How does MobileMums work? Mediators of a physical activity intervention.

Objectives: To establish which Social Cognitive Theory constructs mediated effects of the MobileMums (MMP) program on increased duration and frequency of moderate-vigorous physical activity (MVPA) in women with young children (<5 years). Methods: This secondary data analysis is from a community-based randomised controlled trial. Over 12 weeks, intervention participants received a minimum of 52 individually tailored text messages, one face-to-face and one telephone-delivered session with a trained behavioural counsellor. Participants identified a support person who also received 12 weeks of individually tailored text messages. Control participants received minimal intervention contact. Data were collected pre- and post-program. Five potential mediators were assessed: barrier self-efficacy, goal setting skills, outcome expectancies, perceived environmental opportunity for physical activity and social support for physical activity. Results: Improvements in MVPA frequency were mediated by improvements in barrier self-efficacy, goal setting skills, outcome expectancies and perceived social support. Improvements in MVPA duration resulting from the MMP were mediated by improvements in women's barrier self-efficacy and goal setting skills. Conclusions: MMP improved targeted theoretical constructs and this led to changes in women's MVPA. These findings are valuable for refinement and translation of the MMP and for further research to create theory- and evidence-based physical activity behaviour change programs for women with young children.

Preventive Health Behavior Change Text Message Interventions: A Meta-analysis.

CONTEXT: Existing evidence shows that text message interventions can produce short-term health behavior change. However, understanding is limited regarding intervention characteristics moderating this effect or the long-term effectiveness of text message interventions on behavior change after contact stops. EVIDENCE ACQUISITION: MEDLINE, PubMed Central, ERIC, PsycINFO, and Web of Science were searched for articles published between April 2008 and December 2014 that evaluated an intervention targeting preventive health behaviors, delivered primarily by text message. EVIDENCE SYNTHESIS: Intervention development and design characteristics and research outcomes were evaluated for 51 studies. Thirty-five studies were included in a meta-analysis (conducted in 2015) examining overall effect size and moderators of effect size. The overall pooled effect of interventions was d=0.24 (95% CI=0.16, 0.32, p<0.001) using outcome data collected most proximal to intervention cessation. Seven studies collected data following a no-intervention maintenance period and showed a small but significant pooled maintenance effect (d=0.17, 95% CI=0.03, 0.31, p=0.017, k=7). Few variables significantly moderated intervention efficacy. Interventions that did not use a theoretic basis, used supplementary intervention components, and had a duration of 6-12 months were most effective. The specific behavior being targeted was not associated with differences in efficacy nor was tailoring, targeting, or personalization of text message content. CONCLUSIONS: Text message interventions are capable of producing positive change in preventive health behaviors. Preliminary evidence indicates that these effects can be maintained after the intervention stops. The moderator analysis findings are at odds with previous research, suggesting a need to examine moderators at the behavior-specific level.

Mediation of improvements in sun protective and skin self-examination behaviours: results from the healthy text study.

OBJECTIVE: Melanoma is on the rise, especially in Caucasian populations exposed to high ultraviolet radiation such as in Australia. This paper examined the psychological components facilitating change in skin cancer prevention or early detection behaviours following a text message intervention. METHODS: The Queensland-based participants were 18 to 42 years old, from the Healthy Text study (N = 546). Overall, 512 (94%) participants completed the 12-month follow-up questionnaires. Following the social cognitive model, potential mediators of skin self-examination (SSE) and sun protection behaviour change were examined using stepwise logistic regression models. RESULTS: At 12-month follow-up, odds of performing an SSE in the past 12 months were mediated by baseline confidence in finding time to check skin (an outcome expectation), with a change in odds ratio of 11.9% in the SSE group versus the control group when including the mediator. Odds of greater than average sun protective habits index at 12-month follow-up were mediated by (a) an attempt to get a suntan at baseline (an outcome expectation) and (b) baseline sun protective habits index, with a change in odds ratio of 10.0% and 11.8%, respectively in the SSE group versus the control group. CONCLUSIONS: Few of the suspected mediation pathways were confirmed with the exception of outcome expectations and past behaviours. Future intervention programmes could use alternative theoretical models to elucidate how improvements in health behaviours can optimally be facilitated.

Patient Preferences for Receiving Remote Communication Support for Lifestyle Physical Activity Behaviour Change: The Perspective of Patients with Musculoskeletal Disorders from Three Hospital Services.

