Effects of a Web-Based Intervention on Physical Activity and Metabolism in Older Adults: Randomized Controlled Trial

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Abstract

Background

Lack of physical activity leads to detrimental changes in body composition and metabolism, functional decline, and increased risk of disease in old age. The potential of Web-assisted interventions for increasing physical activity and improving metabolism in older individuals holds great promise but to our knowledge it has not been studied.

Objective

The goal of our study was to assess whether a Web-based intervention increases physical activity and improves metabolic health in inactive older adults.

Methods

We conducted a 3-month randomized, waitlist-controlled trial in a volunteer sample of 235 inactive adults aged 60-70 years without diabetes. The intervention group received the Internet program Philips DirectLife, which was directed at increasing physical activity using monitoring and feedback by accelerometer and digital coaching. The primary outcome was relative increase in physical activity measured objectively using ankle- and wrist-worn accelerometers. Secondary outcomes of metabolic health included anthropometric measures and parameters of glucose metabolism.

Results

In total, 226 participants (97%) completed the study. At the ankle, activity counts increased by 46% (standard error [SE] 7%) in the intervention group, compared to 12% (SE 3%) in the control group ( P _difference<.001). Measured at the wrist, activity counts increased by 11% (SE 3%) in the intervention group and 5% (SE 2%) in the control group ( P _difference=.11). After processing of the data, this corresponded to a daily increase of 11 minutes in moderate-to-vigorous activity in the intervention group versus 0 minutes in the control group ( P _difference=.001). Weight decreased significantly more in the intervention group compared to controls (−1.5 kg vs −0.8 kg respectively, P=.046), as did waist circumference (−2.3 cm vs −1.3 cm respectively, P=.036) and fat mass (−0.6% vs 0.07% respectively, P=.025). Furthermore, insulin and HbA1c levels were significantly more reduced in the intervention group compared to controls (both P<.05).

Conclusions

This was the first study to show that in inactive older adults, a 3-month Web-based physical activity intervention was effective in increasing objectively measured daily physical activity and improving metabolic health. Such Web-based interventions provide novel opportunities for large scale prevention of metabolic deregulation in our rapidly aging population.

Trial Registration

Dutch Trial Registry: NTR 3045; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3045 (Archived by WebCite at http://www.webcitation.org/6KPw52dCc).

Related collections

Most cited references 22

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Total daily physical activity and the risk of AD and cognitive decline in older adults.

A S Buchman, P. Boyle, L Yu … (2012)

Studies examining the link between objective measures of total daily physical activity and incident Alzheimer disease (AD) are lacking. We tested the hypothesis that an objective measure of total daily physical activity predicts incident AD and cognitive decline. Total daily exercise and nonexercise physical activity was measured continuously for up to 10 days with actigraphy (Actical®; Philips Healthcare, Bend, OR) from 716 older individuals without dementia participating in the Rush Memory and Aging Project, a prospective, observational cohort study. All participants underwent structured annual clinical examination including a battery of 19 cognitive tests. During an average follow-up of about 4 years, 71 subjects developed clinical AD. In a Cox proportional hazards model adjusting for age, sex, and education, total daily physical activity was associated with incident AD (hazard ratio = 0.477; 95% confidence interval 0.273-0.832). The association remained after adjusting for self-report physical, social, and cognitive activities, as well as current level of motor function, depressive symptoms, chronic health conditions, and APOE allele status. In a linear mixed-effect model, the level of total daily physical activity was associated with the rate of global cognitive decline (estimate 0.033, SE 0.012, p = 0.007). A higher level of total daily physical activity is associated with a reduced risk of AD.

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Meta-analysis of internet-delivered interventions to increase physical activity levels

Cally Davies, John Spence, Corneel Vandelanotte … (2012)

Many internet-delivered physical activity behaviour change programs have been developed and evaluated. However, further evidence is required to ascertain the overall effectiveness of such interventions. The objective of the present review was to evaluate the effectiveness of internet-delivered interventions to increase physical activity, whilst also examining the effect of intervention moderators. A systematic search strategy identified relevant studies published in the English-language from Pubmed, Proquest, Scopus, PsychINFO, CINHAL, and Sport Discuss (January 1990 – June 2011). Eligible studies were required to include an internet-delivered intervention, target an adult population, measure and target physical activity as an outcome variable, and include a comparison group that did not receive internet-delivered materials. Studies were coded independently by two investigators. Overall effect sizes were combined based on the fixed effect model. Homogeneity and subsequent exploratory moderator analysis was undertaken. A total of 34 articles were identified for inclusion. The overall mean effect of internet-delivered interventions on physical activity was d = 0.14 (p = 0.00). Fixed-effect analysis revealed significant heterogeneity across studies (Q = 73.75; p = 0.00). Moderating variables such as larger sample size, screening for baseline physical activity levels and the inclusion of educational components significantly increased intervention effectiveness. Results of the meta-analysis support the delivery of internet-delivered interventions in producing positive changes in physical activity, however effect sizes were small. The ability of internet-delivered interventions to produce meaningful change in long-term physical activity remains unclear.

