The ABEL Feasibility Study (Adherence, Better Health, Exercise and Life Satisfaction): A Randomized Controlled Trial
Phase: NA
Conditions: Obesity
Sponsor: Norges idrettshøgskole

 
The ABEL Feasibility Study  
(Adherence, Better health, Exercise and Life satisfaction): A 
 Randomized Controlled Trial 
 
 
 
 
 
 
 
 
Project manager 
Tron Krosshaug, Professor, Norwegian School of Sport Sciences (NSSS) 
Project group 
Lene A.H. Haakstad, Professor, NSSS, Christina Gjestvang, Researcher NSSS; John 
Magne Kalhovde, Associate professor, Kristiania University College. Elene Mauseth 
Tangen, Research Assistant, NSSS 
 
 
 
Date: 19th of Mars, 2023 

Contents 
1. The epidemic of obesity ...................................................................................................... 1 
1.1 “Exercise as medicine” .................................................................................................... 2 
2.Purpose .............................................................................................................................. 3 
2.1 Research aims ................................................................................................................ 3 
3. Method .............................................................................................................................. 4 
3.1 Women with obesity (n =200) .......................................................................................... 4 
3.1.1 Exercise professionals (n=25) .................................................................................... 5 
3.1.2 Random allocation .................................................................................................... 6 
3.2. General practitioners (n=8) ............................................................................................. 7 
3.3 Outcome measures ...................................................................................................... 7 
3.4 Data analysis ................................................................................................................ 10 
3.4 Ethical considerations ................................................................................................... 10 
4. Implementations .............................................................................................................. 11 
4.1 Project group................................................................................................................ 11 
4.2 Project management and organization ............................................................................. 11 
References ........................................................................................................................... 12 
 

1 
 
1. The epidemic of obesity 
Obesity, defined as “abnormal or excessive fat accumulation that presents a risk to health” (1) 
and a body mass index (BMI) of ≥30, represents a major health challenge and economic 
burden for welfare systems worldwide (2,3,4). For the individuals affected, having obesity is 
associated with a broad range of adverse health consequences ranging from non-
communicable diseases, such as diabetes type 2, metabolic syndrome (5), liver disease (6) 
and cardiovascular disease (7) to negative impacts on mental health (8), higher risk of urinary 
incontinence (9, 10) and can consequently lead to impaired quality of life (11). Today, 
approximately one out of five adults are categorized with obesity in Norway, and the trend in 
obesity rates is predicted to further increase, with the highest prevalence reported among 
women (3, 12, 13). More women than men are also at risk of developing severe forms (≥35 
BMI) of obesity (3,12).  
A report from Menon Economics revealed that the three major economic impacts of obesity 
were: disease burden (costs related to the burden of obesity such as pain and shortened life 
span), productivity costs (loss of productivity in the labor market due to absence from work 
and other obesity-related health reasons), and medical costs (costs related to diagnosis and 
treatment of obesity-related conditions) (2). The total economic cost of obesity in Norway 
was estimated to be approximately 68 billion NOK yearly (2). Disease burden represented the 
highest cost (39 billion NOK), followed by productivity costs (17 billion) and medical costs 
(12 billion NOK) (2). 
Living with obesity is reported to account for 80-85% of the risk of developing non-
communicable diseases such as diabetes type 2 (14). Hence, women with obesity experiences 
a 28 times greater risk of developing diabetes type 2 than women of normal weight (15). 
Among women with BMI of ≥35, this increases to a 92 times greater risk (15). Guidance on 
regular physical activity, exercise and healthy eating is traditionally the first measure taken 
for patient who undergo treatment for obesity (3). Physical activity is defined as “any bodily 
movement produced by skeletal muscles that requires energy expenditure above resting 
level” (16). Exercise is defined as “a regular and structured subset of physical activity 
performed deliberately with a specific purpose, for instance improving some aspects of health 
or physical fitness” (16). Increased physical fitness and improved health can reduce the risk 
of the adverse consequences of obesity, independently of weight loss (17,18, 19). Hence, 
physical activity and exercise can minimize the risk of premature mortality and further 
development of non-communicable diseases related to obesity (such as diabetes type 2) (20, 
21, 22,). However, the health benefits of physical activity and exercise rapidly decrease if it is 
not performed regularly (23) Fewer women with obesity are reported to meet the Norwegian 
government's recommendation for physical activity (150 to 300 minutes of moderate- 
intensity or 75 to 150 minutes of vigorous-intensity per week), compared with normal 
weighted women (16 % versus 57%) (24, 25). Having multimorbidity because of obesity, is 
also associated with not following guidelines (26). Further research investigating methods on 
getting more women with obesity regularly active are therefore needed.  

