What are the most effective behaviour change techniques to promote physical activity and/or reduce sedentary behaviour in inactive adults? A systematic review protocol Patient self-management in primary care patients with mild COPD – protocol of a randomised controlled trial of telephone health coaching Examining the theory‐effectiveness hypothesis: A systematic review of systematic reviews A behaviour change intervention to reduce sedentary time in people with chronic obstructive pulmonary disease: protocol for a randomised controlled trial. A systematic review of school-based interventions targeting physical activity and sedentary behaviour among older adolescents RCT of a theory-based intervention promoting healthy eating and physical activity amongst out-patients older than 65 years. Identifying the content of home-based health behaviour change interventions for frail older people: a systematic review protocol Physical activity coaching of patients with rheumatoid arthritis in everyday practice: a long-term follow-up. Improving Diabetes care through Examining, Advising, and prescribing (IDEA): protocol for a theory-based cluster randomised controlled trial of a multiple behaviour change intervention aimed at primary healthcare professionals The efficacy of motivational counselling and SMS reminders on daily sitting time in patients with rheumatoid arthritis: a randomised controlled trial Using a behaviour change techniques taxonomy to identify active ingredients within trials of implementation interventions for diabetes care Theory of planned behaviour cognitions do not predict self-reported or objective physical activity levels or change in the ProActive trial. Psychosocial interventions for people with dementia: An overview and commentary on recent developments Efficacy of a theory-based behavioural intervention to increase physical activity in an at-risk group in primary care (ProActive UK): a randomised trial Promoting physical activity using an activity monitor and a tailored web-based advice: design of a randomized controlled trial [ISRCTN93896459] Views and experiences of behaviour change techniques to encourage walking to work: a qualitative study A causal modelling approach to the development of theory-based behaviour change programmes for trial evaluation. Effects of an intervention based on self-determination theory on self-reported leisure-time physical activity participation The contribution of lifestyle coaching of overweight patients in primary care to more autonomous motivation for physical activity and healthy dietary behaviour: results of a longitudinal study Participation in health-promoting behaviour: influences on community-dwelling older Chinese people. Impact of a physical activity intervention program on cognitive predictors of behaviour among adults at risk of Type 2 diabetes (ProActive randomised controlled trial) Mediators of change following a senior school physical activity intervention. Effects of workplace-based dietary and/or physical activity interventions for weight management targeting healthcare professionals: a systematic review of randomised controlled trials
Introduction Large proportions of the population are not meeting recommended levels of physical activity and have increasingly sedentary lifestyles . Low levels of physical activity are predictive of poor health outcomes and time spent sedentary is related to a host of risk factors independently of physical activity levels . Building an evidence base of the best approaches to intervene in the lifestyles of inactive individuals is crucial in preventing long-term disease , disability and higher mortality rates . Methods and analysis Systematic search es will be conducted on all relevant data bases ( eg , PubMed , Scopus , CINAHL , PsycINFO ) . Studies will be included if they assess interventions aim ed at changing physical activity or sedentary behaviour levels in adults ( over 18 ) who are inactive and do not suffer from chronic conditions . Studies must also be r and omised controlled trials ( RCTs ) , have a primary outcome of physical activity or sedentary behaviour , and measure outcomes at least 6 months after intervention completion . Studies will be coded using the Behaviour Change Technique ( BCT ) taxonomy v1 and Template for Intervention Description and Replication ( TIDieR ) guidelines . 2 review ers will independently screen full-text articles and extract data on study characteristics , participants , BCTs , intervention features and outcome measures . Study quality will also be assessed independently by 2 review ers using the Cochrane risk of bias tool . A meta- analysis will be considered if there is sufficient homogeneity across outcomes . GRADE criteria will be used to assess quality of evidence . Dissemination This will be the first review to systematic ally appraise interventions aim ed at changing the physical activity or sedentary behaviour of inactive individuals using RCT design s with a 6-month follow-up post-intervention . This review will better inform intervention design ers targeting inactive population s and inform the design of a future complex intervention . Review registration number This protocol was registered with the International Prospect i ve Register of Systematic Review s ( PROSPERO ) on 17 October 2014 ( registration number : CRD42014014321 ) Background The prevalence of diagnosed chronic obstructive pulmonary disease ( COPD ) in the UK is 1.8 % , although it is estimated that this represents less than half of the total disease in the population as much remains undiagnosed . Case finding initiatives in primary care will identify people with mild disease and symptoms . The majority of self-management trials have identified patients from secondary care clinics or following a hospital admission for exacerbation of their condition . This trial will recruit a primary care population with mild symptoms of COPD and use telephone health coaching to encourage self-management . Methods / Design In this study , using a multi-centred r and omised controlled trial ( RCT ) across at least 70 general practice s in Engl and , we plan to establish the effectiveness of nurse-led telephone health coaching to support self-management in primary care for people who report only mild symptoms of their COPD ( MRC grade 1 and 2 ) compared to usual care . The intervention focuses on taking up smoking cessation services , increasing physical activity , medication management and action planning and is underpinned by behavioural change theory . In total , we aim to recruit 556 