Pilot Randomised Controlled Trial of a Web-Based Intervention to Promote Healthy Eating, Physical Activity and Meaningful Social Connections Compared with Usual Care Control in People of Retirement Age Recruited from Workplaces

Jose Lara, Nicola O'Brien, Alan Godfrey, Ben Heaven, Elizabeth H Evans, Scott Lloyd, Suzanne Moffatt, Paula J Moynihan, Thomas D Meyer, Lynn Rochester, Falko F Sniehotta, Martin White, John C Mathers, Jose Lara, Nicola O'Brien, Alan Godfrey, Ben Heaven, Elizabeth H Evans, Scott Lloyd, Suzanne Moffatt, Paula J Moynihan, Thomas D Meyer, Lynn Rochester, Falko F Sniehotta, Martin White, John C Mathers

Abstract

Background: Lifestyle interventions delivered during the retirement transition might promote healthier ageing. We report a pilot randomised controlled trial (RCT) of a web-based platform (Living, Eating, Activity and Planning through retirement; LEAP) promoting healthy eating (based on a Mediterranean diet (MD)), physical activity (PA) and meaningful social roles.

Methods: A single blinded, two-arm RCT with individual allocation. Seventy-five adult regular internet users living in Northeast England, within two years of retirement, were recruited via employers and randomised in a 2:1 ratio to receive LEAP or a 'usual care' control. Intervention arm participants were provided with a pedometer to encourage self-monitoring of PA goals. Feasibility of the trial design and procedures was established by estimating recruitment and retention rates, and of LEAP from usage data. At baseline and 8-week follow-up, adherence to a MD derived from three 24-hour dietary recalls and seven-day PA by accelerometry were assessed. Healthy ageing outcomes (including measures of physiological function, physical capability, cognition, psychological and social wellbeing) were assessed and acceptability established by compliance with measurement protocols and completion rates. Thematically analysed, semi-structured, qualitative interviews assessed acceptability of the intervention, trial design, procedures and outcome measures.

Results: Seventy participants completed the trial; 48 (96%) participants in the intervention and 22 (88%) in the control arm. Participants had considerable scope for improvement in diet as assessed by MD score. LEAP was visited a median of 11 times (range 1-80) for a mean total time of 2.5 hours (range 5.5 min- 8.3 hours). 'Moving more', 'eating well' and 'being social' were the most visited modules. At interview, participants reported that diet and PA modules were important and acceptable within the context of healthy ageing. Participants found both trial procedures and outcome assessments acceptable.

Conclusions: The trial procedures and the LEAP intervention proved feasible and acceptable. Effectiveness and cost-effectiveness of LEAP to promote healthy lifestyles warrant evaluation in a definitive RCT.

Trial registration: ClinicalTrials.gov NCT02136381.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. CONSORT 2010 Flow Diagram.
Fig 1. CONSORT 2010 Flow Diagram.

