Engaging men in chronic disease prevention is critical as rates of obesity in men continue to increase, coupled with men being less likely to proactively seek preventative health care services.
Objective:
To report on the recruitment and baseline characteristics of a healthy lifestyle program using the power of sport (hockey) to engage men.
Study Design and Analysis:
Cluster randomized controlled trial where 42 sites were randomly assigned to either the intervention or wait-list control group. The intervention group received the Hockey Fans in Training (Hockey FIT) program (3-month active phase; 9-month minimally-supported phase) while the control group continued with usual activities for 12 months.
Setting:
Sites were located across 40 cities in Canada and the U.S., selected based on the availability/interest of both a local major junior/professional hockey team and an implementation partner.
Population Studied:
Men aged 35-65 years with a body mass index (BMI) ≥ 27 kg/m2 and who were fans of the local hockey team. Participants were recruited through the hockey team (i.e., social media, email blasts, website) and using other traditional recruitment methods.
Intervention:
Hockey FIT is a gender-sensitized, off-ice, healthy lifestyle program, designed to appeal to hockey fans through support from their local team and based on men's preferences (e.g., group-based competition, humour, being with like-minded and -sized men).
Outcome Measures:
In-person assessments (weight, height, waist circumference, blood pressure, glycated hemoglobin, fitness) and online questionnaires (physical activity, sedentary time, healthy eating, health-related quality of life, and demographics) were completed at baseline, 3, and 12 months. Accelerometry-based step counters were also used to measure steps over 7 days at each time point.
Results:
1,397 individuals were assessed for eligibility and 997 men were enrolled. Most participants heard about Hockey FIT through social media and team email blasts (41% and 29%, respectively). Participants averaged 48.6 years of age (± 8.3 SD), had mean BMI values of 35.3 kg/m2 (± 6.1), were predominately white, and had varying levels of education.
Conclusions:
By partnering with local hockey teams, we were able to engage men in a healthy lifestyle program. While participants were among the target audience intended for the study, targeted recruitment is needed to attract more diverse populations.
Abstract Background Despite the proven relationship between lifestyle and morbidity and mortality, rates of chronic disease (e.g. obesity) continue to rise in paradox to the myriad of studies supporting lifestyle behaviour change. Men have been less likely to seek out preventative care or lifestyle programs, putting them at risk. In response, Hockey Fans In Training (Hockey FIT) was developed as a group-based, lifestyle intervention leveraging the draw of hockey fandom to engage middle-aged men with overweight or obesity in lifestyle change. Encouraging pilot study results informed the optimization and delivery of the intervention through a cluster randomized controlled trial in 42 sites in Canada and the USA. Methods A process evaluation was conducted to evaluate intervention acceptability and fidelity and adaptations. Community-based sites were randomly allocated to Hockey FIT intervention (immediate program start) or wait-list control (12-month delay). Qualitative process evaluation data were collected from intervention sites and included seven virtual participant focus groups and one interview (n = 35 participants), open-ended participant feedback questionnaires (n = 316), interviews with program coaches (n = 22), post-session coach reflections (n = 233), and interviews with implementation partners (n = 16). A process of content analysis by question was performed and data saturation was reached. Results Themes fell into the following categories: (i) motivations for joining Hockey FIT; (ii) effective program components; and (iii) adaptations and suggested improvements. Conclusions The process evaluation detailed success engaging men in lifestyle change using sport fandom, and the importance of capitalizing further on competition within groups to drive behavioural change through user-friendly supports and greater engagement with hockey. Clinical Trial information ClinicalTrials.gov. ID: NCT03636282
Approximately 1 in 4 Canadian adults are living with obesity, indicating a need to provide accessible, sustainable, and locally tailored programs to manage the disease long-term. HFIT Grad was a 6-week exercise and physical activity pilot program offered to previous participants who completed Hockey FIT (a 12-week healthy lifestyle program for male hockey fans who were overweight or had obesity) within the last 12 months.
Objective:
Evaluate the acceptability of HFIT Grad for promoting maintenance of health behaviours developed in Hockey FIT.
Study Design and Analysis:
Participants who completed HFIT Grad (n=27) were invited to participate in a virtual focus group (FG) over Zoom and program exit survey. FG was recorded, de-identified, and transcribed verbatim. Two researchers analyzed the transcripts and open-ended program exit survey responses thematically.
Setting:
HFIT Grad was delivered at two local community fitness facilities in Ontario, Canada.
Population Studied:
Past male participants who were overweight or had obesity, completed the Hockey FIT Program, and HFIT Grad.
Intervention:
HFIT Grad was delivered for 60 minutes, 2 times a week, across 6 weeks by previous Hockey FIT coaches with a background in fitness. Coaches were trained in the protocol and encouraged to adapt the exercises to fit participant abilities.
Outcome Measures:
One FG and program exit survey responses.
Results:
Participants signed up for HFIT Grad in pursuit of greater accountability in shifting back to or maintaining the health behaviour changes they made during Hockey FIT. HFIT Grad filled a previous gap in the Hockey FIT program by focusing on dynamic and challenging workouts, fostered by the advanced knowledge of the program coaches who were able to adapt, and add equipment that had not been used previously. Getting back together with their Hockey FIT peers was identified as an effective part of the program, increasing the bonds they had to each other and solidifying their commitment to helping each other maintain a healthy lifestyle. Suggestions for program improvement include incorporating check points for nutrition goals, running the program for more than six weeks with longer sessions, and one-on-one or more tailored exercises with more equipment.
