The negative consequences of COVID-19 national lockdowns have been well documented, including the... more The negative consequences of COVID-19 national lockdowns have been well documented, including the worsening of mental health for many, and the amplification of preexisting inequalities. As a counterpoint, the current study utilises a mixed-methods coproduction approach to share psychosocial insights into the adoption of positive changes made during national lockdown in Scotland. The study examined: i) the psychosocial patterning of positive behavior changes, ii) the psychosocial processes by which positive change was realised, and worked with partner organizations to share these insights. Methods: A sequential mixed-methods design included an online survey (n=2445) assessing positive changes in sleep and physical activity patterns, and the role of socio-demographics, mood, social support, coping, and resilience, with multivariate logistic regression analysis. Interviews were employed with a purposive diverse sub-sample of people self-reporting high levels of positive change (n=48) and used thematic analysis. Results: The survey identified positive behavior change was significantly patterned by age, gender and vulnerability to COVID-19. Higher levels of positive reframing and active coping in relation to stress were associated with higher levels of positive behavior change. Higher symptoms of depression, planning, and selfdistraction were associated with less positive behavior change. Thematic analysis showed the centrality of perceptions of time, opportunities to self-reflect and engage with the natural world, access support in diverse ways, actively build routine and purposefully build selfefficacy and a sense of control were key to initiating positive change. Conclusions: The current study yields insights into achieving positive behavior change at a time of international crisis.
medRxiv (Cold Spring Harbor Laboratory), Mar 5, 2021
Acknowledgements: We would like to thank our participants for taking part in the project and our ... more Acknowledgements: We would like to thank our participants for taking part in the project and our project partners (Actify, Mind the Men, Scottish Older People's Assembly).
International Journal of Environmental Research and Public Health, Dec 14, 2020
We examine the impact of the COVID-19 outbreak and concomitant restrictions (i.e., lockdown) on 2... more We examine the impact of the COVID-19 outbreak and concomitant restrictions (i.e., lockdown) on 24-hour movement behaviors (i.e., physical activity, sitting, sleep) in a purposive sample of people (n = 3230) reporting change recruited online. Participants' self-reported time spent in moderate-to-vigorous physical activity (MVPA), walking, sitting and sleep prior to lockdown (T1), during the first national lockdown (T2) and as restrictions initially started to ease (T3). For each 24-hour movement behavior, category-shifts are reported (positive, negative or did not change), as well as the percentage of participants recording positive/negative changes across clusters of behaviors and the percentage of participants recording improvement or maintenance of change across time. From T1 to T2 walking decreased, whereas MVPA, sitting and sleep increased, from T2 to T3 levels returned to pre-lockdown for all but MVPA. Participants who changed one behavior positively were more likely to report a positive change in another and 50% of those who reported positive changes from T1 to T2 maintained or improved further when restrictions started to ease. The current study showed that a large proportion of the sample reported positive changes, most notably those displaying initially poor levels of each behavior. These findings will inform salutogenic intervention development.
International Journal of Environmental Research and Public Health, Jun 24, 2020
Background: Prolonged sedentary behaviour (SB) is associated with risk of chronic diseases. Digit... more Background: Prolonged sedentary behaviour (SB) is associated with risk of chronic diseases. Digital interventions in SB require mixed method evaluations to understand potential for impact in real-world settings. In this study, the RE-AIM QuEST evaluation framework will be used to understand the potential of a digital health promotion application which targets reducing and breaking up SB across multiple workplace settings. Methods: Four companies and 80 employees were recruited to use a digital application. Questionnaires were used to measure SB, and additional health and work-related outcomes at baseline, one month, three month and six month follow-up. Qualitative data was collected through focus groups with employees and interviews with stakeholders. Questionnaire data was analysed using Wilcoxon Sign Rank tests and qualitative data was thematically analysed. Results: The digital application significantly increased standing time at one month for the total group and transitions per hour in one of the companies. Facilitators and barriers were identified across RE-AIM. Conclusions: Addressing the barriers which have been identified, while maintaining the positive attributes will be critical to producing an effective digital application which also has the potential for impact in the real world.
medRxiv (Cold Spring Harbor Laboratory), Sep 25, 2020
Multiple studies have highlighted the negative impact of COVID-19 and its particular effects on v... more Multiple studies have highlighted the negative impact of COVID-19 and its particular effects on vulnerable sub-populations. Complementing this work, here, we report on the social patterning of self-reported positive changes experienced during COVID-19 national lockdown in Scotland. The CATALYST study collected data from 3342 adults in Scotland during weeks 9-12 of a national lockdown. Using a cross-sectional design, participants completed an online questionnaire providing data on key sociodemographic and health variables, and completed a measure of positive change. The positive change measure spanned diverse domains (e.g., more quality time with family, developing new hobbies, more physical activity, and better quality of sleep). We used univariate analysis and stepwise regression to examine the contribution of a range of sociodemographic factors (e.g., age, gender, ethnicity, educational attainment, and employment status) in explaining positive change. There were clear sociodemographic differences across positive change scores. Those reporting higher levels of positive change were female, from younger age groups, married or living with their partner, employed, and in better health. Overall our results highlight the social patterning of positive changes during lockdown in Scotland. These findings begin to illuminate the complexity of the unanticipated effects of national lockdown and will be used to support future intervention development work sharing lessons learned from lockdown to increase positive health change amongst those who may benefit.