2 
 
1.1 “Exercise as medicine” 
Treatment for obesity in the primary healthcare service in Norway is largely coordinated by 
general practitioners (GP) (2). Today, GPs can prescribe “exercise as medicine” to patients 
with diabetes type 2, hypertension, obesity or cardiovascular disease (27). “Green 
prescriptions” (tailored advice and guidance on lifestyle factors related to development of 
disease, such as physical activity, exercise and healthy eating) was first founded in 2003 as an 
alternative to medical treatment for patients with diabetes type 2 and hypertension (28). 
Green prescriptions involve a specific target payment code for medical procedures “101”, 
meaning that GPs receive financial incentives to discuss physical activity and healthy eating 
with the patient (28).  
However, 41% of GPs in 2006 reported that they had newer prescribed green prescriptions to 
their patients (29, 30). Attalin et al. (2012) reported that 63% of GPs listed patient’s non-
adherence to the tailored advice they were given as main barrier for not implementing green 
prescriptions in their practice (31). Low adherence may be associated with that the current 
green prescription model is lacking sufficient follow-up of patients (29). To increase patient’s 
adherence, GPs are requesting a follow-up alternative that includes social support, nutritional 
guidance, and reduced costs for exercise participation (29). Low adherence can also be 
associated with that GPs are found to have less positive attitudes towards health promotion in 
primary health care (32). Attalin et al. (2012) reported that only 52% of GPs wished to 
acquire skills in consulting patients on physical activity and exercise (31). Thus, increase GPs 
knowledge on mental and physical health outcomes by utilizing exercise as medicine, may 
also rise the use of green prescriptions. According to the “ABC framework for prescribing 
exercise as medicine” developed by O’Regan et al. (2021) (33), it is highlighted that 
providing patients with in-person coaching is essential to maintain adherence. Lundqvist et al. 
(2019) (34) observed that patients who received structured coaching by health personnel for 
six months became more active, and coaching was also correlated with positive predictors for 
exercise and physical activity adherence (self-efficacy and stages of change) (34). This was 
also observed in patients with obesity, where offering in-person coaching and social support 
was the greatest promotors for exercise adherence (35). The “ABC framework” also states the 
importance of establishing collaborations with professions such as exercise professionals to 
be able to provide sufficient individualized follow-up and coaching of patients (21, 35). This 
was confirmed by Tulloch et al. (2005) (36), where the most effective intervention to improve 
exercise adherence among patients was a collaboration between GPs and exercise 
professionals. Therefore, in-person coaching by an exercise professional may have the means 
to get more patients with obesity regularly active, and can potentially be the follow-up 
alternative the current green prescription model is lacking (35,37).  
Considering the expenses and practical considerations associated with in-person coaching, 
has former studies displayed the advantage of web-based behavioral support for patients with 
lifestyle diseases such as obesity (38). It is a timesaving, cost effective, and can potentially be 
an important contributor for a sustainable green prescription model. However, web-based 
behavioral support often proves to have poor completion rate, and need to be combined with 

3 
 
face-to-face guidance and feedback in order to increase adherence (39, 40). For instance, 
Elley et al. (2019) (41) observed that a follow-up model, consistent of a combination of in-
person exercise coaching and telephone calls improved adherence to exercise and physical 
activity. However, when combining in-person coaching and web-based behavioral support, 
there is still limited knowledge on how frequent in-person coaching needs to occur, in order 
to increase adherence. For instance, Ries et al. (2003) (42) observed that providing patients 
with monthly in-person coaching, and weekly telephone calls on the non-supervised weeks, 
only produced modest improvements in adherence. More knowledge on frequency of follow-
up is therefore essential for an approach towards an economical sustainable green 
prescription model. For example, mean costs per patients for different frequency of in-person 
coaching are: four sessions monthly: 2400 NOK/monthly per patient. two sessions monthly 
1500 NOK/monthly per patient NOK or one session monthly. 1050 NOK/monthly per 
patient. In discrepancy, the potential expense of sessions with an exercise professional may 
be profitable in the long run, and the general mean cost per patient for in-person follow-up is 
lower compared with the current costs associated with obesity and non-communicable 
diseases (2). 
2. Purpose 
The ultimate ambition of this project is to identify an economical sustainable model to get 
women with obesity regularly active, with improved health and physical fitness, and thus 
lower risk of developing severe health challenges. 
The current study will be the first step in the development of such a model, where we aim to 
conduct a pilot/feasibility study to prepare for a large-scale study by establishing estimates of 
effect sizes, and to investigate barriers for successful implementation. 
The ABEL Feasibility Study will evaluate the effect of three follow-up models with different 
frequency of physical follow-up by an exercise professional, on exercise adherence and total 
physical activity level. A secondary objective of this project is to evaluate if these follow-up 
models can improve mental and physical health and physical fitness in women with obesity. 
Finally, we aim to identify potential barriers to successful implementation of a “green 
prescription” among participants, GPs and exercise professionals. 
2.1 Research aims 
1. In women with obesity (BMI≥30), what is the effect of in-person exercise coaching 
(high vs. medium vs. low dosage) on exercise adherence and total physical activity 
level? 
 
2. In women with obesity (BMI≥30), what is the effect of in-person exercise coaching 
(high vs. medium vs. low dosage) on mental health variables (quality of life, self-
efficacy and barriers and motivation to exercise)?  
 

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3. In women with obesity (BMI≥30), what is the effect of in-person exercise coaching 
(high vs. medium vs. low dosage) on health (glycated hemoglobin, cholesterol, blood 
pressure, waist circumference, BMI and urinary incontinence) and physical fitness 
(aerobic endurance, muscular strength)? 
 
4. Is adherence to exercise and succeeding health effects associated with the exercise 
professionals’ level of education and knowledge base? 
 
5. What are the participant's experiences, barriers and facilitators of participating in the 
ABEL-project? 
 
6. What are the general practitioners’ experiences, barriers and facilitators of using the 
“green prescription”? 
 
3. Method 
3.1 Women with obesity (n =200) 
In the present feasibility study, women with obesity (BMI of ≥30, n=200) will be recruited to 
a 20-week randomized control trial (RCT) with four arms (Table 1). The groups are provided 
the same frequency (each week) of follow-up by the exercise professional, with a different 
dose of in-person exercise coaching and web-based behavioral support. Enrollment will be 
limited to age between 18 to 65 years, no fitness club membership six months prior to 
recruitment, low-active (<150 minutes of moderate-intensity or 75 minutes of vigorous-
intensity per week), Norwegian speaking, and in possession of a smartphone. Exclusion 
criteria’s are: chronic disease or pathology (e.g severe hypertension 180/110 mm Hg), heart 
disease or lung disease hindering exercise, changing GP during the intervention, functional 
impairment due to injuries hindering physical activity and exercise, and traveling during the 
intervention period, or at the time baseline and follow-up measures will be conducted. 
 
Participants will be recruited via social media platforms (Facebook and Instagram) from rural 
(Sandnessjøen, Narvik, Svolvær, Sørumsand, Sogndal and Førde) and urban locations (Oslo, 
Bergen, Stavanger, Tromsø, Bodø and Arendal) spread across Norway. An advertisement on 
Facebook and Instagram will be posted, including contact information to one of the project 
fellows. Interested participants can contact the research fellow, and is informed to contact 
their GP. Due to practical reasons associated with the geographical spread of the project, 
members from the project group at NSS are not able to perform health screening of all 
participants. Therefore, to ensure that none of the participants have any contraindications for 
participating in the project, all participants will undergo a general health screening at their 
GP. 
 
