Out-of-home eating (takeaway, take-out and fast-foods) is associated with intakes of higher energy and fat, and lower intakes of micronutrients, and is associated with excess weight gain. In 2017, a unique opportunity arose to measure the association between the opening of a new multi-national fast-food restaurant (McDonald's) and consumption of fast-food on young people aged 11-16. This study uses a repeated cross-sectional design to explore group level change over time with respect to out-of-home eating behaviours of young people. Two secondary schools in Redcar and Cleveland agreed to participate and facilitated the completion of a questionnaire on their pupils eating behaviours at three timepoints a) prior to the new restaurant opening, b) three months post-opening and c) nine months post opening. Reported frequency of visits to McDonald's showed a statistically significant increase in visits between 3 and 9 months of the restaurant opening. This research asks and explores the question of whether the introduction of a new multi-national fast-food restaurant influences eating habits of young people attending schools near the new outlet.

Background The COVID-19 pandemic changed the way many industries work, including contact centres, with some employees working from home and new on-site restrictions/measures in place representing even greater challenges for employers around staff engagement and wellbeing. This study aimed to understand the interplay of individual, social, environmental and organisational factors influencing physical activity and sedentary behaviour in UK contact centre employees, how the pandemic impacted these factors, and their relevance for the future of hybrid working. Methods Individual interviews (n = 33) were conducted with participants (staff working full and part time, on site and from home) from four UK contact centres. A topic guide based on the ecological model was developed to understand current barriers and facilitators to physical activity and (reducing) sedentary behaviour during and outside of working hours. Thematic analysis was carried out using a codebook and a deductive coding approach to identify themes. Results Three key insights are provided. First, participants felt they were generally sitting more and moving less since the first UK-wide lockdown. Second, factors which negatively impacted on these behaviours were evident across all levels of the ecological model. These included individual and social barriers (e.g., lack of motivation and preferable physical activity options) as well as environmental and organisational barriers (e.g., poor home office setup, back-to-back virtual meetings). There were a mix of new and existing barriers (exacerbated by the pandemic) and several of these were linked to homeworking. Third, organisational support requirements (e.g., homeworking ergonomic support) and existing facilitators (such as the provision of informational support and flexible working arrangements) were identified. Conclusion Solutions to reduce sedentary behaviours and increase physical activity in contact centres need to address barriers from the individual to the organisational level. Whilst the study was undertaken in the UK, the results are like to be applicable globally. Trial registration Clinical trial registration: The trial for the wider project has been registered on the ISRCTN database: http://www.isrctn.com/ISRCTN11580369.

Abstract Purpose Contact centres have been identified as high-pressured workplaces where staff are sedentary, and one in four experience musculoskeletal problems. Stand Up for Health (SUH) is an intervention developed using the 6SQuID intervention development framework to target sedentary behaviour in contact centres. It is an adaptive intervention based on the Social Cognitive Theory and the Social Ecological Model. The aim of this study was to test the acceptability and feasibility of implementing SUH in contact centres. Methods The study used a stepped-wedge cluster randomised trial design and included eleven UK-based contact centres. Intervention implementation involved working with contact centre stakeholders to develop a customised action plan that aligned with SUH’s theory of change. This was operationalised to include two workshops, creating a SUH committee, and loaning equipment (desk-risers, exercise equipment) to each centre. During the pandemic, online staff consults replaced these activities. The process evaluation adopted the RE-AIM framework to understand acceptability and feasibility of implementing the SUH intervention. Interviews and focus groups were conducted with 33 staff members and stakeholders, and 96 participants completed an activity preference questionnaire. Qualitative data were analysed using a codebook thematic analysis approach and descriptive statistics were used to describe activity preferences. Results The intervention was acceptable and feasible to deliver, and most contact centres implemented several activities aligned with each level of the programme’s theory of change. All centres reported that more than 50% of staff participated in at least one SUH activity (during the pre-lockdown period). Perceived benefits such as reduced sedentary behaviour, increased physical activity, and improved staff morale and mood were reported by contact centre staff and stakeholders. Participants felt that SUH was particularly significant because it increased awareness of sedentary behaviour, encouraged movement, and helped staff manage stress. Conclusions SUH is an adaptive multicomponent programme that considers the culture and contexts of contact centres. The programme shows potential as an appealing and acceptable intervention, impacting several wellbeing outcomes. Next steps include adapting the intervention for the post-pandemic work context, and further pilot testing before large scale evaluation. Funding Source National Institute for Health Research (NIHR) [PHR project grant: 17/149/19]

