Rhys Tague

Effectiveness of a web- and mobile phone-based intervention to promote physical activity and healthy eating in middle-aged males: randomized controlled trial of the ManUp study.

Background The high number of adult males engaging in low levels of physical activity and poor dietary practices, and the health risks posed by these behaviors, necessitate broad-reaching intervention strategies. Information technology (IT)-based (Web and mobile phone) interventions can be accessed by large numbers of people, yet there are few reported IT-based interventions targeting males’ physical activity and dietary practices. Objective This study examines the effectiveness of a 9-month IT-based intervention (ManUp) to improve the physical activity, dietary behaviors, and health literacy in middle-aged males compared to a print-based intervention. Methods Participants, recruited offline (eg, newspaper ads), were randomized into either an IT-based or print-based intervention arm on a 2:1 basis in favor of the fully automated IT-based arm. Participants were adult males aged 35-54 years living in 2 regional cities in Queensland, Australia, who could access the Internet, owned a mobile phone, and were able to increase their activity level. The intervention, ManUp, was based on social cognitive and self-regulation theories and specifically designed to target males. Educational materials were provided and self-monitoring of physical activity and nutrition behaviors was promoted. Intervention content was the same in both intervention arms; only the delivery mode differed. Content could be accessed throughout the 9-month study period. Participants’ physical activity, dietary behaviors, and health literacy were measured using online surveys at baseline, 3 months, and 9 months. Results A total of 301 participants completed baseline assessments, 205 in the IT-based arm and 96 in the print-based arm. A total of 124 participants completed all 3 assessments. There were no significant between-group differences in physical activity and dietary behaviors (P≥.05). Participants reported an increased number of minutes and sessions of physical activity at 3 months (exp(β)=1.45, 95% CI 1.09-1.95; exp(β)=1.61, 95% CI 1.17-2.22) and 9 months (exp(β)=1.55, 95% CI 1.14-2.10; exp(β)=1.51, 95% CI 1.15-2.00). Overall dietary behaviors improved at 3 months (exp(β)=1.07, 95% CI 1.03-1.11) and 9 months (exp(β)=1.10, 95% CI 1.05-1.13). The proportion of participants in both groups eating higher-fiber bread and low-fat milk increased at 3 months (exp(β)=2.25, 95% CI 1.29-3.92; exp(β)=1.65, 95% CI 1.07-2.55). Participants in the IT-based arm were less likely to report that 30 minutes of physical activity per day improves health (exp(β)=0.48, 95% CI 0.26-0.90) and more likely to report that vigorous intensity physical activity 3 times per week is essential (exp(β)=1.70, 95% CI 1.02-2.82). The average number of log-ins to the IT platform at 3 and 9 months was 6.99 (SE 0.86) and 9.22 (SE 1.47), respectively. The average number of self-monitoring entries at 3 and 9 months was 16.69 (SE 2.38) and 22.51 (SE 3.79), respectively. Conclusions The ManUp intervention was effective in improving physical activity and dietary behaviors in middle-aged males with no significant differences between IT- and print-based delivery modes. Trial Registration Australian New Zealand Clinical Trials Registry: ACTRN12611000081910; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000081910 (Archived by WebCite at http://www.webcitation.org/6QHIWad63).

WALK 2.0 - using Web 2.0 applications to promote health-related physical activity : a randomised controlled trial protocol

