Andy Pringle

Optimizing lifestyles for men regarded as ‘hard-to-reach’ through top-flight football/soccer clubs

This study assessed the effect of a 12-week behavioural intervention delivered in and by English Premier League football/soccer clubs, and its influence on lifestyle behaviours, in men typically regarded as hard-to-reach. One hundred and thirty men aged 18 years or older engaging in the programme self-reported data on optimal lifestyle behaviours (OLBs) (physical activity, diet, smoking and alcohol consumption) at pre- and post-intervention. Logistic regression models were used to predict the likelihood of OLBs post-intervention. Healthy behaviours were uncommon at baseline, yet at 12 weeks, 19% (n = 24) of men displayed positive change in one behaviour and 67% (n = 87) had changed ≥2. A combination of improving diet (odds ratio [OR] = 2.76; 95% confidence interval [CI] = 1.65-4.63) and being employed (OR = 4.90, CI = 1.46-16.5) significantly increased the likelihood of reporting ≥150 min of physical activity per week. Increased physical activity significantly increased the likelihood of self-reporting a healthy diet (OR = 2.32, CI = 1.36-3.95). This study shows that a 12-week behavioural intervention can reach and engage a proportion of at risk men. Further, among such men, the intervention helped to stabilize and improve several of the most important lifestyle behaviours that impact mortality and morbidity.

Cost effectiveness of interventions to improve moderate physical-activity: A study in nine UK sites

Objective: With growing concerns to establish the value for returns on public health investment, there is a need to identify cost-effective physical activity interventions. This study measured change in moderate physical activity (MPA) in seven community-based intervention types, costs and cost-effectiveness of the interventions, and possible explanations for cost variation. Design: Between 2004 and 2006, pre- and post-intervention assessments identified demographics and MPA levels, and quarterly interviews with intervention managers identified key implementation costs. Setting: Nine sites across the UK. Method: MPA was collected using self-report measures. MPA categories (sedentary, lightly, moderately, highly active) were assigned at pre- and post-intervention. Differences between pre- and post-intervention scores identified MPA change (median metabolic equivalent (MET)-minutes/week) in completers. Cost, attendance and activity data were combined to estimate the average monthly implementation cost, cost per participant attending interventions, and the cost per completer improving MPA category. An economic model was built to estimate the cost per Quality Adjusted Life Year (QALY) gained and potential savings to the National Health Service (NHS). Results: Demographics (n = 984) show that those who engaged with the interventions were predominantly white, British older females. In completers (N = 1,051), 37.9 per cent improved at least one MPA category. The cost per completer improving MPA category ranged from c£260 to c£2,786 (N = 1000). The cost per QALY gained from intervention types ranged from c£47 to c£509, which was below the £20,000 threshold implicit in National Institute for Health and Clinical Excellence (NICE) decisions. Future cost savings to the NHS per intervention participant ranged from c£769 to c£4,891. In the case of each of the interventions, this saving per participant exceeds the implementation cost per participant, which ranged from c£55 to c£3,420 (N = 6940). Conclusions: MPA interventions are cost-effective.

Reaching older people with PA delivered in football clubs: the reach, adoption and implementation characteristics of the Extra Time Programme

BackgroundOlder adults (OA) represent a core priority group for physical activity and Public Health policy. As a result, significant interest is placed on how to optimise adherence to interventions promoting these approaches. Extra Time (ET) is an example of a national programme of physical activity interventions delivered in professional football clubs for OA aged 55+ years. This paper aims to examine the outcomes from ET, and unpick the processes by which these outcomes were achieved.MethodsThis paper represents a secondary analysis of data collected during the evaluation of ET. From the 985 OA reached by ET, n=486 adopted the programme and completed post-intervention surveys (typically 12 weeks). We also draw on interview data with 18 ET participants, and 7 staff who delivered the programme. Data were subject to thematic analysis to generate overarching and sub themes.ResultsOf the 486 participants, the majority 95%, (n= 462) were White British and 59.7% (n=290) were female. Most adopters (65.4%/n=318) had not participated in previous interventions in the host clubs. Social interaction was the most frequently reported benefit of participation (77.2%, n=375). While the reach of the club badge was important in letting people know about the programme, further work enhanced adoption and satisfaction. These factors included (i) listening to participants, (ii) delivering a flexible age-appropriate programme of diverse physical and social activities, (iii) offering activities which satisfy energy drives and needs for learning and (iv) extensive opportunities for social engagement.ConclusionsFindings emerging from this study indicate that physical activity and health interventions delivered through professional football clubs can be effective for engaging OA.