International Journal of Environmental Research and Public Health, Aug 10, 2020
Welbot is a nudge-based digital intervention that aims to reduce sedentary behaviour and improve ... more Welbot is a nudge-based digital intervention that aims to reduce sedentary behaviour and improve physical and mental wellbeing at work. The purpose of this study was to pilot test the Welbot intervention. Forty-one (6M/35F) University staff (M age = 43-years) participated in this study, which was a single arm repeated measures trial conducted over three weeks of intervention. The primary outcome was sedentary behaviour (measured subjectively and objectively) and secondary outcomes included: mental wellbeing, procrastination, depression, anxiety and stress, and work engagement. A subset of participants (n = 6) wore an ActivPAL to objectively measure activity data, while another subset of participants (n = 6) completed a qualitative semi-structured interview to ascertain experiences of using Welbot. Following the intervention, a Friedman non-parametric test revealed that participants self-reported significantly less time sitting and more time standing and objectively recorded more steps at the week-1 follow-up. A series of paired t-tests exhibited that changes in all secondary outcomes were in the expected direction. However, only improvements in depression, anxiety, and stress were significant. After using Welbot, thematic analysis demonstrated that participants perceived they had a positive behaviour change, increased awareness of unhealthy behaviours at work, and provided suggestions for intervention improvement. Overall, findings provided indications of the potential positive impact Welbot may have on employees' wellbeing, however, limitations are noted. Recommendations for intervention improvement including personalisation (e.g., individual preferences for nudges and the option to sync Welbot with online calendars) and further research into how users engage with Welbot are provided.
Background: The impact of bronchiectasis on sedentary behaviour and physical activity is unknown.... more Background: The impact of bronchiectasis on sedentary behaviour and physical activity is unknown. It is important to explore this to identify the need for physical activity interventions and how to tailor interventions to this patient population. We aimed to explore the patterns and correlates of sedentary behaviour and physical activity in bronchiectasis. Methods: Physical activity was assessed in 63 patients with bronchiectasis using an ActiGraph GT3X+ accelerometer over seven days. Patients completed: questionnaires on health-related quality-of-life and attitudes to physical activity (questions based on an adaption of the transtheoretical model (TTM) of behaviour change); spirometry; and the modified shuttle test (MST). Multiple linear regression analysis using forward selection based on likelihood ratio statistics explored the correlates of sedentary behaviour and physical activity dimensions. Between-group analysis using independent sample t-tests were used to explore differences for selected variables. Results: Fifty-five patients had complete datasets. Average daily time, mean(standard deviation) spent in sedentary behaviour was 634(77)mins, light-lifestyle physical activity was 207(63)mins and moderate-vigorous physical activity (MVPA) was 25(20)mins. Only 11% of patients met recommended guidelines. Forced expiratory volume in one-second percentage predicted (FEV 1 % predicted) and disease severity were not correlates of sedentary behaviour or physical activity. For sedentary behaviour, decisional balance 'pros' score was the only correlate. Performance on the MST was the strongest correlate of physical activity. In addition to the MST, there were other important correlate variables for MVPA accumulated in ≥10-minute bouts (QOL-B Social Functioning) and for activity energy expenditure (Body Mass Index and QOL-B Respiratory Symptoms). Conclusions: Patients with bronchiectasis demonstrated a largely inactive lifestyle and few met the recommended physical activity guidelines. Exercise capacity was the strongest correlate of physical activity, and dimensions of the QOL-B were also important. FEV 1 % predicted and disease severity were not correlates of sedentary behaviour or physical activity. The inclusion of a range of physical activity dimensions could facilitate in-depth exploration of patterns of physical activity. This study demonstrates the need for interventions targeted at reducing sedentary behaviour and increasing physical activity, and provides information to tailor interventions to the bronchiectasis population.
Background: There are challenges for researchers and clinicians to select the most appropriate ph... more Background: There are challenges for researchers and clinicians to select the most appropriate physical activity tool, and a balance between precision and feasibility is needed. Currently it is unclear which physical activity tool should be used to assess physical activity in Bronchiectasis. The aim of this research is to compare assessment methods (pedometer and IPAQ) to our criterion method (ActiGraph) for the measurement of physical activity dimensions in Bronchiectasis (BE), and to assess their feasibility and acceptability. Methods: Patients in this analysis were enrolled in a cross-sectional study. The ActiGraph and pedometer were worn for seven consecutive days and the IPAQ was completed for the same period. Statistical analyses were performed using SPSS 20 (IBM). Descriptive statistics were used; the percentage agreement between ActiGraph and the other measures were calculated using limits of agreement. Feedback about the feasibility of the activity monitors and the IPAQ was obtained. Results: There were 55 (22 male) data sets available. For step count there was no significant difference between the ActiGraph and Pedometer, however, total physical activity time (mins) as recorded by the ActiGraph was significantly higher than the pedometer (mean ± SD, 232 (75) vs. 63 (32)). Levels of agreement between the two devices was very good for step count (97% agreement); and variation in the levels of agreement were within accepted limits of ±2 standard deviations from the mean value. IPAQ reported more bouted-moderate-vigorous physical activity (MVPA) [mean, SD; 167(170) vs 6(9) mins/day], and significantly less sedentary time than ActiGraph [mean, SD; 362(115) vs 634(76) vmins/day]. There were low levels of agreement between the two tools (57% sedentary behaviour; 0% MVPA 10+), with IPAQ under-reporting sedentary behaviour and over-reporting MVPA 10+ compared to ActiGraph. The monitors were found to be feasible and acceptable by participants and researchers; while the IPAQ was accepta ble to use, most patients required assistance to complete it. Conclusions: Accurate measurement of physical activity is feasible in BE and will be valuable for future trials of therapeutic interventions. ActiGraph or pedometer could be used to measure simple daily step counts, but ActiGraph was superior as it measured intensity of physical activity and was a more precise measure of time spent walking. The IPAQ does not appear to represent an accurate measure of physical activity in this population.