BackgroundPhysical inactivity is one of the leading modifiable causes of death and disease in Australia. National surveys indicate less than half of the Australian adult population are sufficiently active to obtain health benefits. The Internet is a potentially important medium for successfully communicating health messages to the general population and enabling individual behaviour change. Internet-based interventions have proven efficacy; however, intervention studies describing website usage objectively have reported a strong decline in usage, and high attrition rate, over the course of the interventions. Web 2.0 applications give users control over web content generated and present innovative possibilities to improve user engagement. There is, however, a need to assess the effectiveness of these applications in the general population. The Walk 2.0 project is a 3-arm randomised controlled trial investigating the effects of “next generation” web-based applications on engagement, retention, and subsequent physical activity behaviour change.Methods/design504 individuals will be recruited from two sites in Australia, randomly allocated to one of two web-based interventions (Web 1.0 or Web 2.0) or a control group, and provided with a pedometer to monitor physical activity. The Web 1.0 intervention will provide participants with access to an existing physical activity website with limited interactivity. The Web 2.0 intervention will provide access to a website featuring Web 2.0 content, including social networking, blogs, and virtual walking groups. Control participants will receive a logbook to record their steps. All groups will receive similar educational material on setting goals and increasing physical activity. The primary outcomes are objectively measured physical activity and website engagement and retention. Other outcomes measured include quality of life, psychosocial correlates, and anthropometric measurements. Outcomes will be measured at baseline, 3, 12 and 18 months.DiscussionThe findings of this study will provide increased understanding of the benefit of new web-based technologies and applications in engaging and retaining participants on web-based intervention sites, with the aim of improved health behaviour change outcomes.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12611000157976

Effectiveness of a website and mobile phone based physical activity and nutrition intervention for middle-aged males: Trial protocol and baseline findings of the ManUp Study

BackgroundCompared to females, males experience higher rates of chronic disease and mortality, yet few health promotion initiatives are specifically aimed at men. Therefore, the aim of the ManUp Study is to examine the effectiveness of an IT-based intervention to increase the physical activity and nutrition behaviour and literacy in middle-aged males (aged 35–54 years).Method/DesignThe study design was a two-arm randomised controlled trial, having an IT-based (applying website and mobile phones) and a print-based intervention arm, to deliver intervention materials and to promote self-monitoring of physical activity and nutrition behaviours. Participants (n = 317) were randomised on a 2:1 ratio in favour of the IT-based intervention arm. Both intervention arms completed assessments at baseline, 3, and 9 months. All participants completed self-report assessments of physical activity, sitting time, nutrition behaviours, physical activity and nutrition literacy, perceived health status and socio-demographic characteristics. A randomly selected sub-sample in the IT-based (n = 61) and print-based (n = 30) intervention arms completed objective measures of height, weight, waist circumference, and physical activity as measured by accelerometer (Actigraph GT3X). The average age of participants in the IT-based and print-based intervention arm was 44.2 and 43.8 years respectively. The majority of participants were employed in professional occupations (IT-based 57.6%, Print-based 54.2%) and were overweight or obese (IT-based 90.8%, Print-based 87.3%). At baseline a lower proportion of participants in the IT-based (70.2%) group agreed that 30 minutes of physical activity each day is enough to improve health compared to the print-based (82.3%) group (p = .026). The IT-based group consumed a significantly lower number of serves of red meat in the previous week, compared to the print-based group (p = .017). No other significant between-group differences were observed at baseline.DiscussionThe ManUp Study will examine the effectiveness of an IT-based approach to improve physical activity and nutrition behaviour and literacy. Study outcomes will provide much needed information on the efficacy of this approach in middle aged males, which is important due to the large proportions of males at risk, and the potential reach of IT-based interventions.Trial registrationACTRN12611000081910

Using Web 2.0 applications to promote health-related physical activity: findings from the WALK 2.0 randomised controlled trial