patients with COPD confirmed by spirometry with follow up at six and 12 months . The primary outcome is health related quality of life using the St Georges Respiratory Question naire ( SGRQ ) . Spirometry and BMI are measured at baseline . Secondary outcomes include self-reported health behaviours ( smoking and physical activity ) , physical activity measured by accelerometery ( at 12 months ) , psychological morbidity , self-efficacy and cost-effectiveness of the intervention . Longitudinal qualitative interviews will explore how engaged participants were with the intervention and how embedded behaviour change was in every day practice s. Discussion This trial will provide robust evidence about the effectiveness of a novel telephone health coaching intervention to promote behaviour change and prevent disease progression in patients with mild symptoms of dyspnoea in primary care . Trial registration Current controlled trials IS RCT N06710391 PURPOSE Health interventions based on theory may be more effective than those that are not . This review of review s synthesizes all published r and omized controlled trial ( RCT ) meta-analytic evidence from the last decade to examine whether theory-based interventions were found to be associated with more effective  adult health behaviour change interventions . METHODS Systematic review s including meta-analyses were identified by search ing Medline , CINAHL , PsycINFO , and CDSR . A narrative synthesis was used to summarize and analyse the evidence . Only review s including RCTs of health behaviour change interventions with adults aged 18 + published from 2007 to 2017 were included . RESULTS Of 8,659 articles , nine systematic review s met inclusion criteria . The majority of review s ( n = 8) suggested no increased effectiveness for theory-based compared to non-theory-based interventions for effectiveness of outcomes relating to health behaviour . Less than half of the RCTs included in the review s reported the use of theory ( 85/183 ) . Two review s suggested interventions based on control theory , motivational interviewing , or self-determination theory were associated with greater effectiveness for physical activity and /or dietary interventions and outcomes . Method ological and reporting issues limit the conclusions . CONCLUSIONS Theory-based interventions as currently operationalized in systematic review s were not found to be more effective than non-theory-based interventions . Method ological and reporting issues at study and review level may not reflect the true utility of theory use within health behaviour interventions . The promotion of theory use may benefit from using a multifaceted argument , rather than a narrow focus of increased effectiveness . Statement of contribution What is already known on this subject ? Theory use is regularly promoted by cl aim ing that it will lead to more effective behaviour change interventions . Theory use has been frequently linked to effectiveness within systematic review s of behaviour change interventions . The theory-effectiveness hypothesis has not been systematic ally examined at the systematic review level . What does this study add ? Theory use as operationalized by systematic review authors was not associated with increased effectiveness within systematic review s examining r and omized controlled trials of behaviour change interventions in adults . Interventions based on control theory , motivational interviewing , or self-determination theory were associated with greater effectiveness for physical activity and /or dietary interventions and outcomes . Theory use should be promoted using a multifaceted argument , and assertions for increased effectiveness of theory-based interventions should only be used in domains where specific evidence exists to support this cl aim INTRODUCTION Replacing sedentary behaviour with light intensity physical activity ( ie , activities classified as less than three metabolic equivalents , such as slow-paced walking ) may be a more realistic strategy for reducing cardiometabolic risk in people with chronic obstructive pulmonary disease than only aim ing to increase levels of moderate-vigorous intensity physical activity . Behaviour change interventions to reduce sedentary behaviour in people with chronic obstructive pulmonary disease have not yet been developed or tested . RESEARCH QUESTIONS Is a 6-week behaviour change intervention effective and feasible in reducing sedentary time in people with chronic obstructive pulmonary disease ? DESIGN This study will be a multi-centre , r and omised , controlled trial with concealed allocation , assessor blinding , and intention-to-treat analysis , comparing a 6-week behaviour change intervention aim ed at reducing sedentary time with a sham intervention in people with chronic obstructive pulmonary disease . PARTICIPANTS AND SETTING Seventy participants will be recruited from the waiting lists for pulmonary rehabilitation programs at Royal Prince Alfred Hospital and Prince of Wales Hospital , Sydney , Australia . INTERVENTION The behaviour change intervention aims to reduce sedentary time through a process of guided goal setting with participants to achieve two target behaviours : ( 1 ) replace sitting and lying down with light-intensity physical activity where possible , and ( 2 ) st and up and move for 2minutes after 30minutes of continuous sedentary time . Three face-to-face sessions and three phone sessions will be held with a physiotherapist over the 6-week intervention period . The ' capability ' , ' opportunity ' , ' motivation ' and ' behaviour ' ( COM-B ) model will be applied to each participant to determine which components of behaviour ( capability , opportunity or motivation ) need to change in order to reduce sedentary time . Based on this ' behavioural diagnosis ' , the Behaviour Change Wheel will be used to systematic ally select appropriate behaviour change techniques to assist participants in achieving their weekly goals . Behaviour change techniques will include providing information about the health consequences of sedentary behaviour , self-monitoring and review of weekly goals , problem-solving of barriers to achieving weekly goals , and providing feedback on sedentary time using the Jawbone UP3 activity monitor . CONTROL The sham intervention will consist of weekly phone calls for 6 weeks , to enquire whether the participants ' health status has changed over the intervention period ( eg , hospitalised for an acute exacerbation ) . No instructions regarding physical activity or exercise will be given . MEASUREMENTS Outcomes will be assessed at baseline , at the end of the 6-week intervention period , and at the 3-month follow-up . Primary outcome measures will be : ( 1 ) total sedentary time , including the pattern of accumulation of sedentary time , assessed by the activPAL3 activity monitor , and ( 2 ) feasibility of the intervention assessed by uptake and retention of participants , participant compliance , self-reported achievement of weekly goals , and adverse events . Secondary outcome measures will include functional exercise capacity , health-related quality of life , domain-specific and behaviour-specific sedentary time , patient activation , and anxiety and depression .  