Clinical trial NCT02629666: Exercise Referral Schemes Enhanced by Self-Management Strategies to Battle Sedentary Behaviour
Official title: Exercise Referral Schemes Enhanced by Self-Management Strategies to Battle Sedentary Behaviour
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Physical Activity
Biological Aging
Frail Older Adults
Controlled Clinical Trials, Randomized
Sedentary Behaviour
Exercise Referral Schemes
Physical Function
Lead sponsor: University Ramon Llull
Sponsor class: OTHER
Collaborators: name: Fundació Salut i Envelliment de la Universitat Autònoma de Barcelona
name: University of Southern Denmark
name: Queen's University, Belfast
name: University of Ulm
name: Sport Initiative et Loisir Bleu Association
name: University of Glasgow
First posted: 2015-12-14
Enrollment: 1360
Sex: ALL
Minimum age (years): 65
Standard ages: OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: PREVENTION

Brief summary: The increase of the elderly population leads to increased prevalence of frailty, risk for poor health outcomes, and related health and social care costs. Lack of physical activity (PA) and established sedentary behaviours (SB) constitute an additional burden, as they are related to progression of chronic disease and disabling conditions. An existing initiative to battle SB and insufficient PA levels are exercise referral schemes (ERS) implemented in primary care, where insufficiently active individuals are referred to a third party service (sports centre or leisure facility) that prescribes and monitors an exercise programme tailored to the patients' needs. ERS had shown improvements in PA in the short-term, but may have limited power to change SB and produce long-term effects. Thus, ERS might be enhanced by self-management strategies (SMS) to promote behavioural change. Such strategies based on social cognitive theory have been shown to increase self-confidence, power to act, and involvement in exercise. In a first stage, a systematic review, focus groups and a feasibility study will be conducted. Then, a three-armed pragmatic randomized controlled trial (RCT) will assess the long-term effectiveness (18-month follow-up) of a complex intervention on sedentary behaviour (SB) in an elderly population, based on existing ERS enhanced by self-management strategies (SMS). It will be compared to ERS alone and to general recommendations plus two educational sessions. The RCT will include 1338 subjects and will have a follow up of 18 months. The effect on SB will be measured as sitting time and the number of minutes spent in activities requiring ≤ 1.5 Metabolic Equivalent Tasks, and PA as daily counts per minute and intensity of exercise, and daily step counts. Secondary outcomes will include: physical function, healthcare use and costs, anthropometry, bioimpedance, blood pressure, self-rated health and quality of life, activities of daily living, anxiety, depressive symptoms, social network, physical activity self-regulation, self-efficacy for exercise, disability, fear of falling, loneliness, executive function, and physical fatigue. In a subsample, the level of frailty-associated biomarkers and inflammation, and sarcopenia-associated markers of muscle quality will be analysed. A process evaluation will be performed throughout the trial. SITLESS will assess policy makers in deciding how or whether ERS should be further implemented or restructured in order to increase its adherence, efficacy and cost-effectiveness.


Eligibility criteria: Inclusion Criteria:

Community-dwelling older persons aged 65 or above.

Able to walk without help of another person during 2 minutes, and without major physical limitations, defined as a score on the Short Physical Performance Battery (Guralnik et al., 1995) of 4 or above. The use of an assistive device will be permitted.

Insufficiently active and/or Self-report sitting too much during a usual day. Answer yes to the following question: 'Do you perform regular physical activity (PA) at least 30 minutes five or more days of the week (please only refer to physical activity that makes the participant run out of breath while doing it or it doesn't allow him/her to maintain a conversation while doing the activity (do not count regular walking)?'

And/or answer yes to question: 'For most days, do you feel you sit for too long (6-8 hours or more a day)? Some examples might include when watching TV, working the computer / laptop or when doing sitting-based hobbies such as sewing'.

Exclusion Criteria:

Dementia assessed with the six-Item Screener. Participants with three or more errors should be excluded.

Unstable medical conditions (e.g. elevated blood pressure after medication) or with symptomatic cardiovascular disease.

Any medical condition which may interfere with the study design (e.g. end-stage disease).

Refuse to wear an accelerometer (primary outcome)

Unable to attend during the study period (80% of the total sessions).

Had participated in an ERS in the 6 months prior the study.

Primary outcomes:
measure: Change in sitting time
timeFrame: During 7 days. Outcome measure will be collected (T0) baseline pre-intervention, (T1) at month 4 post intervention, (T2) at month 16 (12 months after the end of the intervention), and (T3) at month 22 (18 months after the end of the intervention)
measure: Change in minutes spent in sedentary behaviour
timeFrame: During 7 days. Outcome measure will be collected (T0) baseline pre-intervention, (T1) at month 4 post intervention, (T2) at month 16 (12 months after the end of the intervention), and (T3) at month 22 (18 months after the end of the intervention)
measure: Change in total activity counts per minute
timeFrame: During 7 days. Outcome measure will be collected (T0) baseline pre-intervention, (T1) at month 4 post intervention, (T2) at month 16 (12 months after the end of the intervention), and (T3) at month 22 (18 months after the end of the intervention)
Secondary outcomes:
measure: Change in use and costs of the healthcare system
timeFrame: Outcome measure will be collected (T0) baseline pre-intervention, (T1) at month 4 post intervention, (T2) at month 16 (12 months after the end of the intervention), and (T3) at month 22 (18 months after the end of the intervention)
measure: Change in % fat and % muscle
timeFrame: Outcome measure will be collected (T0) baseline pre-intervention, (T1) at month 4 post intervention, (T2) at month 16 (12 months after the end of the intervention), and (T3) at month 22 (18 months after the end of the intervention)
measure: Change in health-related quality of life
timeFrame: Outcome measure will be collected (T0) baseline pre-intervention, (T1) at month 4 post intervention, (T2) at month 16 (12 months after the end of the intervention), and (T3) at month 22 (18 months after the end of the intervention)
measure: Change in activities of daily living performance
timeFrame: Outcome measure will be collected (T0) baseline pre-intervention, (T1) at month 4 post intervention, (T2) at month 16 (12 months after the end of the intervention), and (T3) at month 22 (18 months after the end of the intervention)
measure: Change in depressive symptoms
timeFrame: Outcome measure will be collected (T0) baseline pre-intervention, (T1) at month 4 post intervention, (T2) at month 16 (12 months after the end of the intervention), and (T3) at month 22 (18 months after the end of the intervention)
measure: Change in anxiety symptoms
timeFrame: Outcome measure will be collected (T0) baseline pre-intervention, (T1) at month 4 post intervention, (T2) at month 16 (12 months after the end of the intervention), and (T3) at month 22 (18 months after the end of the intervention)
measure: Changes in social network
timeFrame: Outcome measure will be collected (T0) baseline pre-intervention, (T1) at month 4 post intervention, (T2) at month 16 (12 months after the end of the intervention), and (T3) at month 22 (18 months after the end of the intervention)
measure: Changes in Physical activity self-regulation
timeFrame: Outcome measure will be collected (T0) baseline pre-intervention, (T1) at month 4 post intervention, (T2) at month 16 (12 months after the end of the intervention), and (T3) at month 22 (18 months after the end of the intervention)
measure: Changes in Self-efficacy for exercise
timeFrame: Outcome measure will be collected (T0) baseline pre-intervention, (T1) at month 4 post intervention, (T2) at month 16 (12 months after the end of the intervention), and (T3) at month 22 (18 months after the end of the intervention)
measure: Changes in Disability
timeFrame: Outcome measure will be collected (T0) baseline pre-intervention, (T1) at month 4 post intervention, (T2) at month 16 (12 months after the end of the intervention), and (T3) at month 22 (18 months after the end of the intervention)
measure: Changes in Fear of falling
timeFrame: Outcome measure will be collected (T0) baseline pre-intervention, (T1) at month 4 post intervention, (T2) at month 16 (12 months after the end of the intervention), and (T3) at month 22 (18 months after the end of the intervention)
measure: Change in Loneliness perception
timeFrame: Outcome measure will be collected (T0) baseline pre-intervention, (T1) at month 4 post intervention, (T2) at month 16 (12 months after the end of the intervention), and (T3) at month 22 (18 months after the end of the intervention)
measure: Change in Executive function