This study examined patients' preference ratings for receiving support via remote communication to increase their lifestyle physical activity. Methods. People with musculoskeletal disorders (n = 221 of 296 eligible) accessing one of three clinics provided preference ratings for "how much" they wanted to receive physical activity support via five potential communication modalities. The five ratings were generated on a horizontal analogue rating scale (0 represented "not at all"; 10 represented "very much"). Results. Most (n = 155, 70%) desired referral to a physical activity promoting intervention. "Print and post" communications had the highest median preference rating (7/10), followed by email and telephone (both 5/10), text messaging (1/10), and private Internet-based social network messages (0/10). Desire to be referred was associated with higher preference for printed materials (coefficient = 2.739, p < 0.001), telephone calls (coefficient = 3.000, p < 0.001), and email (coefficient = 2.059, p = 0.02). Older age was associated with lower preference for email (coefficient = -0.100, p < 0.001), texting (coefficient = -0.096, p < 0.001), and social network messages (coefficient = -0.065, p < 0.001). Conclusion. Patients desiring support to be physically active indicated preferences for interventions with communication via print, email, or telephone calls.

The cost-effectiveness of the MobileMums intervention to increase physical activity among mothers with young children: a Markov model informed by a randomised controlled trial.

OBJECTIVES: To determine the cost-effectiveness of the MobileMums intervention. MobileMums is a 12-week programme which assists mothers with young children to be more physically active, primarily through the use of personalised SMS text-messages. DESIGN: A cost-effectiveness analysis using a Markov model to estimate and compare the costs and consequences of MobileMums and usual care. SETTING: This study considers the cost-effectiveness of MobileMums in Queensland, Australia. PARTICIPANTS: A hypothetical cohort of over 36 000 women with a child under 1 year old is considered. These women are expected to be eligible and willing to participate in the intervention in Queensland, Australia. DATA SOURCES: The model was informed by the effectiveness results from a 9-month two-arm community-based randomised controlled trial undertaken in 2011 and registered retrospectively with the Australian Clinical Trials Registry (ACTRN12611000481976). Baseline characteristics for the model cohort, treatment effects and resource utilisation were all informed by this trial. MAIN OUTCOME MEASURES: The incremental cost per quality-adjusted life year (QALY) of MobileMums compared with usual care. RESULTS: The intervention is estimated to lead to an increase of 131 QALYs for an additional cost to the health system of 1.1 million Australian dollars (AUD). The expected incremental cost-effectiveness ratio for MobileMums is 8608 AUD per QALY gained. MobileMums has a 98% probability of being cost-effective at a cost-effectiveness threshold of 64 000 AUD. Varying modelling assumptions has little effect on this result. CONCLUSIONS: At a cost-effectiveness threshold of 64 000 AUD, MobileMums would likely be a cost-effective use of healthcare resources in Queensland, Australia. TRIAL REGISTRATION NUMBER: Australian Clinical Trials Registry; ACTRN12611000481976.

User preferences for text message-delivered skin cancer prevention and early detection.

Evidence is needed for the acceptability and user preferences of receiving skin cancer-related text messages. We prepared 27 questions to evaluate attitudes, satisfaction with program characteristics such as timing and spacing, and overall satisfaction with the Healthy Text program in young adults. Within this randomised controlled trial (age 18-42 years), 546 participants were assigned to one of three Healthy Text message groups; sun protection, skin self-examination, or attention-control. Over a 12-month period, 21 behaviour-specific text messages were sent to each group. Participants' preferences were compared between the two interventions and control group at the 12-month follow-up telephone interview. In all three groups, participants reported the messages were easy to understand (98%), provided good suggestions or ideas (88%), and were encouraging (86%) and informative (85%) with little difference between the groups. The timing of the texts was received positively (92%); however, some suggestions for frequency or time of day the messages were received from 8% of participants. Participants in the two intervention groups found their messages more informative, and triggering behaviour change compared to control. Text messages about skin cancer prevention and early detection are novel and acceptable to induce behaviour change in young adults.

Randomized Controlled Trial of an Improved Version of MobileMums, an Intervention for Increasing Physical Activity in Women with Young Children.