Conclusions:
Based on participant feedback, the program was considered acceptable for the purpose of maintaining and improving health behaviour changes developed during Hockey FIT.
HealtheSteps is a 6-month lifestyle program, whereby participants at risk for chronic disease meet bi-monthly with a trained HealtheSteps coach to set prescriptions in the areas of physical activity, exercise, and healthy eating. PURPOSE: A process evaluation was conducted alongside a pragmatic randomized controlled trial to explore the acceptability of delivering HealtheSteps to participants at risk for chronic disease by members of the community working at primary care and health services organizations in Southwestern Ontario. METHODS: Data for the process evaluation included interviews with trained HealtheSteps coaches post-program (month 6) and interviews with participants, 6 months post- program (month 12). All coach interviews (n=12) and a purposeful sample of participant interviews (n=13) were analyzed separately. The sample of participant interviews were selected based on maximum variation in terms of site location, age, gender, ethnicity, marital status, education, occupation, body mass index, average daily step count, and self- rated health. Transcripts were read through by the research team; key themes and exemplar quotes to support these themes were then identified and summarized. RESULTS: Coaches found HealtheSteps was easy to deliver as the focus was only on three key risk factors for chronic disease. Coaches noted group sessions, ensuring participants had the same coach at every session, and evaluating participant readiness prior to beginning the program, could improve the program for future delivery. Participants spoke positively of their coaches and found the program promoted accountability over their healthy lifestyle changes through tracking progress and step counts on the pedometer, and meeting with their coach. Participant suggestions to improve the program included providing pedometers for participants to continue to monitor physical activity, and providing opportunities for the participants to be accountable to their lifestyle changes long-term, once the formal in-person coaching sessions are complete. CONCLUSIONS: HealtheSteps is an acceptable program for improving the lifestyle habits of individuals at risk for chronic disease. Moving forward, the suggestions for improving the program delivery do not require significant changes to the program protocol.
In Canada and the U.S., a greater proportion of men (vs. women) have overweight or obesity. Despite this, men are underrepresented in weight loss research and fewer are recruited into weight loss services.
Objective:
To determine whether participants who received an innovative gender-sensitized healthy lifestyle program (Hockey Fans in Training: Hockey FIT) would have greater weight loss and reduced waist circumference (WC), after 3 and 12 months, compared with a wait-list control group.
Study Design and Analysis:
Cluster randomized controlled trial whereby 42 sites were randomly assigned to either the intervention (i.e., Hockey FIT) or a wait-list control group (i.e., usual activities for 12 months). Analyses were conducted using linear mixed effects models for cluster design and repeated measures.
Setting:
Sites in Canada and the U.S. were selected based on availability/interest of both a local major junior/professional hockey team and a community implementation partner (e.g., YMCA).
Population Studied:
Men aged 35-65 years with a body mass index (BMI) ≥27 kg/m2, recruited primarily through the hockey team's social media and email communications.
Intervention:
Hockey FIT is an office, group-based program, designed to appeal to hockey fans through support from their local team and is grounded in men's preferences (e.g., competition, humour). During the 3-month active phase, participants attended 12 weekly, 90-minute sessions incorporating both education and exercise, and led by certified coaches. During the 9-month minimally-supported phase, participants were encouraged to sustain their health behaviour changes.
Outcome Measures:
In-person assessments were completed at baseline, 3 and 12 months, and included measurements of weight, height, and WC.
Results:
Participants (n=997) averaged 48.6 years of age (± 8.3 SD) and had mean baseline BMI values of 35.3 kg/m2 (± 6.1). By 3 months, participants in the Hockey FIT group lost 2.50 kg more (95% CI -3.36 to -1.64, p<0.0001) than the wait-list control group, and by 12 months this difference between groups remained (-1.61 kg, 95% CI: -2.55 to -0.67, p=0.001). Similarly, Hockey FIT led to greater WC reduction at both 3 and 12 months, compared with the wait-list control group.
Conclusions:
A gender-sensitized healthy lifestyle program for men, using the power of sport as an engagement strategy, had a positive impact on both short and long-term weight-related outcomes.
Physical inactivity, sedentary behavior, and poor diet are contributing to the rise in chronic disease rates throughout the world. HealtheSteps™ is a lifestyle prescription program focused on reducing risk factors for chronic disease through in-person coaching sessions, goal setting and tracking, and technology supports. A process evaluation was conducted alongside a pragmatic randomized controlled trial to: (a) explore the acceptability of HealtheSteps™ program from coach and participant perspectives; and (b) identify where the program can be improved. Participants at risk or diagnosed with a chronic disease were recruited from five primary care/health services organizations into HealtheSteps™. Participants met with a trained coach bi-monthly for 6 months and set goals for physical activity (step counts), exercise (moderate to vigorous activity), and healthy eating. Coaches were interviewed at month 6 and participants at month 12 (6 months postprogram). All coach interviews (n = 12) were analyzed along with a purposeful sample of participant interviews (n = 13). Coaches found that HealtheSteps™ was easy to deliver and recommendations for exercise and healthy eating were helpful. Including discussions on participant readiness to change, along with group sessions, and more in-depth healthy eating resources were suggested by coaches to improve the program. Participants described the multiple avenues of accountability provided in the program as helpful. However, more feedback and interaction during and postprogram from coaches were suggested by participants. HealtheSteps™ is an acceptable program from the perspectives of both coaches and participants with suggested improvements not requiring significant changes to the core program design.
