Cindy M. Gray

A gender-sensitised weight loss and healthy living programme for overweight and obese men delivered by Scottish Premier League football clubs (FFIT): a pragmatic randomised controlled trial

BACKGROUND The prevalence of male obesity is increasing but few men take part in weight loss programmes. We assessed the effect of a weight loss and healthy living programme on weight loss in football (soccer) fans. METHODS We did a two-group, pragmatic, randomised controlled trial of 747 male football fans aged 35-65 years with a body-mass index (BMI) of 28 kg/m(2) or higher from 13 Scottish professional football clubs. Participants were randomly assigned with SAS (version 9·2, block size 2-9) in a 1:1 ratio, stratified by club, to a weight loss programme delivered by community coaching staff in 12 sessions held every week. The intervention group started a weight loss programme within 3 weeks, and the comparison group were put on a 12 month waiting list. All participants received a weight management booklet. Primary outcome was mean difference in weight loss between groups at 12 months, expressed as absolute weight and a percentage of their baseline weight. Primary outcome assessment was masked. Analyses were based on intention to treat. The trial is registered with Current Controlled Trials, number ISRCTN32677491. FINDINGS 374 men were allocated to the intervention group and 374 to the comparison group. 333 (89%) of the intervention group and 355 (95%) of the comparison group completed 12 month assessments. At 12 months the mean difference in weight loss between groups, adjusted for baseline weight and club, was 4·94 kg (95% CI 3·95-5·94) and percentage weight loss, similarly adjusted, was 4·36% (3·64-5·08), both in favour of the intervention (p<0·0001). Eight serious adverse events were reported, five in the intervention group (lost consciousness due to drugs for pre-existing angina, gallbladder removal, hospital admission with suspected heart attack, ruptured gut, and ruptured Achilles tendon) and three in the comparison group (transient ischaemic attack, and two deaths). Of these, two adverse events were reported as related to participation in the programme (gallbladder removal and ruptured Achilles tendon). INTERPRETATION The FFIT programme can help a large proportion of men to lose a clinically important amount of weight; it offers one effective strategy to challenge male obesity. FUNDING Scottish Government and The UK Football Pools funded delivery of the programme through a grant to the Scottish Premier League Trust. The National Institute for Health Research Public Health Research Programme funded the assessment (09/3010/06).

Interventions with potential to reduce sedentary time in adults: systematic review and meta-analysis

Context Time spent in sedentary behaviours (SB) is associated with poor health, irrespective of the level of physical activity. The aim of this study was to evaluate the effect of interventions which included SB as an outcome measure in adults. Methods Thirteen databases, including The Cochrane Library, MEDLINE and SPORTDiscus, trial registers and reference lists, were searched for randomised controlled trials until January 2014. Study selection, data extraction and quality assessment were performed independently. Primary outcomes included SB, proxy measures of SB and patterns of accumulation of SB. Secondary outcomes were cardiometabolic health, mental health and body composition. Intervention types were categorised as SB only, physical activity (PA) only, PA and SB or lifestyle interventions (PA/SB and diet). Results Of 8087 records, 51 studies met the inclusion criteria. Meta-analysis of 34/51 studies showed a reduction of 22 min/day in sedentary time in favour of the intervention group (95% CI −35 to −9 min/day, n=5868). Lifestyle interventions reduced SB by 24 min/day (95% CI −41 to −8 min/day, n=3981, moderate quality) and interventions focusing on SB only by 42 min/day (95% CI −79 to −5 min/day, n=62, low quality). There was no evidence of an effect of PA and combined PA/SB interventions on reducing sedentary time. Conclusions There was evidence that it is possible to intervene to reduce SB in adults. Lifestyle and SB only interventions may be promising approaches. More high quality research is needed to determine if SB interventions are sufficient to produce clinically meaningful and sustainable reductions in sedentary time.