References

    1. Kirkwood TB (2008) A systematic look at an old problem. Nature 451: 644–647. 10.1038/451644a
    1. Khaw KT, Wareham N, Bingham S, Welch A, Luben R, et al. (2008) Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study. PLoS Med 5: e12 10.1371/journal.pmed.0050012
    1. van Dam RM, Li T, Spiegelman D, Franco OH, Hu FB (2008) Combined impact of lifestyle factors on mortality: prospective cohort study in US women. BMJ 337: a1440 10.1136/bmj.a1440
    1. King K, Meader N, Wright K, Graham H, Power C, et al. (2015) Characteristics of interventions targeting multiple lifestyle risk behaviours in adult populations: a systematic scoping review. PLoS One 10: e0117015 10.1371/journal.pone.0117015
    1. Christensen K, Doblhammer G, Rau R, Vaupel JW (2009) Ageing populations: the challenges ahead. The Lancet 374: 1196–1208.
    1. Ebbinghaus B (2006) Reforming early retirement in Europe, Japan and the USA Oxford: Oxford University Press.
    1. Schäfer M, Jaeger-Erben M, Bamberg S (2012) Life Events as Windows of Opportunity for Changing Towards Sustainable Consumption Patterns?. Journal of Consumer Policy 35: 65–84.
    1. Nutting PA (1986) Health promotion in primary medical care: problems and potential. Prev Med 15: 537–548.
    1. Nooyens AC, Visscher TL, Schuit AJ, van Rossum CT, Verschuren WM, et al. (2005) Effects of retirement on lifestyle in relation to changes in weight and waist circumference in Dutch men: a prospective study. Public Health Nutr 8: 1266–1274.
    1. Ogilvie D, Cummins S, Petticrew M, White M, Jones A, et al. (2011) Assessing the Evaluability of Complex Public Health Interventions: Five Questions for Researchers, Funders, and Policymakers. Milbank Quarterly 89: 206–225. 10.1111/j.1468-0009.2011.00626.x
    1. Lara J, Hobbs N, Moynihan P, Meyer T, Adamson A, et al. (2014) Effectiveness of dietary interventions among adults of retirement age: a systematic review and meta-analysis of randomized controlled trials. BMC Med 12: 60 10.1186/1741-7015-12-60
    1. Hobbs N, Godfrey A, Lara J, Errington L, Meyer TD, et al. (2013) Are behavioral interventions effective in increasing physical activity at 12 to 36 months in adults aged 55 to 70 years? A systematic review and meta-analysis. BMC Med 11: 75 10.1186/1741-7015-11-75
    1. Heaven B, Brown LJ, White M, Errington L, Mathers JC, et al. (2013) Supporting Well-Being in Retirement through Meaningful Social Roles: Systematic Review of Intervention Studies. The Milbank Quarterly 91: 222–287. 10.1111/milq.12013
    1. White M, Adams J, Heywood P (2009) How and why do interventions that increase health overall widen inequalities within populations? In: Babones S, editor. Social Inequality and Public Health. Bristol, UK: The Policy Press; pp. 65–82.
    1. Celis-Morales C, Lara J, Mathers JC (2015) Personalising nutritional guidance for more effective behaviour change. Proc Nutr Soc 74: 130–138. 10.1017/S0029665114001633
    1. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, et al. (2008) Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 337: a1655 10.1136/bmj.a1655
    1. Moore GF, Audrey S, Barker M, Bond L, Bonell C, et al. (2015) Process evaluation of complex interventions: Medical Research Council guidance. BMJ 350: h1258 10.1136/bmj.h1258
    1. Lara J, Evans EH, O'Brien N, Moynihan PJ, Meyer TD, et al. (2014) Association of behaviour change techniques with effectiveness of dietary interventions among adults of retirement age: a systematic review and meta-analysis of randomised controlled trials. BMC Med 12: 177 10.1186/s12916-014-0177-3
    1. O'Brien N, McDonald S, Araújo-Soares V, Lara J, Errington L, et al. (2015) The features of interventions associated with long-term effectiveness of physical activity interventions in adults aged 55 to 70 years: a systematic review and meta-analysis. Health Psychol Rev 1–29.
    1. Heaven B, O'Brien N, Evans EH, White M, Meyer TD, et al. (2015) Mobilizing Resources for Well-being: Implications for Developing Interventions in the Retirement Transition. Gerontologist.
    1. McDonald S, O'Brien N, White M, Sniehotta FF (2015) Changes in physical activity during the retirement transition: a theory-based, qualitative interview study. Int J Behav Nutr Phys Act 12: 25 10.1186/s12966-015-0186-4
