Rural Environments and Community Health (REACH): a randomised controlled trial protocol for an online walking intervention in rural adults

BackgroundRural Australian adults are continually shown to be insufficiently active with higher prevalence of lifestyle-related diseases associated with physical inactivity compared to urban adults. This may, partly, be attributable to the challenges associated with implementing community-based physical activity programs in rural communities. There is a need for broadly accessible physical activity programs specifically tailored to the unique attributes of rural communities. The aim of the Rural Environments And Community Health (REACH) study is to evaluate the effectiveness of an online-delivered physical activity intervention for increasing regular walking among adults living in rural areas of South Australia.Methods/DesignThis is a randomised controlled trial. The intervention is 12-weeks with a 12-month follow-up. Participants will be insufficiently active, aged 18 to 70 years and randomly assigned to either Control or Intervention group. Participants receive a pedometer, but only the Intervention group will receive access to the purpose built REACH website where they will report steps taken, affect and ratings of perceived exertion during daily walking. These variables will be used to establish individualised step goals for increasing walking. Control participants will receive a paper diary to record their variables and generic incremental step goals.The primary outcome measures are time spent in sedentary, light and moderate-to-vigorous intensity physical activity, measured by accelerometry. Secondary outcomes include 1) health measures (anthropometric and physiological), 2) psychological well-being, 3) diet quality, and 4) correlates of physical activity (exercise self-efficacy and physical activity environments). Measures will be collected at baseline, post-intervention, 6-month and 12-month follow-up.DiscussionThis protocol describes the implementation of a trial testing the effectiveness of an online resource designed to assist rural Australians to become more physically active. The outcomes of this study will guide the efforts of health promotion professionals by providing evidence for a relatively inexpensive, widely accessible and effective method for increasing physical activity that can be utilized by anyone with access to the internet. Findings may indicate future directions for the implementation of physical activity and other health related interventions in rural communities.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTR12614000927628 (registered 28 August 2014).

[1]  Tomer Shemesh,et al.  Agreement between laboratory results and on-site pathology testing using Bayer DCA2000+ and Cholestech LDX point-of-care methods in remote Australian Aboriginal communities. , 2006, Clinica chimica acta; international journal of clinical chemistry.

[2]  F. Penedo,et al.  Exercise and well-being: a review of mental and physical health benefits associated with physical activity , 2005, Current opinion in psychiatry.

[3]  V. Noonan,et al.  Submaximal exercise testing: clinical application and interpretation. , 2000, Physical therapy.

[4]  T. Laatikainen,et al.  Physical activity behaviours of adults in the Greater Green Triangle region of rural Australia. , 2008, The Australian journal of rural health.

[5]  A. Pack,et al.  A survey screen for prediction of apnea. , 1995, Sleep.

[6]  R. Eston,et al.  Perceptually regulated training at RPE13 is pleasant and improves physical health. , 2012, Medicine and science in sports and exercise.

[7]  G. Borg Perceived exertion as an indicator of somatic stress. , 2019, Scandinavian journal of rehabilitation medicine.

[8]  P. Ekkekakis,et al.  The Pleasure and Displeasure People Feel When they Exercise at Different Intensities , 2011, Sports medicine.

[9]  Amanda J. Patterson,et al.  The Anti Cancer Council of Victoria FFQ: relative validity of nutrient intakes compared with weighed food records in young to middle‐aged women in a study of iron supplementation , 2000, Australian and New Zealand journal of public health.

[10]  C. Hardy,et al.  Not What, but How One Feels: The Measurement of Affect during Exercise , 1989 .

[11]  Catrine Tudor-Locke,et al.  How Many Steps/Day Are Enough? Preliminary Pedometer Indices for Public Health , 2004 .

[12]  Usdhhs Physical Activity and Health: A Report of the Surgeon General , 1996 .

[13]  Benjamin Schüz,et al.  Adoption and maintenance of four health behaviors: Theory-guided longitudinal studies on dental flossing, seat belt use, dietary behavior, and physical activity , 2007, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[14]  Ilse de Bourdeaudhuij,et al.  Environmental Correlates of Physical Activity in a Sample of Belgian Adults , 2003, American journal of health promotion : AJHP.

[15]  P. Lovibond,et al.  Manual for the Depression Anxiety Stress Scales. 2 , 1995 .