Background: The global incidence of type 1 diabetes is rising, and youths with type 1 diabetes co... more Background: The global incidence of type 1 diabetes is rising, and youths with type 1 diabetes continue to suffer poorer health than peers without diabetes. Evidence suggests youths with type 1 diabetes have physical activity (PA) levels well below the recommendations for health and have high levels of sedentary behaviour. An active lifestyle is therefore recommended to improve health. There is limited research showing effective lifestyle behaviour change in this population; therefore, an evidence gap exists between the need to promote physical activity in type 1 diabetes care and lack of understanding on how to do this. This protocol paper describes a feasibility and pilot study of the ActivPals programme-an intervention to support active lifestyles in youths with type 1 diabetes. Methods/design: Key intervention components have been identified from preliminary work (individual and family focus, peer mentoring, technology integration and improved communication and understanding) and are being developed into a pragmatic randomised controlled trial (RCT) supported by recruitment pathways. A steering group of health care professionals and managers will refine the intervention to patient needs. A pilot trial is providing data on intervention implementation, acceptability and feasibility. Twenty youths with type 1 diabetes are being recruited and randomised into an intervention or control group. Physical activity is being measured objectively using the Actigraph GT3X+ monitor at baseline and 1-month follow-up. Contextual factors associated with intervention delivery are being explored. Discussion: This study will contribute to the development of evidence-based, user-informed and pragmatic interventions leading to healthier lifestyles in youths with type 1 diabetes.
through professional networks and social media. The survey asked CPs to record their perceptions ... more through professional networks and social media. The survey asked CPs to record their perceptions on how often patients sought advice on several common sleep problems, as either 'very often' (most days), 'often' (1-3 times/week), 'occasionally' (1-3 times/month) or 'rarely' < once/month). Other areas included self-rated confidence dealing with requests on sleep problems (1-5 Likert scale: 1 being 'not confident' and 5 'confident'), estimated proportion of GPreferred requests for advice and the perceived need for community-based sleep-related services. Data analyses were descriptive. Results Completed responses were obtained from 120 CPs. Results summarised in figures 1 and 2. Combining 'often' and 'very often', the most common sleep-related problems encountered were insomnia (60%) and sleepiness/tiredness/fatigue (54%). Half the CPs self-rated their confidence as 3 on the 'confident-not confident' scale. Fifty-seven percent reported that they received no undergraduate training on sleep problems. Proposed pharmacist involvement in sleep screening/signposting services or a pharmacy-based intervention/referral programme was supported by 78% and 70% respectively. Fifty-eight percent of CPs were 'very often' or 'often' asked about symptoms of OSAS, with the majority (93%) asked 'occasionally'. Discussion CPs frequently encounter patients with symptoms of sleep disorders, but their confidence and training in dealing with these is lacking. This study highlights the need for specialist sleep training for pharmacists and the development of pharmacy-based services to support and improve patient outcomes.
Heart Rate Variability (HRV), and 6-minute walk test (6MWT). Nonparametric and parametric statist... more Heart Rate Variability (HRV), and 6-minute walk test (6MWT). Nonparametric and parametric statistics were used with p≤0.05. Data are mean (SD) or md (Q1,Q3) for self-report measures. RESULTS: In both MSD and C groups prior to BD, QOL correlated with FIS (rs =-0.63) and BDI (rs =-0.70). FIS correlated with BDI (rs = 0.72). HRV correlated with QOL (rs= 0.47) and BDI (rs =-0.56) but not with FIS. (rs =-0.32). No variables correlated with 6MWT. For the MSD group, HRV (pre = 31 (19) post = 38 (19) ms, p = 0.03) and 6MWT (pre = 432 (114) post = 462 (126) m, p = 0.03) increased. Of the self-report outcomes, BDI improved (pre= 9 (5,15) post = 4 (0,10), p = 0.04). There were no changes in any measured outcome for the C group. CONCLUSION: BD can lead to significant improvements in HRV and depression. Further, HRV but not 6MWT might mediate improvements in QOL through depression in pwMS. This study was supported by the Greater Milwaukee Foundation.
Little is known about the response of post‐partum women from deprived backgrounds to weight manag... more Little is known about the response of post‐partum women from deprived backgrounds to weight management interventions, however behavioural intervention trials in disadvantaged communities are often characterised by recruitment difficulties. Recruitment and retention is key to the robust conduct of an effective trial, and exploratory work is essential prior to a definitive randomised controlled trial. This paper describes strategies used to recruit to the WeighWell feasibility study, which aimed to recruit 60 overweight or obese post‐partum women living in areas of deprivation to a trial of a weight‐loss intervention. Recruitment strategies included the following: (1) distribution of posters and ‘business cards’; (2) newspaper advertisements; (3) visits to community groups; and (4) personalised letters of invitation sent via the National Health Service (NHS). Potential participants were screened for eligibility following response to a Freephone number. Body mass index was calculated u...