INTRODUCTION:Contact centres have higher levels of sedentary behaviour than other office-based workplaces. Stand Up for Health (SUH) is a theory-based intervention developed using the 6SQuID framework to reduce sedentary behaviour in contact centre workers. The aim of this study was to test acceptability and feasibility of implementing SUH in UK contact centres. METHODS:The study was conducted in 2020-2022 (pre COVID and during lockdown) and used a stepped-wedge cluster randomised trial design including a process evaluation. The intervention included working with contact centre managers to develop and implement a customised action plan aligning with SUH's theory of change. Workplace sedentary time, measured using activPAL™ devices, was the primary outcome. Secondary outcomes included productivity, mental wellbeing, musculoskeletal health and physical activity. Empirical estimates of between-centre standard deviation and within-centre standard deviation of outcomes from pre-lockdown data were calculated to inform sample size calculations for future trials. The process evaluation adopted the RE-AIM framework to understand acceptability and feasibility of implementing the intervention. Interviews and focus groups were conducted with contact centre employees and managers, and activity preferences were collected using a questionnaire. RESULTS:A total of 11 contact centres participated: 155 employees from 6 centres in the pre-lockdown data collection, and 54 employees from 5 centres post-lockdown. Interviews and focus groups were conducted with 33 employees and managers, and 96 participants completed an intervention activity preference questionnaire. Overall, the intervention was perceived as acceptable and feasible to deliver. Most centres implemented several intervention activities aligned with SUH's theory of change and over 50% of staff participated in at least one activity (pre-lockdown period). Perceived benefits including reduced sedentary behaviour, increased physical activity, and improved staff morale and mood were reported by contact centre employees and managers. CONCLUSIONS:SUH demonstrates potential as an appealing and acceptable intervention, impacting several wellbeing outcomes. TRIAL REGISTRATION:The trial has been registered on the ISRCTNdatabase: http://www.isrctn.com/ISRCTN11580369.

AbstractObjective:To quantify the extent of food and beverage advertising on bus shelters in a deprived area of the UK, to identify the healthfulness of advertised products, and any differences by level of deprivation. The study also sought to assess the creative strategies used and extent of appeal to young people.Design:Images of bus shelter advertisements were collected via in person photography (in 2019) and Google Street View (photos recorded in 2018). Food and beverage advertisements were grouped into one of seventeen food categories and classified as healthy/less healthy using the UK Nutrient Profile Model. The deprivation level of the advertisement location was identified using the UK Index of Multiple Deprivation.Setting:Middlesbrough and Redcar and Cleveland in South Teesside.Participants:N/AResults:Eight hundred and thirty-two advertisements were identified, almost half (48·9 %) of which were for foods or beverages. Of food and non-alcoholic beverage adverts, 35·1 % were less healthy. Most food advertisements (98·9 %) used at least one of the persuasive creative strategies. Food advertisements were found to be of appeal to children under 18 years of age (71·9 %). No differences in healthiness of advertised foods were found by level of deprivation.Conclusions:Food advertising is extensive on bus shelters in parts of the UK, and a substantial proportion of this advertising is classified as less healthy and would not be permitted to be advertised around television programming for children. Bus shelter advertising should be considered part of the UK policy deliberations around restricting less healthy food marketing exposure.