Background/Aim Web 2.0 internet technology has great potential in promoting physical activity. This trial investigated the effectiveness of a Web 2.0-based intervention on physical activity behaviour, and the impact on website usage and engagement. Methods 504 (328 women, 126 men) insufficiently active adult participants were randomly allocated to one of two web-based interventions or a paper-based Logbook group. The Web 1.0 group participated in the existing 10 000 Steps programme, while the Web 2.0 group participated in a Web 2.0-enabled physical activity intervention including user-to-user interaction through social networking capabilities. ActiGraph GT3X activity monitors were used to assess physical activity at four points across the intervention (0, 3, 12 and 18 months), and usage and engagement were assessed continuously through website usage statistics. Results Treatment groups differed significantly in trajectories of minutes/day of physical activity (p=0.0198), through a greater change at 3 months for Web 2.0 than Web 1.0 (7.3 min/day, 95% CI 2.4 to 12.3). In the Web 2.0 group, physical activity increased at 3 (mean change 6.8 min/day, 95% CI 3.9 to 9.6) and 12 months (3.8 min/day, 95% CI 0.5 to 7.0), but not 18 months. The Logbook group also increased physical activity at 3 (4.8 min/day, 95% CI 1.8 to 7.7) and 12 months (4.9 min/day, 95% CI 0.7 to 9.1), but not 18 months. The Web 1.0 group increased physical activity at 12 months only (4.9 min/day, 95% CI 0.5 to 9.3). The Web 2.0 group demonstrated higher levels of website engagement (p=0.3964). Conclusions In comparison to a Web 1.0 intervention, a more interactive Web 2.0 intervention, as well as the paper-based Logbook intervention, improved physical activity in the short term, but that effect reduced over time, despite higher levels of engagement of the Web 2.0 group. Trial registration number ACTRN12611000157976.

WALK 2.0: Examining the effectiveness of Web 2.0 features to increase physical activity in a 'real world' setting: an ecological trial

Introduction Low levels of health-enhancing physical activity require novel approaches that have the potential to reach broad populations. Web-based interventions are a popular approach for behaviour change given their wide reach and accessibility. However, challenges with participant engagement and retention reduce the long-term maintenance of behaviour change. Web 2.0 features present a new and innovative online environment supporting greater interactivity, with the potential to increase engagement and retention. In order to understand the applicability of these innovative interventions for the broader population, ‘real-world’ interventions implemented under ‘everyday conditions’ are required. The aim of this study is to investigate the difference in physical activity behaviour between individuals using a traditional Web 1.0 website with those using a novel Web 2.0 website. Methods and analysis In this study we will aim to recruit 2894 participants. Participants will be recruited from individuals who register with a pre-existing health promotion website that currently provides Web 1.0 features (http://www.10000steps.org.au). Eligible participants who provide informed consent will be randomly assigned to one of the two trial conditions: the pre-existing 10 000 Steps website (with Web 1.0 features) or the newly developed WALK 2.0 website (with Web 2.0 features). Primary and secondary outcome measures will be assessed by self-report at baseline, 3 months and 12 months, and include: physical activity behaviour, height and weight, Internet self-efficacy, website usability, website usage and quality of life. Ethics and dissemination This study has received ethics approval from the University of Western Sydney Human Research Ethics Committee (Reference Number H8767) and has been funded by the National Health and Medical Research Council (Reference Number 589903). Study findings will be disseminated widely through peer-reviewed publications, academic conferences and local community-based presentations. Trial registration number Australian New Zealand Clinical Trials Registry Number: ACTRN12611000253909, WHO Universal Trial Number: U111-1119-1755

Associations between quality of life and duration and frequency of physical activity and sedentary behaviour: Baseline findings from the WALK 2.0 randomised controlled trial

