Evaluation of Physical Activity at a Medical Wellness Center

1. Evaluation of Physical Activity at a Medical Wellness Center John C. Sieverdes, PhD University of South Carolina Department of Exercise Science SCTR: April 26th, 2012

2. Our Questions??? • Does motivating factors for health and fitness or weight loss determine who meets the guidelines for physical activity? • What are the Psychosocial differences between people who meet the guidelines versus those who don’t? • How much activity do people get inside a center versus their free-living activity?

3. Background • The 2008 Physical Activity Guidelines for Americans identify that 150 minutes of moderate or 75 minutes of vigorous physical activity is needed to reduce risk of chronic diseases. • Equivalent moderate minutes = mod min + (2 x vig min) • Medical wellness centers have a unique position to implement interventions and increase physical activity.

4. Collaborators Gambettola, Italy Columbia, South Carolina Lake City/Florence, South Carolina

5. A Little More Background • The iH3 wellness center is a unique environment that facilitates physical activity programs (FIT track, LEAN track, RESTORE track). • Currently, programs only measure physical activity inside the facility with a smart key and not free-living activity • Technogym has developed a new type of accelerometer (mywellness key) that integrates free-living physical activity with exercise performed with their line of equipment . • Two validation studies on the MWK has been published so far on free-living activity and treadmill exercise protocols showing the device is valid to measure physical activity (PA) (1-2). • Hermann SD, et al. Evaluation of the Mywellness Key accelerometer. British Journal of Sports Medicine, 2011. 45(2): p. 109-13. • Bergamin M, et al. Validation of the MyWellness Key in Walking and Running Speeds, JSSM, 2012.11(1): p.57-63.

6. The MyWellness Key • The Mywellness Key(Technogym, Spa) • Uniaxial accelerometer, 18.7 grams, • Sampling frequency = 16 HZ, 0.06-12.0 g’s, frequency response 0.1 to 5 Hz. • Worn on the front of the body in-line with the right knee. • Used with Technogym machines and for free-living physical activity • Web portal for goal setting and reports • Measures (On Display and in Web portal) • Energy Expenditure (EE) in real-time MOVE (unitless) against daily MOVE goal • Kcals expended • Minutes of • Light (called free) 1.8-2.9 METs • Moderate (called play) 3.0-5.9 METs • Vigorous (called run) ≥ 6.0 METs

7. Evaluation study setting iH3 Wellness Center Lake City, SC

8. Methods - Protocol • Participant criteria • August, 2011 – January 2012 • n=60 participants, age 18-80 • FIT or LEAN tracks at facility • No gait abnormalities or injuries • Not pregnant • Only involved in iH3 center programs • 10-day evaluation • MWK replaced their center key • MWK used in center’s machines and attached to hip for free-living activity • Given a wear log to track time (>10 hrs/day) • Asked to complete computer-based survey at home or at center • Return MWK, log, and receive a Wellness booklet, $10 off membership dues, and a report of their physical activity

9. Methods - PA The regular center key are being was deactivated during the study The MWK interfaces with all the Technogym aerobic and resistance training equipment Measurement outcomes Aerobic activity: machine-based and free-living) • minutes of light activity • minutes of moderate activity • minutes of vigorous activity • MOVE (volume of activity)

10. Methods - PA • Mywellness key is worn in the clip inline with the right hip

11. Methods – Study Survey • General demographics (age, medical history, SES, occupation, ethnicity, smoker, etc.) • Psychosocial constructs • Self-efficacy (14-item survey) • Self-regulation (20-item survey) • Social support (15-item survey) • Motivation (17-item survey) • Covariates • Physical Environment (IPAQ 13-item) • Perceived Stress (14-item) • Quality of Life SF36 (36-item) • Stage of change (1 item) • Satisfaction with Body Function and Appearance (9-item) • Center for Epidemiologic Studies Depression Scale (20-item)

12. Results

13. Descriptive characteristics of study participants Main findings: In our 60 participants, we found that 63.3% of the participants met the 2008 PA Guidelines by accumulating at least 150 minutes per week of equivalent PA. There was no difference between fitness and weight loss groups BMI, body mass index (kg/m2); m, mean; SD, standard deviation *Statistical differences between fitness/health and weight loss tracks reported using Student’s T-test and Chi-square using an alpha of p=0.05

14. Physical Activity between Fitness and Weight Loss Groups (amount per week) Main Findings: No statistical differences found between tracks Average minutes of activity per week Average MOVE per week

15. Psychosocial associations for participants meeting and not meeting the 2008 Physical Activity Guidelines for Americans (≥150 min/wk of mod min) • Main Findings: • Those who met the PA Guidelines showed higher self-efficacy, self-regulation, and general health perception scores.

16. Odd’s ratios for Psychosocial Associations for Participants Meeting the 2008 Physical Activity Guidelines for Americans • Main Findings • Those who met the PA Guidelines had lower odds of physical functioning and greater odds of having higher self-efficacy (confidence to exercise) and self-regulation (habits of tracking your progress). Model 1 additionally adjusted for age. Model 2 adjusted age and BMI. Meeting the 2008 Physical Activity Guidelines for Americans represent accumulating at least 150 equivalent moderate minutes of physical activity per week.*Statistical differences using logistic regression using an alpha of p=0.05.

17. Average minutes of physical activity per day 80% Contribution of Exercise at iH3 on Daily Activity Findings Volume of activity doubles on an exercise day versus a non-exercise day. Most moderate minutes are from exercise Total = 1199 79% Average MOVE per day 5% 76% = 47% of Exercise Day 88%

18. Average minutes of physical activity per day Average daily minutes of PA between exercise and non-exercise days Findings: On exercise days, there was an increase of 418% for minutes that contribute to the PA Guidelines when compared to a non-exercise day. The amount of light minutes was equal between exercise and non-exercise days. 418% 402% 100% 379% 524%

19. Conclusions • No real differences were found between different tracks and their resultant PA • Participants had approximately the same amount of free-living PA between exercise and non-exercise days. • Participants more than doubled their volume of activity and increased their equivalent minutes contributing to meeting the PA Guidelines by four times on exercise days. • This study stresses the importance of having centers and facilities for populations to engage in leisure-time PA. Incorporation of PA metrics from the Medical Wellness Center accelerometers into physician health records could give a more complete picture of a person’s PA status for monitoring by health professionals.

20. Future Directions • Integration of real-time monitoring using technology to enhance physical activity programs • Wireless transmission of real-time accelerometer data to smartphones or use imbedded accelerometers in smartphones. • Integrating activity measures with health medical systems, health records, or wellness systems. • Looking to incorporate self-efficacy and self-regulation concepts to enhance behavioral intervention programs in mobile health technology (app-based development)

21. Acknowledgements • University of Tulsa • Eric Wickle, PhD • University of Padova • MarcoBergeon, MS • Iowa State University • GregWelk, PhD • Oregon State University • Stewart Trost, PhD • University of South Carolina • Steven N. Blair, PED. • Greg A. Hand, PhD • Sara Wilcox, PhD • Robert Moran, PhD • Patrick Crowley, MS • iH3 Wellness Center • WC Hammett, CEO • Michelle Hickson • Roosevelt Bryant • iH3 center staff • Technogym, Spa • SilvanoZanuso, PhD • Giovanni Strabolli