Evaluation of Physical Activity at a Medical Wellness Center John C. Sieverdes, PhD University of...
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Transcript of Evaluation of Physical Activity at a Medical Wellness Center John C. Sieverdes, PhD University of...
Evaluation of Physical Activity at a Medical Wellness Center
John C. Sieverdes, PhDUniversity of South Carolina
Department of Exercise Science
SCTR: April 26th, 2012
Our Questions???
– Does motivating factors for health and fitness or weight loss determine who meets the guidelines for physical activity?
– What are the Psychosocial differences between people who meet the guidelines versus those who don’t?
– How much activity do people get inside a center versus their free-living activity?
Background • The 2008 Physical Activity Guidelines for Americans identify that 150 minutes of moderate or 75 minutes of vigorous physical activity is needed to reduce risk of chronic diseases.– Equivalent moderate minutes = mod min + (2 x vig min)
• Medical wellness centers have a unique position to implement interventions and increase physical activity.
Collaborators
Gambettola, Italy
Lake City/Florence, South Carolina
Columbia, South Carolina
A Little More Background• The iH3 wellness center is a unique environment that facilitates
physical activity programs (FIT track, LEAN track, RESTORE track).– Currently, programs only measure physical activity inside the facility with a
smart key and not free-living activity
• Technogym has developed a new type of accelerometer (mywellness key) that integrates free-living physical activity with exercise performed with their line of equipment .
• Two validation studies on the MWK has been published so far on free-living activity and treadmill exercise protocols showing the device is valid to measure physical activity (PA) (1-2).
(1) Hermann SD, et al. Evaluation of the Mywellness Key accelerometer. British Journal of Sports Medicine, 2011. 45(2): p. 109-13.
(2) Bergamin M, et al. Validation of the MyWellness Key in Walking and Running Speeds, JSSM, 2012.11(1): p.57-63.
The MyWellness Key• The Mywellness Key (Technogym, Spa)
– Uniaxial accelerometer, 18.7 grams, • Sampling frequency = 16 HZ, 0.06-12.0 g’s, frequency
response 0.1 to 5 Hz.
– Worn on the front of the body in-line with the right knee.
– Used with Technogym machines and for free-living physical activity
– Web portal for goal setting and reports– Measures (On Display and in Web portal)
• Energy Expenditure (EE) in real-time MOVE (unitless) against daily MOVE goal
• Kcals expended• Minutes of
– Light (called free) 1.8-2.9 METs– Moderate (called play) 3.0-5.9 METs– Vigorous (called run) ≥ 6.0 METs
Evaluation study setting
iH3 Wellness CenterLake City, SC
Methods - Protocol• Participant criteria
– August, 2011 – January 2012– n=60 participants, age 18-80– FIT or LEAN tracks at facility– No gait abnormalities or injuries– Not pregnant– Only involved in iH3 center programs
• 10-day evaluation– MWK replaced their center key– MWK used in center’s machines and
attached to hip for free-living activity– Given a wear log to track time (>10
hrs/day)– Asked to complete computer-based
survey at home or at center– Return MWK, log, and receive a
Wellness booklet, $10 off membership dues, and a report of their physical activity
Methods - PAThe regular center key are
being was deactivated duringthe study
The MWK interfaces with all the Technogymaerobic and resistance training equipment
