An Interactive Computer Session to Initiate Physical Activity in Sedentary Cardiac Patients: Randomized Controlled Trial

Fabio A Almeida, Renae L Smith-Ray, David A Dzewaltowski, Russell E Glasgow, Rebecca E Lee, Deborah S K Thomas, Stanley Xu, Paul A Estabrooks, Fabio A Almeida, Renae L Smith-Ray, David A Dzewaltowski, Russell E Glasgow, Rebecca E Lee, Deborah S K Thomas, Stanley Xu, Paul A Estabrooks

Abstract

Background: Physical activity (PA) improves many facets of health. Despite this, the majority of American adults are insufficiently active. Adults who visit a physician complaining of chest pain and related cardiovascular symptoms are often referred for further testing. However, when this testing does not reveal an underlying disease or pathology, patients typically receive no additional standard care services. A PA intervention delivered within the clinic setting may be an effective strategy for improving the health of this population at a time when they may be motivated to take preventive action.

Objective: Our aim was to determine the effectiveness of a tailored, computer-based, interactive personal action planning session to initiate PA among a group of sedentary cardiac patients following exercise treadmill testing (ETT).

Methods: This study was part of a larger 2x2 randomized controlled trial to determine the impact of environmental and social-cognitive intervention approaches on the initiation and maintenance of weekly PA for patients post ETT. Participants who were referred to an ETT center but had a negative-test (ie, stress tests results indicated no apparent cardiac issues) were randomized to one of four treatment arms: (1) increased environmental accessibility to PA resources via the provision of a free voucher to a fitness facility in close proximity to their home or workplace (ENV), (2) a tailored social cognitive intervention (SC) using a "5 As"-based (ask, advise, assess, assist, and arrange) personal action planning tool, (3) combined intervention of both ENV and SC approaches (COMBO), or (4) a matched contact nutrition control (CON). Each intervention was delivered using a computer-based interactive session. A general linear model for repeated measures was conducted with change in PA behavior from baseline to 1-month post interactive computer session as the primary outcome.

Results: Sedentary participants (n=452; 34.7% participation rate) without a gym membership (mean age 58.57 years; 59% female, 78% white, 12% black, 11% Hispanic) completed a baseline assessment and an interactive computer session. PA increased across the study sample (F1,441=30.03, P<.001). However, a time by condition interaction (F3,441=8.33, P<.001) followed by post hoc analyses indicated that SC participants exhibited a significant increase in weekly PA participation (mean 45.1, SD 10.2) compared to CON (mean -2.5, SD 10.8, P=.004) and ENV (mean 8.3, SD 8.1, P<.05). Additionally, COMBO participants exhibited a significant increase in weekly PA participation (mean 53.4, SD 8.9) compared to CON (P<.001) and ENV (P=.003) participants. There were no significant differences between ENV and CON or between SC and COMBO.

Conclusions: A brief, computer-based, interactive personal action planning session may be an effective tool to initiate PA within a health care setting, in particular as part of the ETT system.

Trial registration: Clinicaltrials.gov NCT00432133, https://ichgcp.net/clinical-trials-registry/NCT00432133 (Archived by WebCite at http://www.webcitation.org/6aa8X3mw1).

Keywords: behavioral research; cardiovascular diseases; exercise, physical; human computer interaction; interactive media; treadmill test.

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Flow diagram of participants’ progress through study.

