The development of a family-based wearable intervention using behaviour change and co-design approaches: move and connect.

BACKGROUND: Previous research has explored the effectiveness of wearable activity trackers (wearables) for increasing child physical activity (PA) levels, but there have been mixed results. The use of theoretical frameworks and co-design techniques are recognised ways of increasing an intervention's acceptability and effectiveness. AIMS: This study aims to use co-design workshops and an evidence-based theoretical framework (the Behaviour Change Wheel) to develop a family-based PA intervention using wearables. METHODS: Three stages of intervention development outlined by the Behaviour Change Wheel were used. Co-design workshops with seven families (11 parents and 12 children) and seven PA experts were conducted where stakeholders discussed how to overcome previously identified barriers to families being active and using wearables. This resulted in the intervention's components being developed, with each component's mechanisms of action (e.g. intervention functions and behaviour change techniques) being retrospectively identified. RESULTS: The 'Move & Connect' intervention was developed, which targets family PA and wearable use. The intervention takes a flexible approach and includes eight components, including wearable devices (Fitbit Alta HR), support resources, an introductory workshop, collective challenges, goal setting and reviewing, engagement prompts, social support and health-related resources (e.g. educational videos). The intervention incorporates six intervention functions targeting PA and wearable use: education, training, modelling, persuasion, incentivisation and environmental restructuring and 24 behaviour change techniques, including goal setting, social comparison, feedback on behaviour and graded task. CONCLUSIONS: This is the first known study to use an evidence-based framework and co-design to develop a family-based wearable intervention. The identification of the intervention's mechanisms of action will prove useful when implementing and evaluating the 'Move & Connect' intervention and allow researchers to replicate its components.

Psychosocial work environment and leisure-time physical activity: the Stormont study.

BACKGROUND: Research findings on the relationship between the psychosocial work environment and leisure-time physical activity (LTPA) are equivocal. This might partly be due to studies having focused on a restricted set of psychosocial dimensions, thereby failing to capture all relevant domains. AIMS: To examine cross-sectional associations between seven psychosocial work environment domains and LTPA in a large sample of UK civil servants and to profile LTPA and consider this in relation to UK government recommendations on physical activity. METHODS: In 2012 Northern Ireland Civil Service employees completed a questionnaire including measures of psychosocial working conditions (Management Standards Indicator Tool) and LTPA. We applied bivariate correlations and linear regression analyses to examine relations between psychosocial working conditions and LTPA. RESULTS: Of 26000 civil servants contacted, 5235 (20%) completed the questionnaire. 24% of men and 17% of women reported having undertaken 30min or more of physical activity on five or more days in the past week. In men, job control (-0.08) and peer support (-0.05) were weakly but significantly negatively correlated with LTPA, indicating that higher levels of exposure to these psychosocial hazards was associated with lower levels of LTPA. Job role (-0.05) was weakly but significantly negatively correlated with LTPA in women. These psychosocial work characteristics accounted for 1% or less of the variance in LTPA. CONCLUSIONS: Longitudinal research to examine cause-effect relations between psychosocial work characteristics and LTPA might identify opportunities for psychosocial job redesign to increase employees' physical activity during leisure time.

A survey of sitting time among UK employees.

BACKGROUND: Sedentary behaviour is a known risk factor for a wide range of chronic diseases. This major health risk is likely to increase given the increasingly sedentary nature of work. AIMS: To investigate the prevalence of sedentary behaviour in a sample of UK working-aged adults, across a range of employment sectors. METHODS: A cross-sectional survey conducted with organizations throughout the UK in the education, government administration, retail, telecommunications and service industry sectors. The questionnaire examined employee and organizational information, self-reported domain-specific sitting time, sleep and physical activity. RESULTS: A total of 1141 employees completed the questionnaire, of which 504 completed all aspects of the Domain-Specific Sitting Time Questionnaire for work day sitting. Work time sitting accounted for more than half of the total daily sitting time on a work day (54%). Significantly more time was reported sitting on a work day than time reported sleeping (P < 0.001). Males spent more time sitting at work and using a personal computer at home compared with females. Workers in the telecommunications industry had the highest sitting times. There were significant positive associations between sitting time and body mass index. CONCLUSIONS: There is a pressing need for future workplace health interventions to reduce employee sitting times.