    1. O’Brien N, Heaven B, Teal G, Evans E, Cleland C, et al. (2015) Integrating evidence from systematic reviews, qualitative research and expert knowledge using co-design methods in the pursuit of intervention development: developing “LEAP” a web-based intervention for people in retirement
    1. Lara J, Godfrey A, Evans E, Heaven B, Brown LJE, et al. (2013) Towards measurement of the Healthy Ageing Phenotype in lifestyle-based intervention studies. Maturitas 76: 189–199. 10.1016/j.maturitas.2013.07.007
    1. Schulz K, Altman D, Moher D (2010) CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMJ 340.
    1. Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, et al. (2014) Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ 348: g1687 10.1136/bmj.g1687
    1. Braun T, Bambra C, Booth M, Adetayo K, Milne E (2015) Better health at work? An evaluation of the effects and cost-benefits of a structured workplace health improvement programme in reducing sickness absence. J Public Health (Oxf) 37: 138–142.
    1. Radloff LS (1977) The CES-D Scale: A Self-Report Depression Scale for Research in the General Population. Applied Psychological Measurement 1: 385–401.
    1. Robbins TW, James M, Owen AM, Sahakian BJ, Lawrence AD, et al. (1998) A study of performance on tests from the CANTAB battery sensitive to frontal lobe dysfunction in a large sample of normal volunteers: implications for theories of executive functioning and cognitive aging. Cambridge Neuropsychological Test Automated Battery. J Int Neuropsychol Soc 4: 474–490.
    1. Schwarzer R (2008) Modeling Health Behavior Change: How to Predict and Modify the Adoption and Maintenance of Health Behaviors. Applied Psychology 57: 1–29.
    1. Bach-Faig A, Berry EM, Lairon D, Reguant J, Trichopoulou A, et al. (2011) Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutr 14: 2274–2284. 10.1017/S1368980011002515
    1. Schröder H, Fitó M, Estruch R, Martínez‐González MA, Corella D, et al. (2011) A Short Screener Is Valid for Assessing Mediterranean Diet Adherence among Older Spanish Men and Women. J Nutr 141: 1140–1145. 10.3945/jn.110.135566
    1. Liu B, Young H, Crowe FL, Benson VS, Spencer EA, et al. (2011) Development and evaluation of the Oxford WebQ, a low-cost, web-based method for assessment of previous 24 h dietary intakes in large-scale prospective studies. Public Health Nutrition 14: 1998–2005. 10.1017/S1368980011000942
    1. Goldberg GR, Black AE, Jebb SA, Cole TJ, Murgatroyd PR, et al. (1991) Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off limits to identify under-recording. Eur J Clin Nutr 45: 569–581.
    1. Henry CJ (2005) Basal metabolic rate studies in humans: measurement and development of new equations. Public Health Nutr 8: 1133–1152.
    1. Weiss A, Brozgol M, Dorfman M, Herman T, Shema S, et al. (2013) Does the evaluation of gait quality during daily life provide insight into fall risk? A novel approach using 3-day accelerometer recordings. Neurorehabil Neural Repair 27: 742–752. 10.1177/1545968313491004
    1. Godfrey A, Lord S, Galna B, Mathers JC, Burn DJ, et al. (2014) The association between retirement and age on physical activity in older adults. Age and Ageing 43: 386–393. 10.1093/ageing/aft168
    1. Lord S, Chastin SF, McInnes L, Little L, Briggs P, et al. (2011) Exploring patterns of daily physical and sedentary behaviour in community-dwelling older adults. Age Ageing 40: 205–210. 10.1093/ageing/afq166
    1. Rochester L, Chastin SF, Lord S, Baker K, Burn DJ (2012) Understanding the impact of deep brain stimulation on ambulatory activity in advanced Parkinson's disease. J Neurol 259: 1081–1086. 10.1007/s00415-011-6301-9
    1. Godfrey A, Lara J, Munro CA, Wiuff C, Chowdhury SA, et al. (2015) Instrumented assessment of test battery for physical capability using an accelerometer: a feasibility study. Physiol Meas 36: N71–83. 10.1088/0967-3334/36/5/N71
    1. Godfrey A, Lara J, Del Din S, Hickey A, Munro CA, et al. (2015) iCap: Instrumented assessment of physical capability. Maturitas.
    1. The English Indices of Deprivation 2015.
    1. Guest G, MacQueen KM, Namey EE (2011) Applied Thematic Analysis: SAGE Publications.