Background: Sedentary behaviour is linked to increased risk of type 2 diabetes, cardiovascular disease, musculoskeletal issues and poor mental well-being. Contact (call) centres are associated with higher levels of sedentary behaviour than other office-based workplaces. Stand Up for Health is an adaptive intervention designed to reduce sedentary behaviour in contact centres. Objectives: The objectives were to test the acceptability and feasibility of implementing the intervention; to assess the feasibility of the study design and methods; to scope the feasibility of a future health economic evaluation; and to consider the impact of COVID-19 on the intervention. All sites received no intervention for between 3 and 12 months after the start of the study, as a waiting list control. Design: This was a cluster-randomised stepped-wedge feasibility design. Setting: The trial was set in 11 contact centres across the UK. Participants: Eleven contact centres and staff. Intervention: Stand Up for Health involved two workshops with staff in which staff developed activities for their context and culture. Activities ranged from using standing desks to individual goal-setting, group walks and changes to workplace policies and procedures. Main outcome measures: The primary outcome was accelerometer-measured sedentary time. The secondary outcomes were subjectively measured sedentary time, overall sedentary behaviour, physical activity, productivity, mental well-being and musculoskeletal health. Results: Stand Up for Health was implemented in 7 out of 11 centres and was acceptable, feasible and sustainable (objective 1). The COVID-19 pandemic affected the delivery of the intervention, involvement of contact centres, data collection and analysis. Organisational factors were deemed most important to the success of Stand Up for Health but also the most challenging to change. There were also difficulties with the stepped-wedge design, specifically maintaining contact centre interest (objective 2). Feasible methods for estimating cost-efficiency from an NHS and a Personal Social Services perspective were identified, assuming that alternative feasible effectiveness methodology can be applied. Detailed activity-based costing of direct intervention costs was achieved and, therefore, deemed feasible (objective 3). There was significantly more sedentary time spent in the workplace by the centres that received the intervention than those that did not (mean difference 84.06 minutes, 95% confidence interval 4.07 to 164.1 minutes). The other objective outcomes also tended to favour the control group. Limitations: There were significant issues with the stepped-wedge design, including difficulties in maintaining centre interest and scheduling data collection. Collection of accelerometer data was not feasible during the pandemic. Conclusions: Stand Up for Health is an adaptive, feasible and sustainable intervention. However, the stepped-wedge study design was not feasible. The effectiveness of Stand Up for Health was not demonstrated and clinically important reductions in sedentary behaviour may not be seen in a larger study. However, it may still be worthwhile conducting an effectiveness study of Stand Up for Health incorporating activities more relevant to hybrid workplaces. Future work: Future work could include developing hybrid (office and/or home working) activities for Stand Up for Health; undertaking a larger effectiveness study and follow-up economic analysis (subject to its success); and exploring organisational features of contact centres that affect the implementation of interventions such as Stand Up for Health. Trial registration: This trial is registered as ISRCTN11580369. Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 13. See the NIHR Journals Library website for further project information.

Optimising health and well-being before elective major surgery via prehabilitation initiatives is important for good postoperative outcomes. In a busy tertiary centre in North East England, the lack of a formal prehabilitation service meant that opportunities were being missed to optimise patients for surgery. This quality improvement project aimed to implement and evaluate a community-based prehabilitation service for people awaiting elective major surgery: PREP-WELL. A multidisciplinary, cross-sector team introduced PREP-WELL in January 2018. PREP-WELL provided comprehensive assessment and management of perioperative risk factors in the weeks before surgery. During a 12-month pilot, patients were referred from five surgical specialties at James Cook University Hospital. Data were collected on participant characteristics, behavioural and health outcomes, intervention acceptability and costs, and process-related factors. By December 2018, 159 referrals had been received, with 75 patients (47%) agreeing to participate. Most participants opted for a supervised programme (72%) and were awaiting vascular (43%) or orthopaedic (35%) surgery. Median programme duration was 8 weeks. The service was delivered as intended with participants providing positive feedback. Health-related quality of life (HRQoL; EuroQol 5D (EQ-5D) utility) and functional capacity (6 min walk distance) increased on average from service entry to exit, with mean (95% CI) changes of 0.108 (−0.023 to 0.240) and 35 m (−5 to 76 m), respectively. Further increases in EQ5D utility were observed at 3 months post surgery. Substantially more participants were achieving recommended physical activity levels at exit and 3 months post surgery compared with at entry. The mean cost of the intervention was £405 per patient; £52 per week. The service was successfully implemented within existing preoperative pathways. Most participants were very satisfied and improved their risk profile preoperatively. Funding has been obtained to support service development and expansion for at least 2 more years. During this period, alternative pathways will be developed to facilitate wider access and greater uptake.