References

    1. Williamson J, Pahor M. Evidence regarding the benefits of physical exercise. Arch Intern Med. 2010 Jan 25;170(2):124–5. doi: 10.1001/archinternmed.2009.491.
    1. Warburton DER, Nicol CW, Bredin SSD. Health benefits of physical activity: the evidence. CMAJ. 2006 Mar 14;174(6):801–9. doi: 10.1503/cmaj.051351.
    1. Balady GJ, Chaitman B, Driscoll D, Foster C, Froelicher E, Gordon N, Pate R, Rippe J, Bazzarre T. Recommendations for cardiovascular screening, staffing, and emergency policies at health/fitness facilities. Circulation. 1998 Jun 9;97(22):2283–93.
    1. Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, Macera CA, Castaneda-Sceppa C. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007 Aug;39(8):1435–45. doi: 10.1249/mss.0b013e3180616aa2.
    1. Carlson SA, Fulton JE, Schoenborn CA, Loustalot F. Trend and prevalence estimates based on the 2008 Physical Activity Guidelines for Americans. Am J Prev Med. 2010 Oct;39(4):305–13. doi: 10.1016/j.amepre.2010.06.006.
    1. Leon AS, Franklin BA, Costa F, Balady GJ, Berra KA, Stewart KJ, Thompson PD, Williams MA, Lauer MS, American HA, Council on Clinical Cardiology (Subcommittee on Exercise‚ Cardiac Rehabilitation‚Prevention) Council on Nutrition‚ Physical Activity‚ Metabolism (Subcommittee on Physical Activity) American association of Cardiovascular and Pulmonary Rehabilitation Cardiac rehabilitation and secondary prevention of coronary heart disease: an American Heart Association scientific statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in collaboration with the American association of Cardiovascular and Pulmonary Rehabilitation. Circulation. 2005 Jan 25;111(3):369–76. doi: 10.1161/01.CIR.0000151788.08740.5C.
    1. Bandura A Health promotion from the perspective of social cognitive theory. Psychology and Health. 1998;13(4):623–649. doi: 10.1080/088704498084074.
    1. Conn VS, Hafdahl AR, Mehr DR. Interventions to increase physical activity among healthy adults: meta-analysis of outcomes. Am J Public Health. 2011 Apr;101(4):751–8. doi: 10.2105/AJPH.2010.194381.
    1. Spence JC, Lee RE. Toward a comprehensive model of physical activity. Psychology of Sport and Exercise. 2003 Jan;4(1):7–24. doi: 10.1016/S1469-0292(02)00014-6.
    1. Sallis J, Owen N, Fisher E. Health behavior and health education: Theory, research, and practice. San Francisco: Jossey-Bass; 2008. Ecological models of health behavior.
    1. Dzewaltowski D, Noble J, Shaw J. Physical activity participation: Social cognitive theory versus the theories of reasoned action and planned behavior. Journal of Sport & Exercise Psychology. 1990:388–405.
    1. Lin JS, O'Connor E, Whitlock EP, Beil TL. Behavioral counseling to promote physical activity and a healthful diet to prevent cardiovascular disease in adults: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2010 Dec 7;153(11):736–50. doi: 10.7326/0003-4819-153-11-201012070-00007.
    1. Damush TM, Stewart AL, Mills KM, King AC, Ritter PL. Prevalence and correlates of physician recommendations to exercise among older adults. J Gerontol A Biol Sci Med Sci. 1999 Aug;54(8):M423–7.
    1. Eakin EG, Glasgow RE. Recruitment of managed care Medicare patients for a physical activity study. Am J Health Promot. 1997;12(2):98–101.
    1. Glasgow RE, Eakin EG, Fisher EB, Bacak SJ, Brownson RC. Physician advice and support for physical activity: results from a national survey. Am J Prev Med. 2001 Oct;21(3):189–96.
    1. Wee CC. Physical activity counseling in primary care: the challenge of effecting behavioral change. JAMA. 2001 Aug 8;286(6):717–9.
    1. Hillsdon M, Foster C, Thorogood M. Interventions for promoting physical activity. Cochrane Database Syst Rev. 2005;(1):CD003180. doi: 10.1002/14651858.CD003180.pub2.