Semi-structured interviews will be conducted with participants who receive the behaviour change intervention to explore acceptability and satisfaction with the different components of the intervention . ANALYSIS Analysis of covariance ( ANCOVA ) will be used to calculate between-group comparisons of total sedentary time and the number of bouts of sedentary time>30minutes after adjusting baseline values . Uncertainty about the size of the mean between-group differences will be quantified with 95 % CI . Within-group comparisons will be examined using paired t-tests and described as mean differences with 95 % CIs . Secondary outcome measures will be analysed similarly . The feasibility measures will be analysed descriptively . Semi-structured interviews will be conducted until data saturation is achieved and there are no new emerging themes . De-identified interview transcripts will be coded independently by two research ers and analysed alongside data collection using the COM-B model as a thematic framework . DISCUSSION / SIGNIFICANCE If behaviour change interventions are found to be an effective and feasible method for reducing sedentary time , such interventions may be used to reduce cardiometabolic risk in people with chronic obstructive pulmonary disease . An approach that emphasises participation in light-intensity physical activity may increase the confidence and willingness of people with chronic obstructive pulmonary disease to engage in more intense physical activity , and may serve as an intermediate goal to increase uptake of pulmonary rehabilitation ABSTRACT Lack of  physical activity  (  PA  ) and high levels of sedentary behaviour ( SB ) have been associated with health problems . This systematic review evaluates the effectiveness of school-based interventions to increase PA  and decrease SB  among 15–19-year-old adolescents , and examines whether intervention characteristics ( intervention length , delivery mode and intervention provider ) and intervention content ( i.e. behaviour change techniques , BCTs ) are related to intervention effectiveness . A systematic search of r and omised or cluster r and omised controlled trials with outcome measures of PA and /or SB rendered 10 results . Risk of bias was assessed using the Cochrane risk of bias tool . Intervention content was coded using Behaviour Change Technique Taxonomy v1 . Seven out of 10 studies reported significant increases in PA . Effects were generally small and short-term ( Cohen 's d ranged from 0.132 to 0.659 ) . Two out of four studies that measured SB reported significant reductions in SB . Interventions that increased PA  included a higher number of BCTs , specific BCTs ( e.g. , goal setting , action planning and self-monitoring ) , and were delivered by research staff . Intervention length and mode of delivery were unrelated to effectiveness . More studies are needed that evaluate long-term intervention effectiveness and target SBs among older adolescents A r and omised controlled trial was used to evaluate a theory-based health promotion intervention . The intervention , a healthy living booklet , was design ed to promote healthy eating and physical activity amongst people aged over 65 years attending hospital out-patient clinics . The booklet employed persuasive arguments targeting the most proximal cognitive antecedents of behaviour specified by the theory of planned behaviour , as well as goal setting prompts . Participants ( N = 252 , average age=82 ) were r and omly allocated to a control ( patient satisfaction question naire ) or intervention ( healthy living booklet ) group .  Cognitions and behaviour were measured pre-intervention and at a two week follow up . The intervention group made significantly higher gains in perceived behavioural control , intention and behaviour for both target behaviours , suggesting that the intervention was successful . Sixty three of those invited to set goals to eat more healthily ( e.g. , " to eat five portions of fruit and vegetables a day " ) did so , and 67 % of those who set such goals reported 100 % success in acting on them . By contrast , only 34 % of intervention participants set an activity goal ( e.g. , " a five minute walk everyday " ) , and only 51 % reported 100 % success in enacting these goals . Results suggest that the observed behavioural effects of the healthy eating booklet could be attributed to goal setting as well as changes in perceived behavioural control and intention Background Meeting the needs of the growing number of older people is a challenge for health and social care services . Home-based interventions aim ing to modify health-related behaviours of frail older people have the potential to improve functioning and well-being . Previous review s have focused on whether such interventions are effective , rather than what might make them effective . Recent advances in behavioural science make possible the identification of potential ‘ active ingredients ’ of effective interventions , such as component behaviour change techniques ( BCTs ) , and intended intervention functions ( IFs ; e.g. to educate , to impart skills ) . This paper reports a protocol for a systematic review that seeks to ( a ) identify health behaviour change interventions for older frail people , ( b ) describe the content of these interventions , and ( c ) explore links between intervention content and effectiveness . The protocol is reported in accordance with Preferred Reporting Items for Systematic Review s and Meta-Analyses Protocol s ( PRISMA -P ) 2015 guidelines . Methods / design Studies will be identified through a systematic search of 15 electronic data bases , supplemented by citation tracking . Studies will be retained for review where they report r and omised controlled trials focusing on home-based health promotion delivered by a health professional for frail older people