International Journal of Environmental Research and Public Health, Nov 4, 2021
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Background: Informal caregivers, or carers (unpaid family members and friends), are instrumental ... more Background: Informal caregivers, or carers (unpaid family members and friends), are instrumental to millions worldwide for the ongoing delivery of health and well-being needs. The risk of crisis points (eg, hospitalizations) for caregivers increases with the absence of physical activity. The COVID-19 pandemic is highly likely to have increased the risk of crisis points for caregivers by increasing the amount of time spent indoors due to shielding and lockdown restrictions. Thus, accessible evidence-based tools to facilitate physical activity for caregivers indoors are urgently needed. Objective: The aim of this study was to co-design and develop a novel mobile app to educate and support carers in the undertaking of regular physical activity at home during and beyond COVID-19 restrictions via integration of the transtheoretical model of behavior change and UK physical activity guidelines. Methods: We co-designed a mobile app, "CareFit," by directly involving caregivers, health care professionals, and social care professionals in the requirements, capturing, and evaluation phases of three Agile Scrum design and development sprints. Seven participants representing multistakeholder views took part in three co-design sessions, each of which was followed by a development sprint. Requirements for CareFit were grounded in a combination of behavioral change science and UK government guidelines for physical activity. Results: Participants identified different barriers and enablers to physical activity, such as a lack of time, recognition of existing activities, and concerns regarding safely undertaking physical activity. Requirements analysis highlighted the importance of simplicity in design and a need to anchor development around the everyday needs of caregivers (eg, easy-to-use video instructions). Our final prototype app integrated guidance for undertaking physical activity at home through educational, physical activity, and communication components. Conclusions: Integrating government guidelines with models of behavioral change into a mobile app to support the physical activity of carers is novel. We found that integrating core physical activity guidelines into a co-designed smartphone app with functionality such as a weekly planner and educational material for users is feasible. This work holds promise to fill the gap of effective physical activity solutions for caregivers both during and beyond the COVID-19 pandemic. Further work is now needed to explore the feasibility, acceptability, and usability of the approach in real-world settings.
A systematic review of physical activity and sedentary behavior intervention studies in youth wit... more A systematic review of physical activity and sedentary behavior intervention studies in youth with type 1 diabetes: study characteristics, intervention design, and efficacy. Pediatric Diabetes 2013. Objective: To systematically review physical activity and/or sedentary behavior intervention studies for youth with type 1 diabetes. Methods: Several databases were searched for articles reporting on randomized-controlled trials (RCTs) in youth (<18 yr) with type 1 diabetes. Data was extracted and bias assessed to evaluate study characteristics, intervention design, and efficacy of interventions on physical activity and health. Where sufficient data were available meta-analyses of health outcomes [for hemoglobin A1c (HbA1c)] were performed. Weighted mean differences (WMD) were calculated using fixed and random effect models. Results: The literature search identified 12/2397 full-text articles reporting on 11 studies. Two interventions were wholly unsupervised and only one was based on behavior change theory with no studies exploring changes in behavior processes. Nine interventions aimed to improve fitness or physical activity, two aimed to improve health, and none aimed at changing sedentary behavior. Eight interventions improved physical activity and/or fitness. At least one beneficial effect on health was found in each intervention group apart from two studies where no changes were found. Meta-analysis of 10 studies showed the interventions have a significant beneficial reduction of HbA1c (%), indicating an improvement in glycemic control [WMD, −0.85% (95% CI, −1.45 to −0.25%)]. There were insufficient data to pool other health outcome data. Conclusions: Few RCTs explored the efficacy of unsupervised theory-based physical activity and/or sedentary behavior interventions in youth with type 1 diabetes. Limited reporting made comparison of findings challenging. There was an overall significant beneficial effect of physical activity on HbA1c.
OBJECTIVE-To evaluate effect of exercise consultation on physical activity and resultant physiolo... more OBJECTIVE-To evaluate effect of exercise consultation on physical activity and resultant physiological and biochemical variables at 6 months in people with type 2 diabetes. RESEARCH DESIGN AND METHODS-A total of 70 inactive people with type 2 diabetes were given standard exercise information and were randomized to receive an exercise consultation (n ϭ 35) or not (n ϭ 35). Exercise consultation, based on the transtheoretical model, combines motivational theory and cognitive behavioral strategies into an individualized intervention to promote physical activity. Changes from baseline to 6 months were assessed in 1) physical activity (7-day recall, accelerometer, cardiorespiratory fitness, stage, and processes of change), 2) physiological variables (blood pressure and BMI), and 3) biochemical variables (HbA 1c , lipid profile, and fibrinogen). RESULTS-Between-group differences were recorded for the change in minutes of moderate activity (P Ͻ 0.001) and activity counts (P Ͻ 0.001) per week. Experimental participants recorded an increase in activity counts per week and minutes of moderate activity per week (P Ͻ 0.001). The control group recorded no significant changes. More experimental participants increased stage of change (2 ϭ 22.6, P Ͻ 0.001). Between-group differences were recorded for the change in total exercise duration and peak gradient (P Ͻ 0.005), HbA 1c (P ϭ 0.02), systolic BP (P ϭ 0.02), and fibrinogen (P ϭ 0.03). CONCLUSIONS-Exercise consultation increased physical activity and improved glycemic control and cardiovascular risk factors in people with type 2 diabetes.
