Katrien De Cocker

What do pedometer counts represent? A comparison between pedometer data and data from four different questionnaires

OBJECTIVES To compare physical activity (PA) reported through pedometer registrations (step counts) with PA reported in four different questionnaires; to compare step count thresholds (7,500, 10,000 and 12,500 steps/d) with the PA guideline of 30 min of moderate to vigorous PA (MVPA) per day. SUBJECTS A sample of 310 healthy adults, mean age 38.7 (sd 11.9) years, volunteered to participate. Forty-seven per cent was male and 93 % of the sample was employed. METHODS PA was assessed by interview (Minnesota Leisure Time Physical Activity Questionnaire (MLTPAQ)), three self-administered questionnaires (long version and short version of the International Physical Activity Questionnaire (long-form IPAQ, short-form IPAQ), Baecke questionnaire) and seven consecutive days of pedometer registration. RESULTS Step counts correlated positively with questionnaire-based PA. The strongest correlations were found between step counts and total PA reported in the long-form IPAQ (rs = 0.37), moderate PA reported in the short-form IPAQ (rs = 0.33), total and moderate PA reported in the MLTPAQ (rs = 0.32), and the total and leisure-time PA indices (excluding sport) reported in the Baecke questionnaire (rs = 0.44). According to step counts, 22.6 % of the participants were somewhat active, 18.7 % active and 39.4 % highly active. As assessed by the long-form IPAQ, short-form IPAQ and MLTPAQ, the guideline of 30 min MVPA/d was reached by respectively 85.4 %, 84.8 % and 68.0 % of participants. CONCLUSION Pedometer-based data offer adequate information to discriminate between levels of PA. Caution is needed when comparing active samples based on different PA recommendations.

Pedometer-Determined Physical Activity and Its Comparison With the International Physical Activity Questionnaire in a Sample of Belgian Adults

Pedometer-determined physical activity (PA) levels in Belgian adults were provided and compared to PA scores reported in the International Physical Activity Questionnaire (IPAQ). The representative sample (N = 1,239) of the Belgian population took on average 9,655 (4,526) steps/day. According to pedometer indices 58.4% were insufficiently active. Steps/day differed significantly between gender (F = 5.0, p = .026), age groups (F = 3.3, p = .01), employment status (F = 6.2, p = .013), and days of monitoring (F = 7.4, p = .007). Steps/day were negatively correlated to the time spent sitting and positively to PA at work, in transport, and in leisure time (p < .001). Steps data can discriminate between PA levels reported in the IPAQ. Belgian population pedometer-determined PA levels are higher than those reported in samples of the United States; however, there is a wide distribution of ambulatory behavior.

Understanding occupational sitting: Prevalence, correlates and moderating effects in Australian employees

OBJECTIVE To (1) compare occupational sitting between different socio-demographic, health-related, work-related and psychosocial categories, (2) identity socio-demographic, health-related, work-related and psychosocial correlates of occupational sitting, and (3) examine the moderating effect of work-related factors in the relation between correlates and occupational sitting. METHODS Randomly-selected Australian adults completed a web-based survey assessing socio-demographic (country of birth, gender, age, education, income), health-related (general health, weight, physical activity), work-related (employment status, occupational task, occupational classification) and sedentary-specific psychosocial (social norm, social support, self-efficacy, control, advantages, disadvantage, intention) factors, and occupational sitting-time. t-tests, ANOVAs and multiple linear regression analyses were conducted (in 2013) on a sample of employees (n=993). RESULTS Respondents sat on average for 3.75 (SD=2.45) h/day during work. Investigated correlates explained 41% of the variance in occupational sitting. More occupational sitting was associated with being male, being younger, higher education and income, part-time and full-time employment, sedentary job tasks, white-collar/professional occupations, higher BMI, and perceiving more advantages of sitting less at work. Employment status and occupational classification moderated the association between control to sit less and occupational sitting. A lack of control to sit less was associated with higher occupational sitting in part-time and full-time workers, but not in casual workers; and in white-collar and professional workers, but not in blue-collar workers. CONCLUSIONS Most important contributors to occupational sitting were work-related and socio-demographic correlates. More research is needed to confirm present results.