Measurement outcomes Aerobic activity: machine-based and free-living)
– minutes of light activity– minutes of moderate activity– minutes of vigorous activity– MOVE (volume of activity)
Methods - PA
• Mywellness key is worn in the clip inline with the right hip
Methods – Study Survey• General demographics (age, medical history, SES, occupation, ethnicity, smoker,
etc.)• Psychosocial constructs
– Self-efficacy (14-item survey) – Self-regulation (20-item survey)– Social support (15-item survey)– Motivation (17-item survey)
• Covariates– Physical Environment (IPAQ 13-item)– Perceived Stress (14-item)– Quality of Life SF36 (36-item)– Stage of change (1 item)– Satisfaction with Body Function and Appearance (9-item)– Center for Epidemiologic Studies Depression Scale (20-item)
Results
Variable Total Fitness/ Health Group
Weight loss Group
P-value
Met 2008 PA Guidelines Yes 38; 63.3% 21; 63.6% 17; 63.0% 0.96 for Americans, n; % No 22; 36.7% 12; 36.4% 10; 37.0% ---Age (years), n; m(SD) Total 60; 44.1(13.4) 33; 47.7(13.9) 27; 39.6(11.5) 0.32
M 17; 40.9(12.5) 12; 42.4(13.0) 5; 37.4(11.7) 0.90F 43; 45.3(13.7) 21; 50.8(13.8) 22; 40.1(11.6) 0.45
Weight (kg), n; m(SD) Total 60; 86.3(23.9) 33; 83.1(21.8) 27; 90.2(26.1) 0.33M 17; 94.9(24.3) 12; 87.8(15.3) 5; 112.1(34.7) 0.03*F 43; 82.9(23.1) 21; 80.4(24.7) 22; 85.2(21.8) 0.58
BMI (kg/m2), n; m(SD) Total 60; 31.2(8.8) 33; 30.5(8.8) 27; 32.0(8.8) 0.97M 17; 31.4(9.6) 12; 30.2(9.5) 5; 34.2(10.4) 0.73F 43; 31.1(8.5) 21; 30.7(8.6) 22; 31.5(8.6) 0.99
Descriptive characteristics of study participants
Main findings:In our 60 participants, we found that 63.3% of the participants met the 2008 PA Guidelines by accumulating at least 150 minutes per week of equivalent PA. There was no difference between fitness and weight loss groups
BMI, body mass index (kg/m2); m, mean; SD, standard deviation*Statistical differences between fitness/health and weight loss tracks reported using Student’s T-test and Chi-square using an alpha of p=0.05
Physical Activity between Fitness and Weight Loss Groups (amount per week)
Fitness/Health
Weight Loss
0
1000
2000
3000
4000
5000
6000
5,2995,015
light minutes
moderate minutes
vigorous minutes
MVPA minutes
equivalent moderate minutes
0
50
100
150
200
250
300
350
400
334.2
143.8
32.1
175.9208.0
312.7
149.8
20.3
170.2190.5
Fitness/HealthWeight Loss
Aver
age
min
utes
of a
ctivi
ty p
er w
eek
Aver
age
MO
VE p
er w
eek
Main Findings:No statistical differences found between tracks
Variable, score range Meets PA Guidelines n=34
Does not meet PA Guidelines
n=20
P-value
Self Efficacy, 0-100 73.5(17.8) 59.7(19.0) 0.01*Social Support (SS) all >0.29Self-regulation (SR) SR (Goal Setting, 10-50) 32.1(9.9) 25.0(11.2) 0.02* SR (Planning, 10-50) 29.9(6.8) 27.1(7.4) 0.16Intrinsic Motivation Autonomous Motivation, 7-49 41.1(10.1) 41.4(8.7) 0.93 Controlled Motivation, 7-49 23.2(9.1) 21.3(11.4) 0.48 Amotivation, 3-21 5.3(2.5) 7.2(4.2) 0.09Satisfaction with Body Function, -18 to +18 6.8(9.0) 3.2(10.5) 0.19Satisfaction with Body Appearance, -9 to +9 1.2(5.6) -0.2(5.3) 0.38Quality of Life (SF-36) Physical functioning, 0-100 91.9(12.9) 82.0(23.4) 0.09 General health perceptions, 0-100 75.8(14.4) 66.3(17.3) 0.03*
Psychosocial associations for participants meeting and not meeting the 2008 Physical Activity Guidelines for Americans (≥150 min/wk of mod min)
Main Findings:Those who met the PA Guidelines showed higher self-efficacy, self-regulation, and general health perception scores.