Football Fans in Training: the development and optimization of an intervention delivered through professional sports clubs to help men lose weight, become more active and adopt healthier eating habits

BackgroundThe prevalence of obesity in men is rising, but they are less likely than women to engage in existing weight management programmes. The potential of professional sports club settings to engage men in health promotion activities is being increasingly recognised. This paper describes the development and optimization of the Football Fans in Training (FFIT) programme, which aims to help overweight men (many of them football supporters) lose weight through becoming more active and adopting healthier eating habits.MethodsThe MRC Framework for the design and evaluation of complex interventions was used to guide programme development in two phases. In Phase 1, a multidisciplinary working group developed the pilot programme (p-FFIT) and used a scoping review to summarize previous research and identify the target population. Phase 2 involved a process evaluation of p-FFIT in 11 Scottish Premier League (SPL) clubs. Participant and coach feedback, focus group discussions and interviews explored the utility/acceptability of programme components and suggestions for changes. Programme session observations identified examples of good practice and problems/issues with delivery. Together, these findings informed redevelopment of the optimized programme (FFIT), whose components were mapped onto specific behaviour change techniques using an evidence-based taxonomy.Resultsp-FFIT comprised 12, weekly, gender-sensitised, group-based weight management classroom and ‘pitch-side’ physical activity sessions. These in-stadia sessions were complemented by an incremental, pedometer-based walking programme. p-FFIT was targeted at men aged 35-65 years with body mass index ≥ 27 kg/m2. Phase 2 demonstrated that participants in p-FFIT were enthusiastic about both the classroom and physical activity components, and valued the camaraderie and peer-support offered by the programme. Coaches appreciated the simplicity of the key healthy eating and physical activity messages. Suggestions for improvements that were incorporated into the optimized FFIT programme included: more varied in-stadia physical activity with football-related components; post-programme weight management support (emails and a reunion session); and additional training for coaches in SMART goal setting and the pedometer-based walking programme.ConclusionsThe Football Fans in Training programme is highly acceptable to participants and SPL coaches, and is appropriate for evaluation in a randomised controlled trial.

You've got to walk before you run: positive evaluations of a walking program as part of a gender-sensitized, weight-management program delivered to men through professional football clubs

OBJECTIVE To explore mens views of a pedometer-based walking program, part of a weight-management intervention delivered through Scottish Premier League football clubs, and the congruence or challenge this poses to masculine identities. METHODS Semistructured telephone interviews with a sample of participants in a gender-sensitized, group weight-management program. Interviewing continued until data saturation was reached (n = 29). RESULTS All men were positive about the context, style of delivery, and content of the broader intervention. These things encouraged men to increase their physical activity (and adopt other behavioral changes) that they may not otherwise have found appealing. The success and acceptability of the walking program resided in three interrelated factors: (a) the utility of pedometers as a technology for motivation, self-monitoring and surveillance, and target setting; (b) the speed with which fitness was regained and weight reduced (enabling men to begin to do more desired forms of physical activity, and so regain visceral, experiential, and pragmatic masculine capital); and (c) bolstering their masculine identities through the receipt of the program in a valued, masculinised context. CONCLUSIONS These data suggest that men will enthusiastically embrace a graduated walking program when the presentation is gender sensitive in context, content, and delivery. Pedometers were viewed as a valuable, reliable technological aid which motivated men and empowered them in self-monitoring of progress toward self-defined goals. Many men experienced the walking program as a means of regaining fitness, thereby enabling them to also regain valued masculine identities and activities, and a step toward regaining a more acceptable masculine body.

