Advertisement

Efficacy of an m-Health Physical Activity and Sleep Health Intervention for Adults: A Randomized Waitlist-Controlled Trial

  • Beatrice Murawski
    Affiliations
    Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, New South Wales, Australia

    Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
    Search for articles by this author
  • Ronald C. Plotnikoff
    Affiliations
    Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, New South Wales, Australia

    Faculty of Education and Arts, School of Education, University of Newcastle, Callaghan, New South Wales, Australia
    Search for articles by this author
  • Anna T. Rayward
    Affiliations
    Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, New South Wales, Australia

    Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
    Search for articles by this author
  • Christopher Oldmeadow
    Affiliations
    Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia

    Faculty of Health, Center for Clinical Epidemiology and Biostatistics, Callaghan, New South Wales, Australia

    Clinical Research Design and Statistics Unit, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
    Search for articles by this author
  • Corneel Vandelanotte
    Affiliations
    Physical Activity Research Group, Appleton Institute, Central Queensland University, Rockhampton, Queensland, Australia
    Search for articles by this author
  • Wendy J. Brown
    Affiliations
    Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, Queensland, Australia
    Search for articles by this author
  • Mitch J. Duncan
    Correspondence
    Address correspondence to: Mitch J. Duncan, PhD, ATC Building Level 3, The University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia.
    Affiliations
    Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, New South Wales, Australia

    Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
    Search for articles by this author

      Introduction

      Interventions that improve both physical activity and sleep quality may be more effective in improving overall health. The purpose of the Synergy Study is to test the efficacy of a mobile health combined behavior intervention targeting physical activity and sleep quality.

      Study design

      Randomized, waitlist-controlled trial.

      Setting/participants

      This study had an app-based delivery mode, Australia-wide. The participants were 160 adults who reported insufficient physical activity and poor sleep quality in an eligibility survey.

      Intervention

      The intervention was a mobile app providing educational resources, goal setting, self-monitoring, and feedback strategies. It included 12 weeks of personalized support including weekly reports, tool sheets, and prompts.

      Main outcome measures

      Outcomes were assessed at baseline, 3 months (primary), and 6 months (secondary endpoint). Self-reported minutes of moderate-to-vigorous intensity physical activity and sleep quality were co-primary outcomes. Resistance training; sitting time; sleep hygiene; sleep timing variability; insomnia severity; daytime sleepiness; quality of life; and depression, anxiety, and stress symptoms were secondary outcomes. Data were collected between June 2017 and February 2018 and analyzed in August 2018.

      Results

      At 3 months, between-group differences in moderate-to-vigorous intensity physical activity were not statistically significant (p=0.139). Significantly more participants in the intervention group engaged in ≥2 days/week (p=0.004) of resistance training. The intervention group reported better overall sleep quality (p=0.009), subjective sleep quality (p=0.017), sleep onset latency (p=0.013), waketime variability (p=0.018), sleep hygiene (p=0.027), insomnia severity (p=0.002), and lower stress symptoms (p=0.032) relative to waitlist controls. At 6 months, group differences were maintained for sleep hygiene (p=0.048), insomnia severity (p=0.002), and stress symptoms (p=0.006). Differences were observed for bedtime variability (p=0.023), sleepiness (p<0.001), daytime dysfunction (p=0.039), and anxiety symptoms (p=0.003) at 6 months, but not 3 months.

      Conclusions

      This remotely delivered intervention did not produce statistically significant between-group differences in minutes of moderate-to-vigorous intensity physical activity. Significant short-term differences in resistance training and short- and medium-term differences in sleep health in favor of the intervention were observed.

      Trial registration

      This study is registered at anzctr.org.au ACTRN12617000376347.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

      1. WHO. Global strategy on diet, physical activity and health. Physical inactivity: A global public health problem. www.who.int/dietphysicalactivity/factsheet_inactivity/en/. Accessed April 1, 2016.

