Prosjektbeskrivelse
Increased physical activity (PA) and a healthy diet have consistently been shown to independently be associated with lower risk of a range of chronic non-communicable diseases and have been a primary focus of the public health guidelines for decades. PA (increased energy expenditure) and diet (caloric restriction, in part via improved diet quality) are also cornerstones in the prevention and management of overweight and obesity, which are strongly linked to risk of type 2 diabetes, cardiovascular diseases (CVD) and overall mortality. Data from randomised controlled trials shows that a combination of increased PA and dietary change is more effective for weight loss than each component alone, as well as being the most effective in reducing blood lipids and blood pressure.
More recently, there has been a large body of observational data suggesting that high levels of sedentary behaviour (SED) is associated with high risk of a range of adverse health outcomes including CVD, all-cause mortality and incident type 2 diabetes. However, evidence regarding how much changing SED changes risk of these conditions is more limited. The extent to which reducing sitting time, as opposed to increasing PA, influences biomarkers of cardiometabolic risk is presently uncertain and an important question for public health.
EuroFIT was a pragmatic two-arm randomised controlled trial conducted in 2016 and 2017 in 15 professional football clubs in England (five clubs), the Netherlands (four clubs), Norway (three clubs), and Portugal (three clubs). EuroFIT was designed to support men to become gradually more physically active, reduce their sedentary time, and improve their diet and to maintain these changes to at least 12 months after baseline. The program was delivered at club stadia by trained club coaches, to groups of 15-20 men over 12, weekly, 90-minute sessions that combined interactive learning of behavior change techniques with graded group-based moderate intensity PA. An additional reunion meeting was scheduled 6-9 months after the start of the program. The comparison group was on a waiting list for the 12 months of the RCT. Subsequently, participants in the comparison group were offered the EuroFIT intervention.
To facilitate behavior change, EuroFIT drew on theories derived from various schools of thought in psychology and sociology. From psychology, EuroFIT drew explicitly on contemporary theories of motivation specifically, self-determination theory and achievement goal theory. The goal was to facilitate participants to develop internalised, autonomous motivation that is both self-relevant and self-referenced for becoming more active, sitting less and eating a healthier diet. These theories emphasise the need to ground behavior change in autonomous forms of motivation and to do so in a mastery-oriented, warm and supportive environment as opposed to externally imposed forms of motivation which tell men what they ‘ought’ to do. The theories also emphasise setting task-oriented, self-referenced and personally meaningful goals, rather than externally or ego-oriented goals to encourage ‘healthier living’. The change processes encouraged by these theories were operationalised in relation to initiating and maintaining change and taught the use of a set of behaviour change techniques (BCTs), presented to participants as a ‘toolbox’ from which they could choose the ‘tools’ they felt to be appropriate for them. These included self-monitoring, goal setting, problem solving, action planning and social support to both initiate and support change in the long term. Coaches facilitated interaction between men in sessions to help vicarious learning and to enhance motivation through enjoyment.
Over the course of the study, participants changed PA, sedentary time, diet and body weight by varying amounts, which provides the opportunity to understand more about the relative effects of each of these changes on biomarkers of cardiometabolic risk. The aim of this study was therefore firstly to investigate the associations between changes in PA, SED and dietary intake on changes in body weight and secondly to investigate the associations between changes in PA, sedentary time and dietary intake, and the associated change in body weight, on changes in a cardiometabolic risk score, in men who participated in the EuroFIT study. The attempt to change PA, SED and dietary intake in four countries in Europe show that the EuroFIT program helped men achieve increases in physical activity 12 months after baseline (around 600 steps or 6 minutes per day) but that post program improvements in sedentary behavior were not maintained to 12 months. The program also helped men improve a range of secondary outcomes including diet, weight, markers of psychological health and markers of cardio-metabolic health which, if maintained, would be expected to be clinically significant. The theory informed behavior change motivational components were important in assisting men to persist at the PA and dietary prescriptions and enhanced social interaction. The change processes encouraged by these theories were operationalised in relation to initiating and maintaining behaviour change. Qualitative data confirmed that the theories to emphasise setting task-oriented, self-referenced and personally meaningful goals, rather than externally or ego-oriented goals to encourage ‘healthier living’, was successful. The men felt the program was supportive of their efforts and improved their well-being.
It should be noted that the benefits of changing PA and diet on cardiometabolic risk seem to have been largely mediated through change in body weight.
Funding source
The research was funded by the European Union’s Seventh Framework Program for research technological development and demonstration under Grant Agreement no: 602170. The funder had no role in the study’s design or conduct; data collection, management, analysis or interpretation; manuscript preparation, review or approval. Views and opinions expressed are those of the authors and do not necessarily reflect those of the European Union.