BACKGROUND Despite the known health benefits of physical activity (PA), less than half and less than one-third of older adults in Germany reach the PA recommendations for endurance training and strength training, respectively, of the World Health Organization. The aim of this study is to investigate the implementation and effectiveness over the course of 9 months of two interventions (information technology [IT]-based vs print-based) for PA promotion among initially inactive older adults in a randomized, crossover trial. This study is part of a large research consortium (2015-2021) investigating different aspects of PA promotion. The IT-based intervention was previously developed and refined, while the print-based intervention was newly developed during this funding phase. OBJECTIVE We aim to compare the effectiveness and examine the preferences of study participants regarding both delivery modes. METHODS Our target sample size was 390 initially inactive community-dwelling older adults aged ≥60 years at baseline (3-month follow-up [T1]: expected n=300; 9-month follow-up [T2]: expected n=240) who were randomized to one of two interventions for self-monitoring PA: IT-based (50%) or print-based (50%) intervention. In addition, 30% of the IT-based intervention group received a PA tracker. At T1, participants in both groups could choose whether they prefered to keep their assigned intervention or cross over to the other group for the following 6 months (T2). Participants’ intervention preferences at baseline were collected retrospectively to run a post hoc matched-mismatched analysis. During the initial 3-month intervention period, both intervention groups were offered weekly group sessions that were continued monthly between T1 and T2. A self-administered questionnaire and 3D accelerometers were employed to assess changes in PA between baseline, T1, and T2. Adherence to PA recommendations, attendance at group sessions, and acceptance of the interventions were also tracked. RESULTS The funding period started in February 2018 and ends in January 2021. We obtained institutional review board approval for the study from the Medical Association in Bremen on July 3, 2018. Data collection was completed on January 31, 2020, and data cleaning and analysis started in February 2020. We expect to publish the first results by the end of the funding period. CONCLUSIONS Strategies to promote active aging are of particular relevance in Germany, as 29% of the population is projected to be ≥65 years old by 2030. Regular PA is a key contributor to healthy aging. This study will provide insights into the acceptance and effectiveness of IT-based vs print-based interventions to promote PA in initially inactive individuals aged ≥60 years. Results obtained in this study will improve the existing evidence base on the effectiveness of community-based PA interventions in Germany and will inform efforts to anchor evidence-based PA interventions in community structures and organizations via an allocation of permanent health insurance funds. CLINICALTRIAL German Registry of Clinical Trials DRKS00016073; https://tinyurl.com/y983586m INTERNATIONAL REGISTERED REPORT DERR1-10.2196/15168
A systematic review was conducted to evaluate the impact of public smoking bans on social inequalities in children's secondhand smoke (SHS) exposure at home.Five databases were electronically searched for articles on children's SHS exposure at home related to public smoking bans. In addition, the gray literature and German public health journals were considered. Search was restricted to English and German publications. Of 3037 records screened, 25 studies fulfilled the inclusion criteria by either measuring SHS exposure before and after public smoking ban introduction or by comparing exposure between regions with and without smoke-free legislation. Studies were further examined whether they additionally reported on impacts on social inequalities in SHS exposure. Information on children's SHS exposure at home in relation to smoke-free legislation were extracted by one reviewer and checked for accuracy by a second reviewer. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity (PRISMA-E) guidelines for equity-focused systematic reviews, the PROGRESS-Plus framework was applied to data extraction and analysis with focus on social inequalities in SHS exposure. Results were visualized by a harvest plot.Eight studies gave results on the impact of public smoking bans on social inequalities in children's SHS exposure. Whereas only one study indicated widening of the social gap in exposure, seven studies showed no impact or a reduction of social inequalities in exposure.First evidence on short-term impact of public smoking bans does not support the assumption of intervention-generated inequalities in children's SHS exposure at home. Future studies should focus on long-term equity impacts of smoke-free legislation.There are substantial social inequalities in children's SHS exposure in many countries. Both hypotheses on the effect of smoke-free legislation on children's SHS exposure at home, the displacement hypothesis and the social diffusion hypothesis, did not take social inequalities into account. Up to now, only few studies analyzed the effects of smoke-free legislation on social inequalities in children's SHS exposure at home. Public smoking bans had overall no negative impact on social inequalities in children's SHS exposure at home. More consistent reporting of absolute and relative inequalities is needed to comprehensively assess equity impact of smoke-free legislation.