    1. Eakin E, Reeves M, Lawler S, Graves N, Oldenburg B, Del MC, Wilke K, Winkler E, Barnett A. Telephone counseling for physical activity and diet in primary care patients. Am J Prev Med. 2009 Feb;36(2):142–9. doi: 10.1016/j.amepre.2008.09.042.
    1. The Writing Group for the Activity Counseling Trial Research Group Effects of Physical Activity Counseling in Primary Care: The Activity Counseling Trial: A Randomized Controlled Trial. JAMA. 2001;286(6):677–687. doi: 10.1001/jama.286.6.677.
    1. Bennett GG, Glasgow RE. The delivery of public health interventions via the Internet: actualizing their potential. Annu Rev Public Health. 2009;30:273–92. doi: 10.1146/annurev.publhealth.031308.100235.
    1. Dallery J, Riley W, Nahum-Shani I. Research designs to developevaluate technology-based health behavior interventions. In: Marsch L, Lord S, Dallery J, editors. Behavioral health care and technology: Using science-based innovations to transform practice. Carry, NC: Oxford University Press. , 978019931. Cary, NC: Oxford University Press; 2014. pp. 179–185.
    1. Fanning J, Mullen SP, McAuley E. Increasing physical activity with mobile devices: a meta-analysis. J Med Internet Res. 2012;14(6):e161. doi: 10.2196/jmir.2171.
    1. King AC, Ahn DK, Oliveira BM, Atienza AA, Castro CM, Gardner CD. Promoting physical activity through hand-held computer technology. Am J Prev Med. 2008 Feb;34(2):138–42. doi: 10.1016/j.amepre.2007.09.025.
    1. Duncan TE, Duncan SC, Beauchamp N, Wells J, Ary DV. Development and evaluation of an interactive CD-ROM refusal skills program to prevent youth substance use: "refuse to use". J Behav Med. 2000 Feb;23(1):59–72.
    1. Block G, Wakimoto P, Metz D, Fujii ML, Feldman N, Mandel R, Sutherland B. A randomized trial of the Little by Little CD-ROM: demonstrated effectiveness in increasing fruit and vegetable intake in a low-income population. Prev Chronic Dis. 2004 Jul;1(3):A08.
    1. Casazza K, Ciccazzo M. Improving the dietary patterns of adolescents using a computer-based approach. J Sch Health. 2006 Feb;76(2):43–6. doi: 10.1111/j.1746-1561.2006.00067.x.
    1. Tessaro I, Rye S, Parker L, Mangone C, McCrone S. Effectiveness of a nutrition intervention with rural low-income women. Am J Health Behav. 2007;31(1):35–43. doi: 10.5555/ajhb.2007.31.1.35.
    1. Glasgow RE, Bull SS. Making a Difference With Interactive Technology: Considerations in Using and Evaluating Computerized Aids for Diabetes Self-Management Education. Diabetes Spectrum. 2001 Apr 01;14(2):99–106. doi: 10.2337/diaspect.14.2.99.
    1. Parekh S, King D, Boyle FM, Vandelanotte C. Randomized controlled trial of a computer-tailored multiple health behaviour intervention in general practice: 12-month follow-up results. Int J Behav Nutr Phys Act. 2014;11(1):41. doi: 10.1186/1479-5868-11-41.
    1. Kroeze W, Werkman A, Brug J. A systematic review of randomized trials on the effectiveness of computer-tailored education on physical activity and dietary behaviors. Ann Behav Med. 2006 Jun;31(3):205–23. doi: 10.1207/s15324796abm3103_2.
    1. Norman GJ, Zabinski MF, Adams MA, Rosenberg DE, Yaroch AL, Atienza AA. A review of eHealth interventions for physical activity and dietary behavior change. Am J Prev Med. 2007 Oct;33(4):336–345. doi: 10.1016/j.amepre.2007.05.007.
    1. van den Berg MH, Schoones JW, Vliet Vlieland TPM. Internet-based physical activity interventions: a systematic review of the literature. J Med Internet Res. 2007;9(3):e26. doi: 10.2196/jmir.9.3.e26.
    1. Compernolle S, Vandelanotte C, Cardon G, De BI, De CK. Effectiveness of a web-based, computer-tailored, pedometer-based physical activity intervention for adults: a cluster randomized controlled trial. J Med Internet Res. 2015;17(2):e38. doi: 10.2196/jmir.3402.
