The Association Between Web-Based or Face-to-Face Lifestyle Interventions on the Perceived Benefits and Barriers to Exercise in Midlife Women: Three-Arm Equivalency Study

Abstract

Background Noncommunicable diseases pose a significant threat to women’s health globally, with most diseases being attributed to modifiable risk factors such as physical inactivity. Women perceive a range of benefits and barriers to exercise; however, there is little evidence about the effect of different lifestyle intervention delivery modes on perceptions of exercise. Objective This study aimed to compare the effect of a multiple health behavior change (MHBC) intervention called the Women’s Wellness Program. This intervention was delivered in 3 different modes on perceived exercise benefits, perceived exercise barriers, and actual physical activity and exercise in midlife women. Methods Women aged 45 to 65 years were recruited via the study website. They were assigned in blocks to 3 different treatment groups (A: Web-based independent; B: face-to-face with nurse consultations; and C: Web-based with virtual nurse consultations). All participants received the 12-week intervention that utilizes principles from social-cognitive theory to provide a structured guide to promote healthy lifestyle behaviors with an emphasis on regular exercise and healthy eating. Data were collected using a self-report Web-based questionnaire at baseline (T1) and postintervention (T2) including perceived exercise benefits and barriers and exercise and physical activity. A data analysis examined both within- and between-group changes over time. Results Participants in this study (N=225) had a mean age of 50.9 years (SD 5.9) and most were married or living with a partner (83.3%, 185/225). Attrition was 30.2% with 157 participants completing the final questionnaire. Women in all intervention groups reported a significant increase in positive perceptions of exercise (P<.05); a significant increase in exercise and overall physical activity (P<.01) with moderate-to-large effect sizes noted for overall physical activity (d=0.5 to d=0.87). Participants receiving support from registered nurses in the face-to-face and Web-based groups had a greater magnitude of change in benefit perceptions and physical activity than those in the Web-based independent group. There was no significant change in exercise barrier perceptions within or between groups over time. Conclusions The results of this study suggest that the (MHBC) intervention is effective in increasing exercise benefit perceptions, overall physical activity, and exercise in midlife women. Although Web-based programs are cost-effective and flexible and can be delivered remotely, providing a range of options including face-to-face group delivery and personalized electronic health coaching from registered nurses has the potential to enhance participant engagement and motivation.

A scoping review of behavior change techniques used to promote physical activity among women in midlife

“…Approximately half of these articles ( k = 13) provided very brief descriptions that “goal setting” served as a topic of discussion during group sessions (Carels et al, 2004 ; Fitzgibbon et al, 2005 ; Gaston et al, 2007 ; Scarinci et al, 2014 ), individual consultations with study personnel (Anderson et al, 2006 ; Wilbur et al, 2008 ; Hayashi et al, 2010 ; Long et al, 2013 ; Koniak-Griffin et al, 2015 ; Low et al, 2015 ), or via print or web-based study materials (Ortí and Donaghy, 2004 ; Napolitano et al, 2006 ; Sharpe et al, 2010 ), but did not provide specifics on the nature of goal-setting discussions or materials. In contrast, 12 articles provided more specific details on how goal setting was incorporated (Peterson et al, 2005 ; Costanzo et al, 2006 ; Keyserling et al, 2008 ; Samuel-Hodge et al, 2009 , 2013 ; Agomo et al, 2015 ; Butryn et al, 2016 ; Wilbur et al, 2016 , 2017 ; McGuire et al, 2019 ; Nazari et al, 2020 ; Shariati et al, 2021 ), and there was considerable variability in how goal setting was implemented across these articles.…”

A Scoping Review of Behavior Change Techniques Used to Promote Physical Activity among Women in Midlife

“…Approximately half of these articles (k = 13) provided very brief descriptions that "goal setting" served as a topic of discussion during group sessions (Carels et al, 2004;Fitzgibbon et al, 2005;Gaston et al, 2007;Scarinci et al, 2014), individual consultations with study personnel (Anderson et al, 2006;Hayashi et al, 2010;Koniak-Griffin et al, 2015;Long et al, 2013;Low et al, 2015;Wilbur et al, 2008), or via print or web-based study materials (Napolitano et al, 2006;Orti & Donaghy, 2004;Sharpe et al, 2010), but did not provide specifics on the nature of goal-setting discussions or materials. In contrast, 12 articles provided more specific details on how goal setting was incorporated (Agomo et al, 2015;Butryn et al, 2016;Costanzo et al, 2006;Keyserling et al, 2008;McGuire et al, 2019;Nazari et al, 2020;Peterson et al, 2005;Samuel-Hodge et al, 2009, 2013Shariati et al, 2020;Wilbur et al, 2016Wilbur et al, , 2017, and there was considerable variability in how goal setting was implemented across these articles.…”

“…For example, 3 articles described focusing on helping participants learn how to set specific behavioral goals that had clear parameters. Two involved individual consultations with study personnel who provided support for developing personal and realistic SMART (Specific, Measurable, Achievable, Relevant, and Time-bound) PA goals (Costanzo et al, 2006;McGuire et al, 2019). The third article indicated that participants were led to set 2-3 PA goals by their intervention facilitators during individual sessions, with follow-up and goal re-setting as these sessions progressed (Keyserling et al, 2008).…”

“…The specific problemsolving skills were not described, with the exception of limited details provided by Scarinci et al, (2014; i.e., problem-solving "steps" were taught and problem-solving "ability" was evaluated). Similarly, 11 articles referenced the use of planning and/or intention formation with respect to PA behavior, using group or individual intervention time to set a weekly schedule for activity (date/time/location; Agomo et al, 2015;Anderson et al, 2006;Butryn et al, 2016;Costanzo et al, 2006;Ehlers et al, 2015;Fitzgibbon et al, 2005;Keyserling et al, 2008;McGuire et al, 2019;Wilbur et al 2005;Zenk et al, 2009) or being guided through the process with a video (Nazari et al, 2020).…”

“…Specifically, behavioral modeling was provided through live demonstrations of activities during group sessions (e.g., Fitzgibbon et al, 2005;Keyserling et al, 2008;Koniak-Griffin , 2015;Samuel-Hodge et al, 2009;2013), via video demonstrations of activities (e.g., Nazari et al, 2020;Wilbur et al, 2008;, or both (e.g., Costanzo et al, 2006). Another approach reported was to have facilitators hand out photographic illustrations of activities during intervention sessions (McGuire et al, 2019). Models were intervention facilitators or peers who were already successful with PA, professionals (e.g., athletes, coaches), though in many cases, the model was not specified (e.g., Gaston et al, 2007;Wilbur et al, 2017).…”