Suzanne McDonald

The features of interventions associated with long-term effectiveness of physical activity interventions in adults aged 55-70 years: a systematic review and meta-analysis

Content, delivery and effects of physical activity (PA) interventions are heterogeneous. There is a need to identify intervention features (content and delivery) related to long-term effectiveness. Behaviour change techniques (BCTs) and modes of intervention delivery were coded in 19 randomised controlled trials included in a systematic review of PA interventions for adults aged 55–70 years, published between 2000 and 2010, with PA outcomes ≥12 months after randomisation; protocol registration: PROSPERO CRD42011001459. Meta-analysis, moderator analyses and meta-regression were conducted. Meta-analysis revealed that interventions were effective in promoting PA compared with no/minimal intervention comparators [d = 0.29, 95% CI = 0.19–0.40, I2 = 79.8%, Q-value = 89.16 (df = 18, p < 0.01)]. Intervention features often concurred and goal setting was the most commonly used BCT. Subgroup analyses suggested that interventions using the BCT feedback may be more effective, whilst interventions using printed materials or the BCTs information on where and when to perform the behaviour and information on consequences of behaviour to the individual may be less effective. Meta-regression revealed that neither the number of BCTs nor self-regulatory BCTs significantly related to effect size. Feedback appears to be a potentially effective candidate BCT for future interventions promoting long-term PA. Considering concurrence of intervention features alongside moderator analyses is important.

The state of the art and future opportunities for using longitudinal n-of-1 methods in health behaviour research: a systematic literature overview.

ABSTRACT n-of-1 studies test hypotheses within individuals based on repeated measurement of variables within the individual over time. Intra-individual effects may differ from those found in between-participant studies. Using examples from a systematic review of n-of-1 studies in health behaviour research, this article provides a state of the art overview of the use of n-of-1 methods, organised according to key methodological considerations related to n-of-1 design and analysis, and describes future challenges and opportunities. A comprehensive search strategy (PROSPERO:CRD42014007258) was used to identify articles published between 2000 and 2016, reporting observational or interventional n-of-1 studies with health behaviour outcomes. Thirty-nine articles were identified which reported on n-of-1 observational designs and a range of n-of-1 interventional designs, including AB, ABA, ABABA, alternating treatments, n-of-1 randomised controlled trial, multiple baseline and changing criterion designs. Behaviours measured included treatment adherence, physical activity, drug/alcohol use, sleep, smoking and eating behaviour. Descriptive, visual or statistical analyses were used. We identify scope and opportunities for using n-of-1 methods to answer key questions in health behaviour research. n-of-1 methods provide the tools needed to help advance theoretical knowledge and personalise/tailor health behaviour interventions to individuals.

Randomised Controlled Feasibility Trial of an Evidence-Informed Behavioural Intervention for Obese Adults with Additional Risk Factors

Background Interventions for dietary and physical activity changes in obese adults may be less effective for participants with additional obesity-related risk factors and co-morbidities than for otherwise healthy individuals. This study aimed to test the feasibility and acceptability of the recruitment, allocation, measurement, retention and intervention procedures of a randomised controlled trial of an intervention to improve physical activity and dietary practices amongst obese adults with additional obesity related risk factors. Method Pilot single centre open-labelled outcome assessor-blinded randomised controlled trial of obese (Body Mass Index (BMI)≥30 kg/m2) adults (age≥18 y) with obesity related co-morbidities such as type 2 diabetes, impaired glucose tolerance or hypertension. Participants were randomly allocated to a manual-based group intervention or a leaflet control condition in accordance to a 2∶1 allocation ratio. Primary outcome was acceptability and feasibility of trial procedures, secondary outcomes included measures of body composition, physical activity, food intake and psychological process measures. Results Out of 806 potentially eligible individuals identified through list searches in two primary care general medical practices N = 81 participants (63% female; mean-age = 56.56(11.44); mean-BMI = 36.73(6.06)) with 2.35(1.47) co-morbidities were randomised. Scottish Index of Multiple Deprivation (SIMD) was the only significant predictor of providing consent to take part in the study (higher chances of consent for invitees with lower levels of deprivation). Participant flowcharts, qualitative and quantitative feedback suggested good acceptance and feasibility of intervention procedures but 34.6% of randomised participants were lost to follow-up due to overly high measurement burden and sub-optimal retention procedures. Participants in the intervention group showed positive trends for most psychological, behavioural and body composition outcomes. Conclusions The intervention procedures were found to be acceptable and feasible. Attrition rates were unacceptably high and areas for improvements of trial procedures were identified. Trial Registration Controlled-Trials.com ISRCTN90101501

Dynamic modelling of n-of-1 data: powerful and flexible data analytics applied to individualised studies

