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dc.contributor.authorTaylor, AHen
dc.contributor.authorTaylor, RSen
dc.contributor.authorIngram, WMen
dc.contributor.authorAnokye, Nen
dc.contributor.authorDean, Sen
dc.contributor.authorJolly, Ken
dc.contributor.authorMutrie, Nen
dc.contributor.authorLambert, Jen
dc.contributor.authorYardley, Len
dc.contributor.authorGreaves, Cen
dc.contributor.authorKing, Jen
dc.contributor.authorMcAdam, Cen
dc.contributor.authorSteele, Men
dc.contributor.authorPrice, Len
dc.contributor.authorStreeter, Aen
dc.contributor.authorCharles, Nen
dc.contributor.authorTerry, Ren
dc.contributor.authorWebb, Den
dc.contributor.authorCampbell, Jen
dc.contributor.authorHughes, Len
dc.contributor.authorAinsworth, Ben
dc.contributor.authorJones, Ben
dc.contributor.authorJane, Ben
dc.contributor.authorErwin, Jen
dc.contributor.authorLittle, Pen
dc.contributor.authorWoolf, Aen
dc.contributor.authorCavanagh, Cen
dc.descriptionNo embargo required.en

<jats:sec id="abs1-1"> <jats:title>Background</jats:title> <jats:p>There is modest evidence that exercise referral schemes increase physical activity in inactive individuals with chronic health conditions. There is a need to identify additional ways to improve the effects of exercise referral schemes on long-term physical activity.</jats:p> </jats:sec> <jats:sec id="abs1-2"> <jats:title>Objectives</jats:title> <jats:p>To determine if adding the e-coachER intervention to exercise referral schemes is more clinically effective and cost-effective in increasing physical activity after 1 year than usual exercise referral schemes.</jats:p> </jats:sec> <jats:sec id="abs1-3"> <jats:title>Design</jats:title> <jats:p>A pragmatic, multicentre, two-arm randomised controlled trial, with a mixed-methods process evaluation and health economic analysis. Participants were allocated in a 1 : 1 ratio to either exercise referral schemes plus e-coachER (intervention) or exercise referral schemes alone (control).</jats:p> </jats:sec> <jats:sec id="abs1-4"> <jats:title>Setting</jats:title> <jats:p>Patients were referred to exercise referral schemes in Plymouth, Birmingham and Glasgow.</jats:p> </jats:sec> <jats:sec id="abs1-5"> <jats:title>Participants</jats:title> <jats:p>There were 450 participants aged 16–74 years, with a body mass index of 30–40 kg/m<jats:sup>2</jats:sup>, with hypertension, prediabetes, type 2 diabetes, lower limb osteoarthritis or a current/recent history of treatment for depression, who were also inactive, contactable via e-mail and internet users.</jats:p> </jats:sec> <jats:sec id="abs1-6"> <jats:title>Intervention</jats:title> <jats:p>e-coachER was designed to augment exercise referral schemes. Participants received a pedometer and fridge magnet with physical activity recording sheets, and a user guide to access the web-based support in the form of seven ‘steps to health’. e-coachER aimed to build the use of behavioural skills (e.g. self-monitoring) while strengthening favourable beliefs in the importance of physical activity, competence, autonomy in physical activity choices and relatedness. All participants were referred to a standard exercise referral scheme.</jats:p> </jats:sec> <jats:sec id="abs1-7"> <jats:title>Primary outcome measure</jats:title> <jats:p>Minutes of moderate and vigorous physical activity in ≥ 10-minute bouts measured by an accelerometer over 1 week at 12 months, worn ≥ 16 hours per day for ≥ 4 days including ≥ 1 weekend day.</jats:p> </jats:sec> <jats:sec id="abs1-8"> <jats:title>Secondary outcomes</jats:title> <jats:p>Other accelerometer-derived physical activity measures, self-reported physical activity, exercise referral scheme attendance and EuroQol-5 Dimensions, five-level version, and Hospital Anxiety and Depression Scale scores were collected at 4 and 12 months post randomisation.