Can professional football clubs deliver a weight management programme for women: a feasibility study.

BACKGROUND: Levels of obesity remain high in the UK. The Football Fans in Training (FFIT) randomised controlled trial (RCT) demonstrated that a 12-week, gender-sensitised weight management, physical activity and healthy eating group programme delivered through professional football clubs helped men aged 35-65 years with BMI at least 28 kg/m2 lose a clinically-significant amount of weight. We aimed to test the feasibility of a minimally-adapted FFIT programme for delivery to women by assessing recruitment and completion rates; determining if the programme content and delivery required further refinement; and evaluating the potential of FFIT for Women to deliver improvements in weight and other clinical, behavioural and psychological outcomes. METHODS: A feasibility study of the FFIT for Women programme including before-and-after measurements of clinical (weight, waist, body mass index [BMI], blood pressure) behavioural (self-reported physical activity, food and alcohol intake) and psychological (self-esteem, positive and negative affect, physical and mental HRQoL) outcomes at five professional football clubs. Post-programme focus groups assessed acceptability of the programme format, content and style of delivery for women. RESULTS: Recruitment across the five clubs resulted in 123 women aged 35-65 years with BMI at least 28 kg/m2 taking part in the study. The mean weight (95.3 kg) and BMI (36.6 kg/m2) of the cohort were both suggestive of high risk of future disease. Of 123 women who started the programme, 94 (76%) completed it; 72 (58.5%) returned for 12-week follow-up measurements. Participants compared FFIT for Women favourably to commercial weight loss programmes and emphasised the importance of the programme's physical activity content. They also spoke positively about group dynamics, suggested that the approach to food was less restrictive than in other weight loss approaches, and broadly enjoyed the football setting. Mean weight loss was 2.87 kg (95% CI 2.09, 3.65, p ≤ 0.001). Mean waist reduction was 3.84 cm (2.92, 4.77, p ≤ 0.001). CONCLUSION: In this evaluation, FFIT for Women was feasible, acceptable and demonstrated potential as a weight loss programme. Our findings suggest the programme has the potential to produce outcomes that are on a par with existing commercial and state-funded offerings.

Long-term weight loss trajectories following participation in a randomised controlled trial of a weight management programme for men delivered through professional football clubs: a longitudinal cohort study and economic evaluation.

BACKGROUND: Obesity is a major public health concern requiring innovative interventions that support people to lose weight and keep it off long term. However, weight loss maintenance remains a challenge and is under-researched, particularly in men. The Football Fans in Training (FFIT) programme engages men in weight management through their interest in football, and encourages them to incorporate small, incremental physical activity and dietary changes into daily life to support long-term weight loss maintenance. In 2011/12, a randomised controlled trial (RCT) of FFIT demonstrated effectiveness and cost-effectiveness at 12 months. The current study aimed to investigate long-term maintenance of weight loss, behavioural outcomes and lifetime cost-effectiveness following FFIT. METHODS: A longitudinal cohort study comprised 3.5-year follow-up of the 747 FFIT RCT participants. Men aged 35-65 years, BMI ≥ 28 kg/m2 at RCT baseline who consented to long-term follow-up (n = 665) were invited to participate: those in the FFIT Follow Up Intervention group (FFIT-FU-I) undertook FFIT in 2011 during the RCT; the FFIT Follow Up Comparison group (FFIT-FU-C) undertook FFIT in 2012 under routine (non-research) conditions. The primary outcome was objectively-measured weight loss (from baseline) at 3.5 years. Secondary outcomes included changes in self-reported physical activity and diet at 3.5 years. Cost-effectiveness was estimated at 3.5 years and over participants' lifetime. RESULTS: Of 665 men invited, 488 (73%; 65% of the 747 RCT participants) attended 3.5-year measurements. The FFIT-FU-I group sustained a mean weight loss of 2.90 kg (95% CI 1.78, 4.02; p < 0.001) 3.5 years after starting FFIT; 32.2% (75/233) weighed ≥5% less than baseline. The FFIT-FU-C group had lost 2.71 kg (1.65, 3.77; p < 0.001) at the 3.5-year measurements (2.5 years after starting FFIT); 31.8% (81/255) weighed ≥5% less than baseline. There were significant sustained improvements in self-reported physical activity and diet in both groups. The estimated incremental cost-effectiveness of FFIT was £10,700-£15,300 per QALY gained at 3.5 years, and £1790-£2200 over participants' lifetime. CONCLUSIONS: Participation in FFIT under research and routine conditions leads to long-term weight loss and improvements in physical activity and diet. Investment in FFIT is likely to be cost-effective as part of obesity management strategies in countries where football is popular. TRIAL REGISTRATION: ISRCTN32677491 , 20 October 2011.