        • Hoyos C
        • Glozier N
        • Marshall NS
        Recent evidence on worldwide trends on sleep duration.
        Curr Sleep Med Rep. 2015; 1: 195‒204
        • Buman MP
        • Phillips BA
        • Youngstedt SD
        • Kline CE
        • Hirshkowitz M
        Does nighttime exercise really disturb sleep? Results from the 2013 National Sleep Foundation Sleep in America Poll.
        Sleep Med. 2014; 15: 755‒761
        • Duncan MJ
        • Kline CE
        • Rebar AL
        • Vandelanotte C
        • Short CE
        Greater bed- and wake-time variability is associated with less healthy lifestyle behaviors: a cross-sectional study.
        Z Gesundh Wiss. 2016; 24: 31‒40
        • Adams RJ
        • Appleton SL
        • Taylor AW
        • et al.
        Sleep health of Australian adults in 2016: results of the 2016 Sleep Health Foundation national survey.
        Sleep Health. 2017; 3: 35‒42
      2. The Department of Health. Australia's Physical Activity and Sedentary Behaviour Guidelines for Adults (18–64 years). www.webcitation.org/6pseaziKS. Published 2014. Accessed February 15, 2017.

        • Buysse DJ
        Sleep health: can we define it? Does it matter?.
        Sleep. 2014; 37: 9‒17
        • Shiroma EJ
        • Lee IM
        Physical activity and cardiovascular health: lessons learned from epidemiological studies across age, gender, and race/ethnicity.
        Circulation. 2010; 122: 743‒752
        • Aune D
        • Norat T
        • Leitzmann M
        • Tonstad S
        • Vatten LJ
        Physical activity and the risk of type 2 diabetes: a systematic review and dose–response meta-analysis.
        Eur J Epidemiol. 2015; 30: 529‒542
        • Shan Z
        • Ma H
        • Xie M
        • et al.
        Sleep duration and risk of type 2 diabetes: a meta-analysis of prospective studies.
        Diabetes Care. 2015; 38: 529‒537
        • Hoevenaar-Blom MP
        • Spijkerman AM
        • Kromhout D
        • van den Berg JF
        • Verschuren WM
        Sleep duration and sleep quality in relation to 12-year cardiovascular disease incidence: the MORGEN study.
        Sleep. 2011; 34: 1487‒1492
      3. Deloitte Access Economics. Asleep on the Job: Costs of Inadequate Sleep in Australia. Sleep Health Foundation. www.sleephealthfoundation.org.au/news/special-reports/asleep-on-the-job-costs-of-inadequate-sleep-in-australia.html. Accessed January 4, 2018.

