Exercise interventions for the groups and communities Flashcards
Levels of interventions (Bauman et al 2012)
- individual
- interpersonal
- environmental
- regional or national policy
- global
Pros and cons of group community approaches
Pros:
- social support
- can introduce competition
- wider reach
- better cost-effectiveness
- often have a ‘captive audience’
Cons:
- hard to tailor to individual needs
- less intensive-tends to have lower individual impact
- needs to overcome social anxieties
- have to manage group dynamics
Brownson et al (2010) and McKinlay (1995) levels of intervention
Downstream: individual intensive programmes, individual self-directed programmes, small group programmes
midstream- school/wprk site programs, regional community programs
Upstream- national promotion/education campaigns, policy to reduce access and advertising or unhealthy factors, tax,economic incentives
Burke et al (2006) meta-analysis comparing:
a) home based no contact
b) home based with contact
c) standard exercise group
d) true groups exercise
Increased social support and/or contact from other participants,researchers and HCPs is associated with greater beneficial effects
Harden et al (2015) realist review on multiple groups (men women, older, younger etc, varying health statsus etc and conditions
concluded the positive effect of group based PA interventions is pervasive across populations and settings
Group interventions (Farrance et al., 2016) adherence to community based group exercise interventions for older people. the factors influencing adherence are:
Factors influencing adherence:
percieved benefits empowering effects social connectedness individual behaviour programme design instructor behaviour
individual adaptabillity
location
affordability
Methods to ensure people keep coming to your group intervention?
Educational content- -increase understanding of the physical and mental benefits
- be friendly, enthusiastic
- tailor activities to individuals capabilities
- give feedback in a supportive manner
- encourage interaction among group members (e.g. activities in pairs)
- ensure sessions are on at convenient times, check local transport timetables, encourage car sharing
What is a community? pt 1
can be based on:
geography, culture, social stratification and organisations
What is a community part 2
communities are not homogeneous
people may belong to several communities
the meaning and significance of community varies- it is important to think carefully about how you define it because it will influence how community representatives are identified and how you communicate with them
Community interventions-schools
“the primary institution with promoting activity in young people: - Cale and Harris (2006)
4 ideals of school and PA
- Reach- access to almost all children is feasible
- Children spend about 40% of their waking time in school
- PE classes-ideal opportunity to educate and provide opportunities for exercise/activity
- sustained exposure to health message and expertise- adopting an ecological, multi-level approach
Dobbins et al. (2013) are school based interventions effective?
positive effects on duration of MVPA, TV viewing and v02 max
some evidence showing increases in children engaged in MVPA during school hours
No impact on BP, HR, BMI
small to moderate effects but could be maintained
Future implications and limitations of Dobbins et al. (2013)
more positive results with:
- longer intervention
- delivered by PE teacher or researcher
- combination of curricula, printed resources and other components
Limitations
- inconsistent outcome measures
- lack of blinding of assessors
- reliance on self-reported behaviour
Lai et al. (2014) school interventions effectiveness?
- 10/13 studies found a sustained effect on PA
- 1/3 studies reported a sustained impact on fitness
- 2/2 studies reported improvement in fundamental movement skills
associations and limitations of Lai et al. (2014)
Associations:
- studies tended to be based on theoretical models
- interventions of longer duration’s (>1 year) more likely to be successful
Limitations:
- adequate retention rates (>30%) only found in 4 studies
- lack of blinding of assessors
- reliance on subjective outcome measures
conclusions and implications of school based interventions?
should:
- compromise of multiple components
- reach out beyond the school to include parents, communities and healthcare providers
- last at least a year
- ensure teachers are trained and feel confident at delivering content
Mcdonald et al., (2018) effectiveness of interventions aiming to impact PA in specific school settings
active travel adn active classroom breaks were most successful (67-75% studies has positive results, respectively)
interventions aimed at PE, after school and break time PA were less successful
the most successful interventions were less burdensome _> teachers, parents and children may have been more receptive
Sebire et al. (2013) concluded
Conclusion: interventions should be fun, satisfying and seek to enhance autonomy, competence and relatedness
community interventions-workplace
why is activity important?
inactivity leads to back pain, type 2 diabetes and contributes to obesity (all resulting in loss of productivity)
more active workforce likely to be physically and mentally healthier (happier workforce, increased productivity, less cost to society)
Community interventions-work place
move to improve (Dishman et al. 2009)
12 week interventions at various sites within an organisation involved the following:
utlised individual goal setting- gradual increases in 10 minute bouts of MVPA and step counts
Team goals- 75% of team reaching 150 mins/week MVPA and/ or 10,000 steps each day
Incentives
Senior management endorsement
environmental prompts and education
Move to improve Dishman et al. (2009) results:
Proportion of intervention groyp meeting PA guidelines increased from 31% to 51%, no change was seen in control
increased perceptions of management support and employee involvement
Brockman and Fox (2011)
- increased parking charges,
- better changing facilities,
- bike storage,
- a subsided bike purchase scheme
- car sharing
- free university bus and subsided city bus passes
- Bristol council reduced availability of non-resident permits
results showed…
regularly walking to work 19-30%
cycling to work 7-12%
cark to work 50-33%
Workplace challenge 2018 found
after 3 months 73% in inactive employees in sport
after 6 months 84% inactive employees reaching 150 mins of exercise each week
after 6 months sickness leave reduced by 0.6 days
19% increase in cycling to work
16% in walking to work
Perceptions of employers
walk to work intervention (Audrey and Procter, 2016)
positives and negative?
diasdavantages- need to provide changing facilities, employees need to travel for work; safety concerns
resisance- individuals choice, not a business priority
cynicism- lack of interest among employees, might be seen as a cost saving initiatives, not much employers can do anyway
Uncertainity-how best to promote walking? lack of incentives
Benefits- healthier and happier workforce, responsible employer, no lateness due to traffic, frees parking for customers
enablers- offering flexi-time, introducing competition, offering breakfast as an incentive
Wider community overall view?
- create an environment that supports healthy behavior
- population shifts will change norm and might promote further improvements
- many small individual improvements translate into large populaton effects
Community interventions should aim to
make use and develop existing assests
enhance community spirit and simultaneously decrease lonliness
empower members of minority/disadvantaged groups -> reduce health inequalities
why is wider community interventions harder to enforce?
more gatekeepers to get on board
higher initial cost
harder to evaluate
Mummery and Brown (2008) aim to increase physical activity in the adult population of rockhampton , Australia
Downstream:
Midstream:
upstream:
Downstream: promotion of PA by health professionals- promotion material and training in PA counselling
Midstream: Marketing strategies- maintain the brand “10,000 steps”
- print,radio, tv campaigns
- newsletters
upstream: environmental support for physical activity
- repair key footpaths
- erecting 10k step signs
- distributing maps to encourage walking
Results of rockhamptom 10k steps?
results show large increase in population achieving recommended activity levels from 2001 to 2003
95% were aware of 10k steps at follow-up
18% had used a pedometer in the last 17 months (vs. 6% Mackay population)
27% recieved PA advice from HP (Up from 23%)
conclusion: was effective at preventing declines in PA
Women seem to be early adopters
Advice from Mummery and brown 2008) on implementing wider community interventions included?
- important to involv the community in planning and implementation
-seek support from a range of public, private and commercial sectors, not just health sectors
-take time to build good relationships with all those involved in the project
-different communication methods may be needed for different groups within the community
-environmental factors can facilitate and impede PA - need to attend to both
-different intervention
strategies will need to be evaluated differently