Effectiveness of a Web-Based, Computer-Tailored, Pedometer-Based Physical Activity Intervention for Adults: A Cluster Randomized Controlled Trial

Background Computer-tailored physical activity (PA) interventions delivered through the Internet represent a promising and appealing method to promote PA at a population level. However, personalized advice is mostly provided based on subjectively measured PA, which is not very accurate and might result in the delivery of advice that is not credible or effective. Therefore, an innovative computer-tailored PA advice was developed, based on objectively pedometer-measured PA. Objective The study aim was to evaluate the effectiveness of a computer-tailored, pedometer-based PA intervention in working adults. Methods Participants (≥18 years) were recruited between May and December 2012 from eight Flemish workplaces. These workplaces were allocated randomly to an intervention or control group. Intervention group participants (n=137) received (1) a booklet with information on how to increase their steps, (2) a non-blinded pedometer, and (3) an Internet link to request computer-tailored step advice. Control group participants (n=137) did not receive any of the intervention components. Self-reported and pedometer-based PA were assessed at baseline (T0), and 1 month (T1) and 3 months (T2) months post baseline. Repeated measures analyses of covariance were used to examine intervention effects for both the total sample and the at-risk sample (ie, adults not reaching 10,000 steps a day at baseline). Results The recruitment process resulted in 274 respondents (response rate of 15.1%) who agreed to participate, of whom 190 (69.3%) belonged to the at-risk sample. Between T0 and T1 (1-month post baseline), significant intervention effects were found for participants’ daily step counts in both the total sample (P=.004) and the at-risk sample (P=.001). In the at-risk sample, the intervention effects showed a daily step count increase of 1056 steps in the intervention group, compared to a decrease of 258 steps in the control group. Comparison of participants’ self-reported PA revealed a significant intervention effect for time spent walking in the at-risk sample (P=.02). Intervention effects were still significant 3 months post baseline for participants’ daily step counts in both the total sample (P=.03) and the at-risk sample (P=.02); however, self-reported PA differences were no longer significant. Conclusions A computer-tailored, pedometer-based PA intervention was effective in increasing both pedometer-based and self-reported PA levels, mainly in the at-risk participants. However, more effort should be devoted to recruit and retain participants in order to improve the public health impact of the intervention. Trial Registration ClinicalTrials.gov: NCT02080585; https://clinicaltrials.gov/ct2/show/NCT02080585 (Archived by WebCite at http://www.webcitation.org/6VvQnRQSy).

Acceptability and feasibility of potential intervention strategies for influencing sedentary time at work: focus group interviews in executives and employees

BackgroundOccupational sitting can be the largest contributor to overall daily sitting time in white-collar workers. With adverse health effects in adults, intervention strategies to influence sedentary time on a working day are needed. Therefore, the present aim was to examine employees’ and executives’ reflections on occupational sitting and to examine the potential acceptability and feasibility of intervention strategies to reduce and interrupt sedentary time on a working day.MethodsSeven focus groups (four among employees, n = 34; three among executives, n = 21) were conducted in a convenience sample of three different companies in Flanders (Belgium), using a semi-structured questioning route in five themes [personal sitting patterns; intervention strategies during working hours, (lunch) breaks, commuting; and intervention approach]. The audiotaped interviews were verbatim transcribed, followed by a qualitative inductive content analysis in NVivo 10.ResultsThe majority of participants recognized they spend their working day mostly sitting and associated this mainly with musculoskeletal health problems. Participants suggested a variety of possible strategies, primarily for working hours (standing during phone calls/meetings, PC reminders, increasing bathroom use by drinking more water, active sitting furniture, standing desks, rearranging the office) and (lunch) breaks (physical activity, movement breaks, standing tables). However, several barriers were reported, including productivity concerns, impracticality, awkwardness of standing, and the habitual nature of sitting. Facilitating factors were raising awareness, providing alternatives for simply standing, making some strategies obligatory and workers taking some personal responsibility.ConclusionsThere are some strategies targeting sedentary time on a working day that are perceived to be realistic and useful. However several barriers emerged, which future trials and practical initiatives should take into account.