        • Ding D
        • Lawson KD
        • Kolbe-Alexander TL
        • et al.
        The economic burden of physical inactivity: a global analysis of major non-communicable diseases.
        Lancet. 2016; 388: 1311‒1324
        • Kruk J.
        Health and economic costs of physical inactivity.
        Asian Pac J Cancer Prev. 2014; 15: 7499‒7503
        • Rayward AT
        • Duncan MJ
        • Brown WJ
        • Plotnikoff RC
        • Burton NW
        A cross-sectional cluster analysis of the combined association of physical activity and sleep with sociodemographic and health characteristics in mid-aged and older adults.
        Maturitas. 2017; 102: 56‒61
        • Price M
        • Yuen EK
        • Goetter EM
        • et al.
        mHealth: a mechanism to deliver more accessible, more effective mental health care.
        Clin Psychol Psychother. 2014; 21: 427‒436
        • Muller AM
        • Alley S
        • Schoeppe S
        • Vandelanotte C
        The effectiveness of e−& mHealth interventions to promote physical activity and healthy diets in developing countries: a systematic review.
        Int J Behav Nutr Phys Act. 2016; 13: 109
        • Ye YY
        • Chen NK
        • Chen J
        • et al.
        Internet-based cognitive-behavioural therapy for insomnia (ICBT-i): a meta-analysis of randomised controlled trials.
        BMJ Open. 2016; 6e010707
        • Murawski B
        • Wade L
        • Plotnikoff RC
        • Lubans DR
        • Duncan MJ
        A systematic review and meta-analysis of cognitive and behavioral interventions to improve sleep health in adults without sleep disorders.
        Sleep Med Rev. 2018; 40: 160‒169
        • McEwan D
        • Beauchamp MR
        • Kouvousis C
        • et al.
        Examining the active ingredients of physical activity interventions underpinned by theory versus no stated theory: a meta-analysis.
        Health Psychol Rev. 2018; 13: 1‒17
        • Mc Sharry J
        • Olander EK
        • French DP
        Do single and multiple behavior change interventions contain different behavior change techniques? A comparison of interventions targeting physical activity in obese populations.
        Health Psychol. 2015; 34: 960‒965
        • Kline CE.
        The bidirectional relationship between exercise and sleep: implications for exercise adherence and sleep improvement.
        Am J Lifestyle Med. 2014; 8: 375‒379
        • Dolezal BA
        • Neufeld EV
        • Boland DM
        • Martin JL
        • Cooper CB
        Interrelationship between sleep and exercise: a systematic review.
        Adv Prev Med. 2017; 20171364387
        • Buman MP
        • Epstein DR
        • Gutierrez M
        • et al.
        BeWell24: development and process evaluation of a smartphone “app” to improve sleep, sedentary, and active behaviors in U.S. Veterans with increased metabolic risk.
        Transl Behav Med. 2016; 6: 438‒448
        • Pepin V
        • Boucetta S
        • Chan-Thim E
        • et al.
        The role of sleep and physical activity on the risk for cardiovascular disease.
        Curr Cardiovasc Risk Rep. 2014; 8: 1‒10
        • James E
        • Freund M
        • Booth A
        • et al.
        Comparative efficacy of simultaneous versus sequential multiple health behavior change interventions among adults: a systematic review of randomised trials.
        Prev Med. 2016; 89: 211‒223
        • Meader N
        • King K
        • Wright K
        • et al.
        Multiple risk behavior interventions: meta-analyses of RCTs.
        Am J Prev Med. 2017; 53: e19‒e30
        • Murawski B
        • Plotnikoff RC
        • Rayward AT
        • et al.
        Randomised controlled trial using a theory-based m-health intervention to improve physical activity and sleep health in adults: the Synergy Study protocol.
        BMJ Open. 2018; 8e018997
        • Doig GS
        • Simpson F
        Randomization and allocation concealment: a practical guide for researchers.
        J Crit Care. 2005; 20: 187‒191
        • Duncan MJ
        • Vandelanotte C
        • Trost SG
        • et al.
        Balanced: a randomised trial examining the efficacy of two self-monitoring methods for an app-based multi-behaviour intervention to improve physical activity, sitting and sleep in adults.
        BMC Public Health. 2016; 16: 670
        • Australian Institute of Health and Welfare
        The Active Australia Survey: A Guide and Manual for Implementation, Analysis and Reporting.
        AIHW, Canberra2003
        • Reeves MM
        • Marshall AL
        • Owen N
        • Winkler EA
        • Eakin EG
        Measuring physical activity change in broad-reach intervention trials.
        J Phys Act Health. 2010; 7: 194‒202
        • Brown W
        • Burton N
        • Marshall A
        • Miller Y
        Reliability and validity of a modified self-administered version of the Active Australia physical 2 activity survey in a sample of mid-age women.
        Aust N Z J Public Health. 2008; 32: 535‒541
        • Buysse DJ
        • Reynolds 3rd, CF
        • Monk TH
        • Berman SR
        • Kupfer DJ
        The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research.
        Psychiatry Res. 1989; 28: 193‒213
        • Backhaus J
        • Junghanns K
        • Broocks A
        • Riemann D
        • Hohagen F
        Test–retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia.
        J Psychosom Res. 2002; 53: 737‒740
        • Bampton EA
        • Johnson ST
        • Vallance JK
        Profiles of resistance training behavior and sedentary time among older adults: associations with health-related quality of life and psychosocial health.
        Prev Med Rep. 2015; 2: 773‒776
        • Chau JY
        • van der Ploeg HP
        • Dunn S
        • Kurko J
        • Bauman AE
        A tool for measuring workers’ sitting time by domain: the Workforce Sitting Questionnaire.
        Br J Sports Med. 2011; 45: 1216‒1222
        • Mastin DF
        • Bryson J
        • Corwyn R
        Assessment of sleep hygiene using the Sleep Hygiene Index.
        J Behav Med. 2006; 29: 223‒227
        • Monk TH
        • Buysse DJ
        • Kennedy KS
        • et al.
        Measuring sleep habits without using a diary: the sleep timing questionnaire.
        Sleep. 2003; 26: 208‒212
        • Morin CM
        • Belleville G
        • Belanger L
        • Ivers H
        The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response.
        Sleep. 2011; 34: 601‒608
        • Johns MW.
        A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale.
        Sleep. 1991; 14: 540‒545
        • Ware Jr., J
        • Kosinski M
        • Keller SD
        A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity.
        Med Care. 1996; 34: 220‒233
        • Hays RD
        • Morales LS.
        The RAND-36 measure of health-related quality of life.
        Ann Med. 2001; 33: 350‒357
        • Henry JD
        • Crawford JR.
        The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample.
        Br J Clin Psychol. 2005; 44: 227‒239
        • Kolt GS
        • Rosenkranz RR
        • Vandelanotte C
        • et al.
        Using Web 2.0 applications to promote health-related physical activity: findings from the WALK 2.0 randomised controlled trial.
        Br J Sports Med. 2017; 51: 1433‒1440
      4. SUS BJ. A quick and dirty usability scale. In:. Jordan PW, Thomas B, Weerdmeester BA, McClelland AL, eds. Usability Evaluation in Industry. Vol. 189. London: Taylor & Francis; 1996:194.