ABSTRACT N-of-1 studies are based on repeated observations within an individual or unit over time and are acknowledged as an important research method for generating scientific evidence about the health or behaviour of an individual. Statistical analyses of n-of-1 data require accurate modelling of the outcome while accounting for its distribution, time-related trend and error structures (e.g., autocorrelation) as well as reporting readily usable contextualised effect sizes for decision-making. A number of statistical approaches have been documented but no consensus exists on which method is most appropriate for which type of n-of-1 design. We discuss the statistical considerations for analysing n-of-1 studies and briefly review some currently used methodologies. We describe dynamic regression modelling as a flexible and powerful approach, adaptable to different types of outcomes and capable of dealing with the different challenges inherent to n-of-1 statistical modelling. Dynamic modelling borrows ideas from longitudinal and event history methodologies which explicitly incorporate the role of time and the influence of past on future. We also present an illustrative example of the use of dynamic regression on monitoring physical activity during the retirement transition. Dynamic modelling has the potential to expand researchers’ access to robust and user-friendly statistical methods for individualised studies.

N-of-1 randomised controlled trials in health psychology and behavioural medicine: A commentary on Nyman et al., 2016

N-of-1 Randomised Controlled Trials (N-of-1 RCTs) are an important recent addition to the repertoire of study designs in health psychology and behavioural medicine. They provide an opportunity to e...

Does physical activity and sedentary behavior change during the retirement transition? Findings from a series of novel N-of-1 natural experiments

A systematic review of randomized controlled trials studying the preventive effects of physical exercise, manual and behavioural treatments in acute low back pain and neck painIntroduction: The global financial crisis has left governments struggling to reduce their budget deficits. Loans and taxes are two important financial instruments for governments to close their budget gaps. According to models of temporal discounting and expected utility individuals should experience loans as a greater loss than taxes, depleting psychological resources and reducing individuals’ capacity to cope with stressors. The present research examined patterns of cardiovascular (CV) reactivity associated with exposure to loans or taxes. Methods: We randomised 73 students to one of three groups: loans, taxes, control (baseline). Participants in the experimental groups imagined finishing university with debts and having to repay the sums outstanding as a proportion of their salaried income over the next 30 years either via a loan repayment, or via taxes. Participants in the control group imagined finishing university, and then working in salaried employment over the next 30 years. All participants then performed a variant of the Trier Social Stress Test (TSST), whilst CV responses were monitored [BP (blood pressure), ECG (electrocardiogram), ICG (impedance cardiogram)]. Results: Compared to the control group, participants in the loan group exhibited maladaptive CV responses during the stress task (higher BP and higher total peripheral resistance [TPR]). Conversely, participants in the taxes group exhibited more adaptive CV responses and did not differ from the control group. Conclusions: Economic considerations have dominated debates surrounding macro-financial performance. The present research highlights the need to consider the psychological costs and benefits of tax-based and loan-based financial instruments.

N-of-1 methods in health behaviour research: a systematic review

A systematic review of randomized controlled trials studying the preventive effects of physical exercise, manual and behavioural treatments in acute low back pain and neck painIntroduction: The global financial crisis has left governments struggling to reduce their budget deficits. Loans and taxes are two important financial instruments for governments to close their budget gaps. According to models of temporal discounting and expected utility individuals should experience loans as a greater loss than taxes, depleting psychological resources and reducing individuals’ capacity to cope with stressors. The present research examined patterns of cardiovascular (CV) reactivity associated with exposure to loans or taxes. Methods: We randomised 73 students to one of three groups: loans, taxes, control (baseline). Participants in the experimental groups imagined finishing university with debts and having to repay the sums outstanding as a proportion of their salaried income over the next 30 years either via a loan repayment, or via taxes. Participants in the control group imagined finishing university, and then working in salaried employment over the next 30 years. All participants then performed a variant of the Trier Social Stress Test (TSST), whilst CV responses were monitored [BP (blood pressure), ECG (electrocardiogram), ICG (impedance cardiogram)]. Results: Compared to the control group, participants in the loan group exhibited maladaptive CV responses during the stress task (higher BP and higher total peripheral resistance [TPR]). Conversely, participants in the taxes group exhibited more adaptive CV responses and did not differ from the control group. Conclusions: Economic considerations have dominated debates surrounding macro-financial performance. The present research highlights the need to consider the psychological costs and benefits of tax-based and loan-based financial instruments.