    1. Mouton A, Cloes M. Web-based interventions to promote physical activity by older adults: promising perspectives for a public health challenge. Arch Public Health. 2013;71(1):16. doi: 10.1186/0778-7367-71-16.
    1. Brough C, Boyce S, Houchen-Wolloff L, Sewell L, Singh S. Evaluating the interactive web-based program, activate your heart, for cardiac rehabilitation patients: a pilot study. J Med Internet Res. 2014;16(10):e242. doi: 10.2196/jmir.3027.
    1. Mouton A, Cloes M. Efficacy of a web-based, center-based or combined physical activity intervention among older adults. Health Educ Res. 2015 Mar 15;30(3):422–435. doi: 10.1093/her/cyv012.
    1. Gibbons RJ, Balady GJ, Beasley JW, Bricker JT, Duvernoy WF, Froelicher VF, Mark DB, Marwick TH, McCallister BD, Thompson PD, Winters WL, Yanowitz FG, Ritchie JL, Cheitlin MD, Eagle KA, Gardner TJ, Garson A, Lewis RP, O'Rourke RA, Ryan TJ. ACC/AHA guidelines for exercise testing: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing) Circulation. 1997 Jul 1;96(1):345–54.
    1. Borresen J, Lambert MI. Autonomic control of heart rate during and after exercise : measurements and implications for monitoring training status. Sports Med. 2008;38(8):633–46.
    1. Peels DA, Hoogenveen RR, Feenstra TL, Golsteijn RH, Bolman C, Mudde AN, Wendel-Vos GC, de VH, Lechner L. Long-term health outcomes and cost-effectiveness of a computer-tailored physical activity intervention among people aged over fifty: modelling the results of a randomized controlled trial. BMC Public Health. 2014;14:1099. doi: 10.1186/1471-2458-14-1099.
    1. Estabrooks PA, Glasgow RE. Translating effective clinic-based physical activity interventions into practice. Am J Prev Med. 2006 Oct;31(4 Suppl):S45–56. doi: 10.1016/j.amepre.2006.06.019.
    1. Estabrooks PA, Glasgow RE, Xu S, Dzewaltowski DA, Lee RE, Thomas D, Almeida FA, Thayer AN, Smith-Ray RL. Building a multiple modality, theory-based physical activity intervention: The development of CardiACTION! Psychol Sport Exerc. 2011 Jan 1;12(1):46–53. doi: 10.1016/j.psychsport.2010.04.012.
    1. Estabrooks PA, Glasgow RE, Dzewaltowski DA. Physical activity promotion through primary care. JAMA. 2003 Jun 11;289(22):2913–6. doi: 10.1001/jama.289.22.2913.
    1. Macera CA, Pratt M. Public health surveillance of physical activity. Res Q Exerc Sport. 2000 Jun;71(2 Suppl):S97–103.
    1. Brownson RC, Jones DA, Pratt M, Blanton C, Heath GW. Measuring physical activity with the behavioral risk factor surveillance system. Med Sci Sports Exerc. 2000 Nov;32(11):1913–8.
    1. Centers for Disease Control and Prevention (CDC) Prevalence of physical activity, including lifestyle activities among adults--United States, 2000-2001. MMWR Morb Mortal Wkly Rep. 2003 Aug 15;52(32):764–9.
    1. Becker A, Herzberg D, Marsden N, Thomanek S, Jung H, Leonhardt C. A new computer-based counselling system for the promotion of physical activity in patients with chronic diseases--results from a pilot study. Patient Educ Couns. 2011 May;83(2):195–202. doi: 10.1016/j.pec.2010.05.024.
    1. Siemiatycki J. A comparison of mail, telephone, and home interview strategies for household health surveys. Am J Public Health. 1979 Mar;69(3):238–45.
    1. McHorney CA, Kosinski M, Ware JE. Comparisons of the costs and quality of norms for the SF-36 health survey collected by mail versus telephone interview: results from a national survey. Med Care. 1994 Jun;32(6):551–67.
    1. Glasgow RE, Fisher L, Strycker LA, Hessler D, Toobert DJ, King DK, Jacobs T. Minimal intervention needed for change: definition, use, and value for improving health and health research. Transl Behav Med. 2014 Mar;4(1):26–33. doi: 10.1007/s13142-013-0232-1.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj