The study titled ‘Behavior Change and Compliance Outcomes of a Novel Web-Based Health Behavior Tool Integrated Into Certified Exercise Practitioner Services: Twelve-Week, Two-Arm, Randomized Pre-Post Trial’ was published in the Journal of Medical Internet Research. This research aimed to assess the effectiveness of a digital tool designed to promote healthy lifestyle behaviors among participants receiving services from certified exercise practitioners (CEPs).
Background
Healthy lifestyle behaviors, such as maintaining a balanced diet, engaging in regular physical activity, ensuring adequate sleep, avoiding tobacco, moderating alcohol consumption, and managing stress, are linked to a lower risk of chronic diseases and enhanced well-being. Digital interventions have emerged as effective platforms for promoting these behaviors, yet few have been integrated into CEP services or addressed multiple health domains.
Objective
The primary objective of this study was to evaluate changes in health behaviors during the implementation of the Food, Exercise, Sleep, and Stress (FESS) web-based questionnaire as an adjunct to traditional face-to-face services provided by CEPs. The study also aimed to compare changes across two different prompting frequencies for questionnaire completion.
Methods
This research utilized a two-arm, randomized pre-post intervention design involving 41 participants (23 women), with a median age of 65 years. Participants were recruited from CEP clinics and were randomized to complete the FESS questionnaire either three times per week (3-day group) or daily (everyday group) for a duration of 12 weeks. The questionnaire tracked health behaviors across four domains and provided health tips.
Outcomes were assessed using the assessment version of the FESS questionnaire at baseline, 6 weeks, and 12 weeks. Changes in questionnaire responses were analyzed over time using Friedman ANOVA and Wilcoxon signed-rank post hoc tests. Group differences between prompting frequencies were evaluated using the Mann-Whitney U test. Compliance was measured by the proportion of completed questionnaires relative to the total prescribed for each participant.
Additionally, the validity of the exercise domain was assessed by comparing self-reported physical activity and sedentary time from daily FESS responses with accelerometer-derived measures in a subsample of participants.
Results
The findings indicated positive or no changes in most health behaviors, with significant improvements noted in vegetable consumption, water intake, stress management, and sleep quality. Notably, the everyday group exhibited larger changes in stress and sleep behaviors, while the 3-day group demonstrated higher compliance rates. However, compliance declined over time in both groups. The accelerometer validation revealed low rates of overreporting exercise and underreporting sedentary behavior among participants.
Conclusions
The FESS questionnaire proved feasible and was associated with observed changes in health behaviors, particularly in diet, stress, and sleep when integrated into CEP services. While daily use correlated with larger observed changes, the decline in compliance over time presents a challenge for sustained behavior change.
What this study does not show
This study does not establish a direct causal relationship between the use of the FESS questionnaire and long-term health outcomes, nor does it provide evidence of sustained behavior change beyond the 12-week intervention period.
Evidence scorecard
- Analytic validity: established
- Clinical validity: established
- Clinical utility: established
The evidence class is human_rct.