8 times higher complete adherence rates than those in the nonincentive program group (39.2% vs 8.1%), also yielding significantly higher odds to complete the intervention (odds ratio [OR] 12.638) for the incentive program group. Gender significantly moderated the effect with men in the incentive group showing higher odds to be completely adherent than women overall and men in the nonincentive group (OR 1.761). Furthermore, older age and male gender were significant predictors of complete adherence for all participants, whereas BMI did not predict intervention completion. CONCLUSIONS: This is the first naturalistic study in the field of web-based PA interventions that shows the potential of even small financial incentives to increase program adherence. Male users, in particular, seem to be strongly motivated by incentives to complete the intervention. Based on these findings, health care providers can use differentiated incentive systems to increase regular participation in web-based PA interventions.

A group- and smartphone-based psychological intervention to increase and maintain physical activity in patients with musculoskeletal conditions: study protocol for a randomized controlled trial ("MoVo-App").

BACKGROUND: Interventions designed to increase the level of physical activity are crucial in the treatment of patients with musculoskeletal conditions. The psychological group-based intervention MoVo-LISA based on the Motivation-Volition (MoVo) Process Model has been shown to effectively promote physical activity. The aim of this study is to evaluate whether a MoVo-based app (MoVo-App) subsequent to MoVo-LISA during orthopedic inpatient care can support people to increase and maintain their amount of physical activity. METHODS/DESIGN: In this parallel-group randomized controlled trial, patients with musculoskeletal disorders will be randomized to either (a) a combination of the group-based intervention program MoVo-LISA to promote physical activity plus the MoVo-App or (b) the group-based intervention program alone without the app. The intervention group will receive the MoVo-App after discharge from inpatient rehabilitation. They receive help to increase and maintain their level of physical activity (initiated by the group program) by tracking their health goals, activity plans, major barriers, and barrier management that were developed during the group-based program. We will recruit 224 initially minimally active participants during orthopedic rehabilitation care. Outcomes are assessed at clinic admission; discharge; 6 weeks; and 3 (post-treatment), 6, and 12 months after discharge (follow-up). The primary outcome is sport activity (active/inactive and minutes of activity) at 6-month follow-up. Secondary outcomes are movement activity, cognitive mediators of behavioral change (e.g., self-efficacy, action planning), and health-related variables (e.g., pain intensity, depression). To evaluate intervention effects, linear mixed effects models (both on intention-to-treat basis with an additional per-protocol analysis) will be conducted with each outcome variable and with time as the within-subjects factor and group as the between-subjects factor, along with all two-way interactions and accounting for covariates as fixed effects. DISCUSSION: This is the first evaluation of the effectiveness of an app in combination with a face-to-face group intervention to promote physical activity. The approach of using an app in addition to an effective face-to-face intervention program, both based on the MoVo model, might sustain positive intervention effects introduced in routine health care. TRIAL REGISTRATION: The trial "A group- and smartphone-based psychological intervention to increase physical activity in patients with musculoskeletal conditions: A randomized controlled trial" is registered at the World Health Organization International Clinical Trials Registry Platform via the German Clinical Studies Trial Register (DRKS), DRKS00014814. Registered on 18 October 2018; URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00014814.