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Evaluation of Physical Activity at a Medical Wellness Center John C. Sieverdes, PhD University of South Carolina Department of Exercise Science SCTR: April 26 th , 2012

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Page 1: Evaluation of Physical Activity at a Medical Wellness Center John C. Sieverdes, PhD University of South Carolina Department of Exercise Science SCTR: April

Evaluation of Physical Activity at a Medical Wellness Center

John C. Sieverdes, PhDUniversity of South Carolina

Department of Exercise Science

SCTR: April 26th, 2012

Page 2: Evaluation of Physical Activity at a Medical Wellness Center John C. Sieverdes, PhD University of South Carolina Department of Exercise Science SCTR: April

Our Questions???

– Does motivating factors for health and fitness or weight loss determine who meets the guidelines for physical activity?

– What are the Psychosocial differences between people who meet the guidelines versus those who don’t?

– How much activity do people get inside a center versus their free-living activity?

Page 3: Evaluation of Physical Activity at a Medical Wellness Center John C. Sieverdes, PhD University of South Carolina Department of Exercise Science SCTR: April

Background • The 2008 Physical Activity Guidelines for Americans identify that 150 minutes of moderate or 75 minutes of vigorous physical activity is needed to reduce risk of chronic diseases.– Equivalent moderate minutes = mod min + (2 x vig min)

• Medical wellness centers have a unique position to implement interventions and increase physical activity.

Page 4: Evaluation of Physical Activity at a Medical Wellness Center John C. Sieverdes, PhD University of South Carolina Department of Exercise Science SCTR: April

Collaborators

Gambettola, Italy

Lake City/Florence, South Carolina

Columbia, South Carolina

Page 5: Evaluation of Physical Activity at a Medical Wellness Center John C. Sieverdes, PhD University of South Carolina Department of Exercise Science SCTR: April

A Little More Background• The iH3 wellness center is a unique environment that facilitates

physical activity programs (FIT track, LEAN track, RESTORE track).– Currently, programs only measure physical activity inside the facility with a

smart key and not free-living activity

• Technogym has developed a new type of accelerometer (mywellness key) that integrates free-living physical activity with exercise performed with their line of equipment .

• Two validation studies on the MWK has been published so far on free-living activity and treadmill exercise protocols showing the device is valid to measure physical activity (PA) (1-2).

(1) Hermann SD, et al. Evaluation of the Mywellness Key accelerometer. British Journal of Sports Medicine, 2011. 45(2): p. 109-13.

(2) Bergamin M, et al. Validation of the MyWellness Key in Walking and Running Speeds, JSSM, 2012.11(1): p.57-63.

Page 6: Evaluation of Physical Activity at a Medical Wellness Center John C. Sieverdes, PhD University of South Carolina Department of Exercise Science SCTR: April

The MyWellness Key• The Mywellness Key (Technogym, Spa)

– Uniaxial accelerometer, 18.7 grams, • Sampling frequency = 16 HZ, 0.06-12.0 g’s, frequency

response 0.1 to 5 Hz.

– Worn on the front of the body in-line with the right knee.

– Used with Technogym machines and for free-living physical activity

– Web portal for goal setting and reports– Measures (On Display and in Web portal)

• Energy Expenditure (EE) in real-time MOVE (unitless) against daily MOVE goal

• Kcals expended• Minutes of

– Light (called free) 1.8-2.9 METs– Moderate (called play) 3.0-5.9 METs– Vigorous (called run) ≥ 6.0 METs

Page 7: Evaluation of Physical Activity at a Medical Wellness Center John C. Sieverdes, PhD University of South Carolina Department of Exercise Science SCTR: April

Evaluation study setting

iH3 Wellness CenterLake City, SC

Page 8: Evaluation of Physical Activity at a Medical Wellness Center John C. Sieverdes, PhD University of South Carolina Department of Exercise Science SCTR: April

Methods - Protocol• Participant criteria

– August, 2011 – January 2012– n=60 participants, age 18-80– FIT or LEAN tracks at facility– No gait abnormalities or injuries– Not pregnant– Only involved in iH3 center programs

• 10-day evaluation– MWK replaced their center key– MWK used in center’s machines and

attached to hip for free-living activity– Given a wear log to track time (>10

hrs/day)– Asked to complete computer-based

survey at home or at center– Return MWK, log, and receive a

Wellness booklet, $10 off membership dues, and a report of their physical activity

Page 9: Evaluation of Physical Activity at a Medical Wellness Center John C. Sieverdes, PhD University of South Carolina Department of Exercise Science SCTR: April

Methods - PAThe regular center key are

being was deactivated duringthe study

The MWK interfaces with all the Technogymaerobic and resistance training equipment

Measurement outcomes Aerobic activity: machine-based and free-living)

– minutes of light activity– minutes of moderate activity– minutes of vigorous activity– MOVE (volume of activity)

Page 10: Evaluation of Physical Activity at a Medical Wellness Center John C. Sieverdes, PhD University of South Carolina Department of Exercise Science SCTR: April

Methods - PA

• Mywellness key is worn in the clip inline with the right hip

Page 11: Evaluation of Physical Activity at a Medical Wellness Center John C. Sieverdes, PhD University of South Carolina Department of Exercise Science SCTR: April