A meta-analysis of physical activity interventions in the 'retirement window'

Background: Theorised pathways in an ‘extended’ common-sense model of illness representations (CSM) in those affected by Irritable Bowel Syndrome (IBS) were examined. Analysis contrasted between those using complementary medicines (CAM-users) and those not using CAM (non-users). Methods: A web-based cross-sectional survey. Participants (n=653) were recruited from an IBS self-help network and other online illness discussion forums and assessed on the IPQ-R, the BMQ-General, the Brief-COPE and IBS-QOL. Findings: CAM-users reported poorer quality of life compared to non-users. Stronger perceptions of illness consequences and emotional representations were strongly correlated with reduced quality of life and poorer emotional outcomes in both groups. Self-blame and behavioural disengagement partially mediated the pathway from perception to outcome. Discussion: Findings suggest consistency with CSM theory. The detected influence of representations on quality of life (via coping strategies) suggests health psychologists could address components of illness perceptions to improve quality of life in those affected by IBS.Background: Psychological preparation has been demonstrated to improve post-operative outcomes including pain and health care resource use. This systematic review (registered with the Cochrane Anaesthesia Review Group) will investigate which methods of preparation are effective and for which outcomes. Economic data will be reviewed where available. Methods: Randomised controlled trials (RCTs) of adults undergoing elective surgery under general anaesthesia are included. Papers are identified using electronic searches, reference lists and contact with authors of studies to identify unpublished research. Expected results: In a meta-analysis including 38 RCTs, Johnston and Vogele (1993) found psychological preparation to be effective in improving various postoperative outcomes. It is expected that this up-dated review will provide further evidence about which techniques are effective because more studies are now available. Current stage of work: Papers are being screened for inclusion. Discussion: Identifying effective pre-surgical interventions may result in improved patient outcomes and healthcare resource use.[Extract] Background: Qualities of resilience have been strongly identified within farming populations. This resilience is being challenged, with high suicide rates raising concerns about the mental health of the farming population. This research explored those factors which impacted the resilience of farming families of Australia. Methods: Interviews were conducted (N=53 participants) and analysed using Grounded Theory and Content Analysis. Based on qualitative findings, a subsequent sample (N=278) of farming families from across Australia completed the survey. Measures of stressors, work-life balance, coping, buffering characteristics and well-being were distributed. Findings: Outcomes suggested themes of commitment and identification with farming helped build resilience. Path analysis indicated that buffering characteristics mediated and moderated the impact of stressors and role interference on indicators of well-being, χ² (18)=23.98, p=0.156. Discussion: Recommendations were made for raising awareness to the farming community of the risk factors for poor health and suggestions for increasing the resilience of groups at-risk of poor well-being.Resiliance and Health - 26th Conference of the European Health Psychology Society, Prague, Czech Republic, 21st - 25th August 2012Using two behavioral risk tasks (Balloon Analogue Risk Task BART; Lejuez et al. 2002 and Columbia Card Task, CCT; Figner et al. 2009) that mimic important features of real-world risk taking behaviors, we investigated the effects of different types of negative affect on risk taking. Methods: Participants (N¼50) were first administered the Hospital Anxiety and Depression Scale (HADS; Zigmond et al. 1983). One month later, they completed the BART and the cold CCT, in counterbalanced order. State mood was assessed before participants played the CCT and BART. Findings: Higher levels of anxiety were associated with less risk taking in both tasks; depression was unrelated to risk taking. Hierarchical regression analysis showed that these findings were robust to mood effects. Discussion: Findings from the current study indicated that healthy subjects’ risk taking tendencies vary between anxiety and depression. Implications for prevention of health risks are discussed. 194 EHPS 2012 abstracts Downloaded byBackground: Physical exercise contributes to healthy ageing, and strength training has beenshown to improve independence in older people.Method: Six hundred older people wererandomly selected from ...Background: Conceptual clarification of salutogenesis (Antonovsky 1987) and resilience – what is common and different? Methods: A systematic research synthesis 1992–2010 based on about 1300 papers ...Resiliance and Health - 26th Conference of the European Health Psychology Society, Prague, Czech Republic, 21st - 25th August 2012This conference abstract looks provides an analysis of the behaviour change techniques used in Scottish Government supported behaviour change interventionsBackground: The aim of this research was to examine variables that influence attention to health information in order to develop a predictive model. Methods: Community participants(N=330) were randomly assigned to one of two conditions presenting information about coronary heart disease (CHD) or road accidents. Information was either risk or neutral in valency. Attention to information was measured using a surprise recall task. Other variables measured included perceived risk, optimism, control and coping strategies. Findings: Overall, participants in the CHD condition remembered significantly more risk information than participants in the road condition. Participants in the road condition endorsed significantly lower beliefs in personal control perceptions while also endorsing greater beliefs in other’s control over their own road outcomes. Discussion: While perceived control is usually emphasised as integral in adopting protective behaviours these findings suggest that they are also central in communicating health information.

