Christina C. Loitz

UWALK: the development of a multi-strategy, community-wide physical activity program.

UWALK is a multi-strategy, multi-sector, theory-informed, community-wide approach using e and mHealth to promote physical activity in Alberta, Canada. The aim of UWALK is to promote physical activity, primarily via the accumulation of steps and flights of stairs, through a single over-arching brand. This paper describes the development of the UWALK program. A social ecological model and the social cognitive theory guided the development of key strategies, including the marketing and communication activities, establishing partnerships with key stakeholders, and e and mHealth programs. The program promotes the use of physical activity monitoring devices to self-monitor physical activity. This includes pedometers, electronic devices, and smartphone applications. In addition to entering physical activity data manually, the e and mHealth program provides the function for objective data to be automatically uploaded from select electronic devices (Fitbit®, Garmin and the smartphone application Moves) The RE-AIM framework is used to guide the evaluation of UWALK. Funding for the program commenced in February 2013. The UWALK brand was introduced on April 12, 2013 with the official launch, including the UWALK website on September 20, 2013. This paper describes the development and evaluation framework of a physical activity promotion program. This program has the potential for population level dissemination and uptake of an ecologically valid physical activity promotion program that is evidence-based and theoretically framed.

Strength of Messaging in Changing Attitudes in a Workplace Wellness Program

The potential benefits of workplace wellness programs are limited by low participation rates of employees, which could be due in part to ineffective persuasion by program providers. This study uses the Elaboration Likelihood Model, as a guiding theory in mixed methods research, to investigate feedback messages about physical activity delivered in a workplace wellness program. This study uses questionnaire and interview data from 32 employees to determine if personally relevant health messages are associated with either positive or negative responses to the messages and subsequent attitude change. General feedback is more appreciated by those who are less fit but are not effective in changing attitudes toward physical activity. Individually targeted messages result in a significant positive attitude change for participants responding positively to the messages. This suggests that individualized health promotion messages provide a stronger argument for individuals, thus increasing the likelihood of attitude change.

Sociodemographic patterns of leisure-time physical activity of Albertans 2000 to 2011

Background: Physical inactivity has been a significant health concern among the Canadian population over the last decade. Purpose: To study the trend in leisure-time physical activity (LTPA) of Albertans from 2000 to 2011 and to assesses the relationship between sociodemographic factors and LTPA. Methods: Cross-sectional design was used. Data were obtained in 2000 (n = 1200), 2002 (n = 1209), 2005 (n = 1208), 2006 (n=1207), 2008 (n=1313) and 2010 (n=1202) through representative random telephone surveys. The Godin Leisure-Time Exercise Questionnaire was used for all three surveys, in addition to questions about sociodemographic information (age, income, education, marital status). Men and women were considered active if they expended at least 38 or 35 metabolic equivalents (METs) per week, respectively. Results: From 2000 to 2005, the proportion of active Albertans increased from 54.2% to 60.2% whereas from 2006 to 2011 it decreased from 57.4% to 54.3%. Controlling for sex, logistic regression analyses showed that, compared to the youngest adults, the oldest adults were the least likely to be active (OR = 0.16 to 0.55) over the last decade. The highest quintile of income was the most likely to be active from 2000 to 2008 (OR = 1.96 to 2.28). Education was not related to LTPA. Conclusion: Older age remained a risk for inactivity over the decade and high income supported LTPA until 2008. Marital status inconsistently affected activity status in Albertans over the last decade. Education was not related to LTPA.

Re-examining the Dimensions of Obligatory Exercise

The authors examined the factor structure and psychometric properties of the Obligatory Exercise Questionnaire using exploratory factor analyses (Study 1), and confirmatory factor analyses (Study 2). The relationships between obligatory exercise and other psychological variables including: motivation, subjective well-being, physical self-concept, social physique anxiety, and behavioral intention were also examined. The analyses revealed three factors underlying the OEQ: exercise behavior, exercise emotionality, and preoccupation with exercise. Theoretically consistent relationships were observed between obligatory exercise and other psychological variables. Overall, negative emotionality associated with missing a workout appears to be an important indicator of obligatory exercise. From a psychometric perspective, the OEQ is a good measure, however conceptual problems remain. The creation of a theory surrounding obligatory exercise involving multiple constituent factors would be a logical next step for this area of research.

A Systematic Review of Interventions to Increase Stair Use

CONTEXT Stair climbing is an accessible activity that can be incorporated into ones daily lifestyle to increase physical activity levels and provide health benefits. This review summarizes the effectiveness of stair interventions and explores key differences that may influence intervention effectiveness. EVIDENCE ACQUISITION Interventions to increase stair use published from January 1990 to July 2015 were identified in PubMed, Sport Discus, Web of Science, Environment Complete, CINAHL, Trial Register of Promoting Health Interventions, Embase, Scopus, and PsycINFO. Eligibility criteria included original studies, published in peer-reviewed journals, targeting adult samples, and clearly describing intervention design and results. Studies were also required to measure the use of stairs compared with an elevator, escalator, or moving stairway at baseline and during at least one timepoint when the intervention was in effect. Studies were required to provide data to determine if the intervention resulted in significant changes in stair use/climbing. EVIDENCE SYNTHESIS The search results yielded 2,136 articles in total; 54 articles met the criteria, which resulted in a final sample of 67 studies included in the analyses. Interventions settings included public sites (75%), worksites (21%), or a combination of both (4%). For Phase 1 results, 72% of studies reported significant improvements in stair use (n=10 of 14) and stair climbing (n=38 of 53). CONCLUSIONS Evidence from the review demonstrates support for the effectiveness of interventions to increase stair use and stair climbing. Although evidence supports the effectiveness of stair interventions in public settings, less support is provided for worksites.

