Date Published: February 5, 2019
Publisher: Public Library of Science
Author(s): Sally Wyke, Christopher Bunn, Eivind Andersen, Marlene N. Silva, Femke van Nassau, Paula McSkimming, Spyros Kolovos, Jason M. R. Gill, Cindy M. Gray, Kate Hunt, Annie S. Anderson, Judith Bosmans, Judith G. M. Jelsma, Sharon Kean, Nicolas Lemyre, David W. Loudon, Lisa Macaulay, Douglas J. Maxwell, Alex McConnachie, Nanette Mutrie, Maria Nijhuis-van der Sanden, Hugo V. Pereira, Matthew Philpott, Glyn C. Roberts, John Rooksby, Øystein B. Røynesdal, Naveed Sattar, Marit Sørensen, Pedro J. Teixeira, Shaun Treweek, Theo van Achterberg, Irene van de Glind, Willem van Mechelen, Hidde P. van der Ploeg, Sanjay Basu
Abstract: BackgroundReducing sitting time as well as increasing physical activity in inactive people is beneficial for their health. This paper investigates the effectiveness of the European Fans in Training (EuroFIT) programme to improve physical activity and sedentary time in male football fans, delivered through the professional football setting.Methods and findingsA total of 1,113 men aged 30–65 with self-reported body mass index (BMI) ≥27 kg/m2 took part in a randomised controlled trial in 15 professional football clubs in England, the Netherlands, Norway, and Portugal. Recruitment was between September 19, 2015, and February 2, 2016. Participants consented to study procedures and provided usable activity monitor baseline data. They were randomised, stratified by club, to either the EuroFIT intervention or a 12-month waiting list comparison group. Follow-up measurement was post-programme and 12 months after baseline. EuroFIT is a 12-week, group-based programme delivered by coaches in football club stadia in 12 weekly 90-minute sessions. Weekly sessions aimed to improve physical activity, sedentary time, and diet and maintain changes long term. A pocket-worn device (SitFIT) allowed self-monitoring of sedentary time and daily steps, and a game-based app (MatchFIT) encouraged between-session social support. Primary outcome (objectively measured sedentary time and physical activity) measurements were obtained for 83% and 85% of intervention and comparison participants. Intention-to-treat analyses showed a baseline-adjusted mean difference in sedentary time at 12 months of −1.6 minutes/day (97.5% confidence interval [CI], −14.3–11.0; p = 0.77) and in step counts of 678 steps/day (97.5% CI, 309–1.048; p < 0.001) in favor of the intervention. There were significant improvements in diet, weight, well-being, self-esteem, vitality, and biomarkers of cardiometabolic health in favor of the intervention group, but not in quality of life. There was a 0.95 probability of EuroFIT being cost-effective compared with the comparison group if society is willing to pay £1.50 per extra step/day, a maximum probability of 0.61 if society is willing to pay £1,800 per minute less sedentary time/day, and 0.13 probability if society is willing to pay £30,000 per quality-adjusted life-year (QALY). It was not possible to blind participants to group allocation. Men attracted to the programme already had quite high levels of physical activity at baseline (8,372 steps/day), which may have limited room for improvement. Although participants came from across the socioeconomic spectrum, a majority were well educated and in paid work. There was an increase in recent injuries and in upper and lower joint pain scores post-programme. In addition, although the five-level EuroQoL questionnaire (EQ-5D-5L) is now the preferred measure for cost-effectiveness analyses across Europe, baseline scores were high (0.93), suggesting a ceiling effect for QALYs.ConclusionParticipation in EuroFIT led to improvements in physical activity, diet, body weight, and biomarkers of cardiometabolic health, but not in sedentary time at 12 months. Within-trial analysis suggests it is not cost-effective in the short term for QALYs due to a ceiling effect in quality of life. Nevertheless, decision-makers may consider the incremental cost for increase in steps worth the investment.Trial registrationInternational Standard Randomised Controlled Trials, ISRCTN-81935608.
Partial Text: Physical activity is important in preventing chronic diseases, including cardiovascular disease, type 2 diabetes, and several cancers [1,2]. Global recommendations from the World Health Organisation (WHO) advise at least 150 minutes per week in moderate-to-vigorous physical activity. Recent estimates show that nearly one third of adults worldwide do not meet these recommendations and around 9% of premature deaths worldwide in 2008 can be attributed to lack of physical activity . Not meeting the WHO physical activity recommendations costs healthcare systems globally 53.8 billion international dollars (INT$), with an additional indirect cost of INT$13.7 billion .
Participants were recruited between September 19, 2015, and February 2, 2016. Participant flow through the trial is shown in Fig 1. Main reasons for exclusion for men who showed interest in the trial were BMI <27 kg/m2 (42.4%), inability to reach men after they expressed interest, men not being approached because the study had reached the maximum number of participants at a club (39.3%). Participants spanned all sociodemographic groups, but a majority were ‘native’ to the study country (meaning each of the participant, their mother, and their father was born there), had at least 12 years of education, were in full-time work, and were married or living with a partner (Table 1). At baseline, participants’ mean daily step count was 8,372 steps/day, sedentary time was 625 minutes/day, and BMI was 33.2 kg/m2. Source: http://doi.org/10.1371/journal.pmed.1002736