Methods – Study Survey• General demographics (age, medical history, SES, occupation, ethnicity, smoker,

etc.)• Psychosocial constructs

– Self-efficacy (14-item survey) – Self-regulation (20-item survey)– Social support (15-item survey)– Motivation (17-item survey)

• Covariates– Physical Environment (IPAQ 13-item)– Perceived Stress (14-item)– Quality of Life SF36 (36-item)– Stage of change (1 item)– Satisfaction with Body Function and Appearance (9-item)– Center for Epidemiologic Studies Depression Scale (20-item)

Page 12: Evaluation of Physical Activity at a Medical Wellness Center John C. Sieverdes, PhD University of South Carolina Department of Exercise Science SCTR: April

Results

Page 13: Evaluation of Physical Activity at a Medical Wellness Center John C. Sieverdes, PhD University of South Carolina Department of Exercise Science SCTR: April

Variable Total Fitness/ Health Group

Weight loss Group

P-value

Met 2008 PA Guidelines Yes 38; 63.3% 21; 63.6% 17; 63.0% 0.96 for Americans, n; % No 22; 36.7% 12; 36.4% 10; 37.0% ---Age (years), n; m(SD) Total 60; 44.1(13.4) 33; 47.7(13.9) 27; 39.6(11.5) 0.32

M 17; 40.9(12.5) 12; 42.4(13.0) 5; 37.4(11.7) 0.90F 43; 45.3(13.7) 21; 50.8(13.8) 22; 40.1(11.6) 0.45

Weight (kg), n; m(SD) Total 60; 86.3(23.9) 33; 83.1(21.8) 27; 90.2(26.1) 0.33M 17; 94.9(24.3) 12; 87.8(15.3) 5; 112.1(34.7) 0.03*F 43; 82.9(23.1) 21; 80.4(24.7) 22; 85.2(21.8) 0.58

BMI (kg/m2), n; m(SD) Total 60; 31.2(8.8) 33; 30.5(8.8) 27; 32.0(8.8) 0.97M 17; 31.4(9.6) 12; 30.2(9.5) 5; 34.2(10.4) 0.73F 43; 31.1(8.5) 21; 30.7(8.6) 22; 31.5(8.6) 0.99

Descriptive characteristics of study participants

Main findings:In our 60 participants, we found that 63.3% of the participants met the 2008 PA Guidelines by accumulating at least 150 minutes per week of equivalent PA. There was no difference between fitness and weight loss groups

BMI, body mass index (kg/m2); m, mean; SD, standard deviation*Statistical differences between fitness/health and weight loss tracks reported using Student’s T-test and Chi-square using an alpha of p=0.05

Page 14: Evaluation of Physical Activity at a Medical Wellness Center John C. Sieverdes, PhD University of South Carolina Department of Exercise Science SCTR: April

Physical Activity between Fitness and Weight Loss Groups (amount per week)

Fitness/Health

Weight Loss

0

1000

2000

3000

4000

5000

6000

5,2995,015

light minutes

moderate minutes

vigorous minutes

MVPA minutes

equivalent moderate minutes

0

50

100

150

200

250

300

350

400

334.2

143.8

32.1

175.9208.0

312.7

149.8

20.3

170.2190.5

Fitness/HealthWeight Loss

Aver

age

min

utes

of a

ctivi

ty p

er w

eek

Aver

age

MO

VE p

er w

eek

Main Findings:No statistical differences found between tracks

Page 15: Evaluation of Physical Activity at a Medical Wellness Center John C. Sieverdes, PhD University of South Carolina Department of Exercise Science SCTR: April

Variable, score range Meets PA Guidelines n=34

Does not meet PA Guidelines

n=20

P-value

Self Efficacy, 0-100 73.5(17.8) 59.7(19.0) 0.01*Social Support (SS) all >0.29Self-regulation (SR) SR (Goal Setting, 10-50) 32.1(9.9) 25.0(11.2) 0.02* SR (Planning, 10-50) 29.9(6.8) 27.1(7.4) 0.16Intrinsic Motivation Autonomous Motivation, 7-49 41.1(10.1) 41.4(8.7) 0.93 Controlled Motivation, 7-49 23.2(9.1) 21.3(11.4) 0.48 Amotivation, 3-21 5.3(2.5) 7.2(4.2) 0.09Satisfaction with Body Function, -18 to +18 6.8(9.0) 3.2(10.5) 0.19Satisfaction with Body Appearance, -9 to +9 1.2(5.6) -0.2(5.3) 0.38Quality of Life (SF-36) Physical functioning, 0-100 91.9(12.9) 82.0(23.4) 0.09 General health perceptions, 0-100 75.8(14.4) 66.3(17.3) 0.03*

Psychosocial associations for participants meeting and not meeting the 2008 Physical Activity Guidelines for Americans (≥150 min/wk of mod min)

Main Findings:Those who met the PA Guidelines showed higher self-efficacy, self-regulation, and general health perception scores.