The negative consequences of COVID-19 national lockdowns have been well documented, including the... more The negative consequences of COVID-19 national lockdowns have been well documented, including the worsening of mental health for many, and the amplification of preexisting inequalities. As a counterpoint, the current study utilises a mixed-methods coproduction approach to share psychosocial insights into the adoption of positive changes made during national lockdown in Scotland. The study examined: i) the psychosocial patterning of positive behavior changes, ii) the psychosocial processes by which positive change was realised, and worked with partner organizations to share these insights. Methods: A sequential mixed-methods design included an online survey (n=2445) assessing positive changes in sleep and physical activity patterns, and the role of socio-demographics, mood, social support, coping, and resilience, with multivariate logistic regression analysis. Interviews were employed with a purposive diverse sub-sample of people self-reporting high levels of positive change (n=48) and used thematic analysis. Results: The survey identified positive behavior change was significantly patterned by age, gender and vulnerability to COVID-19. Higher levels of positive reframing and active coping in relation to stress were associated with higher levels of positive behavior change. Higher symptoms of depression, planning, and selfdistraction were associated with less positive behavior change. Thematic analysis showed the centrality of perceptions of time, opportunities to self-reflect and engage with the natural world, access support in diverse ways, actively build routine and purposefully build selfefficacy and a sense of control were key to initiating positive change. Conclusions: The current study yields insights into achieving positive behavior change at a time of international crisis.
medRxiv (Cold Spring Harbor Laboratory), Mar 5, 2021
Acknowledgements: We would like to thank our participants for taking part in the project and our ... more Acknowledgements: We would like to thank our participants for taking part in the project and our project partners (Actify, Mind the Men, Scottish Older People's Assembly).
International Journal of Environmental Research and Public Health, Dec 14, 2020
We examine the impact of the COVID-19 outbreak and concomitant restrictions (i.e., lockdown) on 2... more We examine the impact of the COVID-19 outbreak and concomitant restrictions (i.e., lockdown) on 24-hour movement behaviors (i.e., physical activity, sitting, sleep) in a purposive sample of people (n = 3230) reporting change recruited online. Participants' self-reported time spent in moderate-to-vigorous physical activity (MVPA), walking, sitting and sleep prior to lockdown (T1), during the first national lockdown (T2) and as restrictions initially started to ease (T3). For each 24-hour movement behavior, category-shifts are reported (positive, negative or did not change), as well as the percentage of participants recording positive/negative changes across clusters of behaviors and the percentage of participants recording improvement or maintenance of change across time. From T1 to T2 walking decreased, whereas MVPA, sitting and sleep increased, from T2 to T3 levels returned to pre-lockdown for all but MVPA. Participants who changed one behavior positively were more likely to report a positive change in another and 50% of those who reported positive changes from T1 to T2 maintained or improved further when restrictions started to ease. The current study showed that a large proportion of the sample reported positive changes, most notably those displaying initially poor levels of each behavior. These findings will inform salutogenic intervention development.
International Journal of Environmental Research and Public Health, Jun 24, 2020
Background: Prolonged sedentary behaviour (SB) is associated with risk of chronic diseases. Digit... more Background: Prolonged sedentary behaviour (SB) is associated with risk of chronic diseases. Digital interventions in SB require mixed method evaluations to understand potential for impact in real-world settings. In this study, the RE-AIM QuEST evaluation framework will be used to understand the potential of a digital health promotion application which targets reducing and breaking up SB across multiple workplace settings. Methods: Four companies and 80 employees were recruited to use a digital application. Questionnaires were used to measure SB, and additional health and work-related outcomes at baseline, one month, three month and six month follow-up. Qualitative data was collected through focus groups with employees and interviews with stakeholders. Questionnaire data was analysed using Wilcoxon Sign Rank tests and qualitative data was thematically analysed. Results: The digital application significantly increased standing time at one month for the total group and transitions per hour in one of the companies. Facilitators and barriers were identified across RE-AIM. Conclusions: Addressing the barriers which have been identified, while maintaining the positive attributes will be critical to producing an effective digital application which also has the potential for impact in the real world.
medRxiv (Cold Spring Harbor Laboratory), Sep 25, 2020
Multiple studies have highlighted the negative impact of COVID-19 and its particular effects on v... more Multiple studies have highlighted the negative impact of COVID-19 and its particular effects on vulnerable sub-populations. Complementing this work, here, we report on the social patterning of self-reported positive changes experienced during COVID-19 national lockdown in Scotland. The CATALYST study collected data from 3342 adults in Scotland during weeks 9-12 of a national lockdown. Using a cross-sectional design, participants completed an online questionnaire providing data on key sociodemographic and health variables, and completed a measure of positive change. The positive change measure spanned diverse domains (e.g., more quality time with family, developing new hobbies, more physical activity, and better quality of sleep). We used univariate analysis and stepwise regression to examine the contribution of a range of sociodemographic factors (e.g., age, gender, ethnicity, educational attainment, and employment status) in explaining positive change. There were clear sociodemographic differences across positive change scores. Those reporting higher levels of positive change were female, from younger age groups, married or living with their partner, employed, and in better health. Overall our results highlight the social patterning of positive changes during lockdown in Scotland. These findings begin to illuminate the complexity of the unanticipated effects of national lockdown and will be used to support future intervention development work sharing lessons learned from lockdown to increase positive health change amongst those who may benefit.