in community setting s , written in English , and either published from 1980 onwards , or , for registered trials only , unpublished but completed with results obtainable from authors . Interventions will be coded for their content ( BCTs , IFs ) and for evidence of effectiveness ( outcome data relating to behavioural and health outcomes ) . Analyses will describe characteristics of all interventions . Interventions for which effectiveness data are available will be categorised into those showing evidence of effectiveness versus those showing no such evidence . The potential for each intervention characteristic to contribute to change in behaviour or health outcomes will be estimated by calculating the percentage of all interventions featuring those characteristics that have shown effectiveness . Discussion Results will reveal the strategies that have been drawn on within home-based interventions to modify the health behaviours of frail older people , and highlight those more associated with positive changes in behaviour and health . Findings from this review will provide a useful basis for underst and ing , developing , and implementing behaviour change interventions in this field . Systematic review registration PROSPERO OBJECTIVES To investigate the long-term effects on perceived general health , disease activity , pain , activity limitation and cognitive behavioural factors of a one-year coaching programme performed in ordinary physical therapy practice to promote the adoption of health-enhancing physical activity in patients with early rheumatoid arthritis ( RA ) . METHODS A total of 228 patients with early RA , from 10 rheumatology clinics in Sweden , were r and omly assigned to an intervention group ( IG ; n = 94 ) or a control group ( CG ; n = 134 ) . The IG was coached by physical therapists during the first year to adopt health-enhancing levels of physical activity ( 30 minutes/day , moderately intensive , ≥ 4 days/week ) . No coaching was given during the subsequent year between post-intervention and follow-up . Follow-up assessment consisted of a postal question naire on physical activity and of visual analogue scales for ratings of general health perception and pain . The Health Assessment Question naire Disability Index ( HAQ ) and the Disease Activity Score in 28 joints ( DAS 28 ) were collected at regular medical check-ups . RESULTS Sixty-five ( 69 % ) participants in the IG and 92 ( 69 % ) in the CG completed the entire study period by filling in the follow-up question naire on physical activity two years after baseline . The intervention seemed to lack any significant influence on long-term outcome . However , different patterns of change in physical activity behaviour were observed in the two groups . CONCLUSIONS No long-term improvement in perceived general health or other outcomes were found in the follow-up . This may partly be because the intervention lacked several important behavioural elements for physical activity maintenance Background New clinical research findings may require clinicians to change their behaviour to provide high- quality care to people with type 2 diabetes , likely requiring them to change multiple different clinical behaviours . The present study builds on findings from a UK-wide study of theory-based behavioural and organisational factors associated with prescribing , advising , and examining consistent with high- quality diabetes care . Aim To develop and evaluate the effectiveness and cost of an intervention to improve multiple behaviours in clinicians involved in delivering high- quality care for type 2 diabetes . Design / methods We will conduct a two-armed cluster r and omised controlled trial in 44 general practice s in the North East of Engl and to evaluate a theory-based behaviour change intervention . We will target improvement in six underperformed clinical behaviours highlighted in quality st and ards for type 2 diabetes : prescribing for hypertension ; prescribing for glycaemic control ; providing physical activity advice ; providing nutrition advice ; providing on-going education ; and ensuring that feet have been examined . The primary outcome will be the proportion of patients appropriately prescribed and examined ( using anonymised computer records ) , and advised ( using anonymous patient surveys ) at 12 months . We will use behaviour change techniques targeting motivational , volitional , and impulsive factors that we have previously demonstrated to be predictive of multiple health professional behaviours involved in high- quality type 2 diabetes care . We will also investigate whether the intervention was delivered as design ed ( fidelity ) by coding audiotaped workshops and interventionist delivery reports , and operated as hypothesised ( process evaluation ) by analysing responses to theory-based postal question naires . In addition , we will conduct post-trial qualitative interviews with practice teams to further inform the process evaluation , and a post-trial economic analysis to estimate the costs of the intervention and cost of service use . Discussion Consistent with UK Medical Research Council guidance and building on previous development research , this pragmatic cluster r and omised trial will evaluate the effectiveness of a theory-based complex intervention focusing on changing multiple clinical behaviours to improve quality of diabetes care . Trial registration IS RCT N66498413 Objectives The aim of this report is to investigate the efficacy of an individually tailored , theory-based behavioural intervention for reducing daily sitting time , pain and fatigue , as well as improving health-related quality of life , general self-efficacy , physical function and cardiometabolic biomarkers in patients with rheumatoid arthritis ( RA ) . Methods In this r and omised controlled trial 150 patients with RA were r and omised to an  intervention  or a  no-intervention control group . The intervention group received three individual motivational counselling sessions and short message service or text messages aim ed at reduction of sedentary behaviour during the 16-week intervention period . Primary outcome was change in daily sitting time measured objective ly by ActivPAL . Secondary outcomes included change in pain , fatigue , physical function , general self-efficacy , quality of life , blood pressure , blood lipids , haemoglobin A1c , body weight , body mass index , waist circumference and waist – hip ratio . Results 75 patients were allocated to each group . Mean reduction in daily sitting time was −1.61 hours/day