Objective: To evaluate the feasibility and acceptability of the Takeaway Masterclass, a three-hour training session delivered to staff of independent takeaway food outlets that promoted healthy cooking practices and menu options. Design: A mixed-methods study design. All participating food outlets provided progress feedback at 6 weeks post-intervention. Baseline and 6-week post-intervention observational and self-reported data were collected in half of participating takeaway food outlets. Setting: North East England. Participants: Independent takeaway food outlet owners and managers. Results: Staff from eighteen (10 % of invited) takeaway food outlets attended the training; attendance did not appear to be associated with the level of deprivation of food outlet location. Changes made by staff that required minimal effort or cost to the business were the most likely to be implemented and sustained. Less popular changes included using products that are difficult (or expensive) to source from suppliers, or changes perceived to be unpopular with customers. Conclusion: The Takeaway Masterclass appears to be a feasible and acceptable intervention for improving cooking practices and menu options in takeaway food outlets for those who attended the training. Further work is required to increase participation and retention and explore effectiveness, paying particular attention to minimising adverse inequality effects.

Purpose: To assess physical activity outcomes of a pedometer-based physically active learning (PAL) intervention in primary school children. Methods: Six paired schools were randomly allocated to either a 6-week teacher-led pedometer-based physically active learning intervention or a control (n = 154, female = 60%, age = 9.9 [0.3] y). Accelerometers assessed total daily sedentary time, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). Preintervention mean daily MVPA minutes grouped participants as Low Active (<45 min/d) and High Active (≥45 min/d). Results: From the final sample size, the intervention (n = 52) significantly improved LPA versus control (n = 31, P = .04), by reducing sedentary time. More intervention (+10%) than control (+3%) pupils met the 60 minutes per day guidelines. In both intervention subgroups, pupils spent less time in LPA (P < .05) versus control. The greatest nonsignificant increase was found in the Low Active pupils MVPA levels. Conclusions: Improvements in LPA were statistically significant in the intervention versus control group. In subgroup analysis, Low Active pupils in the intervention showed the greatest beneficial effects and the Most Active pupils may have replaced MVPA and sedentary time with LPA. The intervention group housed clusters of pupils showing variable responsiveness, justifying routine examination of subgroup variability in future studies.

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Choices in the design and delivery of digital health behaviour interventions may have a direct influence on subsequent usage and engagement. Few studies have been able to make direct, detailed comparisons of differences in usage between interventions that are delivered via web or app. This study compared the usage of two versions of a digital stress management intervention, one delivered via a website (Healthy Paths) and the other delivered via an app (Healthy Mind). Design modifications were introduced within Healthy Mind to take account of reported differences in how individuals engage with websites compared to apps and mobile phones. Data were collected as part of an observational study nested within a broader exploratory trial of Healthy Mind. Objective usage of Healthy Paths and Healthy Mind were automatically recorded, including frequency and duration of logins, access to specific components within the intervention and order of page/screen visits. Usage was compared for a two week period following initial registration. In total, 381 participants completed the registration process for Healthy Paths (web) and 162 participants completed the registration process for Healthy Mind (app). App users logged in twice as often (Mdn = 2.00) as web users (Mdn = 1.00), U = 13,059.50, p ≤ 0.001, but spent half as much time (Mdn = 5.23 min) on the intervention compared to web users (Mdn = 10.52 min), U = 19,740.00, p ≤ 0.001. Visual exploration of usage patterns over time revealed that a significantly higher proportion of app users (n = 126, 82.35%) accessed both types of support available within the intervention (i.e. awareness and change-focused tools) compared to web users (n = 92, 40.17%), χ2(1, n = 382) = 66.60, p < 0.001. This study suggests that the digital platform used to deliver an intervention (i.e. web versus app) and specific design choices (e.g. navigation, length and volume of content) may be associated with differences in how the intervention content is used. Broad summative usage data (e.g. total time spent on the intervention) may mask important differences in how an intervention is used by different user groups if it is not complemented by more fine-grained analyses of usage patterns over time. Trial registration number: ISRCTN67177737.