International Journal of Environmental Research and Public Health, Aug 10, 2020
Welbot is a nudge-based digital intervention that aims to reduce sedentary behaviour and improve ... more Welbot is a nudge-based digital intervention that aims to reduce sedentary behaviour and improve physical and mental wellbeing at work. The purpose of this study was to pilot test the Welbot intervention. Forty-one (6M/35F) University staff (M age = 43-years) participated in this study, which was a single arm repeated measures trial conducted over three weeks of intervention. The primary outcome was sedentary behaviour (measured subjectively and objectively) and secondary outcomes included: mental wellbeing, procrastination, depression, anxiety and stress, and work engagement. A subset of participants (n = 6) wore an ActivPAL to objectively measure activity data, while another subset of participants (n = 6) completed a qualitative semi-structured interview to ascertain experiences of using Welbot. Following the intervention, a Friedman non-parametric test revealed that participants self-reported significantly less time sitting and more time standing and objectively recorded more steps at the week-1 follow-up. A series of paired t-tests exhibited that changes in all secondary outcomes were in the expected direction. However, only improvements in depression, anxiety, and stress were significant. After using Welbot, thematic analysis demonstrated that participants perceived they had a positive behaviour change, increased awareness of unhealthy behaviours at work, and provided suggestions for intervention improvement. Overall, findings provided indications of the potential positive impact Welbot may have on employees' wellbeing, however, limitations are noted. Recommendations for intervention improvement including personalisation (e.g., individual preferences for nudges and the option to sync Welbot with online calendars) and further research into how users engage with Welbot are provided.
Background: The impact of bronchiectasis on sedentary behaviour and physical activity is unknown.... more Background: The impact of bronchiectasis on sedentary behaviour and physical activity is unknown. It is important to explore this to identify the need for physical activity interventions and how to tailor interventions to this patient population. We aimed to explore the patterns and correlates of sedentary behaviour and physical activity in bronchiectasis. Methods: Physical activity was assessed in 63 patients with bronchiectasis using an ActiGraph GT3X+ accelerometer over seven days. Patients completed: questionnaires on health-related quality-of-life and attitudes to physical activity (questions based on an adaption of the transtheoretical model (TTM) of behaviour change); spirometry; and the modified shuttle test (MST). Multiple linear regression analysis using forward selection based on likelihood ratio statistics explored the correlates of sedentary behaviour and physical activity dimensions. Between-group analysis using independent sample t-tests were used to explore differences for selected variables. Results: Fifty-five patients had complete datasets. Average daily time, mean(standard deviation) spent in sedentary behaviour was 634(77)mins, light-lifestyle physical activity was 207(63)mins and moderate-vigorous physical activity (MVPA) was 25(20)mins. Only 11% of patients met recommended guidelines. Forced expiratory volume in one-second percentage predicted (FEV 1 % predicted) and disease severity were not correlates of sedentary behaviour or physical activity. For sedentary behaviour, decisional balance 'pros' score was the only correlate. Performance on the MST was the strongest correlate of physical activity. In addition to the MST, there were other important correlate variables for MVPA accumulated in ≥10-minute bouts (QOL-B Social Functioning) and for activity energy expenditure (Body Mass Index and QOL-B Respiratory Symptoms). Conclusions: Patients with bronchiectasis demonstrated a largely inactive lifestyle and few met the recommended physical activity guidelines. Exercise capacity was the strongest correlate of physical activity, and dimensions of the QOL-B were also important. FEV 1 % predicted and disease severity were not correlates of sedentary behaviour or physical activity. The inclusion of a range of physical activity dimensions could facilitate in-depth exploration of patterns of physical activity. This study demonstrates the need for interventions targeted at reducing sedentary behaviour and increasing physical activity, and provides information to tailor interventions to the bronchiectasis population.
Background: There are challenges for researchers and clinicians to select the most appropriate ph... more Background: There are challenges for researchers and clinicians to select the most appropriate physical activity tool, and a balance between precision and feasibility is needed. Currently it is unclear which physical activity tool should be used to assess physical activity in Bronchiectasis. The aim of this research is to compare assessment methods (pedometer and IPAQ) to our criterion method (ActiGraph) for the measurement of physical activity dimensions in Bronchiectasis (BE), and to assess their feasibility and acceptability. Methods: Patients in this analysis were enrolled in a cross-sectional study. The ActiGraph and pedometer were worn for seven consecutive days and the IPAQ was completed for the same period. Statistical analyses were performed using SPSS 20 (IBM). Descriptive statistics were used; the percentage agreement between ActiGraph and the other measures were calculated using limits of agreement. Feedback about the feasibility of the activity monitors and the IPAQ was obtained. Results: There were 55 (22 male) data sets available. For step count there was no significant difference between the ActiGraph and Pedometer, however, total physical activity time (mins) as recorded by the ActiGraph was significantly higher than the pedometer (mean ± SD, 232 (75) vs. 63 (32)). Levels of agreement between the two devices was very good for step count (97% agreement); and variation in the levels of agreement were within accepted limits of ±2 standard deviations from the mean value. IPAQ reported more bouted-moderate-vigorous physical activity (MVPA) [mean, SD; 167(170) vs 6(9) mins/day], and significantly less sedentary time than ActiGraph [mean, SD; 362(115) vs 634(76) vmins/day]. There were low levels of agreement between the two tools (57% sedentary behaviour; 0% MVPA 10+), with IPAQ under-reporting sedentary behaviour and over-reporting MVPA 10+ compared to ActiGraph. The monitors were found to be feasible and acceptable by participants and researchers; while the IPAQ was accepta ble to use, most patients required assistance to complete it. Conclusions: Accurate measurement of physical activity is feasible in BE and will be valuable for future trials of therapeutic interventions. ActiGraph or pedometer could be used to measure simple daily step counts, but ActiGraph was superior as it measured intensity of physical activity and was a more precise measure of time spent walking. The IPAQ does not appear to represent an accurate measure of physical activity in this population.