Weight management for overweight and obese men delivered through professional football clubs: a pilot randomized trial

BackgroundThe prevalence of male obesity is increasing, but men are less likely than women to attend existing weight management programmes. We have taken a novel approach to reducing perceived barriers to weight loss for men by using professional football (soccer) clubs to encourage participation in a weight management group programme, gender-sensitised in content and style of delivery. Football Fans in Training (FFIT) provides 12 weeks of weight loss, physical activity and healthy eating advice at top professional football clubs in Scotland. This pilot randomized trial explored the feasibility of using these clubs as a setting for a randomized controlled trial of 12 month weight loss following men’s participation in FFIT.MethodsA two-arm pilot trial at two Scottish Premier League football clubs (one large, one smaller), with 103 men (aged 35–65, body mass index (BMI) ≥27 kg/m2) individually randomized to the intervention (n=51, received the pilot programme (p-FFIT) immediately) and waitlist comparison (n=52, received p-FFIT after four months) groups. Feasibility of recruitment, randomization, data collection and retention were assessed. Objective physical measurements (weight, waist circumference, blood pressure, body composition) and questionnaires (self-reported physical activity, diet, alcohol consumption, psychological outcomes) were obtained from both groups by fieldworkers trained to standard protocols at baseline and 12 weeks, and from the intervention group at 6 and 12 months. Qualitative methods elicited men’s experiences of participation in the pilot trial.ResultsFollowing a short recruitment period, the recruitment target was achieved at the large, but not smaller, club. Participants’ mean age was 47.1±8.4 years; mean BMI 34.5±5.0 kg/m2. Retention through the trial was good (>80% at 12 weeks and 6 months; >75% at 12 months), and 76% attended at least 80% of available programme delivery sessions. At 12 weeks, the intervention group lost significantly more weight than the comparison group (4.6% c.f. -0.6%, p<.001) and many maintained this to 12 months (intervention group baseline-12 month weight loss: 3.5%, p<.001). There were also improvements in self-reported physical activity and diet, many sustained long term.ConclusionsThe results demonstrated the feasibility of trial procedures and the potential of FFIT to engage men in sustained weight loss and positive lifestyle change. They supported the conduct of a fully-powered randomized controlled trial.

The effectiveness of the Talking Mats framework in helping people with dementia to express their views on well-being

Deteriorating communication is one of the most distressing aspects of dementia and it becomes increasingly difficult to ensure that the person’s views are heard. This study involved 31 people at different stages of dementia who were each interviewed about their well-being using Talking Mats, a low-tech communication framework, and usual communication methods. The communication effectiveness of each method was compared. This study found that the Talking Mats framework was associated with better communication at all stages of dementia compared to usual communication methods. Better communication effectiveness was evident in the participants’ understanding, engagement, keeping on-track and ability to make their views understood. There was also less repetitive behaviour and less distractibility when using the Talking Mats framework. The findings suggest that the Talking Mats framework can play an important role in improving communication by providing an accessible, low cost tool which family and staff can use with people with dementia to help them express their views.

‘Coz football is what we all have’: masculinities, practice, performance and effervescence in a gender‐sensitised weight‐loss and healthy living programme for men

Abstract In this paper we use a social practice approach to explore mens experience of Football Fans in Training (FFIT), a group‐based weight management programme for men that harnesses mens symbolic attachment to professional football clubs to engage them in lifestyle change. FFIT is delivered by community coaches in clubs’ stadia and is gender‐sensitised in relation to context, content and style of delivery. Using a ‘toolkit’ of concepts from the work of Bourdieu, Goffman and Durkheim we analysed data from 13 focus group discussions with participants, and fieldwork notes from programme observations to investigate the appeal and success of FFIT, and how it worked to support change. Our analysis builds on our work on the importance of shared symbolic commitment to the football club and being with ‘men like me’ to understand how the interaction context facilitated ‘effervescent’ experiences. These experiences encouraged men to make changes to their diet and physical activity, talk about them, practice performing them and implement them in their lives. Thus a social practice approach illuminated the social processes through which lifestyle change was achieved, and we argue that it can deepen and enrich both intervention design and evaluation.