 

5 
 
Table 1.  Intervention arms (High, medium and low dosage in-person exercise coaching and control). 
Intervention arms 
HIGH dosage in-person 
exercise coaching 
 
n= 50 
One in-person exercise session with the exercise 
professional/weekly.  
 
A total of 20 hours of in-person coaching during the 20 weeks 
of intervention.  
MEDIUM dosage in-
person exercise coaching  
 
n= 50 
Two in-person exercise session with the exercise 
professional/monthly, and 15 minutes web-based behavioral 
support on the non-supervised weeks. 
 
Total of 10 hours in-person coaching during the 20 weeks 
intervention. 
LOW dosage in-person 
exercise coaching 
 
n =50 
One in-person exercise session with the exercise 
professional/monthly, and 15 minutes web-based behavioral 
support on the non-supervised weeks. 
 
Total of five hours of in-person coaching during the 20 weeks 
intervention.   
 
Control group 
 
n = 50 
Will be asked to continuing with normal life, and will receive 
regular follow-up care from their GP. This group will be 
giving the “Norwegian Directorate of Health’s” 
recommendations for physical activity and nutrition (43) and 
will have access to the ABEL-app in order to register physical 
activity and exercise, but will not be provided any coaching 
during the 20 weeks. 
 
For group HIGH, MEDIUM and LOW dosage of in-person exercise coaching, the exercise 
professionals will prescribe exercise programs tailored to the individual needs, as well as give 
advice about healthy eating and a balanced meal plan, including ideas, recipes and shopping 
lists. All participants will also get access to a web-based behavioral support (ABEL 
technologies), where individual exercise programs will be available, as well as nutritional 
guidance, graphs for progression and motivational notifications for achievement of goal 
settings. Via the ABEL-app, participants will enter physical activity and exercise data (type 
of activity, duration, intensity, frequency etc.), including the sessions without the exercise 
professional. The parameters that are logged in via the ABEL-app include rate of perceived 
exertion (RPE) for all activity, duration, intensity and type of activity. Weight lifted will also 
be logged for resistance exercise. 
3.1.1 Exercise professionals (n=25) 
A total of 25 exercise professionals, working full time as a personal trainer will follow up the 
participants at one of the following fitness clubs: Feel24, PT-group, Nr1 Fitness, Trento or 
Spenst. These fitness clubs are located in the same area the participant lives and receives 
regular follow-up care from their GP. To minimize error caused by limited knowledge of the 
ABEL-app, and to ensure that the exercise professionals know how to use this system for 

6 
 
coaching participants and data collection, the exercise professionals have finished a web-
based onboarding program, consisting of six modules, of 45 to 60 minutes. In the five first 
modules, the exercise professionals were educated in the functionality of the ABEL-app. The 
sixth module was led by two members from the ABEL-project group, where the exercise 
professionals learned how to conduct testing of participants and instructed in standardized 
test protocols. In addition, instruction videos for all test protocols will be uploaded on the 
ABEL-app. 
To be included in the research project as an exercise professional, the qualifications and 
requirements are: 
 
• A minimum of three years’ experience working part-time as a personal trainer, and 
delivered ≥ 80 training sessions/per month, in three of the last five months, with one 
of the following qualifications:  
1) Higher education: bachelor/master in sports science, or other relevant 
health education (physiotherapy, nursing, osteopath, chiropractor).  
2) Practical experience: A personal training education (one-year education/60 
credits), well as 2000 hours of delivered exercise sessions with clients. 
• Completed an exam, developed by researchers at NSSS and Kristiania University 
College, that covers knowledge in: central elements of exercise (anatomy, physiology, 
biomechanics, aerobic endurance, and muscular strength), physical activity and 
health, coaching and motivation, source criticism and methodology, and exercise 
among patients with obesity. The test scores will be used to evaluate associations 
between the exercise professionals’ level of competence and participants adherence to 
exercise and/or improvement in health and physical fitness. The project will therefore 
also obtain informed consent from the exercise professionals. 
● Signed “professional ethics guideline” document.  
● Completion of “Norway's Anti-Doping Agency’s” and “Norway's counseling About 
Eating Disorders eLearning module. 
3.1.2 Random allocation  
Each participant will be randomly assigned (1:1:1:1) to one intervention group, HIGH, 
MEDIUM, LOW or CONTROL following a simple computer-based randomization program. 
All participants included in the study will conduct the baseline assessments before the 
randomization procedure. The study design will not allow for further masking of study 
participants or the exercise professional (caregivers to the interventions). Those from the 
research group involved in inclusion of the participants or follow-up measurements will not 
have access to the group allocation list. Further, all measurements will be completed and 
plotted without the research group information of group allocation. The statistical analyses 
will be done in SPSS, following a predefined analysis plan and before unmasking the study 
arms.  