Background: The global incidence of type 1 diabetes is rising, and youths with type 1 diabetes co... more Background: The global incidence of type 1 diabetes is rising, and youths with type 1 diabetes continue to suffer poorer health than peers without diabetes. Evidence suggests youths with type 1 diabetes have physical activity (PA) levels well below the recommendations for health and have high levels of sedentary behaviour. An active lifestyle is therefore recommended to improve health. There is limited research showing effective lifestyle behaviour change in this population; therefore, an evidence gap exists between the need to promote physical activity in type 1 diabetes care and lack of understanding on how to do this. This protocol paper describes a feasibility and pilot study of the ActivPals programme-an intervention to support active lifestyles in youths with type 1 diabetes. Methods/design: Key intervention components have been identified from preliminary work (individual and family focus, peer mentoring, technology integration and improved communication and understanding) and are being developed into a pragmatic randomised controlled trial (RCT) supported by recruitment pathways. A steering group of health care professionals and managers will refine the intervention to patient needs. A pilot trial is providing data on intervention implementation, acceptability and feasibility. Twenty youths with type 1 diabetes are being recruited and randomised into an intervention or control group. Physical activity is being measured objectively using the Actigraph GT3X+ monitor at baseline and 1-month follow-up. Contextual factors associated with intervention delivery are being explored. Discussion: This study will contribute to the development of evidence-based, user-informed and pragmatic interventions leading to healthier lifestyles in youths with type 1 diabetes.
through professional networks and social media. The survey asked CPs to record their perceptions ... more through professional networks and social media. The survey asked CPs to record their perceptions on how often patients sought advice on several common sleep problems, as either 'very often' (most days), 'often' (1-3 times/week), 'occasionally' (1-3 times/month) or 'rarely' < once/month). Other areas included self-rated confidence dealing with requests on sleep problems (1-5 Likert scale: 1 being 'not confident' and 5 'confident'), estimated proportion of GPreferred requests for advice and the perceived need for community-based sleep-related services. Data analyses were descriptive. Results Completed responses were obtained from 120 CPs. Results summarised in figures 1 and 2. Combining 'often' and 'very often', the most common sleep-related problems encountered were insomnia (60%) and sleepiness/tiredness/fatigue (54%). Half the CPs self-rated their confidence as 3 on the 'confident-not confident' scale. Fifty-seven percent reported that they received no undergraduate training on sleep problems. Proposed pharmacist involvement in sleep screening/signposting services or a pharmacy-based intervention/referral programme was supported by 78% and 70% respectively. Fifty-eight percent of CPs were 'very often' or 'often' asked about symptoms of OSAS, with the majority (93%) asked 'occasionally'. Discussion CPs frequently encounter patients with symptoms of sleep disorders, but their confidence and training in dealing with these is lacking. This study highlights the need for specialist sleep training for pharmacists and the development of pharmacy-based services to support and improve patient outcomes.
Heart Rate Variability (HRV), and 6-minute walk test (6MWT). Nonparametric and parametric statist... more Heart Rate Variability (HRV), and 6-minute walk test (6MWT). Nonparametric and parametric statistics were used with p≤0.05. Data are mean (SD) or md (Q1,Q3) for self-report measures. RESULTS: In both MSD and C groups prior to BD, QOL correlated with FIS (rs =-0.63) and BDI (rs =-0.70). FIS correlated with BDI (rs = 0.72). HRV correlated with QOL (rs= 0.47) and BDI (rs =-0.56) but not with FIS. (rs =-0.32). No variables correlated with 6MWT. For the MSD group, HRV (pre = 31 (19) post = 38 (19) ms, p = 0.03) and 6MWT (pre = 432 (114) post = 462 (126) m, p = 0.03) increased. Of the self-report outcomes, BDI improved (pre= 9 (5,15) post = 4 (0,10), p = 0.04). There were no changes in any measured outcome for the C group. CONCLUSION: BD can lead to significant improvements in HRV and depression. Further, HRV but not 6MWT might mediate improvements in QOL through depression in pwMS. This study was supported by the Greater Milwaukee Foundation.
Little is known about the response of post‐partum women from deprived backgrounds to weight manag... more Little is known about the response of post‐partum women from deprived backgrounds to weight management interventions, however behavioural intervention trials in disadvantaged communities are often characterised by recruitment difficulties. Recruitment and retention is key to the robust conduct of an effective trial, and exploratory work is essential prior to a definitive randomised controlled trial. This paper describes strategies used to recruit to the WeighWell feasibility study, which aimed to recruit 60 overweight or obese post‐partum women living in areas of deprivation to a trial of a weight‐loss intervention. Recruitment strategies included the following: (1) distribution of posters and ‘business cards’; (2) newspaper advertisements; (3) visits to community groups; and (4) personalised letters of invitation sent via the National Health Service (NHS). Potential participants were screened for eligibility following response to a Freephone number. Body mass index was calculated u...