</jats:p> </jats:sec> <jats:sec id="abs1-9"> <jats:title>Results</jats:title> <jats:p>Participants had a mean body mass index of 32.6 (standard deviation) 4.4 kg/m<jats:sup>2</jats:sup>, were referred primarily for weight loss and were mostly confident self-rated information technology users. Primary outcome analysis involving those with usable data showed a weak indicative effect in favour of the intervention group (<jats:italic>n</jats:italic> = 108) compared with the control group (<jats:italic>n</jats:italic> = 124); 11.8 weekly minutes of moderate and vigorous physical activity (95% confidence interval –2.1 to 26.0 minutes; <jats:italic>p</jats:italic> = 0.10). Sixty-four per cent of intervention participants logged on at least once; they gave generally positive feedback on the web-based support. The intervention had no effect on other physical activity outcomes, exercise referral scheme attendance (78% in the control group vs. 75% in the intervention group) or EuroQol-5 Dimensions, five-level version, or Hospital Anxiety and Depression Scale scores, but did enhance a number of process outcomes (i.e. confidence, importance and competence) compared with the control group at 4 months, but not at 12 months. At 12 months, the intervention group incurred an additional mean cost of £439 (95% confidence interval –£182 to £1060) compared with the control group, but generated more quality-adjusted life-years (mean 0.026, 95% confidence interval 0.013 to 0.040), with an incremental cost-effectiveness ratio of an additional £16,885 per quality-adjusted life-year.</jats:p> </jats:sec> <jats:sec id="abs1-10"> <jats:title>Limitations</jats:title> <jats:p>A significant proportion (46%) of participants were not included in the primary analysis because of study withdrawal and insufficient device wear-time, so the results must be interpreted with caution. The regression model fit for the primary outcome was poor because of the considerable proportion of participants [142/243 (58%)] who recorded no instances of ≥ 10-minute bouts of moderate and vigorous physical activity at 12 months post randomisation.</jats:p> </jats:sec> <jats:sec id="abs1-11"> <jats:title>Future work</jats:title> <jats:p>The design and rigorous evaluation of cost-effective and scalable ways to increase exercise referral scheme uptake and maintenance of moderate and vigorous physical activity are needed among patients with chronic conditions.</jats:p> </jats:sec> <jats:sec id="abs1-12"> <jats:title>Conclusions</jats:title> <jats:p>Adding e-coachER to usual exercise referral schemes had only a weak indicative effect on long-term rigorously defined, objectively assessed moderate and vigorous physical activity. The provision of the e-coachER support package led to an additional cost and has a 63% probability of being cost-effective based on the UK threshold of £30,000 per quality-adjusted life-year. The intervention did improve some process outcomes as specified in our logic model.</jats:p> </jats:sec> <jats:sec id="abs1-13"> <jats:title>Trial registration</jats:title> <jats:p>Current Controlled Trials ISRCTN15644451.</jats:p> </jats:sec> <jats:sec id="abs1-14"> <jats:title>Funding</jats:title> <jats:p>This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in <jats:italic>Health Technology Assessment</jats:italic>; Vol. 24, No. 63. See the NIHR Journals Library website for further project information.</jats:p> </jats:sec>

dc.format.extent1 - 106en
dc.publisherNational Institute for Health Researchen
dc.titleAdding web-based behavioural support to exercise referral schemes for inactive adults with chronic health conditions: the e-coachER RCTen
dc.typeJournal Article
plymouth.journalHealth Technology Assessmenten
plymouth.organisational-group/Plymouth/Faculty of Health
plymouth.organisational-group/Plymouth/Faculty of Health/Peninsula Medical School
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA/UoA03 Allied Health Professions, Dentistry, Nursing and Pharmacy
plymouth.organisational-group/Plymouth/Research Groups
plymouth.organisational-group/Plymouth/Research Groups/Institute of Health and Community
plymouth.organisational-group/Plymouth/Research Groups/Institute of Translational and Stratified Medicine (ITSMED)
plymouth.organisational-group/Plymouth/Research Groups/Institute of Translational and Stratified Medicine (ITSMED)/CCT&PS
plymouth.organisational-group/Plymouth/Users by role
plymouth.organisational-group/Plymouth/Users by role/Academics
plymouth.organisational-group/Plymouth/Users by role/Post-Graduate Research Students
dc.rights.embargoperiodNot knownen
rioxxterms.typeJournal Article/Reviewen

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