BACKGROUND: Women with young children (<5 years) are an important group for physical activity intervention. PURPOSE: The objective of the study was to evaluate the feasibility, acceptability, and efficacy of MobileMums-a physical activity intervention for women with young children. METHODS: Women were randomized to MobileMums (n = 133) or a control group (n = 130). MobileMums was delivered primarily via individually tailored text messages. Moderate to vigorous physical activity (MVPA) was measured by self-report and an accelerometer at baseline, end of the intervention (13 weeks), and 6 months later (9 months). Changes were analyzed using repeated-measures models. RESULTS: MobileMums was feasible to deliver and acceptable to women. Self-reported MVPA duration (minutes/week) and frequency (days/week) increased significantly post-intervention (13-week intervention effect 48.5 min/week, 95 % credible interval (CI) [13.4, 82.9] and 1.6 days/week, 95 % CI [0.6, 2.6]). Intervention effects were not maintained 6 months later. No effects were observed in accelerometer-derived MVPA. CONCLUSIONS: MobileMums increased women's self-reported MVPA immediately post-intervention. Future investigations need to target sustained physical activity improvements (ACTRN12611000481976).

Can skin cancer prevention and early detection be improved via mobile phone text messaging? A randomised, attention control trial.

OBJECTIVE: To test the impact of a theory-based, SMS (text message)-delivered behavioural intervention (Healthy Text) targeting sun protection or skin self-examination behaviours compared to attention control. METHOD: Overall, 546 participants aged 18-42 years were randomised using a computer-generated number list to the skin self-examination (N=176), sun protection (N=187), or attention control (N=183) text messages group. Each group received 21 text messages about their assigned topic over 12 months (12 weekly messages for 3 months, then monthly messages for the next 9 months). Data were collected via telephone survey at baseline, 3, and 12 months across Queensland from January 2012 to August 2013. RESULTS: One year after baseline, the sun protection (mean change 0.12; P=0.030) and skin self-examination groups (mean change 0.12; P=0.035) had significantly greater improvement in their sun protection habits (SPH) index compared to the attention control group (reference mean change 0.02). The increase in the proportion of participants who reported any skin self-examination from baseline to 12 months was significantly greater in the skin self-examination intervention group (103/163; 63%; P<0.001) than the sun protection (83/173; 48%) or attention control (65/165; 36%) groups. There was no significant effect of the intervention for participants' self-reported whole-body skin self-examination, sun tanning, or sunburn behaviours. CONCLUSION: The Healthy Text intervention was effective in inducing significant improvements in sun protection and any type of skin self-examination behaviours. TRIAL REGISTRATION: The Australian and New Zealand Clinical Trials register (ACTRN12612000577819). FUNDING: Cancer Australia 1011999.

Age, physical inactivity, obesity, health conditions, and health-related quality of life among patients receiving conservative management for musculoskeletal disorders.

BACKGROUND: Musculoskeletal conditions and insufficient physical activity have substantial personal and economic costs among contemporary aging societies. This study examined the age distribution, comorbid health conditions, body mass index (BMI), self-reported physical activity levels, and health-related quality of life of patients accessing ambulatory hospital clinics for musculoskeletal disorders. The study also investigated whether comorbidity, BMI, and self-reported physical activity were associated with patients' health-related quality of life after adjusting for age as a potential confounder. METHODS: A cross-sectional survey was undertaken in three ambulatory hospital clinics for musculoskeletal disorders. Participants (n=224) reported their reason for referral, age, comorbid health conditions, BMI, physical activity levels (Active Australia Survey), and health-related quality of life (EQ-5D). Descriptive statistics and linear modeling were used to examine the associations between age, comorbidity, BMI, intensity and duration of physical activity, and health-related quality of life. RESULTS: The majority of patients (n=115, 51.3%) reported two or more comorbidities. In addition to other musculoskeletal conditions, common comorbidities included depression (n=41, 18.3%), hypertension (n=40, 17.9%), and diabetes (n=39, 17.4%). Approximately one-half of participants (n=110, 49.1%) self-reported insufficient physical activity to meet minimum recommended guidelines and 150 (67.0%) were overweight (n=56, 23.2%), obese (n=64, 28.6%), severely obese (n=16, 7.1%), or very severely obese (n=14, 6.3%), with a higher proportion of older patients affected. A generalized linear model indicated that, after adjusting for age, self-reported physical activity was positively associated (z=4.22, P<0.001), and comorbidities were negatively associated (z=-2.67, P<0.01) with patients' health-related quality of life. CONCLUSION: Older patients were more frequently affected by undesirable clinical attributes of comorbidity, obesity, and physical inactivity. However, findings from this investigation are compelling for the care of patients of all ages. Potential integration of physical activity behavior change or other effective lifestyle interventions into models of care for patients with musculoskeletal disorders is worthy of further investigation.