Delivering men's health interventions in English Premier League football clubs: key design characteristics

OBJECTIVES To investigate the key design characteristics of Premier League Health (PLH), a national programme of mens health improvement delivered in/by 16 English Premier League (EPL) football clubs. STUDY DESIGN Health Trainers (HTs) were hired by EPL clubs to deliver PLH. HTs were the focus of investigations aimed at identifying the active design characteristics of male-specific health promotion interventions. METHODS Semi-structured interviews led by researchers were performed with 13/16 HTs and identified the key design characteristics influential in (I) reaching and (II) helping participants adopt health improvement interventions delivered in professional football club settings. RESULTS HTs believed that combining the appeal of football alongside EPL clubs, offered a unique opportunity to reach adult males, including hard-to-engage-men (HTEM). Awareness raising events held on match days aimed to connect with men, but outreach activities were especially important for engaging participants. Following initial reach, familiar settings, such as the club stadia and community venues were also important for ensuring regular involvement in health improvement sessions. Interventions shaped around mens health needs and delivered at times when participants could more easily attend, were factors which helped to engage men. Supportive social environments and a range of exercise modes and delivery options were also seen by HTs as being similarly important. Both the informality and familiarity of EPL clubs were viewed by HTs as having substantial advantages over conventional NHS settings for reaching and engaging men. Importantly, HTs contributed substantial skills to the delivery of PLH. CONCLUSION Although, top flight professional football clubs can recruit men, including those regarded as hard-to-engage into health improvement programmes, considerable attention to delivery refinement is needed to support male participants adopting interventions aimed at promoting healthy lifestyles.

'Motivate': the effect of a Football in the Community delivered weight loss programme on over 35-year old men and women's cardiovascular risk factors

The purpose of this study was to examine whether an innovative, inclusive and integrated 12-week exercise, behaviour change and nutrition advice-based weight management programme could significantly improve the cardiovascular risk factors of overweight and obese men and women over the age of 35. One hundred and ninety-four men and 98 women (mean age = 52.28 ± 9.74 and 51.19 ± 9.04) attending a community-based intervention delivered by Notts County Football in the Community over one year, took part in the study. Height (m), weight (kg), fitness (meters covered during a 6 min walk) and waist circumference (cm) were measured at weeks 1 and 12 as part of the intervention. Changes in body weight, waist circumference and fitness for men and women were measured by a 2-way repeated measures ANOVA, with significance set to p < 0.05.Weight, waist circumference and fitness significantly improved over time in both men (4.96 kg, 6.29 cm, 70.22 m; p < 0.05) and women (4.26 kg, 5.90 cm, 35.29 m; p < 0.05). The results demonstrated that the FITC lead weight loss intervention was successful in significantly improving cardiovascular risk factors in both men and women. In particular, the weight loss reductions achieved were comparable to those seen in similar, more costly men-only programmes. This is the first study to demonstrate the efficacy of such an intervention in an inclusive, mixed gender programme and more specifically, in women.

Health improvement and professional football: players on the same side?

Although health policies typically express an interest in facilitating healthful changes in people’s lifestyles, population-wide lifestyle interventions (Department of Health [DH], 2010; Hillsdon, Cavill, Nanchahal, Diamond, & White, 2001) have had limited success on improving physical activity (PA) levels in the UK (The Information Centre for Health and Social Care, 2013). One of the central problems here is that few drivers of behaviour are universal. In this understanding, the next best option is to find the shared features of sufficiently large segments of any society that can justifiably be called ‘communities’. One such community is that of football fans. Here, recent evidence indicates that football-based health improvement schemes can successfully recruit and/or improve participants’ health and PA profiles (Brady, Perry, Murdoch, & McKay, 2010; Pringle et al., 2013). Using two examples, we explore the role of professional football clubs in delivering health improvement services to adults identified as a priority in government health policy (DH, 2011a). In doing so, we highlight some of the debates surrounding the commissioning, implementation and the evaluation of PA and lifestyle interventions. The public health ‘case’ for more people, more active, more often is increasingly clear and further supported with evidence from the Chief Medical Officer’s Report on PA (Start Active Stay Active; DH, 2011b). Regular PA prevents and/or manages a range of costly, inactivity-related conditions including coronary heart disease, type 2 diabetes, stroke, obesity, some cancers and mental illness (DH, 2011b). With a supporter profile spanning diverse social strata, it is helpful to consider national figures for inactivity to grasp what might be realised by harnessing the potential of intervening through professional football in the UK. First, as few as 39% of men and 29% of women meet recommended PA guidelines and participate in moderate PA for at least 30 minutes five times a week (The Information Centre for Health and Social Care, 2013). When adults 65 years and older are considered, these participation rates become much worse (DH, 2011b). Since similar profiles are reflected worldwide (Lee et al., 2012), it is unsurprising that physical inactivity is a major public health problem of the twenty-first century (Weiler & Stamatakis, 2010). Linking this perspective to the notion of football as the ‘world game’ (Premier League, 2012a) hints at its even greater relevance to global health.