in the intervention versus 0.59 hours/day increase in the control group between-group difference −2.20 ( 95 % CI −2.72 to −1.69 ; p<0.0001 ) hours/day in favour of the intervention group . Most of the secondary outcomes were also in favour of the intervention . Conclusion An individually tailored , behavioural intervention reduced daily sitting time in patients with RA and improved patient-reported outcomes and cholesterol levels . Trial registration number NCT01969604 ; Results Background Method ological guidelines for intervention reporting emphasise describing intervention content in detail . Despite this , systematic review s of quality improvement ( QI ) implementation interventions continue to be limited by a lack of clarity and detail regarding the intervention content being evaluated . We aim ed to apply the recently developed Behaviour Change Techniques Taxonomy version 1 ( BCTTv1 ) to trials of implementation interventions for managing diabetes to assess the capacity and utility of this taxonomy for characterising active ingredients . Methods Three psychologists independently coded a r and om sample of 23 trials of healthcare system , provider- and /or patient-focused implementation interventions from a systematic review that included 142 such studies . Intervention content was coded using the BCTTv1 , which describes 93 behaviour change techniques ( BCTs ) grouped within 16 categories . We supplemented the generic coding instructions within the BCTTv1 with decision rules and examples from this literature . Results Less than a quarter of possible BCTs within the BCTTv1 were identified . For implementation interventions targeting providers , the most commonly identified BCTs included the following : adding objects to the environment , prompts/cues , instruction on how to perform the behaviour , credible source , goal setting ( outcome ) , feedback on outcome of behaviour , and social support ( practical ) . For implementation interventions also targeting patients , the most commonly identified BCTs included the following : prompts/cues , instruction on how to perform the behaviour , information about health consequences , restructuring the social environment , adding objects to the environment , social support ( practical ) , and goal setting ( behaviour ) . The BCTTv1 mapped well onto implementation interventions directly targeting clinicians and patients and could also be used to examine the impact of system-level interventions on clinician and patient behaviour . Conclusions The BCTTv1 can be used to characterise the active ingredients in trials of implementation interventions and provides specificity of content beyond what is given by broader intervention labels . Identification of BCTs may provide a more helpful means of accumulating knowledge on the content used in trials of implementation interventions , which may help to better inform replication efforts . In addition , prospect i ve use of a behaviour change techniques taxonomy for developing and reporting intervention content would further aid in building a cumulative science of effective implementation interventions OBJECTIVE The objective was to test , in a trial cohort of sedentary adults at risk of Type 2 diabetes , whether theory of planned behaviour ( TPB ) cognitions about becoming more physically active predicted objective and self-reported activity levels and change . DESIGN Participants of a r and omized controlled trial underwent measurement at baseline , 6 and 12 months . METHODS Participants ( N= 365 , 30 - 50 years ) were recruited via their parent or family history registers at 20 general practice s in the UK .  Energy expenditure was measured objective ly at baseline and 1 year . Participants completed question naires assessing physical activity and beliefs about becoming more physically active over the next year at baseline , 6 and 12 months . RESULTS Between baseline and 12 months , objective energy expenditure in the cohort increased by an average of 20 minutes of brisk walking per day . Based on the 252 participants who provided complete data , affective attitude and perceived behavioural control consistently predicted intention , but intention and perceived behavioural control failed to predict physical activity levels or change ( p-values > .05 ) . CONCLUSIONS Failure of the theory to predict behaviour and behaviour change may be due to inapplicability of the theory to this at-risk population or to trial participation and intensive measurement facilitating behaviour change without affecting measured cognitions , or lack of correspondence between cognitive and behavioural measures . A wide range of potential personal and environmental mediators should be considered when design ing physical activity interventions among at-risk groups . High- quality experimental tests of the theory are needed in clinical population An influential review in 2010 concluded that non-pharmacological multi-component interventions have positive effects on cognitive functioning , activities of daily living , behaviour and mood of people with dementia . Our aim here is to provide an up-to- date overview of research into psychosocial interventions and their impact on psychosocial outcomes . We focused on r and omised controlled trials , controlled studies and review s published between October 2008 and August 2015 , since the earlier review . The search of PsychInfo , Medline and the Cochrane data base of systematic review s yielded 61 relevant articles , organised into four themes echoing key phases of the care pathway : Living at home with dementia ( five review s , eight studies ) , carer interventions ( three review s , four studies ) , interventions in residential care ( 16 review s , 12 studies ) and end-of-life care ( three review s , two studies ) , along with an additional group spanning community and institutional setting s ( six review s , two studies ) . Community findings suggested that appointment of dementia specialists and attention to case management can produce positive outcomes ;  physical therapies , cognitive training and modified cognitive behaviour therapy also had a range of benefits . There was more limited evidence of positive benefits for people with dementia through interventions with family carers . Thirty-two articles focused on the management of ‘ behavioural symptoms ’ through a range of interventions all of which had some evidence of benefit . Also a range of multi-component and specific interventions had benefits for cognitive , emotional and behavioural well-being of people with dementia