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’ examines the effectiveness of a web-based questionnaire designed to promote healthy lifestyle behaviors.
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 reduced risk of chronic diseases and enhanced well-being. Digital interventions have emerged as cost-effective methods to promote these behaviors, yet few have been integrated into the services provided by certified exercise practitioners (CEPs).
Objective
The primary aim of this study was to assess 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 offered by CEPs. The study also aimed to compare the changes across two different prompting frequencies.
Methods
This research employed 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, n=21) or daily (everyday group, n=20) over a 12-week period. The FESS 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 using Friedman ANOVA with Wilcoxon signed-rank post hoc tests. Group differences in prompting frequencies were assessed using the Mann-Whitney U test. Compliance was evaluated by calculating the proportion of completed FESS questionnaires relative to the total number prescribed for each participant. 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
Results indicated positive or no changes in most health behaviors, with significant improvements noted in vegetable consumption, water intake, stress management, and sleep quality. Group comparisons revealed larger changes in stress and sleep behaviors in the everyday group, although compliance was higher in the 3-day group. Notably, compliance declined over time in both groups. Validation of the exercise domain showed low rates of overreporting exercise (5.1%) and underreporting sedentary behavior (18.6%).
Conclusions
The FESS questionnaire demonstrated feasibility and was associated with observed changes in health behaviors, particularly in diet, stress, and sleep, when integrated into CEP services. While daily use was linked to larger observed changes, the decline in compliance over time suggests challenges in sustaining engagement with the tool.
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 address the sustainability of behavior changes beyond the intervention period.
Evidence scorecard
- Analytic validity: Established
- Clinical validity: Established
- Clinical utility: Established