[This corrects the article DOI: 10.1371/journal.pone.0169162.].

Intervention outcomes, expressed by mean changes, often overlook variable responsiveness. This may mask some intervention successes. PURPOSE: To explore individual variability in children completing a pedometer intervention. METHODS: Six schools (n=152) were ranked and paired by socio-economic status, with one per pair randomly allocated to a six-week teacher-led pedometer intervention (PI, n=81) or control (C, n=71). Actigraph GT1M accelerometers assessed physical activity (PA) for 7 days. Evenson cut points identified total daily sedentary (SED), light PA (LPA) and moderate-to-vigorous PA (MVPA) expressed as percentage (%) of total daily wear time. For analysis, a PA return of 480+ mins/d, ≥3 school days for pre and post-tests was needed. Mean pre daily MVPA mins were used to categorise subgroups; Non-Achievers <30 (NA1), NA 31–44 (NA2), NA 45–59 (NA3), Achievers >60 (ACH). RESULTS:From 84 included participants (F=60%, 9.9±0.3yrs), no significant differences were found between PI (n=52) and C (n=32) for increases in % time in MVPA (0.30±.67 v 0.13±2.39), LPA (2.03±4.63 v -0.05±4.25) and reducing % of SED time (2.33±5.89 v -0.08±5.52). More PI (17 to 27%) than C (16 to 19%) pupils met 60mins/d guidelines.Versus C, two PI groups improved MVPA. The greatest increases were in NA1 (1.52% above C) and +2.05±2.34% from pre-test. PI-ACH decreased % time in MVPA from pre to post (-2.75±2.85%). All PI subgroups increased % time spent in LPA versus C, with NA2 improving 3.54% above C and PI-NA1 having the greatest improvement (+3.60±6.37%). All PI groups had more favourable SED results; three reducing SED time. The greatest reduction versus C was NA3 (3.95%). The greatest total reduction was in PI-NA1 (-5.65±7.80%). Greater proportions of participants met the 60mins/d guidelines in three PI groups versus C. The largest increase was seen in NA3 (+31%); both ACH groups showed a decline (PI 100 to 67%; C 100 to 40%). CONCLUSIONS: Despite no significant overall PI effects versus C, a greater % of participants met the 60mins/d guidelines. PI found clusters of responsiveness. Pre-PI NA benefited most demonstrating positive changes in eight of nine activity outcomes compared to C, maybe at the expense of the most active. While participant numbers are small, they justify examining sub-population variability in subsequent research.

BACKGROUND:Lifestyle interventions delivered during the retirement transition might promote healthier ageing. We report a pilot randomised controlled trial (RCT) of a web-based platform (Living, Eating, Activity and Planning through retirement; LEAP) promoting healthy eating (based on a Mediterranean diet (MD)), physical activity (PA) and meaningful social roles. METHODS:A single blinded, two-arm RCT with individual allocation. Seventy-five adult regular internet users living in Northeast England, within two years of retirement, were recruited via employers and randomised in a 2:1 ratio to receive LEAP or a 'usual care' control. Intervention arm participants were provided with a pedometer to encourage self-monitoring of PA goals. Feasibility of the trial design and procedures was established by estimating recruitment and retention rates, and of LEAP from usage data. At baseline and 8-week follow-up, adherence to a MD derived from three 24-hour dietary recalls and seven-day PA by accelerometry were assessed. Healthy ageing outcomes (including measures of physiological function, physical capability, cognition, psychological and social wellbeing) were assessed and acceptability established by compliance with measurement protocols and completion rates. Thematically analysed, semi-structured, qualitative interviews assessed acceptability of the intervention, trial design, procedures and outcome measures. RESULTS:Seventy participants completed the trial; 48 (96%) participants in the intervention and 22 (88%) in the control arm. Participants had considerable scope for improvement in diet as assessed by MD score. LEAP was visited a median of 11 times (range 1-80) for a mean total time of 2.5 hours (range 5.5 min- 8.3 hours). 'Moving more', 'eating well' and 'being social' were the most visited modules. At interview, participants reported that diet and PA modules were important and acceptable within the context of healthy ageing. Participants found both trial procedures and outcome assessments acceptable. CONCLUSIONS:The trial procedures and the LEAP intervention proved feasible and acceptable. Effectiveness and cost-effectiveness of LEAP to promote healthy lifestyles warrant evaluation in a definitive RCT. TRIAL REGISTRATION:ClinicalTrials.gov NCT02136381.

