Title: ‘Snacktivity’ to promote physical activity and reduce future risk of disease in the population
Funder: Department of Health and Social Care

Abstract: Background: The UK population has become less physically active and more sedentary. However, there is strong evidence that physical inactivity and high levels of sitting are associated with poorer health and mortality. Guidance states that over a week, aerobic activity should add up to at least 150-mins of at least moderate-vigorous intensity PA (MVPA) in bouts of 10 minutes or more. One way of achieving this is 30-mins of MVPA on at least five days of the week. Meeting this guidance however means making large changes and very few people achieve this weekly. Guidance that sets large behavioural goals for PA has not been successful in getting the population active. A one size approach may not be appropriate and a paradigm shift is required. Snacktivity: An alternative whole day approach to PA that could engage and motivate the public to be more physically active is a concept we have called snacktivity . Rather than focusing on encouraging 150-mins per week of PA (~30-mins per day) in minimum bouts of 10-mins (i.e. large changes), snacktivity focuses on promoting small, but frequent, doses of regular MVPA throughout the day such that at least 150-mins is accumulated weekly, A PA snack typically lasts between 2-5-mins, e.g., walk-talk conversations, walking coffee breaks, using stairs not the lift, walking whilst taking a telephone call etc.. Unlike current guidance, snacktivity encourages breaking up sitting time throughout the day. Snacktivity may help the public to develop confidence to try to become regularly active as small changes are easier for people to initiate and maintain, than large ones. Snacktivity may be particularly appropriate for populations such as the elderly and those with chronic diseases/disabilities; who may find smaller amounts of PA easier to achieve. Reviews of small intervention studies and acute experimental studies suggest the small change approach can result in reduced risk factor outcomes for chronic diseases, but it is not known whether this approach is acceptable, effective, or easier to sustain over time, than a large change approach. Methods: We will conduct a series of studies to develop and refine the snacktivity intervention, including feedback from the public on the intervention. Data from these early studies will be used to inform subsequent feasibility (n=80) and phase III trials (n=966) to test the acceptability and effectiveness of the snacktivity intervention. The intervention will be embedded within NHS health checks and community health services consultations. Technology is now available to provide real time/objective feedback on PA, so paper-based methods are now redundant. We therefore plan to use a smartphone application (snackapp) synchronised with a wrist worn PA tracker with the specific aim of facilitating self-monitoring of snacktivity and offering feedback on behaviour. The snackapp will prompt PA after 1hr of inactivity. Cost effectiveness of the intervention will also be assessed. Dissemination and outputs: The findings will provide policy makers and commissioners with robust evidence regarding the effectiveness and value for money of an alternative approach to promoting PA in the population.

Lay abstract: What is the problem? There is strong evidence that being active and sitting less is important for health. Guidance states that adults should, over a week, complete at least 150-minutes of moderate to vigorous intensity physical activity (30-minutes per/day) in periods of 10-mins or more. However, few people manage this which puts their health at risk. This is concerning and we need new ways to help people to be active daily. The reason why so few people are meeting the current physical activity guidance may be because they have to make big changes to their lifestyle, which can be too difficult. An alternative is an idea we have called snacktivity . Rather than encouraging people to do 30-minutes of physical activity each day in one go, or in 10 min periods, snacktivity focuses on encouraging people to do small physical activity snacks , throughout the day so they achieve 150-minutes of activity per/week. What is snacktivity? An activity snack might typically last between 2-5-minutes (e.g. walk-talk meetings/conversations; using stairs not lifts; walking while on the phone and taking the dog for extra short walks). Small changes are easier for people to make than large ones. The easiest forms of physical activity are those that can be fitted into daily lives, which may make snacktivity a more acceptable approach. A common reason for being inactive is lack of time; snacktivity provides an opportunity to address this. Snacktivity encourages people to break up their sitting throughout the day&ndash; move more often and sit less . Snacktivity may appear worthwhile, but evidence about whether people will do it and whether it works is needed before it can be recommended to the public. What do we plan to do? We will carry out studies to explore public opinion about snacktivity and get feedback on our snacktivity intervention. We will then conduct a small study to see if snacktivity has the potential to work. Participants will be randomised to receive standard advice about physical activity (large changes) or encouragement to achieve their physical activity by snacktivity (small changes). We will promote snacktivity in the intervention group by giving them a physical activity tracker worn on the wrist to help monitor their snacktivity and overall physical activity and access to an App called snackApp that prompts people participate in snacktivity. We will measure physical activity at the start and 12 weeks later. We will then conduct a larger study where participants are randomised to the same two groups above to see if the snacktivity intervention increases physical activity over 12 months. We expect that participants allocated to do snacktivity will do more physical activity each day/week and sit less, than those who receive the current guidance for physical activity.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: STROKE;ORAL AND GASTROINTESTINAL;CARDIOVASCULAR;CANCER AND NEOPLASMS;METABOLIC AND ENDOCRINE