Breast cancer risk reduction--is it feasible to initiate a randomised controlled trial of a lifestyle intervention programme (ActWell) within a national breast screening programme?

BACKGROUND: Breast cancer is the most commonly diagnosed cancer and the second cause of cancer deaths amongst women in the UK. The incidence of the disease is increasing and is highest in women from least deprived areas. It is estimated that around 42% of the disease in post-menopausal women could be prevented by increased physical activity and reductions in alcohol intake and body fatness. Breast cancer control endeavours focus on national screening programmes but these do not include communications or interventions for risk reduction. This study aimed to assess the feasibility of delivery, indicative effects and acceptability of a lifestyle intervention programme initiated within the NHS Scottish Breast Screening Programme (NHSSBSP). METHODS: A 1:1 randomised controlled trial (RCT) of the 3 month ActWell programme (focussing on body weight, physical activity and alcohol) versus usual care conducted in two NHSSBSP sites between June 2013 and January 2014. Feasibility assessments included recruitment, retention, and fidelity to protocol. Indicative outcomes were measured at baseline and 3 month follow-up (body weight, waist circumference, eating and alcohol habits and physical activity). At study end, a questionnaire assessed participant satisfaction and qualitative interviews elicited women's, coaches, and radiographers' experiences. Statistical analysis used Chi squared tests for comparisons in proportions and paired t tests for comparisons of means. Linear regression analyses were performed, adjusted for baseline values, with group allocation as a fixed effect. RESULTS: A pre-set recruitment target of 80 women was achieved within 12 weeks and 65 (81%) participants (29 intervention, 36 control) completed 3 month assessments. Mean age was 58 ± 5.6 years, mean BMI was 29.2 ± 7.0 kg/m(2) and many (44%) reported a family history of breast cancer. The primary analysis (baseline body weight adjusted) showed a significant between group difference favouring the intervention group of 2.04 kg (95% CI -3.24 kg to -0.85 kg). Significant, favourable between group differences were also detected for BMI, waist circumference, physical activity and sitting time. Women rated the programme highly and 70% said they would recommend it to others. CONCLUSIONS: Recruitment, retention, indicative results and participant acceptability support the development of a definitive RCT to measure long term effects. TRIAL REGISTRATION: The trial was registered with Current Controlled Trials (ISRCTN56223933).

"Don't wait for them to come to you, you go to them". A qualitative study of recruitment approaches in community based walking programmes in the UK.

BACKGROUND: This study aimed to examine the experiences of walking promotion professionals on the range and effectiveness of recruitment strategies used within community based walking programmes within the United Kingdom. METHODS: Two researchers recruited and conducted semi-structured interviews with managers and project co-ordinators of community based walking programmes, across the UK, using a purposive sampling frame. Twenty eight interviews were conducted, with community projects targeting participants by age, physical activity status, socio-demographic characteristics (i.e. ethnic group) or by health status. Three case studies were also conducted with programmes aiming to recruit priority groups and also demonstrating innovative recruitment methods. Data analysis adopted an approach using analytic induction. RESULTS: Two types of programmes were identified: those with explicit health aims and those without. Programme aims which required targeting of specific groups adopted more specific recruitment methods. The selection of recruitment method was dependent on the respondent's awareness of 'what works' and the resource capacity at their disposal. Word of mouth was perceived to be the most effective means of recruitment but using this approach took time and effort to build relationships with target groups, usually through a third party. Perceived effectiveness of recruitment was assessed by number of participants rather than numbers of the right participants. Some programmes, particularly those targeting younger adult participants, recruited using new social communication media. Where adopted, social marketing recruitment strategies tended to promote the 'social' rather than the 'health' benefits of walking. CONCLUSIONS: Effective walking programme recruitment seems to require trained, strategic, labour intensive, word-of-mouth communication, often in partnerships, in order to understand needs and develop trust and motivation within disengaged sedentary communities. Walking promotion professionals require better training and resources to deliver appropriate recruitment strategies to reach priority groups.