      5. Cohen J. Statistical Power Analysis for the Behavioral Sciences. Mahwah, NJ: L. Erlbaum Associates; 1988.

        • Davies CA
        • Spence JC
        • Vandelanotte C
        • Caperchione CM
        • Mummery WK
        Meta-analysis of internet-delivered interventions to increase physical activity levels.
        Int J Behav Nutr Phys Act. 2012; 9: 52
        • White H.
        A heteroskedasticity-consistent covariance-matrix estimator and a direct test for heteroskedasticity.
        Econometrica. 1980; 48: 817‒838
        • Warburton DE
        • Nicol CW
        • Bredin SS
        Health benefits of physical activity: the evidence.
        CMAJ. 2006; 174: 801‒809
        • Waters L
        • Reeves M
        • Fjeldsoe B
        • Eakin E
        Control group improvements in physical activity intervention trials and possible explanatory factors: a systematic review.
        J Phys Act Health. 2012; 9: 884‒895
        • Loustalot F
        • Carlson SA
        • Kruger J
        • Buchner DM
        • Fulton JE
        Muscle-strengthening activities and participation among adults in the United States.
        Res Q Exerc Sport. 2013; 84: 30‒38
        • Bennie JA
        • Pedisic Z
        • van Uffelen JGZ
        • et al.
        The descriptive epidemiology of total physical activity, muscle-strengthening exercises and sedentary behaviour among Australian adults - results from the National Nutrition and Physical Activity Survey.
        BMC Public Health. 2016; 16: 73
        • Ihalainen JK
        • Schumann M
        • Eklund D
        • et al.
        Combined aerobic and resistance training decreases inflammation markers in healthy men.
        Scand J Med Sci Sports. 2018; 28: 40‒47
        • Dankel SJ
        • Loenneke JP
        • Loprinzi PD
        Participation in muscle-strengthening activities as an alternative method for the prevention of multimorbidity.
        Prev Med. 2015; 81: 54‒57
        • Zachariae R
        • Lyby MS
        • Ritterband LM
        • O'Toole MS
        Efficacy of internet-delivered cognitive-behavioral therapy for insomnia: a systematic review and meta-analysis of randomized controlled trials.
        Sleep Med Rev. 2016; 30: 1‒10
        • Cunnington D
        • Junge MF
        • Fernando AT
        Insomnia: prevalence, consequences and effective treatment.
        Med J Aust. 2013; 199: S36‒S40
        • Espie CA.
        “Stepped care”: a health technology solution for delivering cognitive behavioral therapy as a first line insomnia treatment.
        Sleep. 2009; 32: 1549‒1558
        • Buysse DJ
        • Germain A
        • Moul DE
        • et al.
        Efficacy of brief behavioral treatment for chronic insomnia in older adults.
        Arch Intern Med. 2011; 171: 887‒895
      6. 2018 Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Scientific Report. Washington, DC: HHS; 2018.