Perceived barriers and facilitators to increasing physical activity among people with musculoskeletal disorders: a qualitative investigation to inform intervention development.

PURPOSE: Musculoskeletal conditions can impair people's ability to undertake physical activity as they age. The purpose of this qualitative study was to investigate perceived barriers and facilitators to undertaking physical activity reported by patients accessing ambulatory hospital clinics for musculoskeletal disorders. PATIENTS AND METHODS: A questionnaire with open-ended items was administered to patients (n=217, 73.3% of 296 eligible) from three clinics providing ambulatory services for nonsurgical treatment of musculoskeletal disorders. The survey included questions to capture the clinical and demographic characteristics of the sample. It also comprised two open-ended questions requiring qualitative responses. The first asked the participant to describe factors that made physical activity more difficult, and the second asked which factors made it easier for them to be physically active. Participants' responses to the two open-ended questions were read, coded, and thematically analyzed independently by two researchers, with a third researcher available to arbitrate any unresolved disagreement. RESULTS: The mean (standard deviation) age of participants was 53 (15) years; n=113 (52.1%) were male. A total of 112 (51.6%) participants reported having three or more health conditions; n=140 (64.5%) were classified as overweight or obese. Five overarching themes describing perceived barriers for undertaking physical activity were "health conditions", "time restrictions", "poor physical condition", "emotional, social, and psychological barriers", and "access to exercise opportunities". Perceived physical activity facilitators were also aligned under five themes, namely "improved health state", "social, emotional, and behavioral supports", "access to exercise environment", "opportunities for physical activities", and "time availability". CONCLUSION: It was clear from the breadth of the data that meaningful supports and interventions must be multidimensional. They should have the capacity to address a variety of physical, functional, social, psychological, motivational, environmental, lifestyle, and other perceived barriers. It would appear that for such interventions to be effective, they should be flexible enough to address a variety of specific concerns.

Moving MobileMums forward: protocol for a larger randomized controlled trial of an improved physical activity program for women with young children.

BACKGROUND: Women with young children (under 5 years) are a key population group for physical activity intervention. Previous evidence highlights the need for individually tailored programs with flexible delivery mechanisms for this group. Our previous pilot study suggested that an intervention primarily delivered via mobile phone text messaging (MobileMums) increased self-reported physical activity in women with young children. An improved version of the MobileMums program is being compared with a minimal contact control group in a large randomised controlled trial (RCT). METHODS/DESIGN: This RCT will evaluate the efficacy, feasibility and acceptability, cost-effectiveness, mediators and moderators of the MobileMums program. Primary (moderate-vigorous physical activity) and secondary (intervention implementation data, health service use costs, intervention costs, health benefits, theoretical constructs) outcomes are assessed at baseline, 3-months (end of intervention) and 9-months (following 6-month no contact: maintenance period).The intervention commences with a face-to-face session with a behavioural counsellor to initiate rapport and gather information for tailoring the 12-week text message program. During the program participants also have access to a: MobileMums Participant Handbook, MobileMums refrigerator magnet, MobileMums Facebook© group, and a MobileMums website with a searchable, on-line exercise directory. A nominated support person also receives text messages for 12-weeks encouraging them to offer their MobileMum social support for physical activity. DISCUSSION: Results of this trial will determine the efficacy and cost-effectiveness of the MobileMums program, and the feasibility of delivering it in a community setting. It will inform the broader literature of physical activity interventions for women with young children and determine whether further investment in the translation of the program is warranted. TRIAL REGISTRATION: The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12611000481976).

Active adults recall their physical activity differently to less active adults: test-retest reliability and validity of a physical activity survey.

ISSUE ADDRESSED: This paper determined the test-retest reliability and criterion validity of a modified version of the Active Australia Survey (AAS) and whether these properties varied across participants' activity levels. METHODS: Participants (n=63) responded to repeat administrations of the AAS and wore an accelerometer for 7 days. Analyses used Spearman's rho (rs,) or weighted kappa (κ) and Bland-Altman methods. Variation in mean difference and 95% limits of agreement (LOA) across average levels of activity were tested by linear regression. RESULTS: Reliability correlations (rs; 95% confidence intervals (CI)) for minutes per week ranged from 0.40 (0.16, 0.59) to 0.80 (0.68, 0.87). For days per week, the agreement (κ; 95% CI) between administrations ranged from 0.43 (0.34, 0.73) to 0.83 (0.61, 0.93). There was a small mean difference between administrations (-8.46 moderate-vigorous minutes per week); 95% LOA widened as participants' average activity levels increased. Validity correlations (rs; 95% CI) for minutes per week ranged from 0.50 (0.28, 0.66) to 0.61 (0.43, 0.75). For days per week, the agreement (κ; 95% CI) ranged from 0.35 (0.10, 0.50) to 0.61 (0.29, 0.87). The mean difference between the AAS and accelerometer and 95% LOA both varied with participants' activity levels. CONCLUSIONS: The reliability and validity of the modified AAS were better than those of previously published versions, but varied according to participants' activity levels. So what? In this study, participants who engaged in more activity had more measurement error than less active participants. This proportionality will have important implications for cross-sectional and intervention studies. This phenomenon needs to be examined for other self-reported physical activity measures.

Social cognitive mediators of the effect of the MobileMums intervention on physical activity.

OBJECTIVE: To explore whether improvements in physical activity following the MobileMums intervention were mediated by changes in Social Cognitive Theory (SCT) constructs targeted in the intervention (barrier self efficacy, goal setting skills, outcome expectancy, social support, and perceived environmental opportunity for exercise). This paper also examined if the mediating constructs differed between initial (baseline to 6 weeks) and overall (baseline to 13 weeks) changes in physical activity. METHODS: Secondary analysis of data from a randomized controlled trial involving 88 postnatal women (<12 months postpartum). Participants were randomized to receive either the 12-week MobileMums intervention or a minimal-contact control condition. Physical activity and proposed mediators were assessed by self-report at baseline, 6 weeks, and 13 weeks. Walking for Exercise frequency was assessed using the Australian Women's Activity Survey and frequency of moderate-to-vigorous physical activity (MVPA) was assessed using a single-item question. RESULTS: Initial improvements in goal-setting skills mediated the relationship between experimental condition and initial changes in MVPA, αß (95% CI) = 0.23(0.01, 0.59), and Walking for Exercise, αß (95% CI) = 0.34(0.06, 0.73). Initial improvements in barrier self efficacy mediated the relationship between experimental condition and initial change in MVPA, αß (95% CI) = 0.36(0.12, 0.65), but not Walking for Exercise. None of the SCT outcomes significantly mediated the relationship between experimental condition and overall (baseline to 13 weeks) change in frequency of MVPA or Walking for Exercise. CONCLUSION: Future interventions with postnatal women using SCT should target barrier self-efficacy and goal setting skills in order to increase physical activity.

Iterative development of MobileMums: a physical activity intervention for women with young children.

BACKGROUND: To describe the iterative development process and final version of 'MobileMums': a physical activity intervention for women with young children (<5 years) delivered primarily via mobile telephone (mHealth) short messaging service (SMS). METHODS: MobileMums development followed the five steps outlined in the mHealth development and evaluation framework: 1) conceptualization (critique of literature and theory); 2) formative research (focus groups, n= 48); 3) pre-testing (qualitative pilot of intervention components, n= 12); 4) pilot testing (pilot RCT, n= 88); and, 5) qualitative evaluation of the refined intervention (n= 6). RESULTS: Key findings identified throughout the development process that shaped the MobileMums program were the need for: behaviour change techniques to be grounded in Social Cognitive Theory; tailored SMS content; two-way SMS interaction; rapport between SMS sender and recipient; an automated software platform to generate and send SMS; and, flexibility in location of a face-to-face delivered component. CONCLUSIONS: The final version of MobileMums is flexible and adaptive to individual participant's physical activity goals, expectations and environment. MobileMums is being evaluated in a community-based randomised controlled efficacy trial (ACTRN12611000481976).

Pilot study of an individualised early postpartum intervention to increase physical activity in women with previous gestational diabetes.

Optimal strategies to prevent progression towards overt diabetes in women with recent gestational diabetes remain ill defined. We report a pilot study of a convenient, home based exercise program with telephone support, suited to the early post-partum period. Twenty eight women with recent gestational diabetes were enrolled at six weeks post-partum into a 12 week randomised controlled trial of Usual Care (n = 13) versus Supported Care (individualised exercise program with regular telephone support; n = 15). Baseline characteristics (Mean ± SD) were: Age 33 ± 4 years; Weight 80 ± 20 kg and Body Mass Index (BMI) 30.0 ± 9.7 kg/m(2). The primary outcome, planned physical activity {Median (Range)}, increased by 60 (0-540) mins/week in the SC group versus 0 (0-580) mins/week in the UC group (P = 0.234). Walking was the predominant physical activity. Body weight, BMI, waist circumference, % body fat, fasting glucose and insulin did not change significantly over time in either group. This intervention designed to increase physical activity in post-partum women with previous gestational diabetes proved feasible. However, no measurable improvement in metabolic or biometric parameters was observed over a three month period.

Living Well with Diabetes: a randomized controlled trial of a telephone-delivered intervention for maintenance of weight loss, physical activity and glycaemic control in adults with type 2 diabetes.

BACKGROUND: By 2025, it is estimated that approximately 1.8 million Australian adults (approximately 8.4% of the adult population) will have diabetes, with the majority having type 2 diabetes. Weight management via improved physical activity and diet is the cornerstone of type 2 diabetes management. However, the majority of weight loss trials in diabetes have evaluated short-term, intensive clinic-based interventions that, while producing short-term outcomes, have failed to address issues of maintenance and broad population reach. Telephone-delivered interventions have the potential to address these gaps. METHODS/DESIGN: Using a two-arm randomised controlled design, this study will evaluate an 18-month, telephone-delivered, behavioural weight loss intervention focussing on physical activity, diet and behavioural therapy, versus usual care, with follow-up at 24 months. Three-hundred adult participants, aged 20-75 years, with type 2 diabetes, will be recruited from 10 general practices via electronic medical records search. The Social-Cognitive Theory driven intervention involves a six-month intensive phase (4 weekly calls and 11 fortnightly calls) and a 12-month maintenance phase (one call per month). Primary outcomes, assessed at 6, 18 and 24 months, are: weight loss, physical activity, and glycaemic control (HbA1c), with weight loss and physical activity also measured at 12 months. Incremental cost-effectiveness will also be examined. Study recruitment began in February 2009, with final data collection expected by February 2013. DISCUSSION: This is the first study to evaluate the telephone as the primary method of delivering a behavioural weight loss intervention in type 2 diabetes. The evaluation of maintenance outcomes (6 months following the end of intervention), the use of accelerometers to objectively measure physical activity, and the inclusion of a cost-effectiveness analysis will advance the science of broad reach approaches to weight control and health behaviour change, and will build the evidence base needed to advocate for the translation of this work into population health practice. TRIAL REGISTRATION: ACTRN12608000203358.

Measuring physical activity change in broad-reach intervention trials.

BACKGROUND: We compared the responsiveness to change (prepost intervention) of 3 commonly-used self-report measures of physical activity. METHODS: In a cluster-randomized trial of a telephone-delivered intervention with primary care patients, physical activity was assessed at baseline and 4 months (n = 381) using the 31-item CHAMPS questionnaire; the 6-item Active Australia Questionnaire (AAQ); and, 2 walking for exercise items from the US National Health Interview Survey (USNHIS). Responsiveness to change was calculated for frequency (sessions/week) and duration (MET x minutes/week) of walking and moderate-to-vigorous intensity physical activity. RESULTS: The greatest responsiveness for walking frequency was found with the USNHIS (0.45, 95% CI: 0.19, 0.72) and AAQ (0.43, 95% CI: 0.19, 0.67), and for walking duration with the USNHIS (0.27, 95% CI 0.13, 0.41) and CHAMPS (0.24, 95% CI: 0.12, 0.36). For moderate-to-vigorous activity, responsiveness for frequency was slightly higher for the AAQ (0.50, 95% CI: 0.30, 0.69); for duration it was slightly higher for CHAMPS (0.32, 95% CI: 0.17, 0.47). CONCLUSIONS: In broad-reach trials, brief self-report measures (USNHIS and AAQ) are useful for their comparability to population physical activity estimates and low respondent burden. These measures can be used without a loss in responsiveness to change relative to a more detailed self-report measure (CHAMPS).

Reliability and validity of the international physical activity questionnaire for assessing walking.

