Questions and Answers
The original WWW research study focussed on low active adults in the West of Scotland. Since completion of this study we have replicated the results in older adults, in workplaces and have been implemented in the wider community via organisations who promote walking for health in Scotland. We are currently developing separate adapted intervention programmes, based on the original WWW programmes for ethnic minority individuals, and visually impaired adults in Scotland.
The intervention programme has several key features that we believe are fundamental to the effectiveness of the programme, these are: a valid and acceptable pedometer to provide the individual with feedback and the capacity to self monitor behaviour; a walking programme booklet, and an individualised physical activity consultation. As this consultation should be tailored to the individual then the programme has the potential to be adapted to any audience, provided they have sufficient independent mobility to perform short bouts of walking. Any adapted approach should be piloted or feedback should be gained from prospective users.
Facilitators to the intervention include a valid and reliable pedometer – research has shown that pedometers that do not provide accurate and consistent feedback are not viewed positively by individuals. An enthusiastic person to conduct the physical activity consultation is also a key facilitator. It is essential that this person uses a guiding style to the consultation, and not a directive style, so that the participant leads on their own decision making about becoming more active. Recruitment remains a challenge in walking studies and promotion efforts, particularly for males and some ethnic groups. A gate-keeper into the target community (for example this could be a key community, cultural or religious leader for a specific ethnic group) can be a significant facilitator.
The aims of the evaluation should match the aims of the programme. Therefore, our primary aim was to increase independent walking behaviour therefore we used the pedometer to assess changes in steps/walked, in addition we also utilised the international physical activity questionnaire (IPAQ; Craig et al, 2003) to assess any changes in physical activity in other domains or modes. Through the use of the IPAQ we were able to detect significant reductions in sitting time. Given the increasing attention given to sedentary behaviour we would suggest an appropriate instrument to assess changes in sitting time.
In our study we evaluated the effect of the intervention on a wide range of health outcomes; physiological biomarkers of inflammation, anthropometric measures such as BMI, bodyfat and waist and hip circumference in addition to self-reported measures of quality of life and well-being. At baseline, the majority of our participants were classified in the normal category of many of these variables, therefore it was not surprising that the intervention did not result in significant changes in these variables over time (with the exception of quality of life and positive mood). However, it could be that in the implementation of this programme different populations with a higher level of disease risk could be included, therefore it will be important for any evaluation to consider what are the major health outcomes of interest for the evaluation.
Currently, within our research centre our main focus is to develop, implement and evaluate interventions to help people sit less and move more. Within this, we target a variety of clinical and community populations. My main research interest within the team is considering the aspect of ethnicity. In Scotland we have limited data on ethnicity and physical activity but the data we do have suggests significant variation by ethnicity with individuals classified as South Asian (Indian, Pakistani or Bangladeshi in origin) reporting lower levels of physical activity than their White UK counterparts. I am currently developing an exploratory feasibility study that will examine how best to adapt our original WWW research study to meet the needs of the South Asian population.