Recruiting participants to walking intervention studies: a systematic review.

PURPOSE: Most researchers who are conducting physical activity trials face difficulties in recruiting participants who are representative of the population or from specific population groups. Participants who are often the hardest to recruit are often those who stand to benefit most (the least active, from ethnic and other minority groups, from neighbourhoods with high levels of deprivation, or have poor health). The aim of our study was to conduct a systematic review of published literature of walking interventions, in order to identify the impact, characteristics, and differential effects of recruitment strategies among particular population groups. METHODS: We conducted standard searches for studies from four sources, (i) electronic literature databases and websites, (ii) grey literature from internet sources, (iii) contact with experts to identify additional "grey" and other literature, and (iv) snowballing from reference lists of retrieved articles. Included studies were randomised controlled trials, controlled before-and-after experimental or observational qualitative studies, examining the effects of an intervention to encourage people to walk independently or in a group setting, and detailing methods of recruitment. RESULTS: Forty seven studies met the inclusion criteria. The overall quality of the descriptions of recruitment in the studies was poor with little detail reported on who undertook recruitment, or how long was spent planning/preparing and implementing the recruitment phase. Recruitment was conducted at locations that either matched where the intervention was delivered, or where the potential participants were asked to attend for the screening and signing up process. We identified a lack of conceptual clarity about the recruitment process and no standard metric to evaluate the effectiveness of recruitment. CONCLUSION: Recruitment concepts, methods, and reporting in walking intervention trials are poorly developed, adding to other limitations in the literature, such as limited generalisability. The lack of understanding of optimal and equitable recruitment strategies evident from this review limits the impact of interventions to promote walking to particular social groups. To improve the delivery of walking interventions to groups which can benefit most, specific attention to developing and evaluating targeted recruitment approaches is recommended.

Lower back pain in physically demanding college academic programs: a questionnaire based study.

BACKGROUND: Lower back pain (LBP) is ranked first as a cause of disability and inability to work, and is expected to affect up to 90% of the worlds population at some point in their lifetime. The annual first time incidence of LBP is 5%, and the annual prevalence (i.e. those suffering at time of questioning) is between 15 and 63%. Prospective studies demonstrate that low back problems do not display a six-week spontaneous recovery pattern, as was once believed. The condition is regularly seen to worsen over time, becoming a chronic disorder, influenced by both physical and psychosocial factors. METHODS: The current study assessed the level of LBP amongst students engaged in educational programs that were physically demanding, and its influence on lower back problems. A 1-year retrospective questionnaire consisting of 37 closed, open and multi-choice questions was designed to ascertain self-reported information on the occurrence, cause and type of LBP. Treatment, care seeking and general knowledge regarding LBP were also recorded. Students were enrolled in BSc Equine Science, BSc Physical Education and BSc Sports & Exercise Science degree programs and a total number of 188 valid questionnaires were collected. RESULTS: The self reported, anthropometrical data for participants in this study are: age 20.9 +/- 2.7 yrs; height 171.8 +/- 9.3 cm; weight 66.7 +/- 10.4 kg; female 64% (n = 120), male 36% (n = 68). The overall self reported prevalence of LBP was 32% (n = 61). Within the LBP population, 77% reported their problem as recurring. Two factors showed significance as having an influence on LBP. They were age (21.6 +/- 3.5 yrs, p = 0.005) and hours of personal training physical activity (14.0 +/- 8.2 hrs per week, p = 0.02). LBP sufferers also displayed poor management of their condition and an interest in education and treatment of their problem. CONCLUSION: The current study revealed high prevalence of LBP consistent with that of the literature, and unveiled a recurrence rate and behavioral habits of sufferers, which are warning signs of a more chronic state to come. Novel data presented here offers strong support for the need for prospective injury tracking, plus educational intervention and treatment aimed at prevention of LBP.