7 
 
3.2. General practitioners (n=8) 
In addition to the RCT, the project will recruit GPs (n=8) from clinics at the rural and urban 
locations to participate in an in-depth interview with researchers from NSSS (see 3.3). GPs 
will be recruited to provide more in-depth understanding on reasons for what the current 
green prescription model is lacking. 
3.3 Outcome measures 
Date will be collected at baseline, continually during, and immediately following the 
intervention period. 
 
Monitoring adherence to subscribed exercise sessions: 
Measures of adherence will be collected through the ABEL-app. Sessions performed with the 
exercise professional will be logged through the ABEL-app of the exercise professional, 
while sessions performed independently will be logged through the ABEL-app of the 
participant. Adherence will be measured by attendance (percentage of exercise sessions 
completed out of exercise sessions offered), as well as intensity (physical exertion of 
sessions) and duration (duration of sessions) (44). 
  
Questionnaire (approximately 25 minutes to complete): 
• Background information: Covering age, smoking, level of education, household 
income. In addition to information about physical activity behavior (fulfillment of 
physical activity recommendations, as well as weekly frequency, duration and modes 
of physical activity). 
• Health-related quality of life: Will be measured by a Norwegian version of The 
MOS 36-item short-form health survey (SF-36) (45).  
• Self-efficacy: Will be measured by a Norwegian abbreviated validated version of the 
Self-Efficacy Survey developed by Sallis et al. (46). 
• Perceived social support from family and friends: Will be measured by a 
Norwegian version of a previous validated survey (47). 
• Stages of change: Will be measured with a previously conducted questionnaire on 
exercise professionals’ effect on changing attitudes towards physical activity 
according to upward moving in the stages of change model (48). To achieve high 
cross-language validation when translating the English 
version into Norwegian language, we used a forward-backward translation technique, 
involving three members of the research group. A bilingual acquaintance of the 
research group with English as mother tongue will finally assured the quality by 
comparing the “new” English version” with the original version. 
• Barriers to exercise: Questions will be based on identified barriers in a previous 
study among Norwegian adult population (n= 12 504) (49) and among fitness club 
members (50). Eighteen barriers will be included in the questionary.  
• Motivation for exercise and physical activity: Will be measured by a Norwegian 
version of the validated survey BREQ-2 (51).   

8 
 
• Urinary incontinence: Will be measured using a Norwegian version of the 
Incontinence Questionnaire-Short Form (ICIQ-UI SF) (52). Awareness and 
knowledge about pelvis floor muscles exercises will be assessed by single questions: 
“Do you do pelvic floor muscle exercises?” If yes, how many times weekly?” “If yes, 
has your exercise professional provided you any coaching on pelvic floor muscle 
exercises?” 
 
At follow-up, we will add questions regarding how satisfied participants are with the digital 
and physical follow-ups, as well as perceived social support from their exercise professional 
during the trial period.  
 
Health factors: 
• Blood pressure, waist circumference and BMI: Measures of blood pressure, waist 
circumference and BMI (height and weight) will be conducted during health 
screening at the GP. These variables are strongly associated with development of non-
communicable diseases and can therefore be a low-cost indicator of general health 
which is minimally intrusive for the participant (53). Data will be scanned and sent to 
NSSS via password protected zip-files after the posttest, and stored on a secure data 
area. 
• Glycated hemoglobin and cholesterol: Testing self test kits (Tigeni, Norway) will 
be given to all participant at baseline and follow-up for collection of blood sample 
markers: glycated hemoglobin and cholesterol (LDL, triglycerides and HDL). All 
values will be collected through capillary blood drawn from finger pricks. The 
participants will conduct the finger pricks test at their respected fitness club. The 
samples will be collected via DHL and sent to Tigeni for further analyses. Data will 
be collected by the GP and sent to NSSS via password protected zip-files after the 
posttest and stored on a secure data area. These testing kits have been shown to be 
reliable and valid for testing for markers as described above (54), and are considered 
to be practicable for the participants (55). Furthermore, due to the spread among the 
participants geographically, there is a need for achievable methods for collecting these 
markers.  
 