Sitting time and step counts in office workers.

BACKGROUND: Technological advances mean that many adults are now employed in sedentary occupations. Given evidence linking prolonged sitting to chronic disease risk, understanding sitting and physical activity in and outside the workplace may usefully inform effective interventions. AIMS: To assess sitting time and physical activity during and outside working hours in full-time office workers. METHODS: Participants wore a pedometer and recorded sitting times and step counts during and outside working hours for 7 days. Participants were divided into tertiles based on the proportion of time spent sitting at work. Sitting times and step counts reported outside work were compared between groups, using one-way analysis of variance. RESULTS: There were 72 participants. Almost two-thirds (65%) of time at work was spent sitting. The sample accumulated 3742±2493 steps at work and 5159±2474 steps outside work on workdays. Participants in the highest tertile for workplace sitting reported sitting for longer than those in the lowest tertile during transport (64±59 versus 21±16min), after work (154±30 versus 126±51min) and at weekends (382±133 versus 288±124min, all P < 0.05). Work duration and steps reported outside work did not differ between groups. CONCLUSIONS: Office workers who sit for a large proportion of their working day also report sitting for longer outside work. They do not compensate for their sedentary behaviour at work by being more active outside work. Occupational health interventions should focus on reducing workplace and leisure-time sitting in sedentary office workers.

Overweight and obesity in UK firefighters.

BACKGROUND: Obesity among firefighters can present a hindrance to operational effectiveness. In North American studies, 80% of US firefighters are overweight or obese. No studies have explored obesity among firefighters in the UK, and it is unclear whether obesity is a problem among UK firefighters. AIMS: To establish the prevalence of obesity among a large sample of firefighters in the UK and to explore changes in body mass index (BMI) over a 3-year period. METHODS: The BMI and body composition of 735 male firefighters from a UK county fire and rescue service were assessed in 2008 and 2011. RESULTS: In 2008, 65% of the firefighters were either overweight (54%) or obese (11%). In 2011, slightly fewer firefighters were overweight (53%), but the proportion classified as obese increased significantly to 13%. Those classified as normal weight in 2008 were more likely to have gained weight by 2011 in comparison with those categorized as obese at baseline. A lower proportion of firefighters were classified as high risk for obesity based on their waist circumference in 2008. CONCLUSIONS: The proportion of firefighters who are either overweight or obese is lower in this UK sample than that found in US studies. Nevertheless, the proportion of UK firefighters classed as overweight was higher than that found in the general population samples from England. Given the negative implications of obesity for performance, there is a need for further investment in theory-based, sector-specific health promotion research and practice.

Evaluation of a commercially available pedometer used to promote physical activity as part of a national programme.

OBJECTIVE: To assess the accuracy of a pedometer (manufactured by Silva) currently being used as part of a national programme to promote physical activity in the UK. METHODS: Laboratory study: 68 participants (aged 19.2 years (SD 2.7), body mass index (BMI) 22.5 kg/m(2) (SD 3.3)) wore two Silva pedometers (over the right and left hips) while walking on a motorised treadmill at 2, 2.5, 3, 3.5 and 4 mph. Pedometer step counts were compared with actual steps counted. Free-living study: 134 participants (aged 36.4 years (SD 18.1), BMI 26.3 kg/m(2) (SD 5.1)) wore one Silva pedometer, one New-Lifestyles NL-1000 pedometer and an ActiGraph GT1M accelerometer (the criterion) during waking hours for one day. Step counts registered by the Silva and NL-1000 pedometers were compared with ActiGraph step counts. Percentage error of the pedometers were compared across normal-weight (n = 58), overweight (n = 45) and obese (n = 31) participants. RESULTS: Laboratory study: Across the speeds tested percentage error in steps ranged from 6.7 (4 mph) to 46.9% (2 mph). Free-living study: Overall percentage errors of the Silva and NL-1000 pedometers relative to the criterion were 36.3% and 9%, respectively. Significant differences in percentage error of the Silva pedometer were observed across BMI groups (normal-weight 21%, overweight 40.2%, obese 59.2%, p<0.001). CONCLUSION: The findings suggest the Silva pedometer is unacceptably inaccurate for activity promotion purposes, particularly in overweight and obese adults. Pedometers are an excellent tool for activity promotion; however, the use of inexpensive, untested pedometers is not recommended as they will lead to user frustration, low intervention compliance and adverse reaction to the instrument, potentially impacting future public health campaigns.