    1. Guest G, Bunce A, Johnson L (2006) How Many Interviews Are Enough?: An Experiment with Data Saturation and Variability. Field Methods 18: 59–82.
    1. Campbell MK, Tessaro I, DeVellis B, Benedict S, Kelsey K, et al. (2000) Tailoring and targeting a worksite health promotion program to address multiple health behaviors among blue-collar women. Am J Health Promot 14: 306–313.
    1. Brouwer W, Oenema A, Raat H, Crutzen R, de Nooijer J, et al. (2010) Characteristics of visitors and revisitors to an Internet-delivered computer-tailored lifestyle intervention implemented for use by the general public. Health Educ Res 25: 585–595. 10.1093/her/cyp063
    1. Schulz DN, Kremers SP, De Vries H (2015) Tailored eHealth Lifestyle Promotion: Which Behavioral Modules Do Users Prefer? J Health Commun 20: 663–672. 10.1080/10810730.2015.1012243
    1. Sugden JA, Sniehotta FF, Donnan PT, Boyle P, Johnston DW, et al. (2008) The feasibility of using pedometers and brief advice to increase activity in sedentary older women—a pilot study. BMC Health Serv Res 8: 169 10.1186/1472-6963-8-169
    1. Dennison L, Morrison L, Lloyd S, Phillips D, Stuart B, et al. (2014) Does brief telephone support improve engagement with a web-based weight management intervention? Randomized controlled trial. J Med Internet Res 16: e95 10.2196/jmir.3199
    1. Lloyd S, Dennison L, Morrison L, Phillips D, Michie S, et al. (2013) Losing weight online with POWeR: a randomised controlled trial of a web-based behavioural intervention in a community setting. The Lancet 382: S62.
    1. Adamson AJ, Mathers JC (2004) Effecting dietary change. Proc Nutr Soc 63: 537–547.
    1. Bates Beverley, Lennox Alison, Prentice Ann, Bates Chris, Page Polly, et al. (2014) National Diet and Nutrition Survey. In: England PH, editor. London.
    1. Great Britain. Scientific Advisory Committee on Nutrition a (2011) Dietary reference values for energy London: TSO.
    1. Dzewaltowski DA, Estabrooks PA, Klesges LM, Bull S, Glasgow RE (2004) Behavior change intervention research in community settings: how generalizable are the results? Health Promot Int 19: 235–245.
    1. Dobbins TA, Simpson JM, Oldenburg B, Owen N, Harris D (1998) Who comes to a workplace health risk assessment? Int J Behav Med 5: 323–334.
    1. Robroek SJ, van Lenthe FJ, van Empelen P, Burdorf A (2009) Determinants of participation in worksite health promotion programmes: a systematic review. Int J Behav Nutr Phys Act 6: 26 10.1186/1479-5868-6-26
    1. Spittaels H, De Bourdeaudhuij I (2007) Who participates in a computer-tailored physical activity program delivered through the Internet? A comparison of participants' and non-participants' characteristics. Int J Behav Nutr Phys Act 4: 39
    1. Morgan PJ, Collins CE, Plotnikoff RC, Cook AT, Berthon B, et al. (2011) Efficacy of a workplace-based weight loss program for overweight male shift workers: the Workplace POWER (Preventing Obesity Without Eating like a Rabbit) randomized controlled trial. Prev Med 52: 317–325. 10.1016/j.ypmed.2011.01.031
    1. Wight D, Wimbush E, Jepson R, Doi L (2015) Six steps in quality intervention development (6SQuID). J Epidemiol Community Health.
    1. Werkman A, Hulshof PJ, Stafleu A, Kremers SP, Kok FJ, et al. (2010) Effect of an individually tailored one-year energy balance programme on body weight, body composition and lifestyle in recent retirees: a cluster randomised controlled trial. BMC Public Health 10: 110 10.1186/1471-2458-10-110
    1. Schulz DN, Kremers SP, Vandelanotte C, van Adrichem MJ, Schneider F, et al. (2014) Effects of a web-based tailored multiple-lifestyle intervention for adults: a two-year randomized controlled trial comparing sequential and simultaneous delivery modes. J Med Internet Res 16: e26 10.2196/jmir.3094
    1. Papadaki A, Scott JA (2005) The Mediterranean eating in Scotland experience project: evaluation of an Internet-based intervention promoting the Mediterranean diet. Br J Nutr 94: 290–298.
    1. Internet World Stats (2014) Internet User Statistics for the 28 European Union member states.
    1. Nicholas D, Huntington P, Jamali H (2007) Digital health information for the consumer: evidence and policy implications Aldershot: Ashgate.

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