Does tailoring on additional theoretical constructs enhance the efficacy of a print-based physical activity promotion intervention?

OBJECTIVE: To enhance a previously efficacious individually tailored physical activity (PA) promotion intervention by adding theoretical constructs to the tailored feedback. DESIGN: We randomly assigned 248 healthy, underactive (moderate to vigorous physical activity [MVPA] min/week < 90) adults (mean age = 48.8 years, SD = 10.0) to receive either (a) a theoretically tailored (based on 5 constructs from the transtheoretical model and social-cognitive theory [SCT]) print-based PA promotion intervention (print) or (b) the same theoretically tailored print-based PA promotion intervention plus enhanced tailoring addressing 5 additional SCT constructs (enhanced print). MAIN OUTCOME MEASURE: The 7-day physical activity recall administered at baseline, Month 6, and Month 12, with outcomes operationalized as percentage achieving 150 min/week of MVPA. RESULTS: When controlling for covariates, there was a nonsignificant trend in favor of the enhanced print condition reflecting 46% and 50% greater odds of achieving 150 min/week of MVPA at Month 6 and Month 12, respectively. CONCLUSION: Enhanced tailoring based on additional theoretical constructs may result in marginal improvements in physical activity outcomes.

Accelerometer use in a physical activity intervention trial.

This paper describes the application of best practice recommendations for using accelerometers in a physical activity (PA) intervention trial, and the concordance of different methods for measuring PA. A subsample (n = 63; 26%) of the 239 healthy, sedentary adults participating in a PA trial (mean age = 47.5; 82% women) wore the ActiGraph monitor at all 3 assessment time points. ActiGraph data were compared with self-report (i.e., PA weekly recall and monthly log) and fitness variables. Correlations between the PA recall and ActiGraph for moderate intensity activity ranged from 0.16-0.48 and from 0.28-0.42 for vigorous intensity activity. ActiGraph and fitness [estimated VO(2)(ml/kg/min)] had correlations of 0.15-0.45. The ActiGraph and weekly self-report were significantly correlated at all time points (correlations ranged from 0.23 to 0.44). In terms of detecting intervention effects, intervention groups recorded more minutes of at least moderate-intensity PA on the ActiGraph than the control group at 6 months (min = 46.47, 95% CI = 14.36-78.58), but not at 12 months. Limitations of the study include a small sample size and only 3 days of ActiGraph monitoring. To obtain optimal results with accelerometers in clinical trials, the authors recommend following best practice recommendations: detailed protocols for monitor use, calibration of monitors and validation of data quality, and use of validated equations for analysis. The ActiGraph has modest concordance with other assessment tools and is sensitive to change over time. However, until more information validating the use of accelerometry in clinical trials becomes available, properly administered self-report measures of PA should remain part of the assessment battery.

Moderate intensity exercise as an adjunct to standard smoking cessation treatment for women: a pilot study.

Previous randomized controlled trials have not supported moderate intensity exercise as an efficacious adjunct to smoking cessation treatments for women; however, compliance with exercise programs in these studies has been poor. The purpose of this pilot study was to estimate the effects of moderate intensity exercise on smoking cessation outcomes under optimal conditions for exercise program compliance. Sixty previously sedentary, healthy, female smokers were randomized to an 8-week program consisting of brief baseline smoking cessation counseling and the nicotine patch plus either 150 min/week of moderate intensity exercise or contact control. Participants attended a median of 86.4% and 95.5% of prescribed exercise/control sessions, respectively. There was a moderate, though statistically nonsignificant, effect of exercise at post-treatment for objectively verified 7-day point prevalence abstinence (48.3% vs. 23.3%; OR = 3.07, 95% CI: 0.89-11.07) and prolonged abstinence (34.5% vs. 20.0%; OR = 2.11, 95% CI: 0.56-8.32). Effects were attenuated when controlling for potential confounders, and after a 1-month, no-treatment period. The findings provide a preliminary indication that, given adequate compliance, moderate intensity exercise may enhance short-term smoking cessation outcomes for women; however, a larger trial is warranted.

Recruitment of a racially and ethnically diverse sample into a physical activity efficacy trial.