Physical activity in the retirement window: A theory-based interview study

Background: Theorised pathways in an ‘extended’ common-sense model of illness representations (CSM) in those affected by Irritable Bowel Syndrome (IBS) were examined. Analysis contrasted between those using complementary medicines (CAM-users) and those not using CAM (non-users). Methods: A web-based cross-sectional survey. Participants (n=653) were recruited from an IBS self-help network and other online illness discussion forums and assessed on the IPQ-R, the BMQ-General, the Brief-COPE and IBS-QOL. Findings: CAM-users reported poorer quality of life compared to non-users. Stronger perceptions of illness consequences and emotional representations were strongly correlated with reduced quality of life and poorer emotional outcomes in both groups. Self-blame and behavioural disengagement partially mediated the pathway from perception to outcome. Discussion: Findings suggest consistency with CSM theory. The detected influence of representations on quality of life (via coping strategies) suggests health psychologists could address components of illness perceptions to improve quality of life in those affected by IBS.Background: Psychological preparation has been demonstrated to improve post-operative outcomes including pain and health care resource use. This systematic review (registered with the Cochrane Anaesthesia Review Group) will investigate which methods of preparation are effective and for which outcomes. Economic data will be reviewed where available. Methods: Randomised controlled trials (RCTs) of adults undergoing elective surgery under general anaesthesia are included. Papers are identified using electronic searches, reference lists and contact with authors of studies to identify unpublished research. Expected results: In a meta-analysis including 38 RCTs, Johnston and Vogele (1993) found psychological preparation to be effective in improving various postoperative outcomes. It is expected that this up-dated review will provide further evidence about which techniques are effective because more studies are now available. Current stage of work: Papers are being screened for inclusion. Discussion: Identifying effective pre-surgical interventions may result in improved patient outcomes and healthcare resource use.[Extract] Background: Qualities of resilience have been strongly identified within farming populations. This resilience is being challenged, with high suicide rates raising concerns about the mental health of the farming population. This research explored those factors which impacted the resilience of farming families of Australia. Methods: Interviews were conducted (N=53 participants) and analysed using Grounded Theory and Content Analysis. Based on qualitative findings, a subsequent sample (N=278) of farming families from across Australia completed the survey. Measures of stressors, work-life balance, coping, buffering characteristics and well-being were distributed. Findings: Outcomes suggested themes of commitment and identification with farming helped build resilience. Path analysis indicated that buffering characteristics mediated and moderated the impact of stressors and role interference on indicators of well-being, χ² (18)=23.98, p=0.156. Discussion: Recommendations were made for raising awareness to the farming community of the risk factors for poor health and suggestions for increasing the resilience of groups at-risk of poor well-being.Resiliance and Health - 26th Conference of the European Health Psychology Society, Prague, Czech Republic, 21st - 25th August 2012Using two behavioral risk tasks (Balloon Analogue Risk Task BART; Lejuez et al. 2002 and Columbia Card Task, CCT; Figner et al. 2009) that mimic important features of real-world risk taking behaviors, we investigated the effects of different types of negative affect on risk taking. Methods: Participants (N¼50) were first administered the Hospital Anxiety and Depression Scale (HADS; Zigmond et al. 1983). One month later, they completed the BART and the cold CCT, in counterbalanced order. State mood was assessed before participants played the CCT and BART. Findings: Higher levels of anxiety were associated with less risk taking in both tasks; depression was unrelated to risk taking. Hierarchical regression analysis showed that these findings were robust to mood effects. Discussion: Findings from the current study indicated that healthy subjects’ risk taking tendencies vary between anxiety and depression. Implications for prevention of health risks are discussed. 194 EHPS 2012 abstracts Downloaded byBackground: Physical exercise contributes to healthy ageing, and strength training has beenshown to improve independence in older people.Method: Six hundred older people wererandomly selected from ...Background: Conceptual clarification of salutogenesis (Antonovsky 1987) and resilience – what is common and different? Methods: A systematic research synthesis 1992–2010 based on about 1300 papers ...Resiliance and Health - 26th Conference of the European Health Psychology Society, Prague, Czech Republic, 21st - 25th August 2012This conference abstract looks provides an analysis of the behaviour change techniques used in Scottish Government supported behaviour change interventionsBackground: The aim of this research was to examine variables that influence attention to health information in order to develop a predictive model. Methods: Community participants(N=330) were randomly assigned to one of two conditions presenting information about coronary heart disease (CHD) or road accidents. Information was either risk or neutral in valency. Attention to information was measured using a surprise recall task. Other variables measured included perceived risk, optimism, control and coping strategies. Findings: Overall, participants in the CHD condition remembered significantly more risk information than participants in the road condition. Participants in the road condition endorsed significantly lower beliefs in personal control perceptions while also endorsing greater beliefs in other’s control over their own road outcomes. Discussion: While perceived control is usually emphasised as integral in adopting protective behaviours these findings suggest that they are also central in communicating health information.