The effect of a programme to improve men’s sedentary time and physical activity: The European Fans in Training (EuroFIT) randomised controlled trial

Abstract

Background

Reducing sitting time as well as increasing physical activity in inactive people is beneficial for their health. This paper investigates the effectiveness of the European Fans in Training (EuroFIT) programme to improve physical activity and sedentary time in male football fans, delivered through the professional football setting.

Methods and findings

A total of 1,113 men aged 30–65 with self-reported body mass index (BMI) ≥27 kg/m ² took part in a randomised controlled trial in 15 professional football clubs in England, the Netherlands, Norway, and Portugal. Recruitment was between September 19, 2015, and February 2, 2016. Participants consented to study procedures and provided usable activity monitor baseline data. They were randomised, stratified by club, to either the EuroFIT intervention or a 12-month waiting list comparison group. Follow-up measurement was post-programme and 12 months after baseline. EuroFIT is a 12-week, group-based programme delivered by coaches in football club stadia in 12 weekly 90-minute sessions. Weekly sessions aimed to improve physical activity, sedentary time, and diet and maintain changes long term. A pocket-worn device (SitFIT) allowed self-monitoring of sedentary time and daily steps, and a game-based app (MatchFIT) encouraged between-session social support. Primary outcome (objectively measured sedentary time and physical activity) measurements were obtained for 83% and 85% of intervention and comparison participants. Intention-to-treat analyses showed a baseline-adjusted mean difference in sedentary time at 12 months of −1.6 minutes/day (97.5% confidence interval [CI], −14.3–11.0; p = 0.77) and in step counts of 678 steps/day (97.5% CI, 309–1.048; p < 0.001) in favor of the intervention. There were significant improvements in diet, weight, well-being, self-esteem, vitality, and biomarkers of cardiometabolic health in favor of the intervention group, but not in quality of life. There was a 0.95 probability of EuroFIT being cost-effective compared with the comparison group if society is willing to pay £1.50 per extra step/day, a maximum probability of 0.61 if society is willing to pay £1,800 per minute less sedentary time/day, and 0.13 probability if society is willing to pay £30,000 per quality-adjusted life-year (QALY). It was not possible to blind participants to group allocation. Men attracted to the programme already had quite high levels of physical activity at baseline (8,372 steps/day), which may have limited room for improvement. Although participants came from across the socioeconomic spectrum, a majority were well educated and in paid work. There was an increase in recent injuries and in upper and lower joint pain scores post-programme. In addition, although the five-level EuroQoL questionnaire (EQ-5D-5L) is now the preferred measure for cost-effectiveness analyses across Europe, baseline scores were high (0.93), suggesting a ceiling effect for QALYs.

Conclusion

Participation in EuroFIT led to improvements in physical activity, diet, body weight, and biomarkers of cardiometabolic health, but not in sedentary time at 12 months. Within-trial analysis suggests it is not cost-effective in the short term for QALYs due to a ceiling effect in quality of life. Nevertheless, decision-makers may consider the incremental cost for increase in steps worth the investment.

Trial registration

International Standard Randomised Controlled Trials, ISRCTN-81935608.

Abstract

Sally Wyke and colleagues report that the EuroFIT trial, designed to improve fitness in men, improves fitness, weight, and cardiometabolic biomarkers, but not sedenetary time at 12 months.

Author summary

Why was this study done?

• Gender-sensitised lifestyle change programmes in a professional sport setting are an exciting development in men’s health promotion, with the potential to engage men who are underserved by most programmes.

• A healthy lifestyle and weight management programme delivered in professional sporting settings (Football Fans in Training [FFIT]) has been shown to be effective and cost-effective in delivering long-term weight loss in overweight and obese Scottish football fans.

• We drew on the success of FFIT to develop and evaluate the EuroFIT programme in four European countries. Whereas FFIT introduced physical activity and dietary change for weight loss, EuroFIT focused on increasing physical activity and reducing sedentary time as desirable outcomes in their own right.

What did the researchers do and find?

• We conducted a randomised controlled trial ( n = 1,113) in 15 football clubs in four countries and showed that the EuroFIT programme was effective in increasing objectively measured physical activity but not sedentary time 12 months after baseline.

• EuroFIT participants also showed improvements in diet, body weight, indicators of cardiometabolic health, well-being, and other secondary outcomes.

• EuroFIT was not cost-effective in the short term because there were no differences in quality of life because, on the measure we used, participants already had high levels of quality of life at baseline.

What do these findings mean?

• Gender-sensitised lifestyle programmes delivered in professional football clubs have shown great promise in Europe and could play an important public health role in engaging underserved men.

• Changing time spent sedentary proved difficult. Future lifestyle intervention studies should attempt to ensure that participants understand the distinction between being more physically active and spending more time upright.