BACKGROUND: Healthy People 2010 underscores the relevance of eliminating health disparities. Thus, it is paramount to create interventions that promote health for all individuals. PURPOSE: This study examined differences in rates of and reasons for ineligibility among non-Hispanic blacks and whites in a randomized controlled physical activity intervention study. METHODS: Participants (1245 adults) responded to community advertising for the research study. Eligibility at the four pre-randomization assessment sessions was determined by self-reported medical information, resting EKG, 7-Day Physical Activity Recall, fitness test and Stage of Change. We used t-tests to examine the rates of eligibility among participant subgroups. RESULTS: Blacks had higher rates of overall ineligibility (86.9%) than whites (75.1%; p < 0.01) and were more likely to be ineligible due to lack of interest or no-show at a pre-randomization appointment (35.4% vs. 24.3%; p < 0.01). Blacks were more likely to be ineligible for medical reasons after the telephone screen (16.3% vs. 7.8%; p = 0.01). LIMITATIONS: This study did not use a random sampling of potential participants from each of the racial/ethnic groups and thus, there is the potential for selection bias. CONCLUSIONS: Blacks were more likely to choose not to enroll in the study due to a lack of interest, but had similar rates of overall medical ineligibility to whites. This highlights the importance of strategies that enhance interest among blacks, who initially respond to recruitment advertising.

Step into Motion: a randomized trial examining the relative efficacy of Internet vs. print-based physical activity interventions.

Over two-thirds of Americans access the Internet and therefore, the Internet may be an important channel for reaching the large population of sedentary individuals. The purpose of this paper is to describe the methods for a randomized controlled trial examining the efficacy of an Internet-based physical activity intervention relative to a print intervention that has been shown to be effective in previous trials. Specifically, 249 sedentary participants were randomized to receive one of three interventions: 1) Internet-based motivationally-tailored individualized feedback (Tailored Internet); 2) print-based motivationally-tailored individualized feedback (Tailored Print); or 3) physical activity websites currently available to the public (Standard Internet). Participants completed the 7-Day Physical Activity Recall interview, wore an objective physical activity monitor (i.e., ActiGraph), and participated in a treadmill fitness test at baseline, 6, and 12 months. The sample consisted of mostly women (84.2%) and Caucasian individuals (76.4%) who reported exercising an average of 21 min per week at baseline. This is the first study that we are aware of, that has examined the efficacy of a tailored Internet-based physical activity intervention. This study will have implications for the dissemination of Internet-based physical activity interventions.

A comparison of Internet and print-based physical activity interventions.

BACKGROUND: Physical activity interventions tailored to individual characteristics and delivered via print produce greater increases in activity compared with nontailored interventions and controls. Using the Internet to deliver a tailored physical activity intervention offers an alternative to print that might be available to larger populations at a lower cost. METHODS: Participants (N=249 adults; mean [SD] age, 44.5 [9.3] years; and mean [SD] body mass index [calculated as weight in kilograms divided by height in meters squared], 29.4 [6.1]) were randomized to 1 of 3 physical activity interventions: (1) motivationally tailored Internet (tailored Internet, n=81), (2) motivationally tailored print (tailored print, n=86); and (3) 6 researcher-selected Web sites available to the public (standard Internet, n=82). Participants in the tailored Internet and tailored print arms received the same tailored intervention content. Participants were assessed at baseline and at 6 and 12 months. RESULTS: At 6 months, participants in the tailored print arm reported a median of 112.5 minutes of physical activity per week, those in the tailored Internet arm reported 120.0 minutes, and those in the standard Internet arm reported 90.0 minutes (P=.15). At 12 months, the physical activity minutes per week were 90.0, 90.0, and 80.0 for those in the tailored print, tailored Internet, and standard Internet arms, respectively (P=.74). Results indicated no significant differences between the 3 arms. CONCLUSIONS: The use of tailored Internet, tailored print, and standard Internet as part of a behavior change program increased physical activity behavior similarly. Because the use of the Internet was not different from the print-based intervention, this may be an opportunity to reach more sedentary adults in a more cost-effective way. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00200317.

Examination of print and telephone channels for physical activity promotion: Rationale, design, and baseline data from Project STRIDE.