in residential setting s , as well as for quality of life . Overall , interventions tended to be short term with impact only measured in the short term . We recommend further research on interventions to promote living well in the community post-diagnosis and to address end-of-life care . Development of psychosocial interventions would benefit from moving beyond the focus on control of behaviours to focus on wider aspects of life for people with dementia BACKGROUND Declining physical activity is associated with a rising burden of global disease . Efforts to reverse this trend have not been successful . We aim ed to assess the efficacy of a facilitated behavioural intervention to increase the physical activity of sedentary individuals at familial risk of diabetes . METHODS We enrolled 365 sedentary adults who had a parental history of type 2 diabetes . They were recruited from either diabetes or family history registers at 20 general practice clinics in the UK . Eligible participants were r and omly assigned to one of two intervention groups , or to a comparison group . All participants were posted a brief advice leaflet . One intervention group was offered a 1-year behaviour-change programme , to be delivered by trained facilitators in participants ' homes , and the other the same programme by telephone . The programme was design ed to alter behavioural determinants , as defined by the theory of planned behaviour , and to teach behaviour-change strategies . The principal outcome at 1 year was daytime physical activity , which was objective ly measured as a ratio to resting energy expenditure . Analysis was by intention to treat . This study is registered as IS RCT N61323766 . FINDINGS Of 365 patients , we analysed primary endpoints for 321 ( 88 % ) for whom we had data after 1 year of follow-up . At 1 year , the physical-activity ratio of participants who received the intervention , by either delivery route , did not differ from the ratio in those who were given a brief advice leaflet . The mean difference in daytime physical-activity ratio , adjusted for baseline , was -0.04 ( 95 % CI -0.16 to 0.08 ) . The physical-activity ratio did not differ between participants who were delivered the intervention face-to-face or by telephone ( mean difference -0.05 ; 95 % CI -0.19 to 0.10 ) . INTERPRETATION A facilitated theory-based behavioural intervention was no more effective than an advice leaflet for promotion of physical activity in an at-risk group ; therefore health-care providers should remain cautious about commissioning behavioural programmes into individual preventive health-care services Background Ageing is associated with a decrease in physical activity . This decrease particularly occurs during specific transitional life stages . Especially during adolescence and young adulthood a steep decrease in physical activity is observed . Inactive people are often not aware of their inactivity . Providing feedback on the actual physical activity level by an activity monitor can increase awareness and may in combination with an individually tailored physical activity advice stimulate a physically active lifestyle . Methods In a r and omized controlled trial the effectiveness of providing an activity monitor in combination with a personal physical activity advice through the Internet will be examined . Outcome measures are level of physical activity , determinants of physical activity , quality of life , empowerment , aerobic fitness and body composition .  Participants are relatively inactive adolescents and young adults who are measured at baseline , after 3 months intervention and 5 months after the end of the intervention . In addition , facilitating and hindering factors for implementation of the intervention will be investigated . Discussion The use of a personal activity monitor in combination with web-based assisted individually tailored health promotion offers a good opportunity to work interactively with large groups of adolescents and young adults and provide them with advice based on their actual activity level . It has great potential to motivate people to change their behaviour and to our knowledge has not been evaluated before Background High levels of physical inactivity are linked to several chronic diseases including coronary heart disease , type-2 diabetes , obesity , some cancers and poor mental health . Encouraging people to be more active has proven difficult . One way to incorporate physical activity into the daily routine is through the journey to and from work . Although behaviour change techniques ( BCTs ) are considered valuable in promoting behaviour change , there is very little in the published literature about the views and experiences of those encouraged to use them . Methods The Walk to Work study was a feasibility study incorporating an exploratory cluster r and omised controlled trial . The 10-week intervention involved training workplace-based Walk to Work promoters ( volunteers or nominated by participating employers ) to encourage colleagues to increase walking during their daily commute . The intervention used nine specific BCTs : Intention formation , barrier identification , specific goal setting , instruction , general encouragement , self-monitoring of behaviour social support , review of behavioural goals and relapse prevention . Digitally recorded interviews were undertaken with 22 employees , eight of whom were Walk to Work promoters to underst and their views and experiences of using these techniques . The Framework method of data management and constant comparison were used to analyse the data and identify key themes . Results For each individual BCT , there appeared to be people who found it useful in helping them to increase walking to work and others who did not . Following training , the Walk to Work promoters varied in the extent to which they were able to fulfil their role : additional support and encouragement during the 10-week intervention may be required for the promoters to maintain motivation . Wider context ual ( economic climate , unprecedented wet weather ) and organisational ( workload , car parking facilities ) issues were identified that influenced the delivery of , and response to , the intervention . Conclusions Walk to work interventions employing BCTs should include sufficient techniques to enable participants to choose a ‘ package ’ to suit their needs . Additional support at organisational level should also be encouraged , and consideration given to wider context ual factors that impinge on the delivery of , and