Title: Developing an intervention to reduce sedentary behaviour in non-ambulant young people with long-term disabilities.
Funder: Health Education England

Abstract: Background: Evidence suggests sedentary behaviour (1.5 metabolic equivalents and a sitting/reclining posture (3)), increases risk of all-cause mortality, cardio-metabolic disease and mental health problems. In children, causal links between sedentary time and increased body mass index, reduced fitness and low self esteem have been established (4). These risks occur irrespective of the levels of moderate to vigorous physical activity engaged in (4). Young people with disabilities, who are non-ambulant, are at high risk of experiencing negative health outcomes associated with sedentary time (5-12). An achievable approach to reducing this population's sedentary time is displacing it with light physical activity (LPA) (13, 14). No evidence-based interventions to reduce and break up sedentary time, by encouraging LPA, have been developed for this population. This research will develop and test the feasibility of a digital intervention to resolve this unmet need. Aims and Objectives: 1) To co-create a digital health intervention, in partnership with young people who are non-ambulant and key stakeholders, to reduce and break up sedentary behaviour by promoting LPA. 2) To undertake a feasibility study evaluating acceptability of the intervention and elements of the trial protocol to participants, practitioners and organisations delivering it. 3) To collect sufficient data to allow optimisation of the intervention, provide early evidence of effectiveness and ensure there are no unintended negative effects prior to undertaking a pilot study. Methods: Intervention development will follow the six steps in quality intervention development (6SQuID) method (15), and will be underpinned by relevant models and theories (16-19). Crowdsourcing (an innovative online data collection method, defined by Estells-Arolas et al., (20)), will be utilised to engage key stakeholders in the intervention development. A mixed methods, single armed feasibility study with 20 participants will be carried out across a minimum of two sites. Data will be collected via individual interviews, the Children's Assessment of Participation and Enjoyment, activity diaries, ActivPAL4 accelerometers and heart rate monitors. A theory based evaluation of the interview transcripts will be undertaken and summary statistics used to describe the quantitative data. Timelines for delivery: Ethical and health research authority approvals will be obtained and the crowdsourcing platforms will open (December 2019). The platforms will close (February 2021) and recruitment for the feasibility study will begin (April 2021). Data collection for the feasibility study will begin when the intervention is complete (September 2021). Data collection will end (January 2022), to allow data analysis and project completion by June 2022. Anticipated impact and Dissemination: The review undertaken within the 6SQuiD, and the feasibility study will be published in relevant scientific journals and conference presentations made. Public and Patient Involvement representatives will produce a video summarising the findings for online dissemination. The crowdsourcing platforms and dissemination of findings will raise awareness amongst families and professionals regarding the implications of sedentary behaviour, and encourage them to address it in clinical practice. Utilisation of technology in research methodology and interventions will be promoted. Potential long-term benefits include implementation of the intervention in the NHS and wider international commercialisation.

Lay abstract: What is sedentary behaviour? Any behaviour which involves sitting or lying down whilst awake, and not using much energy.What are the aims of this research? To help young people with long-term disabilities, who are unable to walk, spend less time being sedentary. This will be achieved by developing a digital intervention (software) for mobile phones or computers to support them with reducing sedentary behaviour. The intervention could encourage use of standing frames or supportive walkers, active floor time or sitting games or using active gaming systems to reduce sedentary time. To develop the intervention in partnership with young people, their families, health professionals, teachers and academics. To test the intervention with a small group to ask their opinions of it, find out if it can be used in the NHS and prepare for a larger study.Why is this research being done? Long periods of sedentary time can lead to poor health, for example obesity, heart and metabolic diseases such as diabetes and mental health problems. Regularly breaking up sedentary time with light physical activity (e.g., standing) can help to prevent poor health. Research shows that children with disabilities spend more time being sedentary than other children. Older children who are unable to walk are more sedentary than other children with disabilities, so have the greater risk of developing health problems. There are no evidence based interventions to support young people with disabilities to reduce their sedentary behaviour. Designing the intervention in partnership with them will maximise effectiveness and impact.What are we going to do? Developing the intervention: In partnership with young people with disabilities, their families, health professionals, teachers, and experts, we will follow a method based on previous research to develop an intervention that supports young people to reduce their sedentary behaviour. The intervention might include advice, information, links to resources, monitoring of sedentary time, goal setting, rewards and interaction with other users. Participants will contribute via an online forum. This is called crowdsourcing. We will use models and behaviour change theories to develop an intervention that acts at different levels. For example on the individual level, on relationships between people, and in different environments, such as home and school.Testing the intervention: We will recruit 20 people (aged 12 - 25 years) with a range of physical disabilities and varying learning abilities to test the intervention. This will mean it can be used by more people, and have greater impact. Participants' parents, carers, teachers and health professionals will be able to view their progress. To measure sedentary behaviour, participants will wear devices called accelerometers, that collect information about their movements, and a heart rate monitor. They will only be worn during the day. Participants will use the software/engage in the intervention for 12 weeks Participants will take part in interviews and complete questionnaires before and after the intervention.Public and patient involvement A young person's steering group and young people with disabilities have commented on the relevance and importance of this topic, the methods chosen and contributed to the writing of this plain English summary. They will assist with advertising the crowdsourcing forum, developing the intervention, developing the protocol and participant information for testing the intervention, analysing data, reviewing reports and sharing results.What happens next? The results will be used to improve the software, enhance the intervention approach and plan a larger scientific trial. Findings will be shared with participants and published in journals such as 'Pilot and Feasibility Studies.' Presentations will be made at conferences such as Physiotherapy UK. Participants will be invited to participate in any further studies to test the intervention.

Research activity codes: 6.7 PHYSICAL
Health categories: GENERIC HEALTH RELEVANCE