Evidence regarding the impact of acute physically active bouts on cognition in schools is conflicting. Treatment fidelity of PA bouts is often unconfirmed, while many studies focus on few cognitive outcomes. PURPOSE: To investigate effects of a physically active games lesson (PAGL) on cognition in primary school children. METHODS: Six schools (N=123, F=73; 9.9±0.3 yrs) were ranked and paired by socio-economic status, with one per pair randomly allocated, by coin toss, to a ~40 min PAGL (n=62) or sedentary class lesson (n=61). One week post-familiarisation, immediately before and 10-mins after each lesson, pupils completed a computerised cognitive battery (COMPASS); simple, easy and hard reaction time (correct response reaction time, RT), Stroop (RT and % correct answers, %C), Digit Vigilance (RT & %C), Tower of London (ToL; thinking time TT, RT & %C), immediate word recall (%C), delayed word (RT & %C) and picture recall (RT & %C). MVPA was measured in 15-second epochs using accelerometers and Evenson cutpoints. A threshold for the PAGL analysis was ≥12mins MVPA. Two-way ANOVA with repeated measures assessed changes in cognitive outcomes. RESULTS: Average MVPA was 12.19±2.55mins (range 7.00-17.50mins). Only 36 participants (58%) met the MVPA threshold. Negative effects of time were observed for: simple RT (p=0.024); hard RT (RT, p=<0.001; %C, p=0.002); Stroop congruent (%C, p=0.006); Digit-vigilance (RT, p=0.003); immediate word recall (%C, p<0.001); delayed word recall (%C, p<0.001) and delayed picture recall (%C, p<0.001). Positive effects of time were observed for ToL RT (p<0.001). Significant interaction effects favoured the PAGL for ToL thinking RT (p=0.048, Partial eta squared=0.041). CONCLUSIONS: We addressed a range of weaknesses affecting previous studies of the acute effects of PA. Low MVPA excluded many pupils from analysis. MVPA during PAGLs may be insufficiently intense or prolonged to influence these cognitive processes. ToL performance may be improved by MVPA total or the cognitive demands of PAGL lessons.

Background: POWeR, a web-based weight management intervention, has been trialled in a range of implementation settings. We provide an in-depth comparison of previously unexplored usage patterns across these settings using new visualisation software. Methods: A feasibility trial (N=179) and full RCT (N=834) compared the effect of POWeR with varying levels of nurse support. A community-based public health trial examined the role of brief telephone coaching (N=786). A workplace-based observational study examined usage of POWeR alongside a supplemental Smartphone app (N=942). Findings: Visual analysis enabled comparison of usage patterns within and across each study. For example, a greater proportion of app users than web-only users in the workplace study accessed problem solving advice (33.33% vs. 9.30%), X2(1,N=942)=31.17, p<.001, and optional content (18.33% vs. 4.08%), X2(1, N=942)=21.16, p<.001. Discussion: Comparison of usage patterns across and within different implementation settings can generate explanations for continued engagement or disengagement with health behaviour change interventions, thus helping to improve future implementation.