[16]  D. Allen,et al.  A transdisciplinary model integrating genetic, physiological, and psychological correlates of voluntary exercise. , 2007, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[17]  C. Kirschbaum,et al.  Free cortisol levels after awakening: a reliable biological marker for the assessment of adrenocortical activity. , 1997, Life sciences.

[18]  E. Heath Borg's Perceived Exertion and Pain Scales , 1998 .

[19]  Ulf Ekelund,et al.  The ABC of Physical Activity for Health: A consensus statement from the British Association of Sport and Exercise Sciences , 2010, Journal of sports sciences.

[20]  J. Henry,et al.  The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. , 2005, The British journal of clinical psychology.

[21]  F. Rubiano,et al.  New bioimpedance analysis system: improved phenotyping with whole-body analysis , 2004, European Journal of Clinical Nutrition.

[22]  A. Manley Physical Activity And Health: A Report Of The Surgeon General , 2004 .

[23]  P. Ekkekakis Let Them Roam Free? , 2009, Sports medicine.

[24]  B. Littenberg,et al.  Dyspnea ratings for prescribing exercise intensity in patients with COPD. , 1996, Chest.

[25]  D. Carroll,et al.  The effects of physical activity and exercise training on psychological stress and well-being in an adolescent population. , 1992, Journal of psychosomatic research.

[26]  Jeffrey C. Valentine,et al.  Interventions to increase physical activity among aging adults: A meta-analysis , 2002, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[27]  S. McGuire,et al.  Centers for Disease Control and Prevention. State indicator report on Physical Activity, 2014. Atlanta, GA: U.S. Department of Health and Human Services; 2014. , 2014, Advances in nutrition.

[28]  C. Kirschbaum,et al.  Two formulas for computation of the area under the curve represent measures of total hormone concentration versus time-dependent change , 2003, Psychoneuroendocrinology.

[29]  A. Bauman,et al.  Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. , 2007, Circulation.

[30]  Tomoko Aoyama,et al.  Prediction of maximal oxygen uptake from a 3-minute walk based on gender, age, and body composition. , 2013, Journal of physical activity & health.

[31]  M. Marfell-Jones,et al.  International standards for anthropometric assessment. , 2012 .

[32]  B. Noble,et al.  Clinical applications of perceived exertion. , 1982, Medicine and science in sports and exercise.

[33]  M. Rantz,et al.  Integrative Review of Physical Activity Intervention Research with Aging Adults , 2003, Journal of the American Geriatrics Society.

[34]  A. Bandura Social cognitive theory of self-regulation☆ , 1991 .

[35]  C. Matthews,et al.  Best practices for using physical activity monitors in population-based research. , 2012, Medicine and science in sports and exercise.

[36]  D. Mahler,et al.  Target dyspnea ratings predict expected oxygen consumption as well as target heart rate values. , 1999, American journal of respiratory and critical care medicine.

[37]  Andrew Phillips,et al.  Health status differentials across rural and remote Australia. , 2009, The Australian journal of rural health.

[38]  E. A. Locke,et al.  Building a practically useful theory of goal setting and task motivation. A 35-year odyssey. , 2002, The American psychologist.

[39]  C. Kirschbaum,et al.  Salivary cortisol in psychoneuroendocrine research: Recent developments and applications , 1994, Psychoneuroendocrinology.

[40]  L. Mosca,et al.  Clinical Utility of a Fingerstick Technology to Identify Individuals with Abnormal Blood Lipids and High-Sensitivity C-Reactive Protein Levels , 2009, American journal of health promotion : AJHP.

[41]  Michael Catt,et al.  Validation of the GENEA Accelerometer. , 2011, Medicine and science in sports and exercise.

[42]  D. Mahler,et al.  Dyspnea ratings for prescription of cross-modal exercise in patients with COPD. , 1998, Chest.

[43]  Bernard C. K. Choi,et al.  Daily step goal of 10,000 steps: a literature review. , 2007, Clinical and investigative medicine. Medecine clinique et experimentale.

[44]  A. King Interventions to promote physical activity by older adults. , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[45]  J. Humphreys,et al.  Addressing the health disadvantage of rural populations: how does epidemiological evidence inform rural health policies and research? , 2008, The Australian journal of rural health.

[46]  Macfarlane Wv,et al.  Australia's health. , 1962 .

[47]  Daniel J Buysse,et al.  The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research , 1989, Psychiatry Research.

[48]  Betsy Jane Becker,et al.  Physical activity and psychological well-being in advanced age: a meta-analysis of intervention studies. , 2005, Psychology and aging.