(1) Background: Basic vital signs change during normal pregnancy as they reflect the adaptation of maternal physiology. Electronic wearables like fitness bracelets have the potential to provide vital signs continuously in the home environment of pregnant women. (2) Methods: We performed a prospective observational study from November 2019 to November 2020 including healthy pregnant women, who recorded their wrist skin temperature, heart rate, heart rate variability, and breathing rate using an electronic wearable. In addition, eight emotions were assessed weekly using five-point Likert scales. Descriptive statistics and a multivariate model were applied to correlate the physiological parameters with maternal emotions. (3) Results: We analyzed data from 23 women using the electronic wearable during pregnancy. We calculated standard curves for each physiological parameter, which partially differed from the literature. We showed a significant association of several emotions like feeling stressed, tired, or happy with the course of physiological parameters. (4) Conclusions: Our data indicate that electronic wearables are helpful for closely observing vital signs in pregnancy and to establish modern curves for the physiological course of these parameters. In addition to physiological adaptation mechanisms and pregnancy disorders, emotions have the potential to influence the course of physiological parameters in pregnancy.
Abstract Background Despite the crucial role of regular physical activity (PA) for preventing chronic non-communicable diseases, fewer than half of older adults in Germany engage in the recommended levels. Objective: The aim of this study was to compare acceptance and effectiveness of two interventions for PA promotion among initially inactive community-dwelling adults aged 60 years and above in a nine-month randomized trial with a cross-over design. Methods Participants were recruited offline and randomized to (a) a print-based intervention (PRINT n = 113) and (b) a web-based intervention (WEB, n = 129). Thirty percent (n = 38) of those in group (b) received a PA tracker in addition to WEB (WEB+, (c)). All intervention groups were offered ten weekly face-to-face group sessions led by trained student assistants. Afterwards, participants could choose to stay in their group or cross over to one of the other groups. Group sessions were continued monthly for another six months. Three-dimensional accelerometers to assess PA at baseline (T0), three-months (T1) and nine-months (T2) were employed. Intervention acceptance was assessed via self-administered paper-based questionnaires. Linear mixed models were used to calculate differences in moderate-to-vigorous PA (MVPA) between time points and intervention groups. Results Of the initially recruited n = 242 participants, n = 91 (37.6%) were randomized to the WEB group, n = 38 (15.7%) to WEB+ and n = 113 (46.7%) to PRINT and n = 195 participants completed T1. Only n = 1 moved from WEB to PRINT and n = 15 from PRINT to WEB (WEB-WEB: n = 103, PRINT-PRINT: n = 76), when offered to cross over at T1. One-hundred and sixty participants completed T2. MVPA in min per day increased between baseline and T1, but these within-group changes in time disappeared after adjusting for covariates. MVPA decreased by 9 min/day between baseline and T2 (βtime = -9.37, 95% CI: [-18.58; -0.16]), regardless of intervention group (WEB vs. PRINT: βgroup*time = -3.76, 95% CI: [-13.33; 5.82], WEB+ vs. PRINT: βgroup*time = 1.40, 95% CI: [-11.04; 13.83]). Intervention acceptance was generally high. Conclusions Despite high levels of acceptance of web- and print-based interventions for PA promotion and little movement between groups at T1, when given the choice, participation was not associated with increases in PA over time.