Page 16: Evaluation of Physical Activity at a Medical Wellness Center John C. Sieverdes, PhD University of South Carolina Department of Exercise Science SCTR: April

Variable, score range UnadjustedOdds ratio(CI)

Model 1 Odds

ratio(CI)

Model 2 Odds ratio(CI)

Self Efficacy, 0-1001.04(1.01-1.08)*

1.04(1.01-1.07)*

1.04(1.01-1.07)*

Self Regulation (SR)

SR (Goal Setting, 10-50)1.07(1.01-1.14)*

1.07(1.01-1.14)*

1.07(1.01-1.14)*

SR (Planning, 10-50) 1.06(.98-1.15)1.07(.98-1.16)

1.07(.98-1.67)

Quality of Life (SF-36)

Physical functioning, 0-1001.03(.99-1.07)

1.04(1.00-1.08)*

1.04(1.00-1.08)*

Odd’s ratios for Psychosocial Associations for Participants Meeting the 2008 Physical Activity Guidelines for Americans

Main FindingsThose who met the PA Guidelines had lower odds of physical functioning and greater odds of having higher self-efficacy (confidence to exercise) and self-regulation (habits of tracking your progress).

Model 1 additionally adjusted for age.Model 2 adjusted age and BMI.Meeting the 2008 Physical Activity Guidelines for Americans represent accumulating at least 150 equivalent moderate minutes of physical activity per week.*Statistical differences using logistic regression using an alpha of p=0.05.

Page 17: Evaluation of Physical Activity at a Medical Wellness Center John C. Sieverdes, PhD University of South Carolina Department of Exercise Science SCTR: April

Contribution of Exercise at iH3 on Daily Activity

FindingsVolume of activity doubles on an exercise day versus a non-exercise day.

Most moderate minutes are from exercise

light m

inutes

moderate

minutes

vigorous m

inutes

MVPA minutes

equiva

lent m

oderate

minutes0

10

20

30

40

50

60

70

43.7

10.21.3

11.5 12.8

2.3

33.0

9.7

42.7

52.4

MOVE Exe

rcise

Day

MOVE N

on-Exerci

se D

ay0

200

400

600

800

1000

1200

1400

532 559

667

Center-basedFreeliving

Ave

rag

e M

OV

E p

er

day

Ave

rag

e m

inu

tes

of

ph

ysic

al

acti

vity

p

er

day

= 47% of Exercise Day

79%

88%

76%

80%

5%

Total = 1199

Page 18: Evaluation of Physical Activity at a Medical Wellness Center John C. Sieverdes, PhD University of South Carolina Department of Exercise Science SCTR: April

Average daily minutes of PA between exercise and non-exercise days

Findings:On exercise days, there was an increase of 418% for minutes that contribute to the PA Guidelines when compared to a non-exercise day.

The amount of light minutes was equal between exercise and non-exercise days.

light minutes

moderate minutes

vigorous minutes

MVPA minutes

equivalent moderate minutes

0

10

20

30

40

50

60

70

46.0

11.4

2.1

13.515.6

46.043.2

11.0

54.2

65.2

Non-Exercise DayExercise Day

Ave

rag

e m

inu

tes

of

ph

ysic

al

acti

vity

p

er

day

402%

418%

524%

100%379%

Page 19: Evaluation of Physical Activity at a Medical Wellness Center John C. Sieverdes, PhD University of South Carolina Department of Exercise Science SCTR: April

Conclusions• No real differences were found between different tracks and their

resultant PA

• Participants had approximately the same amount of free-living PA between exercise and non-exercise days.

• Participants more than doubled their volume of activity and increased their equivalent minutes contributing to meeting the PA Guidelines by four times on exercise days.

• This study stresses the importance of having centers and facilities for populations to engage in leisure-time PA. Incorporation of PA metrics from the Medical Wellness Center accelerometers into physician health records could give a more complete picture of a person’s PA status for monitoring by health professionals.

Page 20: Evaluation of Physical Activity at a Medical Wellness Center John C. Sieverdes, PhD University of South Carolina Department of Exercise Science SCTR: April

Future Directions

• Integration of real-time monitoring using technology to enhance physical activity programs– Wireless transmission of real-time accelerometer data to

smartphones or use imbedded accelerometers in smartphones.– Integrating activity measures with health medical systems, health

records, or wellness systems.– Looking to incorporate self-efficacy and self-regulation concepts

to enhance behavioral intervention programs in mobile health technology (app-based development)

Page 21: Evaluation of Physical Activity at a Medical Wellness Center John C. Sieverdes, PhD University of South Carolina Department of Exercise Science SCTR: April

Acknowledgements• University of South Carolina

• Steven N. Blair, PED.• Greg A. Hand, PhD• Sara Wilcox, PhD• Robert Moran, PhD• Patrick Crowley, MS

• iH3 Wellness Center• WC Hammett, CEO• Michelle Hickson• Roosevelt Bryant• iH3 center staff

• Technogym, Spa• Silvano Zanuso, PhD• Giovanni Strabolli

• University of Tulsa• Eric Wickle, PhD

• University of Padova• Marco Bergeon, MS

• Iowa State University• Greg Welk, PhD

• Oregon State University• Stewart Trost, PhD