Web-Based Versus Print-Based Physical Activity Intervention for Community-Dwelling Older Adults: Crossover Randomized Trial

Abstract

Background Fewer than half of older German adults engage in the recommended levels of endurance training. Objective The study aim is to compare the acceptance and effectiveness of two interventions for physical activity (PA) promotion among initially inactive community-dwelling older adults ≥60 years in a 9-month, crossover randomized trial. Methods Participants were recruited in person and randomized to one of the following interventions for self-monitoring PA: a print-based intervention (PRINT: 113/242, 46.7%) or a web-based intervention (WEB: 129/242, 53.3%). Furthermore, 29.5% (38/129) of those in the web-based intervention group received a PA tracker in addition to WEB (WEB+). After randomization, the participants and researchers were not blinded. The participants’ baseline intervention preferences were retrospectively assessed. All the intervention groups were offered 10 weekly face-to-face group sessions. Afterward, participants could choose to stay in their group or cross over to one of the other groups, and group sessions were continued monthly for another 6 months. 3D accelerometers to assess PA and sedentary behavior (SB) at baseline (T0), 3-month follow-up (T1), and 9-month follow-up (T2) were used. Adherence to PA recommendations, attendance of group sessions, and intervention acceptance were assessed using self-administered paper-based questionnaires. Linear mixed models were used to calculate differences in moderate to vigorous PA (MVPA) and SB between time points and intervention groups. Results Of the 242 initially recruited participants, 91 (37.6%) were randomized to the WEB group; 38 (15.7%) to the WEB+ group; and 113 (46.7%) to the PRINT group. Overall, 80.6% (195/242) of the participants completed T1. Only 0.4% (1/242) of the participants changed from the WEB group to the PRINT group and 6.2% (15/242) moved from the PRINT group to the WEB group (WEB-WEB: 103/249, (41.4%); PRINT-PRINT: 76/249, 30.5%) when offered to cross over at T1. Furthermore, 66.1% (160/242) of participants completed T2. MVPA in minutes per day increased between baseline and T1, but these within-group changes disappeared after adjusting for covariates. MVPA decreased by 9 minutes per day between baseline and T2 (βtime=−9.37, 95% CI −18.58 to −0.16), regardless of the intervention group (WEB vs PRINT: βgroup*time=−3.76, 95% CI −13.33 to 5.82, WEB+ vs PRINT: βgroup*time=1.40, 95% CI −11.04 to 13.83). Of the participants, 18.6% (38/204) met the PA recommendations at T0, 16.4% (26/159) at T1, and 20.3% (28/138) at T2. For SB, there were no significant group differences or group-by-time interactions at T1 or T2. Intervention acceptance was generally high. The use of intervention material was high to moderate at T1 and decreased by T2. Conclusions There was little movement between intervention groups at T1 when given the choice, and participation was not associated with increases in PA or decreases in SB over time. Trial Registration German Clinical Trials Register DRKS00016073; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016073

The Effectiveness of Interventions to Reduce Sedentary Time in Different Target Groups and Settings in Germany: Systematic Review, Meta-Analysis and Recommendations on Interventions

“…Ten studies [ 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 ] referred to published protocols [ 79 , 80 , 81 , 82 , 83 , 84 ] or trial registry records (trial IDs reported in Table 1 ) which were consulted in these cases. Nine studies [ 69 , 70 , 73 , 76 , 77 , 78 , 85 , 86 , 87 ] were judged to be of high risk of bias and four studies [ 71 , 72 , 74 , 75 ] to have some concerns. No studies were judged to be of low risk of bias.…”

“…In two instances [ 88 , 89 ], the authors referred to an additional paper containing more detailed information on the respective study [ 90 , 91 ]. Of the 15 included studies, 14 studies [ 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 85 , 87 , 88 , 89 ] were published in peer-reviewed journals, 14 were written in English [ 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 85 , 87 , 88 , 89 ] and one [ 86 ] in German. The country of origin was Germany for 13 studies [ 69 , 70 , 71 , 73 , 74 , 75 , 76 , 77 , 78 , 85 , 86 , 87 , 88 ] and Belgium [ 89 ] and the UK [ 72 ] for one study each.…”

Mitigating Feelings of Loneliness and Depression by Means of Web-Based or Print-Based Physical Activity Interventions: Pooled Analysis of 2 Community-Based Intervention Trials

“…This has also been reported by other authors [ 79 ]. As a reaction, the study design for PROMOTE 2 was adapted such that participants could change the type of materials provided at a defined time point on a preference basis, which could improve the loss of participants because of this aspect, as well as the satisfaction with the intervention in a recognizable way [ 52 ].…”

“…As the results of the first study indicated that predominantly already active individuals participated in the study, the exclusion criteria for PROMOTE 2 were modified, and individuals were excluded if they reported being regularly physically active for at least 2.5 hours per week for >1 year before the start of the study. Potential study participants for PROMOTE 2 were excluded if they had already participated in PROMOTE 1 [ 52 ].…”

“…Participants who scored <25 points on the MMSE or <13 points on the MMSE-2:BV were excluded from the analysis. Amendments to the cutoff values for exclusion because of cognitive impairment have been discussed in previous publications [ 50 , 52 ].…”