Variable, score range UnadjustedOdds ratio(CI)
Model 1 Odds
ratio(CI)
Model 2 Odds ratio(CI)
Self Efficacy, 0-1001.04(1.01-1.08)*
1.04(1.01-1.07)*
1.04(1.01-1.07)*
Self Regulation (SR)
SR (Goal Setting, 10-50)1.07(1.01-1.14)*
1.07(1.01-1.14)*
1.07(1.01-1.14)*
SR (Planning, 10-50) 1.06(.98-1.15)1.07(.98-1.16)
1.07(.98-1.67)
Quality of Life (SF-36)
Physical functioning, 0-1001.03(.99-1.07)
1.04(1.00-1.08)*
1.04(1.00-1.08)*
Odd’s ratios for Psychosocial Associations for Participants Meeting the 2008 Physical Activity Guidelines for Americans
Main FindingsThose who met the PA Guidelines had lower odds of physical functioning and greater odds of having higher self-efficacy (confidence to exercise) and self-regulation (habits of tracking your progress).
Model 1 additionally adjusted for age.Model 2 adjusted age and BMI.Meeting the 2008 Physical Activity Guidelines for Americans represent accumulating at least 150 equivalent moderate minutes of physical activity per week.*Statistical differences using logistic regression using an alpha of p=0.05.
Contribution of Exercise at iH3 on Daily Activity
FindingsVolume of activity doubles on an exercise day versus a non-exercise day.
Most moderate minutes are from exercise
light m
inutes
moderate
minutes
vigorous m
inutes
MVPA minutes
equiva
lent m
oderate
minutes0
10
20
30
40
50
60
70
43.7
10.21.3
11.5 12.8
2.3
33.0
9.7
42.7
52.4
MOVE Exe
rcise
Day
MOVE N
on-Exerci
se D
ay0
200
400
600
800
1000
1200
1400
532 559
667
Center-basedFreeliving
Ave
rag
e M
OV
E p
er
day
Ave
rag
e m
inu
tes
of
ph
ysic
al
acti
vity
p
er
day
= 47% of Exercise Day
79%
88%
76%
80%
5%
Total = 1199
Average daily minutes of PA between exercise and non-exercise days
Findings:On exercise days, there was an increase of 418% for minutes that contribute to the PA Guidelines when compared to a non-exercise day.
The amount of light minutes was equal between exercise and non-exercise days.
light minutes
moderate minutes
vigorous minutes
MVPA minutes
equivalent moderate minutes
0
10
20
30
40
50
60
70
46.0
11.4
2.1
13.515.6
46.043.2
11.0
54.2
65.2
Non-Exercise DayExercise Day
Ave
rag
e m
inu
tes
of
ph
ysic
al
acti
vity
p
er
day
402%
418%
524%
100%379%
Conclusions• No real differences were found between different tracks and their
resultant PA
• Participants had approximately the same amount of free-living PA between exercise and non-exercise days.
• Participants more than doubled their volume of activity and increased their equivalent minutes contributing to meeting the PA Guidelines by four times on exercise days.
• This study stresses the importance of having centers and facilities for populations to engage in leisure-time PA. Incorporation of PA metrics from the Medical Wellness Center accelerometers into physician health records could give a more complete picture of a person’s PA status for monitoring by health professionals.
Future Directions
• Integration of real-time monitoring using technology to enhance physical activity programs– Wireless transmission of real-time accelerometer data to
smartphones or use imbedded accelerometers in smartphones.– Integrating activity measures with health medical systems, health
records, or wellness systems.– Looking to incorporate self-efficacy and self-regulation concepts
to enhance behavioral intervention programs in mobile health technology (app-based development)
Acknowledgements• University of South Carolina
• Steven N. Blair, PED.• Greg A. Hand, PhD• Sara Wilcox, PhD• Robert Moran, PhD• Patrick Crowley, MS
• iH3 Wellness Center• WC Hammett, CEO• Michelle Hickson• Roosevelt Bryant• iH3 center staff
• Technogym, Spa• Silvano Zanuso, PhD• Giovanni Strabolli
• University of Tulsa• Eric Wickle, PhD
• University of Padova• Marco Bergeon, MS
• Iowa State University• Greg Welk, PhD
• Oregon State University• Stewart Trost, PhD