Non-traditional wearing positions of pedometers: Validity and reliability of the Omron HJ-203-ED pedometer under controlled and free-living conditions

OBJECTIVES To test the validity and intra-instrument reliability of the HJ-203 Omron pedometer when worn in different positions, under controlled and free-living conditions. DESIGN Cross-sectional. METHODS Forty healthy adults (20 men, 29.5±7.7 years) participated in three controlled tests, i.e. 20 step test, stair climbing (up and down), and treadmill walking (five bouts at different speeds). All participants wore a HJ-203 pedometer in the pants pocket, in a carrier bag, and around the neck. Fifty-four adults (23 men, 33.9±11.1 years) participated in a free-living conditions test, wearing a HJ-203 in the pants pocket and around the neck during one day. RESULTS During controlled tests, absolute percentage error ranged between 0.1% and 14.0%. Accuracy was influenced by wearing position (p<0.001), walking speed (p<0.001), and wearing position×walking speed (p=0.001). Accuracy was poor for pedometers worn in the pants pocket, especially at slower speeds; and best when worn around the neck. During free-living conditions, APE ranged between 30.7% and 36.9% and did not differ statistically between pants pocket and neck position. Intra-instrument reliability varied for controlled tests (ICC=0.14-0.96) and was acceptable during free-living conditions (ICC=0.94). CONCLUSIONS The HJ-203 Omron pedometer showed acceptable accuracy for all wearing positions during stairs walking and treadmill walking at higher speeds; but limited accuracy during free-living conditions when worn at non-traditional wearing positions (necklace and pants pocket). Reliability was acceptable during treadmill walking at higher speeds and free-living conditions.

Web-based, computer-tailored, pedometer-based physical activity advice: development, dissemination through general practice, acceptability, and preliminary efficacy in a randomized controlled trial.

Background Computer tailoring is a relatively innovative and promising physical activity intervention approach. However, few computer-tailored physical activity interventions in adults have provided feedback based on pedometer use. Objectives To (1) describe the development of a Web-based, pedometer-based, computer-tailored step advice intervention, (2) report on the dissemination of this tool through general practice, (3) report on its perceived acceptability, and (4) evaluate the preliminary efficacy of this tool in comparison with a standard intervention. Methods We recruited 92 participants through general practitioners and randomly assigned them to a standard condition (receiving a pedometer-only intervention, n = 47) and a tailored condition (receiving a pedometer plus newly developed, automated, computer-tailored step advice intervention, n = 45). Step counts, self-reported data obtained via telephone interview on physical activity, time spent sitting, and body mass index were assessed at baseline and postintervention. The present sample was mostly female (54/92, 59%), highly educated (59/92, 64%), employed (65/92, 71%), and in good health (62/92, 67%). Results Recruitment through general practitioners was poor (n = 107, initial response rate 107/1737, 6.2%); however, the majority of participants (50/69, 73%) believed it is useful that general practitioners help patients find ways to increase physical activity. In the tailored condition, 30/43 (70%) participants requested the computer-tailored step advice and the majority found it understandable (21/21, 100%), credible (17/18, 94%), relevant (15/18, 83%), not too long (13/18, 72%), instructive (13/18, 72%), and encouraging to increase steps (16/24, 67%). Daily step counts increased from baseline (mean 9237, SD 3749 steps/day) to postintervention (mean 11,876, SD 4574 steps/day) in the total sample (change of 2639, 95% confidence interval 105–5172; F 1 = 5.0, P = .04). No interaction or other time effects were found. Conclusions The majority of participants in the tailored condition accepted the step advice and indicated it was useful. However, in this selected sample of adults, the tailored condition did not show superior effects compared with the standard condition.