A multi-site comparison of environmental characteristics to support workplace walking

OBJECTIVE This study assessed the environmental characteristics of ten universities, comparing the extent to which physical infra-structures are able to support a route-based walking intervention. METHOD Following protocol standardization between and within sites, major pedestrian routes at main suburban campuses in seven countries (Australia, Canada, England, Northern Ireland, Scotland, Spain and the United States) were audited by researchers using an established inventory (March-June 2008). The inventory assessed key characteristics (e.g. size and employee number) and nine specific items (pedestrian facilities, vehicle conflicts, crossings, route-maintenance, walkway width, roadway buffer, universal accessibility, aesthetics and cover), scored on a five-point scale (1=very poor; 5=excellent). Item scores for each route, were combined and weighted, to provide indicators of low (score of 20-39), fair (score of 40-69), or good (score of 70-100) physical infra-structure support. RESULTS Sites varied in area (range of 7-1000 acres) and employee numbers (range of 700-7500 employees). Audits reported good support for route-based walking at seven sites (overall route score range=72.5+/-13.9-82.2+/-17.4), fair support at two sites (overall route score of 69.1+/-11.7 and 61.7+/-14.6), and low support at one site (overall route score of 22.1+/-7.3). CONCLUSIONS Study methods highlight a valuable audit process, while findings identify the need to improve aspects of physical infra-structure at sites where the built environment may be less conducive for route-based walking.

Football and health improvement: an emerging field

Less than 40% of men and 30% of women met the current recommendations for an active lifestyle and with insufficient physical activity levels, concerns prevail over the health and well-being of the ...

An evaluation of the Local Exercise Action Pilots and impact on moderate physical activity

Objective Identifying community physical activity interventions that facilitate increases in moderate physical activity (MPA) is important in meeting targets set in government health policy. This study evaluated community interventions that aimed to increase levels of MPA. Intervention themes included exercise referral, classes and groups, peermentoring, motivational interviewing, campaigns and directories, outdoor activity and training physical activity leaders. Design Longitudinal, pre-intervention and intervention assessments occurred between 2004 and 2006. Setting Recruitment of 10,433 people from ten sites located in areas of high health need across England. Method Demographic data were collected by questionnaire, with seven-day, population-specific self-reports assessing pre-intervention and intervention MPA. Using guidelines for young people and adults, MPA MET-minutes/week were used to assign participants to four MPA categories (sedentary, lightly, moderately and highly active) at pre-intervention and intervention phases. Cross-tabulation established movement between three change categories (reversal, stability and progression). Results From nine sites, 5324 people engaged in the evaluation, and a sub-sample of 998 provided demographic and 1022 self-report baseline and intervention data (i.e. completers) for a typical week’s physical activity participation. Of completers who were sedentary or lightly active at pre-intervention, 58.5 per cent achieved recommended physical activity guidelines. 80.9 per cent who were sedentary at pre-intervention reported as lightly, moderately or highly active at intervention. Conclusions Completers increased overall activity levels, including those sedentary and lightly active at pre-intervention who increased levels to recommended guidelines.

Physical Activity and Sedentary Behavior Clustering: Segmentation to Optimize Active Lifestyles

BACKGROUND Increasingly the health impacts of physical inactivity are being distinguished from those of sedentary behavior. Nevertheless, deleterious health prognoses occur when these behaviors combine, making it a Public Health priority to establish the numbers and salient identifying factors of people who live with this injurious combination. METHODS Using an observational between-subjects design, a nonprobability sample of 22,836 participants provided data on total daily activity. A 2-step hierarchical cluster analysis identified the optimal number of clusters and the subset of distinguishing variables. Univariate analyses assessed significant cluster differences. RESULTS High levels of sitting clustered with low physical activity. The Ambulatory & Active cluster (n = 6254) sat for 2.5 to 5 h·d(-1) and were highly active. They were significantly younger, included a greater proportion of males and reported low Indices of Multiple Deprivation compared with other clusters. Conversely, the Sedentary & Low Active cluster (n = 6286) achieved ≤60 MET·min·wk(-1) of physical activity and sat for ≥8 h·d(-1). They were the oldest cluster, housed the largest proportion of females and reported moderate Indices of Multiple Deprivation. CONCLUSIONS Public Health systems may benefit from developing policy and interventions that do more to limit sedentary behavior and encourage light intensity activity in its place.