BACKGROUND Physical activity (PA) is associated with health benefits such as fewer depressive symptoms. Little is known about whether and how web- and print-based PA interventions work in comparison to a waiting list control group, especially in older individuals. OBJECTIVE Are interventions delivered in a web- or print mode effective with regard to self-reported PA, stage of change, social-cognitive determinants of PA, and feelings of loneliness and symptoms of depression? Is subjective age a mediator and stage of change a moderator of the effect? METHODS n=589 and n=242 older adults 60+ years were recruited and allocated to a print-based or a web-based intervention or assigned to a waiting list control group (WLCG) within two community-based intervention trials over 10 weeks. Missing value imputation using an Expectation Maximization algorithm was applied. Pooled frequency analyses, MANOVA and moderated mediation analyses were conducted. RESULTS Among the 91 individuals not meeting the endurance training recommendation regarding PA based on self-report, more individuals became active if they were exposed to the web-based intervention (47 out of 59=79.7%) or received the print-based intervention (20/25=80.0%) vs. WLCG (5/7=71.4%; difference was not significant with Chi²(df=2)=0.273, p=.872). Of the 630 individuals meeting the recommendation regarding PA prior to the study, more individuals remained active if they were exposed to the web-based intervention (396/411=96.4%) or WLCG (141/150=94.0%) compared to the ones receiving the print-based intervention (63/69=91.3%). A significant difference was observed favoring the two intervention groups over and above the WLCG with F(19, 701)= 4.778; p<.001; Eta²=.098 and a significant interaction of time and group with F(19, 701)= 2.778; p<.001; Eta²=.070 for the predictors of behavior. The effect of the interventions on subjective age, loneliness and symptoms of depression revealed that both between-groups effects (F(3, 717)=8.668; p<.001; Eta²=.018) and the interaction of group and time were significant (F(3, 717)=6.101; p<.001; Eta²=.025). Both interventions had a significant direct effect on symptoms of depression in comparison to WLCG: WEBc’-path=-0.86 [-1.58, -0.13], SE=0.38; PRINTc’-path=-1.96 [-2.99, -0.92], SE=0.53 (validating the previous analyses). Furthermore, subjective age showed a significant effect on symptoms of depression: Sageb-path=0.14 [0.05, 0.23], SE=0.05. An indirect effect of the intervention on symptoms of depression via subjective age was only present for participants who were in actor stage and received the web-based intervention: WEBab-path=-0.14 [-0.34, -0.01], SE=0.09. CONCLUSIONS The web-based intervention appears to be as effective as the print-based intervention. Both modes of delivery might help older individuals to remain or become active: Therefore, they may benefit in terms of successful aging and may have fewer symptoms of depression. CLINICALTRIAL German Registry of Clinical Trials, 11 July 2016, number: DRKS00010052 (PROMOTE I) & German Registry of Clinical Trials, 10 January 2019, number: DRKS00016073 (PROMOTE II) INTERNATIONAL REGISTERED REPORT RR2-10.2196/15168
Background Web‐based, theory‐driven interventions effectively promote older adults’ physical activity. Social‐cognitive mechanisms of their effect on stage of change need to be further researched. Methods Older adults were randomly allocated to intervention group 1 (10‐week online physical activity program), intervention group 2 (same program plus activity tracker), or delayed intervention control group; n = 351 were analyzed (59.6% of originally allocated individuals). Stages of change for recommended endurance and strength training and social‐cognitive predictors of physical activity were assessed using questionnaires at baseline and follow‐up. Intervention effects and mediation were investigated using mixed‐effects ANOVA and ordinal least squares regression. Results Direct effects on stage of change were found for intervention group 1 regarding endurance training ( b intervention group 1 = 0.44, 95% confidence interval [0.15, 0.73]), and both groups regarding strength training ( b intervention group 1 = 1.02, [0.71, 1.33], b intervention group 2 = 1.24, [0.92, 1.56]). Social‐cognitive predictor changes in task self‐efficacy, intention, and action planning explained intervention effect on stage of change, but not to the full extent. Conclusions The results indicate significant web‐based intervention effects on physical activity stage, partly mediated by changes in task self‐efficacy, intention, and action planning.
As part of the AEQUIPA prevention research network, the aim of the PROMOTE II study was to gain insights into primary prevention for healthy aging. One focus was on the development and dissemination of ready-to-use tools and work aids to promote physical activity. As part of a nine-month randomized trial with a cross-over design among adults aged 60 and above, eligible participants from 14 districts in Bremen in proximity to the two study centers (one in the North and one in the East of the city of Bremen, Germany) were randomly assigned to either a) a print-based intervention (PRINT) or b) a web-based intervention (WEB). Randomly selected thirty percent of the web-based intervention group received an activity tracker in addition (WEB+). Usage of program components, attendance of group sessions and acceptance of the intervention were assessed via self-administered paper-based questionnaires three and nine months after baseline as well as feedback interviews and class recordings. Participant feedback was analyzed using quantitative methods on a descriptive basis, as well as using qualitative content analysis of open-ended questions, group-interviews and protocols based on the socio-ecological model as coding framework. This publication provides the coding matrix, including the participant feedback data.
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