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Validation of the GENEA Accelerometer.

Dale W Esliger, Ann Rowlands, Tina L Hurst … (2011)

The study aims were: 1) to assess the technical reliability and validity of the GENEA using a mechanical shaker; 2) to perform a GENEA value calibration to develop thresholds for sedentary and light-, moderate-, and vigorous-intensity physical activity; and 3) to compare the intensity classification of the GENEA with two widely used accelerometers. A total of 47 GENEA accelerometers were attached to a shaker and vertically accelerated, generating 15 conditions of varying acceleration and/or frequency. Reliability was calculated using SD and intrainstrument and interinstrument coefficients of variation, whereas validity was assessed using Pearson correlation with the shaker acceleration as the criterion. Next, 60 adults wore a GENEA on each wrist and on the waist (alongside an ActiGraph and RT3 accelerometer) while completing 10-12 activity tasks. A portable metabolic gas analyzer provided the criterion measure of physical activity. Analyses involved the use of Pearson correlations to establish criterion and concurrent validity and receiver operating characteristic curves to establish intensity cut points. The GENEA demonstrated excellent technical reliability (CVintra = 1.4%, CVinter = 2.1%) and validity (r = 0.98, P < 0.001) using the mechanical shaker. The GENEA demonstrated excellent criterion validity using VO2 as the criterion (left wrist, r = 0.86; right wrist, r = 0.83; waist, r = 0.87), on par with the waist-worn ActiGraph and RT3. The GENEA demonstrated excellent concurrent validity compared with the ActiGraph (r = 0.92) and the RT3 (r = 0.97). The waist-worn GENEA had the greatest classification accuracy (area under the receiver operating characteristic curve (AUC) = 0.95), followed by the left (AUC = 0.93) and then the right wrist (AUC = 0.90). The accuracy of the waist-worn GENEA was virtually identical with that of the ActiGraph (AUC = 0.94) and RT3 (AUC = 0.95). The GENEA is a reliable and valid measurement tool capable of classifying the intensity of physical activity in adults.

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Author and article information

Contributors

Carolien A Wijsman:

Department of Gerontology and GeriatricsLeiden University Medical CenterPO Box 9600Leiden, 2300 RCNetherlands31 71737023831 715266881c.a.wijsman@lumc.nl

Journal

Journal ID (nlm-ta): J Med Internet Res

Journal ID (publisher-id): JMIR

Title: Journal of Medical Internet Research

Publisher: JMIR Publications Inc. (Toronto, Canada )

ISSN (Print): 1439-4456

ISSN (Electronic): 1438-8871

Publication date Collection: November 2013

Publication date (Electronic): 06 November 2013

Volume: 15

Issue: 11

Electronic Location Identifier: e233

Affiliations

[1] ¹Department of Gerontology and Geriatrics Leiden University Medical Center LeidenNetherlands

[2] ²Leyden Academy of Vitality and Ageing LeidenNetherlands

[3] ³Department of Public and Occupational Health, EMGO+Institute VU University Medical Center AmsterdamNetherlands

[4] ⁴Institute for Ageing and Health Newcastle University Newcastle upon TyneUnited Kingdom

[5] ⁵Department of Medical Statistics Molecular Epidemiology Section Leiden University Medical Center LeidenNetherlands

[6] ⁶Netherlands Consortium for Healthy Ageing LeidenNetherlands

[7] ⁷Institute for Evidence-Based Medicine in Old Age, IEMO LeidenNetherlands

Author notes

Corresponding Author: Carolien A Wijsman c.a.wijsman@ 123456lumc.nl

Article

Publisher ID: v15i11e233

DOI: 10.2196/jmir.2843

PMC ID: 3841355

PubMed ID: 24195965

SO-VID: 0df6a769-2ab5-42b6-97bc-b0c675fa1939

Copyright © ©Carolien A Wijsman, Rudi GJ Westendorp, Evert ALM Verhagen, Michael Catt, P Eline Slagboom, Anton JM de Craen, Karen Broekhuizen, Willem van Mechelen, Diana van Heemst, Frans van der Ouderaa, Simon P Mooijaart. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 06.11.2013.

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

History

Date received : 23 July 2013

Date revision requested : 29 August 2013

Date revision received : 12 September 2013

Date accepted : 18 September 2013

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