BACKGROUND: Project STRIDE is a 4-year randomized controlled trial comparing two computer-based expert system guided intervention delivery channels (phone vs. print) for physical activity adoption and short-term maintenance among previously sedentary adults. METHODS: Sedentary adults (n=239) were randomized to one of the following (1) telephone-based, individualized motivationally-tailored feedback; (2) print-based, individualized motivationally-tailored feedback; (3) contact-control delayed treatment group (received intervention after 12 months as control). This paper: (1) outlines the study design, rationale, and participant sample; and (2) describes relationships between baseline variables to better understand their influence on the efficacy of the intervention. RESULTS: Participants averaged 19.8+/-25.0 min of physical activity/week that was at least of moderate intensity, with no group differences. The average estimated VO(2) at 85% of maximum heart rate was 25.6 ml/kg/min. Body fat was 34.1% for women and 23.2% for men and the BMI of the sample averaged 28.5 kg/m(2). CONCLUSIONS: Project STRIDE examines non face-to-face approaches for promoting physical activity behavior. It has unique features including a direct comparison of an expert system guided intervention delivered via phone or print. Future analyses will examine the cost-effectiveness of the interventions and this will likely yield important information for policy-makers.

The efficacy of moderate-intensity exercise as an aid for smoking cessation in women: a randomized controlled trial.

Evidence suggests that vigorous-intensity exercise interventions may be effective for smoking cessation among women; however, few studies have examined the efficacy of a moderate-intensity exercise program. The present study examined the efficacy of moderate-intensity exercise for smoking cessation among female smokers. Healthy, sedentary female smokers (N = 217) were randomly assigned to an 8-week cognitive-behavioral smoking cessation program plus moderate-intensity exercise (CBT+EX) or to the same cessation program plus equal contact (CBT). A subsample received nicotine replacement therapy. Results indicated that the CBT+EX and CBT groups were equally likely to attain smoking cessation at the end of treatment, as measured by cotinine-verified 7-day point-prevalence abstinence (20.2% for CBT+EX vs. 18.5% for CBT). The CBT+EX group was more likely to report smoking cessation, as measured by 7-day point prevalence at the 3-month follow-up (11.9% vs. 4.6%, p<.05), compared with the CBT group. No group differences were found at 12 months by either 7-day point prevalence (7.3% for CBT+EX vs. 8.3% for CBT) or continuous abstinence (0.9% for CBT+EX vs. 0.9% for CBT). Additionally, among participants in the CBT+EX group, those with higher adherence to the exercise prescription were significantly more likely to achieve smoking cessation at the end of treatment than were participants reporting lower adherence to exercise. Our findings indicate that the empirical support for moderate-intensity exercise as an adjunctive treatment to CBT for smoking cessation may be limited. Perhaps future studies could compare moderate- vs. vigorous-intensity physical activity to test their relative efficacy.

Rationale, design, and baseline data for Commit to Quit II: an evaluation of the efficacy of moderate-intensity physical activity as an aid to smoking cessation in women.

BACKGROUND: Commit to Quit II is a 4-year randomized controlled trial comparing the efficacy of a cognitive-behavioral smoking cessation treatment plus moderate-intensity physical activity with the same cessation treatment plus contact control. METHODS: Sedentary women smokers (n = 217) were randomized to receive 8 weeks of treatment followed by 12 months of follow-up. This article outlines the study design, presents baseline data about the sample, and compares the sample to national samples and to our previous study examining vigorous-intensity exercise as an aid to smoking cessation. RESULTS: Married and white participants reported significantly higher levels of nicotine dependence than unmarried and minority participants. Higher levels of nicotine dependence were also significantly related to lower smoking cessation self-efficacy and higher levels of self-reported depression, anxiety, and perceived stress. Additionally, participants smoked significantly more cigarettes (mean 20.6) than a national sample of female smokers (mean 16.1). On average, participants were significantly older, weighed significantly more, and scored significantly higher on a measure of anxiety than participants in our previous trial. CONCLUSIONS: Our sample consisted of women who were heavier smokers than national samples seeking treatment. It remains to be determined how this will impact their ability to attain cessation in the present study.