Effects of a lifestyle program in subjects with Impaired Fasting Glucose, a pragmatic cluster-randomized controlled trial.

BACKGROUND: The worldwide epidemic of type 2 diabetes (T2DM) underlines the need for diabetes prevention strategies. In this study the feasibility and effectiveness of a nurse led lifestyle program for subjects with impaired fasting glucose (IFG) is assessed. METHODS: A cluster randomized clinical trial in 26 primary care practices in the Netherlands included 366 participants older than 45 years with newly diagnosed IFG and motivated to change their lifestyle (intervention group, n = 197; usual care group, n = 169). The one-year intervention, consisting of four to five individual nurse-led consultations, was directed at improving physical activity and dietary habits. The primary outcome measure was body mass index (BMI). Linear and logistic multilevel analyses and a process evaluation were performed. RESULTS: Both groups showed small reductions in BMI at 1 and 2 years, but differences between groups were not significant. At both 1 and 2-year follow-up the number of participants physically active for at least 30 minutes at least five days a week was significantly improved in the intervention group compared to the usual care group (intervention group vs. usual care group: OR1year = 3.53; 95 % CI = 1.69-7.37 and OR2years = 1.97; 95 % CI = 1.22-3.20, respectively). The total drop-out rate was 24 %. Process evaluation revealed that participants in the intervention group received fewer consultations than advised, while some practice nurses and participants considered the RM protocol too intensive. CONCLUSIONS: This relatively simple lifestyle program in subjects with IFG resulted in a significant improvement in reported physical activity, but not in BMI. Despite its simplicity, some participants still considered the intervention too intensive. This viewpoint could be related to poor motivation and an absence of disease burden due to IFG, such that participants do not feel a need for behavioural change. Although the intervention provided some benefit, its wider use cannot be advised. TRIAL REGISTRATION: Current Controlled Trials ISRCTN41209683 , date of registration 16/10/2013h  .

Accelerometers and Internet for physical activity promotion in youth? Feasibility and effectiveness of a minimal intervention [ISRCTN93896459].

OBJECTIVE: To evaluate the feasibility and effectiveness of a 3-month minimal physical activity (PA) intervention in adolescents. METHODS: A randomised controlled trial, including five secondary schools (n=87). In the 3-month intervention (Amsterdam, The Netherlands, 2005) adolescents were provided with a PAM accelerometer, coupled to a web-based tailored PA advice (PAM COACH). Measurements (i.e., PA, determinants of PA, aerobic fitness and anthropometrics) took place at baseline and at 3- and 8-month follow-up. RESULTS: Sixty-five percent of the participants in the intervention group reported to have worn the PAM frequently and 56% of the PAM users uploaded their PAM scores to the PAM COACH at least once. We found significant differences between groups in favour of the intervention group in moderate intensity PA (MPA) for girls after 3 months (411 min/week; 95% CI: 1; 824; P=0.04) and in sedentary time for boys after 8 months (-1801 min/week; 95% CI: -3545; -57; P=0.04). CONCLUSIONS: Although the process evaluation suggests that a substantial proportion of the participants did not regularly wear the PAM and did not upload information to the PAM COACH website, our findings suggest promising intervention effects on MPA among girls and sedentary time among boys.

Reliability and validity of the Activity Questionnaire for Adults and Adolescents (AQuAA).

BACKGROUND: Accurate measures of physical activity are highly needed. We evaluated the test-retest reliability and construct validity of the self-report Activity Questionnaire for Adults and Adolescents (AQuAA). The AQuAA is a commonly used questionnaire in Dutch youth. METHODS: In the test-retest reliability study, 53 adolescents and 58 adults completed the AQuAA twice, with an interval of two weeks. In the validity study, 33 adolescents and 47 adults wore an accelerometer (Actigraph) during two weeks, and subsequently completed the AQuAA. RESULTS: In adolescents the test-retest reliability was fair to moderate (intraclass correlations (ICCs) ranging from 0.30 to 0.59). In adults the test-retest reliability was fair to moderate for the time spent on sedentary, light and moderate intensity activities (ICCs ranging from 0.49 to 0.60), but poor for time spent on vigorous activities (ICC = -0.005). The correlations between the AQuAA and Actigraph were low and nonsignificant. Compared with the Actigraph, time spent on all physical activities was significantly higher according to the questionnaire (except for light intensity activities in adolescents), while time spent on sedentary behaviours was significantly lower. CONCLUSION: Reliability of the AQuAA is fair to moderate. The validity of the AQuAA compared to an accelerometer is poor. Both adolescents and adults underestimate the time spent on sedentary behaviours and overestimate the time spent on physical activities.

Feasibility and effectiveness of online physical activity advice based on a personal activity monitor: randomized controlled trial.

BACKGROUND: Inactive people are often not aware of the fact that they are insufficiently active. Providing insight into their actual physical activity (PA) levels may raise awareness and could, in combination with tailored PA advice, stimulate a physically active lifestyle. OBJECTIVE: This study evaluated the feasibility and effectiveness of a 3-month intervention in which Dutch office workers were provided with a personal activity monitor (PAM) coupled to simple and concise Web-based tailored PA advice (PAM COACH). METHOD: Participants were randomly assigned to the 3-month PAM intervention (n = 51) or received a single written information brochure with brief general PA recommendations (n = 51). Study outcome measures were changes in PA (recall of minutes per week spent on PA, as measured by the Activity Questionnaire for Adolescents and Adults), determinants of PA, aerobic fitness, and body composition. Follow-up measurements were performed immediately after the 3-month intervention and at 8-months, 5 months after the end of the 3-month intervention period. RESULTS: A total of 102 workers, 23 to 39 years old, completed the baseline measurement at the worksite. 48 completed the 3-month follow up and 38 the 8-month follow-up in the intervention group, 50 completed the 3-month follow up and 42 the 8-month follow up in the control group. 35 out of 48 (73%) participants in the PAM intervention group reported wearing the PAM regularly, and the PAM COACH was used almost once a week; 24 out of 46 (52%) PAM users set a personal goal, and 33 (72%) entered their favorite activities on the website. Main reasons for not using these items were lack of interest or not being able to find the item on the website. The majority of PAM users (34 out of 46, 74%) read the advice, of whom 14 (39%) found it unappealing. After the 3-month intervention, no significant intervention effect was observed (adjusted difference in min/week) for sedentary behavior (beta = 10, 95% CI = -435 to 455), light-intensity PA (beta = -129, 95% CI = -337 to 79), moderate-intensity PA (beta = -13, 95% CI = -89 to 63), vigorous-intensity PA (beta= -6, 95% CI = -75 to 62), and moderate- to vigorous-intensity PA (beta = -23, 95% CI = -121 to 76). No significant intervention effect was observed in the PA outcomes at the 8-month follow-up. For the determinants of PA, aerobic fitness, and body composition, no statistically significant intervention effect was observed in the total study population immediately after the 3-month intervention or the 8-month follow-up. CONCLUSIONS: The intervention appeared to be easily applicable to real-life settings. The intervention was ineffective in improving PA behavior or its determinants in healthy office workers. More attention should have been given to the quality and appropriateness of the tailored advice. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): 93896459; http://www.controlled-trials.com/ISRCTN93896459/ (Archived by WebCite at http://www.webcitation.org/5iR3mf7ex).

Reproducibility of a triaxial seismic accelerometer (DynaPort).

PURPOSE: To examine the reproducibility of a triaxial seismic accelerometer under controlled conditions and real-life conditions. METHODS: Instrumental reproducibility was examined using a shaker device. The accelerometers (DynaPort MiniMod; McRoberts B.V., The Hague, The Netherlands) were shaken at four frequencies (0.8, 2.1, 3.6, and 4.6 Hz) in x- and y-directions. The magnitude of acceleration ranged from 0 to 1.277g. Additionally, reproducibility under real-life conditions was examined in 55 adolescents (12-17 yr), with the accelerometer attached to the lower back. Each subject walked four short walking trials on level ground at preferred speed. To make this setting meet real-life conditions, we detached and reattached the accelerometer between trials 2 and 3. Detachment of accelerometer between trials 2 and 3 was done by either the same researcher or different researchers (four in total). Intra- and interobserver reproducibility were calculated. RESULTS: Intra- and interinstrumental intraclass correlation coefficients (ICC) were 0.99 for both x- and y-directions. The intrainstrumental coefficients of variance (CoV) were lower than 1.13%. The interinstrumental CoV were lower than 1.37%. Intraobserver ICC was 0.97, and interobserver ICC was 0.88. CONCLUSION: The reproducibility of the accelerometer is high under the controlled conditions of a shaker device and in walking at preferred speed.

Disagreement in physical activity assessed by accelerometer and self-report in subgroups of age, gender, education and weight status.

BACKGROUND: The purpose of this study is to compare self-reported time (by questionnaire) and objectively measured time (by accelerometer) spent on physical activity at moderate (MPA) and vigorous intensity (VPA) in subgroups of age, gender, education and weight status. METHODS: In total, 236 adolescents (aged 12-18) and 301 adults (aged 22-40), completed the questionnaire and wore an accelerometer for two weeks. RESULTS: Adolescents reported exceptionally more time spent on MPA (mean difference 596 +/- 704 min/wk) and VPA (mean difference 178 +/- 315 min/wk) than was assessed objectively by the accelerometer. Based on the questionnaire, high educated adolescents spent more time on MPA (205 min/wk, p = 0.002) and VPA (120 min/wk, p = 0.01) than low educated adolescents, but according to the accelerometer they spent less time on MPA (149 min/wk, p = 0.001) and VPA (47 min/wk, p = 0.001). Among adults there was moderate agreement between self-reported time and objectively measured time spent on MPA, but in general the reported time spent on MPA (mean difference 107 +/- 334 min/wk) and VPA (mean difference 169 +/- 250 min/wk) exceeded the time measured with the accelerometer. Overweight adults reported significantly more VPA (57 min/wk, p = 0.04) than normal weight adults, but this was not confirmed by the accelerometer data. CONCLUSION: We observed large differences in time spent on MPA and VPA measured by questionnaire and accelerometer in adolescents but reasonably good agreement in adults. Differences between methods varied by gender, education and weight status. This finding raises serious questions about the use of questionnaires to quantify MPA and VPA in adolescents. There is a clear need in advanced valid assessments of PA in adolescents. TRIAL NUMBER: ISRCTN93896459.

Resumption of daily physical activity after day-case laparoscopic cholecystectomy.

BACKGROUND: Laparoscopic cholecystectomy has been proven to be safe and feasible as a day-case procedure. Few studies investigated postoperative activity resumption. The goal of this study was to objectively assess daily physical activity after day-case laparoscopic cholecystectomy and evaluate the effect of encouragement of patients. METHODS: This prospective controlled study measured daily physical activity in an unselected patient population undergoing day-case laparoscopic cholecystectomy by using an accelerometer for 1 week before surgery to 1 week after. First, a control group received standard care. Subsequently, an intervention group was encouraged to swift resumption of daily physical activity by means of standardized advice combined with individualized activity goals. Outcome measures were activity scores, visual analogue scores (VAS) for pain and nausea and subjective factors limiting activity. RESULTS: Sixty-four patients completed the study (n = 28 in the control group, n = 36 in the intervention group). In the control group, 36% of the patients reached their preoperative activity level after 1 week, as compared to 50% in the intervention group (p = 0.19). Resumption of daily physical activity during the first postoperative week in the intervention group was not significantly different from the control group [repeated measures analysis of variance (MANOVA), p = 0.05]. However, in contrast with men, women in the intervention group did show a faster recovery of daily physical activity as compared to the control group (MANOVA, p = 0.02). Although there was no significant difference in postoperative VAS scores for pain and nausea between both groups, patients in the intervention group experienced pain less often as a limiting factor (p = 0.006). CONCLUSION: Recovery of daily physical activity exceeded 1 week in most patients undergoing day-case laparoscopic cholecystectomy. The use of an accelerometer and standardized encouragement accelerated recovery in women.

Promoting physical activity using an activity monitor and a tailored web-based advice: design of a randomized controlled trial [ISRCTN93896459].

BACKGROUND: Ageing is associated with a decrease in physical activity. This decrease particularly occurs during specific transitional life stages. Especially during adolescence and young adulthood a steep decrease in physical activity is observed. Inactive people are often not aware of their inactivity. Providing feedback on the actual physical activity level by an activity monitor can increase awareness and may in combination with an individually tailored physical activity advice stimulate a physically active lifestyle. METHODS: In a randomized controlled trial the effectiveness of providing an activity monitor in combination with a personal physical activity advice through the Internet will be examined. Outcome measures are level of physical activity, determinants of physical activity, quality of life, empowerment, aerobic fitness and body composition. Participants are relatively inactive adolescents and young adults who are measured at baseline, after 3 months intervention and 5 months after the end of the intervention. In addition, facilitating and hindering factors for implementation of the intervention will be investigated. DISCUSSION: The use of a personal activity monitor in combination with web-based assisted individually tailored health promotion offers a good opportunity to work interactively with large groups of adolescents and young adults and provide them with advice based on their actual activity level. It has great potential to motivate people to change their behaviour and to our knowledge has not been evaluated before.