Challenges of being new to Canada: considerations for physical activity

Immigrants to Canada are less likely to be physically active compared with non-immigrants, and the interrelations between personal and environmental factors that influence physical activity for immigrants are largely unexplored. The goal of this qualitative descriptive study was to understand how the experience of being new to Canada impacts opportunities and participation in physical activity. Two focus group interviews with immigrants to Canada were conducted. The first group (n=7) included multicultural health brokers. The second group (n=14) included English as a second language students. Qualitative content analysis was used to determine three themes consistent with the research question: transition to Canadian life, commitments and priorities, and accessibility. Discussion was framed using a social ecological model. Implications for practice and policy are suggested including enhanced community engagement, and organizational modifications. Overall, the development and implementation of physical activity policies and practices for newcomers to Canada should be centered on newcomers’ perspectives and experiences.

Authors’ Response to: “Getting Better Value out of Studies Examining Prompts for Stair Use”

We begin by thanking Dr. Nancy Edwards for her interest in our recent systematic review of interventions to increase stair use. In her letter, Dr. Edwards argues that our review and related primary studies examining interventions to increase stair use have not sufficiently included the characteristics of staircases (e.g., lighting, height, shape and position of handrails, the height of risers, the length of treads, the number of stairs in a run) that can directly influence their use by individuals. She subsequently argues that because stair characteristics are regulated by jurisdiction-specific building codes, it is important to include technical descriptors of stair features to enhance the relevance of research findings for members of building code review committees. We appreciate Dr. Edwards’s insightful comments and for raising important issues on the potential impact of research on practice. As authors of a systematic review, our initial response was that her concerns were outside the scope of our review given the lack of primary papers reporting these characteristics. On further reflection, however, we agree that elements of both building design and public policy are key features of the transdisciplinarity of research needed to successfully address the complex patterns of behavior for something as superficially simple as stair use. That being said, including physical environmental factors or policy aspects in research will be dependent on study design. Specifically, within the social ecological model, point-of-decision prompts-based intervention studies examine stair use at a proximal individual level (e.g., attention, motivation, attitudes), whereas, building design/policy-based intervention studies examine stair use behaviors that are embedded within distal levels of the social ecological model (e.g., policy, environment). Therefore, although the main knowledge translation target is identical (i.e., policy makers) between our review and Dr. Edwards’s suggestion, the dimension of which the practical implication can be drawn is at a different level (i.e., stair users versus stair environment) with different underlying psychological mechanisms (i.e., consciousness versus subconsciousness) and via different approaches (i.e., changing minds versus changing contexts) for behavioral changes. To conclude, although we agree that design elements should be taken into consideration and more research examining staircase characteristics is necessary, we believe that the gap that Dr. Edwards has identified is not one of a single missing factor, but a lack of multilevel transdisciplinary research bringing social scientists, policy makers, and the building industry together to achieve our common and ultimate goal (i.e., long-term, sustainable changes to physical activity behavior).

The effectiveness of workplace interventions to increase physical activity and decrease sedentary behaviour in adults: protocol for a systematic review

BackgroundA physically active lifestyle plays a preventative role in the development of various chronic diseases and mental health conditions. Unfortunately, few adults achieve the minimum amount of physical activity and spend excessive time sitting. Developing targeted interventions to increase active living among adults is an important endeavour for public health. One plausible context to reach adults is the workplace. This systematic review aims to review the effectiveness of workplace interventions on increasing physical activity and decreasing sedentary behaviour in the workplace.MethodsAn advisory group of practitioners will work in collaboration with the research team to inform the systematic review and knowledge mobilization. Fifteen electronic databases will be searched to identify studies examining the effectiveness of workplace interventions on physical activity and sedentary behaviour. All experimental designs and observational studies (non-experimental intervention studies) meeting the study criteria will be included. Studies examining generally healthy, employed, adult participants will be included for the review. Interventions will focus on increasing physical activity and/or decreasing sedentary behaviour from the individual to policy level. The primary outcome variables will be reported or observed physical activity and/or sedentary behaviour in the workplace. Secondary outcomes will include variables ranging from return on investment to quality of life. Study quality will be assessed for risk of bias following the protocol identified in the Cochrane Handbook for Systematic Reviews of Interventions and supplemented by the guidelines developed by the Cochrane Effective Practice and Organisation of Care group, using RevMan. The quality of the evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach. Meta-analyses, forest plots, and harvest plots will be used where appropriate to assess the direction, size, and consistency of the intervention effect across the studies using similar intervention strategies. Follow-up knowledge mobilization activities and products will be developed to support the use of this knowledge in practice.DiscussionThis protocol paper describes a systematic review assessing the effectiveness of various types of workplace interventions on increasing physical activity and decreasing sedentary behaviour at work. Collaborating with an advisory group of potential knowledge users throughout the process postulates a greater use and reach of the information gained from this systematic review by knowledge users.Systematic review registrationPROSPERO CRD42015019398