Physical fitness: 
The exercise professionals will be conducting physical tests of the participants at baseline and 
at the end of the 20-week follow-up, to evaluate the individual progress in strength and 
aerobic endurance. The tests will be performed in the same order (aerobic then strength) at 
baseline and follow-up, with a standardized rest interval of 10 minutes between aerobic and 
strength measures. The results from strength testing will be sent to NSSS via password 
protected zip-files and stored on a secure data area. The results from aerobic testing will be 
logged analog, and sent to NSSS via mail, and plotted manually on secure data area. 
   
• Aerobic endurance: Will be assessed with a standardized incline treadmill-walking 
test. Changes in working heart rate, reported RPE, and changes in heart rate recovery 

9 
 
after the test will be used to assess relative changes in aerobic capacity (56). Each 
participant will use the same treadmill at baseline and follow-up in order to avoid any 
speed and incline variations between different treadmills. Optical heart rate sensors 
(Polar Verity Sense) placed on the upper arm will be used for optimal heart rate 
recordings. Speed will be set at a constant of 6 km/h throughout the test, while 
inclination starts at 0%, and increases by 2% every three minutes. Heart rate and RPE 
values within the last 30 seconds of each load will be noted and used for estimation of 
intensity at each inclination. The exercise test will be stopped when the participants 
reach a reported RPE value of 16 or more, and the participants are asked to stand still 
and up right for two minutes. Heart rate values at one and two minutes will be 
recorded and used as measurements for heart rate recovery. 
 
• Muscular strength: Will be assessed by a 1-RM estimation test in: chest press, close 
grip lat pull down and leg press. All exercises will be performed on the weight 
machines available at the specific location, and may therefore be slightly different. 
However, each participant will be tested on the same machine at baseline and follow-
up. Two to three days before the 1-RM estimation test (test day), participants will 
undergo a familiarization session using each of the exercise equipment, according to 
the recommendations by Balady et al. (2000) (57). A load the participant perceives as 
low intensity will be selected for practice of correct lifting and breathing techniques 
(57). Practice continues until the participant demonstrates proper technique using 
submaximal loads, in all exercises for 10 repetitions. Participants will be asked to 
complete 10 repetitions for warm-up, using the load performed at the familiarization 
session. Thereafter, the load will progressively be increase until the participant 
reaches nine or less repetitions. Resting periods between attempts will be two minutes 
with a maximum of six attempts, and three minutes between each specific exercise. 
Brzycki 1-RM prediction equation (58) will be used to estimate the 1-RM based on 
the resistance and repetitions performed. The equation is mathematically expressed as 
1RM = W/ [102.78– 2.78(R)]/100, where W is the weight used and R is the maximal 
number of repetitions performed.  
 
In-depth interview: 
• Women with obesity (n=15): In parallel with the RCT, 15 participants from the 
intervention groups (HIGH n = 5, MEDIUM n = 5, LOW dosage n = 5) will be 
recruited to participate in a semi-structured in-depth interview (approximately 60 
min). The interview will be led by researchers from the project group, audiotaped and 
transcribed verbatim. An interview guide with open-ended questions will be 
developed by the project group, and based on: 1) Basic Psychological Needs in 
Exercise Scale (BPNES) (59, 60), that assess the extent to which the psychological 
needs of the participants were fulfilled during the intervention. BPNES includes three 
subscales, with four statements per subscale, to assess autonomy, competence, and 
relatedness. 2) A former investigation in Norway, including 14 questions designed to 
address factors associated with exercise adherence and drop-out (61). With regards to 

10 
 
the purpose of this project, we will also add questions regarding how satisficed 
participants where with in-person and digital follow-up by their exercise professional.  
• General practitioners (n=8): The GPs recruited in the project will participate in a 
semi-structured in-depth interview (approximately 45 min). The interview will be led 
by researchers from the project group, audiotaped and transcribed verbatim. Questions 
will be based on a previous qualitative study from 2006, conducted on GPs in Norway 
(29). 
 