response to , the intervention . Trial registration IS RCT N72882329 Theory-based intervention programmes to support health-related behaviour change aim to increase health impact and improve underst and ing of mechanisms of behaviour change . However , the science of intervention development remains at an early stage . We present a causal modelling approach to developing complex interventions for evaluation in r and omized trials . In this approach a generic model links behavioural determinants , causally through behaviour , to physiological and biochemical variables , and health outcomes . It is tailored to context , target population , behaviours and health outcomes . The development of a specific causal model based on theory and evidence is illustrated by the ProActive programme , supporting increased physical activity  among individuals at risk of Type 2 diabetes . The model provides a rational guide to appropriate measures , intervention points and intervention techniques , and can be tested quantitatively . Causal modelling is critically compared to other approaches to intervention development and evaluation , and research directions are indicated Based on self-determination theory , the present study developed and evaluated the utility a school-based intervention to change pupils ’ physical activity intentions and self-reported leisure-time physical activity behaviour . The study evaluated utility of the intervention to promote physical activity participation over a 5-week interval of time . A cluster r and omised design targeting 215 pupils from 10 schools with schools as the unit of r and omisation was adopted ( Male = 106 , Female = 109 , Age = 14.84 , SD = 0.48 ) . Results indicated that pupils who were taught  by autonomy-supportive teachers reported stronger intentions to exercise during leisure time and participated more frequently in leisure-time physical activities than pupils in the control condition . Autonomous motivation and intentions mediated the effects of the intervention on self-reported physical activity behaviour . It is concluded that self-determination theory provides a useful framework for the development of school-based interventions that ultimately affect leisure-time physical activity participation Background Combined lifestyle interventions ( CLIs ) have been advocated as an effective instrument in efforts to reduce overweight and obesity . The odds of maintaining higher levels of  physical activity ( PA ) and healthier dietary behaviour improve when people are more intrinsically motivated to change their behaviour . To promote the shift towards more autonomous types of motivation , facilitator led CLIs have been developed including lifestyle coaching as key element . The present study examined the shift in types of motivation to increase  PA  and  healthy dieting  among participants of a primary care CLI , and the contribution of lifestyle coaching to potential changes in motivational quality . Methods This prospect i ve cohort study included participants of 29 general practice s in the Netherl and s that implemented a CLI named ‘ BeweegKuur ’ .  Question naires including items on demographics , lifestyle coaching and motivation were sent at baseline and after 4 months . Aspects of motivation were assessed with the  Behavioural Regulation and Exercise Question naire ( BREQ-2 ) and the  Regulation of Eating Behaviour Question  naire ( REBS ) . We performed a drop out analysis to identify selective drop-out . Changes in motivation were analysed with t-tests and effect size interpretations ( Cohen ’s d ) , and multivariate regression analysis was used to identify predictors of motivational change . Results For physical activity , changes in motivational regulation were fully in line with the tenets of Self Determination Theory and Motivational Interviewing : participants made a shift towards a more autonomous type of motivation ( i.e. controlled types of motivation decreased and autonomous types increased ) . Moreover , an autonomy supportive coaching style was generally found to predict a larger shift in autonomous types of motivation . For healthy dietary behaviour , however , except for a small decrease in external motivation , no favourable changes in different types of motivation were observed . The relation between coaching and motivation appeared to be influenced by the presence of physical activity guidance in the programme . Conclusions Motivation of participants of a real life primary care CLI had changed towards a more autonomous motivation after 4 months of intervention . Autonomy-supportive lifestyle coaching contributed to this change with respect to physical activity . Lifestyle coaching for healthy diet requires thorough knowledge about the problem of unhealthy dieting and solid coaching skills AIM This paper reports a study to determine the factors affecting community-dwelling older Chinese people 's  health-promoting behaviour in the domains of physical activity , healthy dietary practice s and stress management , and to identify any barriers to these behaviours . BACKGROUND Previous studies have identified factors affecting different types of health-promoting behaviours , including perceived self-efficacy , perceived benefits and five individual characteristics ( age , sex , marital status , education and perceived health ) of older non-Chinese people . However , few studies have simultaneously taken these factors into account in examining community-dwelling Chinese older people 's health-promoting behaviour . METHOD Individual face-to-face interviews were completed in 2002 - 2003 with a convenience sample of 896 community-dwelling older Chinese people in Hong Kong aged between the ages of 60 and 98 ( years mean 76 ) . Participants had no apparent communication and cognition impairments . A structured interview schedule was used to collect the data . RESULTS Multiple regression analysis showed that perceived self-efficacy , perceived benefits and sex together explained 38.4 % of health-promoting behaviour among community-dwelling older Chinese people in Hong Kong . Fatigue during and after physical activity , enjoyment of unhealthy foods and inadequate family and peer support were the most frequently reported barriers to health-promoting behaviour . CONCLUSION When developing health promotion programmes to motivate community-dwelling older Chinese clients to participate in health-promoting behaviour and to minimize barriers , community nurses should include some activities to increase both the perceived self-efficacy and perceived benefits