A RE-AIM evaluation of evidence-based multi-level interventions to improve obesity-related behaviours in adults: a systematic review (the SPOTLIGHT project)

BackgroundThis systematic literature review describes the potential public health impact of evidence-based multi-level interventions to improve obesity-related behaviours in adults, using the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework.MethodsElectronic databases (PubMed, Embase, and The Cochrane Library) were searched to identify intervention studies published between January 2000 and October 2013. The following inclusion criteria were used: (1) the study included at least one outcome measure assessing obesity-related behaviours (i.e. diet, physical activity or sedentary behaviour), (2) the study collected data over at least one year and (3) the study’s intervention targeted adults, was conducted in a specified geographical area or worksite, and was multi-level (i.e. targeting both individual and environmental level). Evidence of RE-AIM of the selected interventions was assessed. Potential public health impact of an intervention was evaluated if information was provided on at least four of the five RE-AIM dimensions.ResultsThirty-five multi-level interventions met the inclusion criteria. RE-AIM evaluation revealed that the included interventions generally had the potential to: reach a large number of people (on average 58% of the target population was aware of the intervention); achieve the assumed goals (89% found positive outcomes); be broadly adopted (the proportion of intervention deliverers varied from 9% to 92%) and be sustained (sixteen interventions were maintained). The highest potential public health impact was found in multi-level interventions that: 1) focused on all levels at the beginning of the planning process, 2) guided the implementation process using diffusion theory, and 3) used a website to disseminate the intervention.ConclusionsAlthough most studies underreported results within the RE-AIM dimensions, the reported Reach, Effectiveness, Adoption, Implementation and Maintenance were positively evaluated. However, more information on external validity and sustainability is needed in order to take informed decisions on the choice of interventions that should be implemented in real-world settings to accomplish long-term changes in obesity-related behaviours.

A Framework for Physical Activity Programs within School-Community Partnerships.

School-community partnerships have shown their potential as incubators for innovations and for contributing to comprehensive physical activity (PA) programs. However, implementation frameworks for school-community partnerships that allow local tailoring of PA programs remain scarce. The present paper aims at documenting the composition of a framework for PA programs within schoolcommunity partnerships. The framework addresses socioecological strategies to promote extracurricular PA opportunities for pupils, which are integrated into five complementary components. To implement and reinforce the five components of the framework, involvement of schools, pupils, family, and community is facilitated by sustainable partnerships between these stakeholders. Partnerships are not only recommended on the school and community level, but also on a broader regional level that covers multiple communities. The development of the framework was an effort to integrate school-community partnerships into a flexible implementation framework for PA promotion. Implications of the framework for research agendas, professional education, and policy are formulated.

The Effectiveness of a Web-Based Computer-Tailored Intervention on Workplace Sitting: A Randomized Controlled Trial.

Background Effective interventions to influence workplace sitting are needed, as office-based workers demonstrate high levels of continued sitting, and sitting too much is associated with adverse health effects. Therefore, we developed a theory-driven, Web-based, interactive, computer-tailored intervention aimed at reducing and interrupting sitting at work. Objective The objective of our study was to investigate the effects of this intervention on objectively measured sitting time, standing time, and breaks from sitting, as well as self-reported context-specific sitting among Flemish employees in a field-based approach. Methods Employees (n=213) participated in a 3-group randomized controlled trial that assessed outcomes at baseline, 1-month follow-up, and 3-month follow-up through self-reports. A subsample (n=122) were willing to wear an activity monitor (activPAL) from Monday to Friday. The tailored group received an automated Web-based, computer-tailored intervention including personalized feedback and tips on how to reduce or interrupt workplace sitting. The generic group received an automated Web-based generic advice with tips. The control group was a wait-list control condition, initially receiving no intervention. Intervention effects were tested with repeated-measures multivariate analysis of variance. Results The tailored intervention was successful in decreasing self-reported total workday sitting (time × group: P<.001), sitting at work (time × group: P<.001), and leisure time sitting (time × group: P=.03), and in increasing objectively measured breaks at work (time × group: P=.07); this was not the case in the other conditions. The changes in self-reported total nonworkday sitting, sitting during transport, television viewing, and personal computer use, objectively measured total sitting time, and sitting and standing time at work did not differ between conditions. Conclusions Our results point out the significance of computer tailoring for sedentary behavior and its potential use in public health promotion, as the effects of the tailored condition were superior to the generic and control conditions. Trial Registration Clinicaltrials.gov NCT02672215; http://clinicaltrials.gov/ct2/show/NCT02672215 (Archived by WebCite at http://www.webcitation.org/6glPFBLWv)