International Journal of Environmental Research and Public Health, Nov 4, 2021
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Background: Informal caregivers, or carers (unpaid family members and friends), are instrumental ... more Background: Informal caregivers, or carers (unpaid family members and friends), are instrumental to millions worldwide for the ongoing delivery of health and well-being needs. The risk of crisis points (eg, hospitalizations) for caregivers increases with the absence of physical activity. The COVID-19 pandemic is highly likely to have increased the risk of crisis points for caregivers by increasing the amount of time spent indoors due to shielding and lockdown restrictions. Thus, accessible evidence-based tools to facilitate physical activity for caregivers indoors are urgently needed. Objective: The aim of this study was to co-design and develop a novel mobile app to educate and support carers in the undertaking of regular physical activity at home during and beyond COVID-19 restrictions via integration of the transtheoretical model of behavior change and UK physical activity guidelines. Methods: We co-designed a mobile app, "CareFit," by directly involving caregivers, health care professionals, and social care professionals in the requirements, capturing, and evaluation phases of three Agile Scrum design and development sprints. Seven participants representing multistakeholder views took part in three co-design sessions, each of which was followed by a development sprint. Requirements for CareFit were grounded in a combination of behavioral change science and UK government guidelines for physical activity. Results: Participants identified different barriers and enablers to physical activity, such as a lack of time, recognition of existing activities, and concerns regarding safely undertaking physical activity. Requirements analysis highlighted the importance of simplicity in design and a need to anchor development around the everyday needs of caregivers (eg, easy-to-use video instructions). Our final prototype app integrated guidance for undertaking physical activity at home through educational, physical activity, and communication components. Conclusions: Integrating government guidelines with models of behavioral change into a mobile app to support the physical activity of carers is novel. We found that integrating core physical activity guidelines into a co-designed smartphone app with functionality such as a weekly planner and educational material for users is feasible. This work holds promise to fill the gap of effective physical activity solutions for caregivers both during and beyond the COVID-19 pandemic. Further work is now needed to explore the feasibility, acceptability, and usability of the approach in real-world settings.
A systematic review of physical activity and sedentary behavior intervention studies in youth wit... more A systematic review of physical activity and sedentary behavior intervention studies in youth with type 1 diabetes: study characteristics, intervention design, and efficacy. Pediatric Diabetes 2013. Objective: To systematically review physical activity and/or sedentary behavior intervention studies for youth with type 1 diabetes. Methods: Several databases were searched for articles reporting on randomized-controlled trials (RCTs) in youth (<18 yr) with type 1 diabetes. Data was extracted and bias assessed to evaluate study characteristics, intervention design, and efficacy of interventions on physical activity and health. Where sufficient data were available meta-analyses of health outcomes [for hemoglobin A1c (HbA1c)] were performed. Weighted mean differences (WMD) were calculated using fixed and random effect models. Results: The literature search identified 12/2397 full-text articles reporting on 11 studies. Two interventions were wholly unsupervised and only one was based on behavior change theory with no studies exploring changes in behavior processes. Nine interventions aimed to improve fitness or physical activity, two aimed to improve health, and none aimed at changing sedentary behavior. Eight interventions improved physical activity and/or fitness. At least one beneficial effect on health was found in each intervention group apart from two studies where no changes were found. Meta-analysis of 10 studies showed the interventions have a significant beneficial reduction of HbA1c (%), indicating an improvement in glycemic control [WMD, −0.85% (95% CI, −1.45 to −0.25%)]. There were insufficient data to pool other health outcome data. Conclusions: Few RCTs explored the efficacy of unsupervised theory-based physical activity and/or sedentary behavior interventions in youth with type 1 diabetes. Limited reporting made comparison of findings challenging. There was an overall significant beneficial effect of physical activity on HbA1c.
OBJECTIVE-To evaluate effect of exercise consultation on physical activity and resultant physiolo... more OBJECTIVE-To evaluate effect of exercise consultation on physical activity and resultant physiological and biochemical variables at 6 months in people with type 2 diabetes. RESEARCH DESIGN AND METHODS-A total of 70 inactive people with type 2 diabetes were given standard exercise information and were randomized to receive an exercise consultation (n ϭ 35) or not (n ϭ 35). Exercise consultation, based on the transtheoretical model, combines motivational theory and cognitive behavioral strategies into an individualized intervention to promote physical activity. Changes from baseline to 6 months were assessed in 1) physical activity (7-day recall, accelerometer, cardiorespiratory fitness, stage, and processes of change), 2) physiological variables (blood pressure and BMI), and 3) biochemical variables (HbA 1c , lipid profile, and fibrinogen). RESULTS-Between-group differences were recorded for the change in minutes of moderate activity (P Ͻ 0.001) and activity counts (P Ͻ 0.001) per week. Experimental participants recorded an increase in activity counts per week and minutes of moderate activity per week (P Ͻ 0.001). The control group recorded no significant changes. More experimental participants increased stage of change (2 ϭ 22.6, P Ͻ 0.001). Between-group differences were recorded for the change in total exercise duration and peak gradient (P Ͻ 0.005), HbA 1c (P ϭ 0.02), systolic BP (P ϭ 0.02), and fibrinogen (P ϭ 0.03). CONCLUSIONS-Exercise consultation increased physical activity and improved glycemic control and cardiovascular risk factors in people with type 2 diabetes.
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