Purpose– The purpose of this paper is to investigate the reasons for participating and not participating in an e-health workplace physical activity (PA) intervention.Design/methodology/approach– Semi-structured interviews and two focus groups were conducted with a purposive sample of employees who enrolled and participated in the intervention and with those who did not complete enrolment, hence did not participate in it. Data were examined using thematic analysis according to the clusters of “reasons for participation” and for “non-participation”.Findings– Reported reasons for participation included a need to be more active, to increase motivation to engage in PA, and to better manage weight. Employees were attracted by the perceived ease of use of the programme and by the promise of receiving reminders. Many felt encouraged to enrol by managers or peers. Reported reasons for non-participation included lack of time, loss of interest towards the programme, or a lack of reminders to complete enrolment.Practical implications– Future e-health workplace behavioural interventions should consider focusing on employees’ needs and motivators to behaviour change, provide regular reminders for participants to complete enrolment and ensure that procedures are completed successfully. Barriers to participation could be identified through formative research with the target population and feasibility studies.Originality/value– This study combines a qualitative analysis of the reasons why some employees decided to enrol in a workplace PA intervention and why some others did not. This study highlights factors to consider when designing, implementing and promoting similar interventions and that could inform strategies to enhance participation in workplace PA interventions.

Background Recent reviews suggest Web-based interventions are promising approaches for weight management but they identify difficulties with suboptimal usage. The literature suggests that offering some degree of human support to website users may boost usage and outcomes. Objective We disseminated the POWeR (“Positive Online Weight Reduction”) Web-based weight management intervention in a community setting. POWeR consisted of weekly online sessions that emphasized self-monitoring, goal-setting, and cognitive/behavioral strategies. Our primary outcome was intervention usage and we investigated whether this was enhanced by the addition of brief telephone coaching. We also explored group differences in short-term self-reported weight loss. Methods Participants were recruited using a range of methods including targeted mailouts, advertisements in the local press, notices on organizational websites, and social media. A total of 786 adults were randomized at an individual level through an online procedure to (1) POWeR only (n=264), (2) POWeR plus coaching (n=247), or (3) a waiting list control group (n=275). Those in the POWeR plus coaching arm were contacted at approximately 7 and 28 days after randomization for short coaching telephone calls aimed at promoting continued usage of the website. Website usage was tracked automatically. Weight was assessed by online self-report. Results Of the 511 participants allocated to the two intervention groups, the median number of POWeR sessions completed was just one (IQR 0-2 for POWeR only, IQR 0-3 for POWeR plus coach). Nonetheless, a substantial minority completed at least the core three sessions of POWeR: 47 participants (17.8%, 47/264) in the POWeR-only arm and 64 participants (25.9%, 64/247) in the POWeR plus coaching arm. Participants in the POWeR plus coaching group persisted with the intervention for longer and were 1.61 times more likely to complete the core three sessions than the POWeR-only group (χ2 1=4.93; OR 1.61, 95% CI 1.06-2.47; n=511). An intention-to-treat analysis showed between-group differences in weight loss (F 2,782=12.421, P<.001). Both intervention groups reported more weight loss than the waiting list control group. Weight loss was slightly, but not significantly, greater in the POWeR plus coaching group. A large proportion of participants assigned to POWeR plus coaching refused phone calls or were not contactable (57.9%, 143/247). Exploratory analyses identified health and sociodemographic differences between those who did and did not engage in coaching when it was made available to them. Users who engaged with coaching used the intervention more and lost more weight than those who did not. Conclusions In common with most Web-based intervention studies, usage of POWeR was suboptimal overall. However, our findings suggest that supplementing Web-based weight management with brief human support could improve usage and outcomes in those who take it up. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 98176068; http://www.controlled-trials.com/ISRCTN98176068 (Archived by WebCite at http://www.webcitation.org/6OKRjM2oy).

Objectives To test the effects of adding text messages to weekly email communications on recipients’ total physical activity (leisure-time; workplace; domestic and garden; and active transportation) in employees of universities and colleges in the UK. Methods A randomised trial with two study groups (email only or email plus text messaging for 12 weeks) was implemented at five workplaces. Data were collected at baseline, immediately after, and four weeks after the intervention. Intervention effects on physical activity were evaluated using latent growth modelling. Results Total physical activity decreased over time in both groups but the decrease was non-significant. The only significant difference between groups was found for workplace physical activity, with the group receiving emails and text messages having a linear decrease of 2.81 Metabolic Equivalent h/week (β = −0.31, p = 0.035) compared to the email only group. Conclusions Sending employees two additional text messages resulted in less physical activity. Further investigation is needed to understand whether text messaging may play a beneficial role in promoting physical activity in workplace settings.