timeFrame: Outcome measure will be collected (T0) baseline pre-intervention, (T1) at month 4 post intervention, (T2) at month 16 (12 months after the end of the intervention), and (T3) at month 22 (18 months after the end of the intervention)
measure: Change in Physical fatigue
timeFrame: Outcome measure will be collected (T0) baseline pre-intervention, (T1) at month 4 post intervention, (T2) at month 16 (12 months after the end of the intervention), and (T3) at month 22 (18 months after the end of the intervention)
measure: Change in general function
timeFrame: Outcome measure will be collected (T0) baseline pre-intervention, (T1) at month 4 post intervention, (T2) at month 16 (12 months after the end of the intervention), and (T3) at month 22 (18 months after the end of the intervention)
measure: Change in handgrip strength
timeFrame: Outcome measure will be collected (T0) baseline pre-intervention, (T1) at month 4 post intervention, (T2) at month 16 (12 months after the end of the intervention), and (T3) at month 22 (18 months after the end of the intervention)
measure: Change in aerobic capacity
timeFrame: Outcome measure will be collected (T0) baseline pre-intervention, (T1) at month 4 post intervention, (T2) at month 16 (12 months after the end of the intervention), and (T3) at month 22 (18 months after the end of the intervention)
measure: Change in static balance
timeFrame: Outcome measure will be collected (T0) baseline pre-intervention, (T1) at month 4 post intervention, (T2) at month 16 (12 months after the end of the intervention), and (T3) at month 22 (18 months after the end of the intervention)
measure: Change in mean strength and power with concentric contraction of isoinertial movement
timeFrame: Outcome measure will be collected (T0) baseline pre-intervention, (T1) at month 4 post intervention, (T2) at month 16 (12 months after the end of the intervention), and (T3) at month 22 (18 months after the end of the intervention)
Other outcomes:
measure: Level of frailty-associated biomarkers and inflammation
timeFrame: Outcome measure will be collected (T0) baseline pre-intervention, and (T1) at month 4 post intervention
measure: Sarcopenia-associated markers of muscle quality
timeFrame: Outcome measure will be collected (T1) at month 4 post intervention
Locations:
city: Barcelona
country: Spain
facility: Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna
state: Please Select
Study officials:
References:
citation: Bizjak DA, Zugel M, Schumann U, Tully MA, Dallmeier D, Denkinger M, Steinacker JM. Do skeletal muscle composition and gene expression as well as acute exercise-induced serum adaptations in older adults depend on fitness status? BMC Geriatr. 2021 Dec 15;21(1):697. doi: 10.1186/s12877-021-02666-0.
citation: Coll-Planas L, Blancafort Alias S, Tully M, Caserotti P, Gine-Garriga M, Blackburn N, Skjodt M, Wirth K, Deidda M, McIntosh E, Rothenbacher D, Gallardo Rodriguez R, Jerez-Roig J, Sansano-Nadal O, Santiago M, Wilson J, Guerra-Balic M, Martin-Borras C, Gonzalez D, Lefebvre G, Denkinger M, Kee F, Salva Casanovas A, Roque I Figuls M; SITLESS group. Exercise referral schemes enhanced by self-management strategies to reduce sedentary behaviour and increase physical activity among community-dwelling older adults from four European countries: protocol for the process evaluation of the SITLESS randomised controlled trial. BMJ Open. 2019 Jun 14;9(6):e027073. doi: 10.1136/bmjopen-2018-027073.
citation: Deidda M, Coll-Planas L, Gine-Garriga M, Guerra-Balic M, Roque I Figuls M, Tully MA, Caserotti P, Rothenbacher D, Salva Casanovas A, Kee F, Blackburn NE, Wilson JJ, Skjodt M, Denkinger M, Wirth K, McIntosh E; SITLESS Team. Cost-effectiveness of exercise referral schemes enhanced by self-management strategies to battle sedentary behaviour in older adults: protocol for an economic evaluation alongside the SITLESS three-armed pragmatic randomised controlled trial. BMJ Open. 2018 Oct 15;8(10):e022266. doi: 10.1136/bmjopen-2018-022266.
citation: Gine-Garriga M, Coll-Planas L, Guerra M, Domingo A, Roque M, Caserotti P, Denkinger M, Rothenbacher D, Tully MA, Kee F, McIntosh E, Martin-Borras C, Oviedo GR, Jerez-Roig J, Santiago M, Sansano O, Varela G, Skjodt M, Wirth K, Dallmeier D, Klenk J, Wilson JJ, Blackburn NE, Deidda M, Lefebvre G, Gonzalez D, Salva A. The SITLESS project: exercise referral schemes enhanced by self-management strategies to battle sedentary behaviour in older adults: study protocol for a randomised controlled trial. Trials. 2017 May 18;18(1):221. doi: 10.1186/s13063-017-1956-x.