of health-promoting behaviour . Future studies should include more critical factors based on theories , empirical evidence and knowledge of culture with sample s that are r and om and from more diverse community setting Background In the ProActive Trial an intensive theory-based intervention program was no more effective than theory-based brief advice in increasing objective ly measured physical activity among adults at risk of Type 2 diabetes . We aim ed to illuminate these findings by assessing whether the intervention program changed cognitions about increasing activity , defined by the Theory of Planned Behaviour , in ways consistent with the theory . Methods N = 365 sedentary participants aged 30–50 years with a parental history of Type 2 diabetes were r and omised to brief advice alone or to brief advice plus the intervention program delivered face-to-face or by telephone . Question naires at baseline , 6 and 12 months assessed cognitions about becoming more physically active . Analysis of covariance was used to test intervention impact . Bootstrapping was used to test multiple mediation of intervention impact . Results At 6 months , combined intervention groups ( face-to-face and telephone ) reported that they found increasing activity more enjoyable ( affective attitude , d = .25 ) , and they perceived more instrumental benefits ( e.g. , improving health ) ( d = .23 ) and more control ( d = .32 ) over increasing activity than participants receiving brief advice alone . Stronger intentions ( d = .50 ) in the intervention groups than the brief advice group at 6 months were partially explained by affective attitude and perceived control . At 12 months , intervention groups perceived more positive instrumental ( d = .21 ) and affective benefits ( d = .29 ) than brief advice participants . The intervention did not change perceived social pressure to increase activity . Conclusion Lack of effect of the intervention program on physical activity over and above brief advice was consistent with limited and mostly small short-term effects on cognitions . Targeting affective benefits ( e.g. , enjoyment , social interaction ) and addressing barriers to physical activity may strengthen intentions , but stronger intentions did not result in more behaviour change . More powerful interventions which induce large changes in TPB cognitions may be needed . Other interventions deserving further evaluation include theory-based brief advice , intensive measurement of physical and psychological factors , and monitoring of physical activity . Future research should consider a wider range of mediators of physical activity change , assess participants ' use of self-regulatory strategies taught in the intervention , and conduct experimental studies or statistical modelling prior to trial evaluation . IS RCT N61323766 It has been suggested that the low level of effectiveness of youth interventions is due to a lack of knowledge regarding the mechanisms responsible for behaviour change . The identification of behaviour mediators is necessary for the progression of physical activity research , as it allows research ers to determine which components of an intervention are responsible for mediating behaviour change . The purpose of this study was to identify mediators of behaviour change in a physical activity intervention for senior school students . Participants ( n=78 ) were r and omly allocated to control or intervention conditions for a period of 10 weeks .  Moderate-to-vigorous physical activity ( MVPA )  and potential mediators were assessed at baseline and post-intervention ( 10 weeks ) . Hypothesized mediators were derived from B and ura 's Social Cognitive Theory and included : peer support , exercise self-efficacy and outcome expectancy . Mediation was assessed using the product-of-coefficients test described by MacKinnon and colleagues , based on the criteria for mediation identified by Baron and Kenny . While none of the variables satisfied all four criteria for mediation among males or females , self-efficacy was able to satisfy the first three criteria among females in the study . Exercise self-efficacy may be a mediator of physical activity behaviour in adolescent girls Background The prevalence of overweight and obesity is high amongst healthcare professionals and there is growing interest in delivering weight loss interventions in the workplace . We conducted a systematic review to ( i ) examine the effectiveness of workplace-based diet and /or physical activity interventions aim ed at healthcare professionals and to ( ii ) identify and describe key components of effective interventions . Seven electronic data bases were systematic ally search ed . Results Thirteen r and omised controlled trials met the inclusion criteria , of which seven had data available for meta- analysis . Where meta- analysis was possible , studies were grouped according to length of follow-up ( < 12 months and ≥12 months ) and behavioural target ( diet only , physical activity only or diet and physical activity ) , with outcome data pooled using a weighted r and om effects model . Nine studies reported statistically significant ( between-group ) differences . Four studies reported being informed by a behaviour change theory . Meta- analysis of all trials reporting weight data demonstrated healthcare professionals allocated to dietary and physical activity interventions lost significantly more body weight ( −3.95 Kg , [ 95 % CI −4.96 to- 2.95 Kg ] ) than controls up to 12 months follow up . Conclusions Workplace diet and /or physical activity interventions targeting healthcare professionals are limited in number and are heterogeneous . To improve the evidence base , we recommend additional evaluations of theory-based interventions and adequate reporting of intervention content
There has been varied success of behaviour change interventions in promoting physical activity behaviour in people who have RA .
Research has shown that people who have rheumatoid arthritis ( RA ) do not usually participate in enough physical activity to obtain the benefits of optimal physical activity levels , including quality of life , aerobic fitness and disease-related characteristics .
Behaviour change theory underpins the promotion of physical activity .
The aim of this systematic review was to explore behaviour change interventions which targeted physical activity behaviour in people who have RA , focusing on the theory underpinning the interventions and the behaviour change techniques utilised using specific behaviour change taxonomy .