Introduction
‘Activities of daily living’, incidental movements and activities not done to increase fitness can be classed as Lifestyle-Embedded Physical Activity (LEPA).
LEPA is worth investigating as although individual contributions are small, it's cumulative effect may be of significance (Tremblay, Esliger, Tremblay, & Colley, 2007). Consequently, low-intensity activity is potentially the most significant day-to-day use of energy (Levine, 2004).
LEPA reduces cardiovascular risks and improves fitness (Ross & McGuire, 2011), (Murphy, Blair, & Murtagh, 2009) When combined with purposeful exercise, it can contribute significantly to meeting activity guidelines (O’Dougherty, Arikawa, Kaufman, Kurzer, & Schmitz, 2010).
LEPA promotion is met with greater acceptance than traditional exercise, suggesting an opportunity for effective activity promotion (Tremblay et al., 2007). This is because people choose more accessible activities (Levine, Vander Weg, Hill, & Klesges, 2006), and it may be more effective to encourage people with minimal interest in exercise-based activity to perform non-exercise activity (Mak, Ho, Lo, McManus, & Lam, 2011).
LEPA is generally understudied and, as most studies utilize structured exercise, few interventions aiming to increase LEPA can be found. Where literature does exist, interventions have minimal impact at the public health level since the settings are primarily clinical (Dunn, Andersen, & Jakicic, 1998). Hence, a community sample will be used in the proposed study. It will examine moderate- and light-intensity activity due to a highlighted need for such research (O’Dougherty et al., 2010).
Additionally, greater insight is needed into public understanding of the variety of ways in which activity guidelines can be met (Dunn et al., 1998).
Messaging of activity guidelines has been done effectively using information-interventions (Heath et al., 2012) (C M Soetens, Vandelanotte, de Vries, & Mummery, 2014). Interventions can be delivered via technology as the target population has a high degree of computer-literacy. While previous studies demonstrate the efficacy of print- and internet-based methods to increase physical activity (Short, James, Plotnikoff, & Girgis, 2011)(Sum & Leung, 2016) and show them to be as effective as face-to-face interventions (Steele, Mummery, & Dwyer, 2007) and each other (Marcus et al., 2007), literature searches have failed to find any such interventions conducted in the context of LEPA.
Method
The primary study aim is to investigate what change, if any, results in participants’ LEPA levels. A secondary objective is to assess any changes to purposeful exercise levels and perceptions of health and how to meet the guidelines. All outcomes will be assessed using the questionnaires. The hypothesis is that the intervention group will perform more LEPA after the intervention than the control.
Intervention details
Participants will receive a single A4 sheet stating the Physical Activity Guidelines (Department of Health, 2011) and providing examples of LEPA that can assist in meeting these. It will be made clear that the suggestions alone are not sufficient to meet the guidelines and that most people require purposeful activity on top of these.
This page will be emailed to participants in the intervention group after completion of questionnaire one. The control group will receive the same document upon completion of questionnaire two. No other information will be provided to either group.
Four weeks after the baseline measurement (and intervention if applicable,) the second questionnaire will be emailed to all participants (the content will be the same as in the first.) Four weeks should be sufficient to see an increase in activity (Napolitano et al., 2003).
A provisional questionnaire and intervention sheet are included in Appendix 2. The Pre-Activity and Medical Questionnaires are also in Appendix 2. The participant information sheet and consent forms are in Appendix 1.
Timescale
Figures 1 and 2 outline the study process and provisional timescale.
Participant selection, recruitment and characteristics
Participants will be university students due to accessibility. It is important to research this population as this period is critical in establishing good activity patterns for adulthood (Keating, Guan, Piñero, & Bridges, 2005). There is no restriction on gender or ethnicity to increase generalizability within the target population.
Eligibility criteria
Inclusion and exclusion criteria are detailed in Table 1. These prioritize participant safety and reduce bias.
Sample size
Twenty to thirty is reasonable because this intervention is fairly novel since no similar work can be found. Participant numbers for internet-based interventions can vary greatly and figures analogous to those suggested are common (Davies, Spence, Vandelanotte, Caperchione, & Mummery, 2012; van den Berg, Schoones, & Vliet Vlieland, 2007). Sample size calculations are not necessary for pilot studies (Thabane et al., 2010); the recommendation is ten percent of that of the parent study (Connelly, 2008), therefore the pilot study sample size will be three.
A control group is valuable as evidence indicates a peak in physical activity levels in January which is uncharacteristic of winter months (Matthews et al., 2001). This may be due to motivation to offset unhealthy holiday patterns. Lack of a control has been a criticism of other studies in University students (Kozak, Nguyen, Yanos, & Fought, 2013).
Experimental approach
Data will be gathered using pre- and post-intervention questionnaires. There is no published questionnaire addressing all the study outcomes therefore one was created using available questionnaires as a basis. Peer-assessment found questionnaire length to be under ten minutes. Affordability, ease of administration and the adequacy of adults' self-report data (Sylvia, Bernstein, Hubbard, Keating, & Anderson, 2014) make use of a questionnaire appropriate. Pedometers are unsuitable for use as they are insensitive to light-intensity activities (Bassett, 2000).
The International Physical Activity Questionnaire (IPAQ) was used to phrase questions relating to moderate-activity as its data demonstrate correlation with accelerometer data in University students (Dinger, Behrens, & Han, 2006). As the IPAQ contains no mention of light-intensity activity, the NEAT questionnaire was used for this domain. It was chosen as its validity has been confirmed using triaxial accelerometers (Hamasaki, Yanai, Kakei, Noda, & Ezaki, 2014). The Scot-PASQ is used to assess purposeful exercise (NHS Health Scotland, Mutrie, & Fitzsimmons, 2013). The Compendium of Physical Activities (Ainsworth et al., 1993) was used to classify activities. After ethical approval, questionnaires will be transferred to Online Surveys; a pilot study will be run on peers to ensure clarity and website function.
The questionnaires will be circulated through social media and email (availability sampling). Random sampling using SPSS will allocate participants to either intervention or control groups to eliminate bias. Questionnaires will include guidance so participants do not misinterpret LEPA's potential contribution, falsely believing it alone to satisfy activity requirements and to avoid participants believing activities to be too light or short to record (O’Dougherty et al., 2010).
The resources required are SPSS software and access to Online Surveys.
Ethical approval will be sought prior to study commencement; ethical procedures have been put in place to align with the BASES Code of Conduct (see Ethics Form). A risk assessment has been conducted. This found the study to involve minimal risks.
Variables and their measurement
The manipulated variable is receival of the intervention. Potential confounding variables include life events, external motivation and limitations on participants' time. The control group is put into place to reduce the effects.
Within-subjects and between-subjects designs will be used, allowing comparison between groups, in addition to within groups in the pre- and post-intervention scenarios.
Statistical analysis
Descriptive analysis of participants will be performed. Descriptive and inferential statistics (namely mixed-factorial ANOVA,) on the main outcome variables will be done via SPSS. Mean minutes per week for each activity category will be reported. Cases missing significant volumes of data will be removed.