Reactivity: an issue for short-term pedometer studies?

OBJECTIVES: To investigate the influence of wearing a pedometer and recording daily step counts on ambulatory activity. METHODS: During the first visit to the laboratory, 50 healthy volunteers, blinded to the study aim, were provided with a sealed pedometer (New-Lifestyles NL-2000) and informed that it was a "body posture monitor" (sealed condition). Participants wore the pedometer throughout waking hours for one week. Upon returning to the laboratory step counts were downloaded and participants were informed that the device was actually a pedometer. They were requested to wear it unsealed for a second one-week period, and to record their step counts in an activity log (unsealed condition). RESULTS: Mean (SD) daily step counts reported in the sealed condition (9541 (3186) steps/day) were significantly lower than step counts reported in the unsealed condition (11385 (3763) steps/day) (p<0.001). CONCLUSIONS: Step counts increased significantly in the unsealed condition. Possible mechanisms for this include the knowledge of wearing a pedometer, the visible step count display and the completion of the activity log. This has validity implications for short-term studies (duration

Four-week pedometer-determined activity patterns in normal weight and overweight UK adults.

OBJECTIVE: To assess pedometer-determined physical activity levels and activity patterns in a sample of free-living normal weight and overweight UK adults. DESIGN: Pedometer-based 4-week observational study. PARTICIPANTS: One hundred and twenty-two healthy participants, recruited from two regions in the UK, classified as normal weight (33 females and 26 males) or overweight (31 females and 32 males), in the age range of 18 to 65 years, completed the study. MEASUREMENTS: Daily step counts were measured using a Yamax SW-200 pedometer, and were then recorded in an activity log. Comparisons were made between activity patterns occurring over different days of the week for the normal weight and overweight groups. Measurements of height, weight and percentage body fat, by bioelectrical impedance, were taken pre- and post-study. RESULTS: A consistent reduction in activity was observed on a Sunday in the overweight group, and mean daily step counts accumulated on Sundays were significantly lower, by an average of 2221 steps/day, when compared with all other days of the week (all P<0.001). In comparison, no day-of-the-week effect was observed in the normal weight group. Mean step counts reported on each day of the week did not differ significantly between the two groups, with the exception of Sunday when the overweight group reported significantly fewer steps than the normal weight participants (8093 versus 10 538, P<0.001). CONCLUSIONS: Activity levels dropped dramatically in the sample of overweight adults on a Sunday. Simple instructions to at-risk individuals, to increase their general activity levels on a Sunday, via general practitioners and public health messages could prove to be a subtle, but effective, strategy to tackle obesity.

Comparison of the neurokinin-1 antagonist GR205171, alone and in combination with the 5-HT3 antagonist ondansetron, hyoscine and placebo in the prevention of motion-induced nausea in man.

AIMS: In man a neurokinin-1 (NK1) receptor antagonist has previously been shown to be ineffective in the prevention of motion-induced nausea. The antiemetic efficacy of NK1 receptor antagonists against chemotherapy-induced emesis is, however, enhanced when combined with a 5-HT3 receptor antagonist. Hence the efficacy of the NK1 antagonist GR205171 in combination with the 5-HT3 antagonist ondansetron (Zofrantrade mark) was assessed in motion-induced nausea. METHODS: GR205171 25 mg i.v., with and without concomitant administration of ondansetron 8 mg i.v., and hyoscine hydrobromide 0. 6 mg orally (positive control) were compared with placebo in a model of motion-induced nausea. The study was performed to a four-period, randomized, balanced, double-blind, crossover design in 16 healthy subjects. The end-point was the exposure to the motion stimulus required to produce moderate nausea in the subjects. RESULTS: The motion stimulus required to produce moderate nausea was significantly greater for the positive control than placebo (P < 0. 001). There was no significant difference between either GR205171 or GR205171 plus ondansetron and placebo (P = 0.648 and 0.342, respectively). CONCLUSIONS: The enhancement of NK1 receptor antagonist antiemetic activity through combination with a 5-HT3 receptor antagonist is not replicated in motion-induced nausea.