Multicentred randomised controlled trial of an augmented exercise referral scheme using web-based behavioural support in individuals with metabolic, musculoskeletal and mental health conditions: protocol for the e-coachER trial

Abstract

IntroductionPhysical activity is recommended for improving health among people with common chronic conditions such as obesity, diabetes, hypertension, osteoarthritis and low mood. One approach to promote physical activity is via primary care exercise referral schemes (ERS). However, there is limited support for the effectiveness of ERS for increasing long-term physical activity and additional interventions are needed to help patients overcome barriers to ERS uptake and adherence.This study aims to determine whether augmenting usual ERS with web-based behavioural support, based on the LifeGuide platform, will increase long-term physical activity for patients with chronic physical and mental health conditions, and is cost-effective.Methods and analysisA multicentre parallel two-group randomised controlled trial with 1:1 individual allocation to usual ERS alone (control) or usual ERS plus web-based behavioural support (intervention) with parallel economic and mixed methods process evaluations. Participants are low active adults with obesity, diabetes, hypertension, osteoarthritis or a history of depression, referred to an ERS from primary care in the UK.The primary outcome measure is the number of minutes of moderate-to-vigorous physical activity (MVPA) in ≥10 min bouts measured by accelerometer over 1 week at 12 months.We plan to recruit 413 participants, with 88% power at a two-sided alpha of 5%, assuming 20% attrition, to demonstrate a between-group difference of 36–39 min of MVPA per week at 12 months. An improvement of this magnitude represents an important change in physical activity, particularly for inactive participants with chronic conditions.Ethics and disseminationApproved by North West Preston NHS Research Ethics Committee (15/NW/0347). Dissemination will include publication of findings for the stated outcomes, parallel process evaluation and economic evaluation in peer-reviewed journals.Results will be disseminated to ERS services, primary healthcare providers and trial participants.Trial registration numberISRCTN15644451; Pre-results.

Adding web-based behavioural support to exercise referral schemes for inactive adults with chronic health conditions: the e-coachER RCT

“…As described previously, 1 there is growing evidence on the effectiveness of technology-based interventions for promotion of PA. 21,22 Studies include a wide range of interventions (from quite simple self-monitoring to interventions with multiple complex behaviour change components), targeted at different clinical groups with different baseline levels of PA, with various PA outcomes reported (very few using objective measures), and with mostly short-term follow-ups. In addition, some comparisons are between intervention versus no intervention and others are versus human contact, although none reports on the effects of adding web-based support to complement face-to-face support provided by ERSs.…”

“…As described elsewhere, 1 evidence-based guidelines recommend both aerobic training and strength training for improving health markers and quality of life among those people with common chronic metabolic conditions [1][2][3][4][5] and musculoskeletal conditions. 6 To prevent or reduce depression, mostly aerobic exercise is recommended.…”

“…an exercise referral scheme (ERS)]. As described previously, 1 in the UK, ERSs have been popular, with an estimated 600 schemes involving up to 100,000 patients per year in 2008. 13 There is currently no single model for ERSs in the UK, but they mainly involve referral to a programme (e.g.…”

“…We called the intervention 'e-coachER' and it was designed to support patients with chronic physical and mental health conditions who have been referred from primary care to an ERS to receive face-to-face support. 1 The overarching aim of the e-coachER intervention was to facilitate long-term PA by promotion of evidence-based self-regulatory skills and to encourage interaction with others (including the ERS professional, family and friends), and founded on selfdetermination theory 31 to build a sense of competence in managing PA, autonomy or control over PA, and connection or relatedness with others. We wanted to encourage uptake and adherence to the ERS but if that was not acceptable or feasible for participants then we offered support to find alternative ways to be physically active in a way that may support their needs as someone who was inactive.…”

“…Initial package includes free pedometer, fridge magnet and access to e-coachER (a website to promote PA via specific BCTs): 1 This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/ licenses/by/4.0/.…”