Physical inactivity and its accompanying adverse sequelae (e.g., obesity and diabetes) are global health concerns. The single most commonly reported physical activity in public health surveys is walking (Centers for Disease Control and Prevention, 2000; Rafferty, Reeves, McGee, & Pivarnik, 2002). As evidence accumulates that walking is important for preventing weight gain (Levine et al., 2008) and reducing the risk of diabetes (Jeon, Lokken, Hu, & van Dam, 2007), there is increased need to capture this behavior in a valid and reliable manner. Although the disadvantages of a self-report methodology are well known (Sallis, & Saelens, 2000), it still represents the most feasible approach for conducting population-level surveillance across developed and developing countries. The International Physical Activity Questionnaire (IPAQ) was created and evaluated as a standardized instrument for this purpose. Although two versions of the IPAQwere designed and evaluated (short: nine items; and long: 31 items), the short form was recommended for population monitoring (Craig et al., 2003). However, it has not been recommended for intervention or research studies that require precise physical activity quantification to examine changes in physical activity at the individual level. IPAQ was also not intended to replace instruments that are more responsive to individual changes in activity level, such as objective measures. In addition to walking behaviors, IPAQ also assesses time spent in moderate- and vigorous-intensity activity as well as sitting behaviors, although the latter is not the focus of this analysis. Aggregated IPAQ data have been previously validated compared to accelerometers, and overall reliability was confirmed across 12 countries (Craig et al., 2003). Previous research showed criterion validity Spearman correlations with a median of 0.30 and test-retest reliability Spearman correlations clustered around 0.8 (Craig et al., 2003). The purpose of this study, however, was to reanalyze these data with respect to validity (again compared to an accelerometer) and test-retest reliability specifically for population monitoring of walking.

MobileMums: a randomized controlled trial of an SMS-based physical activity intervention.

BACKGROUND: Postnatal women (<12 months postpartum) are at increased risk of physical inactivity. PURPOSE: To evaluate the efficacy and feasibility of a theory-based physical activity (PA) intervention delivered to postnatal women primarily via mobile telephone short message service (SMS). METHODS: Eighty-eight women were randomized to the intervention (n = 45) or minimal contact control (n = 43) condition. The 12-week intervention consisted of a face-to-face PA goal-setting consultation, a goal-setting magnet, three to five personally tailored SMS/week and a nominated support person who received two SMS per week. SMS content targeted constructs of social cognitive theory. Frequency (days/week) and duration (min/week) of PA participation and walking for exercise were assessed via self-report at baseline, 6 and 13 weeks. RESULTS: Intervention participants increased PA frequency by 1.82 days/week (SE +/- 0.18) by 13 weeks (F ((2,85)) = 4.46, p = 0.038) and walking for exercise frequency by 1.08 days/week (SE +/- 0.24) by 13 weeks (F ((2,85)) = 5.38, p = 0.02). Positive trends were observed for duration (min/week) of PA and walking for exercise. CONCLUSIONS: Intervention exposure resulted in increased frequency of PA and walking for exercise in postnatal women.

Measuring Physical Activity Change in Broad-Reach Intervention Trials.

BACKGROUND: We compared the responsiveness to change (prepost intervention) of 3 commonly-used self-report measures of physical activity. METHODS: In a cluster-randomized trial of a telephone-delivered intervention with primary care patients, physical activity was assessed at baseline and 4 months (n = 381) using the 31-item CHAMPS questionnaire; the 6-item Active Australia Questionnaire (AAQ); and, 2 walking for exercise items from the US National Health Interview Survey (USNHIS). Responsiveness to change was calculated for frequency (sessions/week) and duration (MET·minutes/week) of walking and moderate-to-vigorous intensity physical activity. RESULTS: The greatest responsiveness for walking frequency was found with the USNHIS (0.45, 95% CI: 0.19, 0.72) and AAQ (0.43, 95% CI: 0.19, 0.67), and for walking duration with the USNHIS (0.27, 95%CI 0.13, 0.41) and CHAMPS (0.24, 95% CI: 0.12, 0.36). For moderate-to-vigorous activity, responsiveness for frequency was slightly higher for the AAQ (0.50, 95% CI: 0.30, 0.69); for duration it was slightly higher for CHAMPS (0.32, 95% CI: 0.17, 0.47). CONCLUSIONS: In broad-reach trials, brief self-report measures (USNHIS and AAQ) are useful for their comparability to population physical activity estimates and low respondent burden. These measures can be used without a loss in responsiveness to change relative to a more detailed self-report measure (CHAMPS).