        • Kovacevic A
        • Mavros Y
        • Heisz JJ
        • Fiatarone Singh MA
        The effect of resistance exercise on sleep: a systematic review of randomized controlled trials.
        Sleep Med Rev. 2018; 39: 52‒68
        • Loprinzi PD
        • Loenneke JP.
        Engagement in muscular strengthening activities is associated with better sleep.
        Prev Med Rep. 2015; 2: 927‒929
        • Norman GR
        • Sloan JA
        • Wyrwich KW
        Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation.
        Med Care. 2003; 41: 582‒592
        • Ng DM
        • Jeffery RW.
        Relationships between perceived stress and health behaviors in a sample of working adults.
        Health Psychol. 2003; 22: 638‒642
        • Guertler D
        • Vandelanotte C
        • Kirwan M
        • Duncan MJ
        Engagement and nonusage attrition with a free physical activity promotion program: the case of 10,000 Steps Australia.
        J Med Internet Res. 2015; 17: e176
      7. Vandelanotte C, Duncan MJ, Kolt GS, et al. More real-world trials are needed to establish if web-based physical activity interventions are effective. Br J Sports Med. In press. Online July 3, 2018. https://doi.org/10.1136/bjsports-2018-099437.

        • Duncan M
        • Murawski B
        • Short CE
        • et al.
        Activity trackers implement different behavior change techniques for activity, sleep, and sedentary behaviors.
        Interact J Med Res. 2017; 6: e13
        • Caperchione CM
        • Duncan MJ
        • Rosenkranz RR
        • et al.
        Recruitment, screening, and baseline participant characteristics in the WALK 2.0 study: a randomized controlled trial using web 2.0 applications to promote physical activity.
        Contemp Clin Trials Commun. 2016; 2: 25‒33
        • Vandelanotte C
        • Reeves MM
        • Brug J
        • De Bourdeaudhuij I
        A randomized trial of sequential and simultaneous multiple behavior change interventions for physical activity and fat intake.
        Prev Med. 2008; 46: 232‒237
        • Blanton S
        • Morris DM
        • Prettyman MG
        • et al.
        Lessons learned in participant recruitment and retention: the EXCITE trial.
        Phys Ther. 2006; 86: 1520‒1533
        • Rogers LQ
        • Courneya KS
        • Oster RA
        • et al.
        Physical activity and sleep quality in breast cancer survivors: a randomized trial.
        Med Sci Sports Exerc. 2017; 49: 2009-2015
      8. Australian Communications and Media Authority. Access to Internet broadband and mobile phones family households. Media and Communications in Australian Families series. 2008;3. www.acma.gov.au/-/media/Research-and-Analysis/Report/pdf/no3_access_to_internet_broadband_and_mobile_phones_family_households-pdf.pdf?la=en. Accessed May 9, 2019.