3.4 Data analysis  
All statistical analysis will be performed using SPSS Statistical Software (IBM Corp. 
Released 2016. IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp). 
Difference in outcome measures between the groups will mainly be evaluated using analysis 
of variance (ANOVA), multivariate analysis of variance (MANOVA) and analysis of 
covariance (ANCOVA) The association between the exercise professional's level of 
education and knowledge base and participants adherence to exercise and/or improvement in 
health and physical fitness, will be assessed using linear regression, controlling for 
cofounding variables. Data will be presented as frequency, percentage or mean with standard 
deviation (SD). Transcripts from the in-dept interviews, will be analyzed using thematic 
analysis.  
3.4 Ethical considerations  
The ABEL-project was reviewed by the Regional Committee for Medical and Health 
Research Ethics (REK) November 2022. REK concluded that, according to the “Act on 
medical and health research” (the Health Research Act 2008), the project did not require full 
review. The project was accepted at Norwegian Centre for Research Data (NSD) January 
2023, and will be registered at ClinicalTrials.gov and NSSS Ethical committee. According to 
the Declaration of Helsinki, all participants will receive written information about the 
project's purpose and procedures and give consent to participate. Participation in this project 
will not involve any harmful or invasive investigations. It will be emphasized that 
participation is voluntary and that anyone who chooses to participate could withdraw partially 
or fully from the project at any time without further explanation. The participants will receive 
membership at a fitness club, regular follow-up sessions with an exercise professional 
(working as a personal trainer), and access to the ABEL-app. No other economic 
compensation will be given to the participants. Based on Norwegian regulations, all raw 
research data will be kept for at least five years after study completion. The IT department at 
NSSS provides storage services. 

11 
 
4. Implementations  
4.1 Project group 
The project group at NSSS has several publications in peer reviewed journals, and a strong 
portfolio within “physical activity as medicine”. The ABEL-project is a collaboration 
between NSSS and the Kristiania university, where the project group has extensive 
experience with health research in various fields: fitness club members, preventive health 
care, exercise and sport science, behavior change, mental health (self-efficacy, life 
satisfaction, and psychological effects of exercise), strength training, as well as randomized 
control trials. The project group will have monthly updates or meetings. A total of two 
professors, one associate professor, one researcher and one research assistant are involved in 
the ABEL-project.  
4.2 Project management and organization 
The ABEL-project is organized and planned by NSSS and Kristiana university college, and 
carried out at the five fitness club chains in Norway. The project emerged as an initiative 
from Abel Technologies who approached researchers at NSSS and Kristiana university 
college. 
 
ABEL Technologies partly finances the project and contribute with assistance in recruiting 
exercise professionals and participants, as well as providing training in the use of the Abel 
digital platform. However, Abel Technologies have had no influence on the scientific 
decisions when designing the RCT. Nor will they take part in writing, analyzing or 
interpreting data. The recruitment of exercise professionals began fall 2022, and recruitment 
of participants is planned to begin in February 2023. Start-up of the intervention, 
questionnaire, test protocols (physical test) and blood tests, are planned to be conducted in 
February 2023 (Table 2). Data analysis and dissemination of results are planned to begin in 
August 2023. During data collection, we will recruit master students from NSSS and 
Kristiania university college, who will have access to some of the collected data to write their 
own master-thesis. The results of the ABEL-project are planned to be published as six 
scientific articles, covering each research questions, submitted to international peer reviewed 
scientific journals. 
 
Table 2. The projects milestones. 
 
Quarter/2022/2023 
TASK 
4/22 
1/23 
2/23 
3/23 
Development of intervention, questionnaire 
and test protocols 
 
 
 
 
Recruitment and start-up of the intervention 
 
 
 
 
Termination of intervention 
 
 
 
 
Analysis and dissemination 
 
 
 
 
 
 
 

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