Evaluation of a website-delivered computer-tailored intervention for increasing physical activity in the general population
Introduction
Regular moderate-intensity physical activity (PA) has an important influence on health and well-being (Paffenbarger et al., 1986, Morris et al., 1990, Dishman, 1992). Health authorities recommend to participate in at least 30 min of moderate-intensity PA on most, preferably all days of the week (Pate et al., 1995, CDC, 2001). More health benefits could be achieved by participating in at least 20 min of continuous vigorous-intensity PA, 3 times a week (ACSM, 1978). However, more than half of the adult population in Western countries does not meet these PA recommendations (Caspersen et al., 2000, Buziarsist et al., 2001). Therefore, effective PA interventions, that can reach large population groups at low costs, are needed.
Today there are more than one billion Internet users worldwide (Miniwatts International, 2006) and many of them use this new communication channel for searching for health information (Fox, 2005). The Internet has created a new opportunity to distribute interventions in a cost-effective manner. Therefore, health providers have started to disseminate behavioral interventions through the Internet, including computer-tailored interventions (Etter, 2005, Oenema et al., 2001, Irvine et al., 2004, Bernhardt, 2001). Although computer-tailored interventions, that provide participants with personal relevant feedback produced by a computerized expert system, have induced significant changes in smoking, diet, and PA (Brug et al., 1999, Skinner et al., 1999, Strecher, 1999, Kreuter et al., 2000); little evidence is available on the effectiveness of website-delivered tailored interventions. In the PA domain, some newly developed websites have been tested for their usability and feasibility (Sciamanna et al., 2002, Leslie et al., 2005, McCoy et al., 2005, Anhoj and Holm Jensen, 2004, Thüring et al., 2003). However few studies have investigated the effectiveness of website-delivered computer-tailored interventions, and have focused mainly on specific population groups such as diabetes patients (McKay et al., 2001) and the elderly (Hageman et al., 2005). Others have targeted PA information to the different stages of change (for example goal setting, activity planning, self-monitoring, rewards, using cues) but did not tailor to other behavioral constructs or determinants at an individual level (Napolitano et al., 2003, Marshall et al., 2003).
Therefore the aim of the current study was to build an existing computer-tailored program, which has been shown to be effective in laboratory settings (Vandelanotte et al., 2005b), into a website-delivered PA intervention for the general population and to evaluate its effectiveness in a real life setting. To our knowledge, the present study is the first to do so. Further, in contrast with other computer-tailored interventions studies which used mostly single feedback moments (Kroeze et al., 2006), we wanted to examine if increased intervention intensity, by additional e-mail reminders and repeated exposure to the tailored advice, increase the effectiveness of the intervention.
Section snippets
Participants and study design
Participants were recruited by distributing brochures to parents of children and school staff of 14 primary and secondary schools, located in three different regions in Belgium. Eligible participants were between 20 and 55 years of age, had no history of cardiovascular diseases, and had access to the Internet. Individuals who were interested and met the eligibility criteria had to return a reply card with their contact information. Potential participants were allocated to one of three study
Participation
At baseline 434 respondents participated in the study of which 285 (66%) completed the 6-month follow-up (see Fig. 1). Drop-out analysis showed that men (χ2 = 4.146, p < 0.05, two-tailed), participants with higher BMI (t = − 2.163, p < 0.05, two-tailed) and those in intervention groups (χ2 = 14.511, p < 0.01, two-tailed) were more likely to drop out. No significant differences were found for baseline PA levels. Total sample characteristics at baseline are shown in Table 2. Compared with the general Belgian
Effects on behavior
The results of this study show that a computer-tailored PA intervention delivered through the Internet could enhance PA levels in healthy volunteers and decrease sitting behavior in comparison with a no-intervention group. Although the effect on MVPA was only significant in a subsample (completers who were insufficiently active), significant changes for total sample were found for active transportation and leisure-time PA. PA behavior is most easily changed in those two activity domains, as
Conclusion
The interactive website, with tailored physical advice was able to increase PA in motivated volunteer participants in comparison with a no-intervention control group. These results indicate that website delivered PA interventions can be effectively and feasibly implemented in real-life situations. More research is needed on optimal intervening intensity as no significant differences were found between both intervention groups. Comparable with previous Internet trials, attrition was high; more
Acknowledgments
Funding for this study was provided by the Policy Research Centre Sport, Physical Activity and Health, which is supported by the Flemish Government. The project was initiated and analyzed by the investigators. We wish to thank IT-specialists Nico Smets and Jannes Pockelé for developing the computer software and their assistance in developing the website Tailored Physical Activity Advice. We also acknowledge Kym Spathonis for proofreading the manuscript and her helpful linguistic suggestions and
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