The study published in the Journal of Medical Internet Research investigates the effectiveness of a novel web-based health behavior tool, known as the Food, Exercise, Sleep, and Stress (FESS) questionnaire, integrated into services provided by certified exercise practitioners (CEPs). The research aimed to assess behavior changes in participants over a 12-week period.
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 crucial for reducing chronic disease risk and enhancing overall well-being. Digital interventions have recently emerged as effective platforms for promoting these behaviors, yet few have been integrated into CEP services or have addressed multiple health domains.
Study Objective
The primary objective of this study was to evaluate changes in health behaviors during the implementation of the FESS questionnaire as an adjunct to traditional face-to-face services provided by CEPs. Additionally, the study aimed to compare changes across two different prompting frequencies: three times per week and daily.
Methods
This randomized pre-post intervention study involved 41 participants (23 women) with a median age of 65 years, recruited from CEP clinics. Participants were randomly assigned to complete the FESS questionnaire either three times per week (3-day group, n=21) or daily (everyday group, n=20) for 12 weeks. The FESS questionnaire tracked health behaviors across four domains and provided relevant health tips.
Outcomes were assessed using the FESS questionnaire at baseline, 6 weeks, and 12 weeks. Changes in responses were analyzed using Friedman ANOVA and Wilcoxon signed-rank post hoc tests. Group differences 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 with accelerometer-derived measures in a subsample.
Results
The findings revealed 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; however, the 3-day group demonstrated higher compliance rates. Compliance declined over the 12-week period in both groups. Validation of the exercise domain indicated low rates of overreporting exercise and underreporting sedentary behavior.
Conclusions
The FESS questionnaire proved to be a feasible tool associated with positive changes in health behaviors, particularly in diet, stress, and sleep, when integrated into CEP services. While daily prompting led to larger observed changes, the decline in compliance over time raises considerations for future implementation strategies.
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 12-week intervention period.
Evidence scorecard
- Analytic validity: established
- Clinical validity: established
- Clinical utility: established