Can the draw of professional football clubs help promote weight loss in overweight and obese men? A feasibility study of the Football Fans in Training programme delivered through the Scottish Premier League

Objective The UK prevalence of male obesity is among the highest in Europe. Excess weight is associated with ill-health, but while 5-10% weight loss can significantly improve future health, men are reluctant to engage in traditional weight management programmes. This study examines the potential of professional football clubs to engage overweight and obese men in weight loss. Football Fans in Training (FFIT) is a 12 week, gender-sensitised weight management and physical activity programme delivered to groups of men at Scottish Premier League (SPL) clubs. Design A mixed-method feasibility study including a pilot randomised trial and process evaluation involving focus groups with participants and coaches delivering FFIT. Setting Two SPL clubs: one large, city-based; one smaller, town-based. Participants 103 men, aged 35–65 years, body mass index (BMI) ≥ 27 kg/m2, randomly assigned to the intervention (receiving FFIT immediately, N=51) or comparison group (receiving FFIT 4 months later, N=52). Main outcome measures The primary outcomes were viability of the recruitment procedures and participant attrition. Process outcomes included acceptability of physical and questionnaire measurement to participants, and acceptability of FFIT to men and coaches. Secondary outcomes included indications of percentage weight loss at 12 weeks, and changes in independently-measured BMI, waist circumference, and self-reported physical activity, eating habits and psychological status post-programme. Results The recruitment target (N=60) was achieved in the large, but not smaller, club, suggesting additional measures may be needed to increase participation at smaller clubs. Attrition was low; 83.5% took part in 12-week measurements. Participants were comfortable with research procedures and very positive about FFIT. The football setting proved to be a particular draw; many indicated they would not have attended a similar programme elsewhere. Similarly positive feedback was received from coaches. The intervention group achieved a mean 4.6% weight loss (SD 2.8) while the comparison group recorded a mean 0.6% weight gain (SD 2.0); and BMI and waist circumference showed a similar pattern (all p<0.001). The intervention group also reported: significant increases in self-esteem and 12-Item Short Form Health Survey (SF-12) scores, physical activity, and consumption of breakfast, fruit and vegetables; and significant decreases in consumption of burgers, pies, crisps, biscuits and chocolate (these changes were significantly different from those reported by the comparison group, p=0.001 to 0.048). Conclusion Professional football clubs can encourage men (a traditionally hard-to-reach group) to engage in gender-sensitised weight management programmes and to make positive lifestyle changes. Follow-up assessments will determine if short-term improvements are maintained.

Efficient and Effective Change Principles in Active Videogames

Active videogames have the potential to enhance population levels of physical activity but have not been successful in achieving this aim to date. This article considers a range of principles that may be important to the design of effective and efficient active videogames from diverse discipline areas, including behavioral sciences (health behavior change, motor learning, and serious games), business production (marketing and sales), and technology engineering and design (human-computer interaction/ergonomics and flow). Both direct and indirect pathways to impact on population levels of habitual physical activity are proposed, along with the concept of a game use lifecycle. Examples of current active and sedentary electronic games are used to understand how such principles may be applied. Furthermore, limitations of the current usage of theoretical principles are discussed. A suggested list of principles for best practice in active videogame design is proposed along with suggested research ideas to inform practice to enhance physical activity.

Talking Mats: the effectiveness of a low technology communication framework to help people with dementia express their views

The aims of this project were to establish whether Talking Mats, a low tech communication framework, helps people with dementia to communicate and to examine how effective the Talking Mats framework is for people at different stages of dementia. Thirty‐one people at three stages of dementia were interviewed about their well‐being under three interview conditions ‐ an unstructured (ordinary) conversation, a structured conversation and using the Talking Mats framework.The results indicated that conversations using the Talking Mats framework improved communication for people at all stages of dementia but that not all people at late‐stage dementia could use the Talking Mats framework effectively.The researchers concluded that the Talking Mats framework may therefore play an important role in improving quality of care by providing a simple, low‐cost tool that family and staff can use to engage with people with dementia and help them express their views about a range of topics.