While physical and mental health benefits of regular physical activity are well known, increasing evidence suggests that limiting sedentary behaviour is also important for health. Evidence shows associations of physical activity and sedentary behaviour with health-related quality of life (HRQoL), however, these findings are based predominantly on duration measures of physical activity and sedentary behaviour (e.g., minutes/week), with less attention on frequency measures (e.g., number of bouts). We examined the association of HRQoL with physical activity and sedentary behaviour, using both continuous duration (average daily minutes) and frequency (average daily bouts≥10 min) measures. Baseline data from the WALK 2.0 trial were analysed. WALK 2.0 is a randomised controlled trial investigating the effects of Web 2.0 applications on engagement, retention, and subsequent physical activity change. Daily physical activity and sedentary behaviour (duration = average minutes, frequency = average number of bouts ≥10 minutes) were measured (ActiGraph GT3X) across one week, and HRQoL was assessed with the ‘general health’ subscale of the RAND 36-Item Health Survey. Structural equation modelling was used to evaluate associations. Participants (N = 504) were 50.8±13.1 (mean±SD) years old with a BMI of 29.3±6.0. The 465 participants with valid accelerometer data engaged in an average of 24.0±18.3 minutes and 0.64±0.74 bouts of moderate-vigorous physical activity per day, 535.2±83.8 minutes and 17.0±3.4 bouts of sedentary behaviour per day, and reported moderate-high general HRQoL (64.5±20.0). After adjusting for covariates, the duration measures of physical activity (path correlation = 0.294, p<0.05) and sedentary behaviour were related to general HRQoL (path coefficient = -0.217, p<0.05). The frequency measure of physical activity was also significant (path coefficient = -0.226, p<0.05) but the frequency of sedentary behaviour was not significantly associated with general HRQoL. Higher duration levels of physical activity in fewer bouts, and lower duration of sedentary behaviour are associated with better general HRQoL. Further prospective studies are required to investigate these associations in different population groups over time.

What is the impact of obtaining medical clearance to participate in a randomised controlled trial examining a physical activity intervention on the socio-demographic and risk factor profiles of included participants?

BackgroundRequiring individuals to obtain medical clearance to exercise prior to participation in physical activity interventions is common. The impact this has on the socio-demographic characteristic profiles of participants who end up participating in the intervention is not clear.MethodsAs part of the multi-component eligibility screening for inclusion in a three-arm randomised controlled trial examining the efficacy of a web-based physical activity intervention, individuals interested in participating were required to complete the Physical Activity Readiness Questionnaire (PAR-Q). The PAR-Q identified individuals as having lower or higher risk. Higher-risk individuals were required to obtain medical exercise clearance prior to enrolment. Comparisons of the socio-demographic characteristics of the lower- and higher-risk individuals were performed using t tests and chi-square tests (p = 0.05).ResultsA total of 1244 individuals expressed interest in participating, and 432 were enrolled without needing to undergo further screening. Of the 251 individuals required to obtain medical clearance, 148 received clearance, 15 did not receive clearance and 88 did not return any form of clearance. A total of 105 individuals were enrolled after obtaining clearance, and the most frequent reason for being required to seek clearance was for using blood pressure/heart condition medication. Higher-risk individuals were significantly older, had a higher body mass index and engaged in more sedentary behaviour than lower-risk individuals.ConclusionsUse of more inclusive participant screening protocols that maintain high levels of participant safety are encouraged. Allowing individuals to obtain medical clearance to participate can result in including a more diverse population likely to benefit most from participation.Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12611000157976). Registered on 9 February 2011.

Interactive visualisation of time-based vital signs

Vital signs interpretation is an important element of patient monitoring. The use of visualisation could enhance this interpretation. We present a model for time-based visual analytics visualisation of vital signs. Our model allows for multiple vital signs to be charted along a time-based axis. The patient management care team then can apply lenses to alter the view being presented of the data, allowing the viewer to understand the meaning and improve the interpretation. The lenses applied will allow for generalisation, refinement, and traversing.

A Time-based Visualization for Web User Classification in Social Networks

This paper presents a new visual analytics framework for analyzing health-related physical activity data. Existing techniques mostly rely on node-links visualizations to represent the usage patterns as social networks. This work takes a different approach that provides interactive scatter-plot visualizations on classified and time-based data. By providing a flexible visualization that can provide different angles on the multidimensional and classified data, the analyst could have better understanding and insight on web user behavior compared to the traditional social network methods. The effectiveness of our method has been demonstrated with a case study on an online portal system for tracking passive physical activity, called Walk 2.0.