JMIR Publications

ABSTRACT

Background:

Exercise referral schemes are recommended for patients with health conditions or risk factors. There is evidence for the initial effectiveness and cost-effectiveness of such schemes for increasing physical activity, but effects often diminish over time. Techniques such as goal setting, self-monitoring and personalised feedback may support motivation for physical activity and maintenance of effects. Use of wearable technologies could provide an opportunity to integrate motivational techniques into exercise schemes. However, little is known about acceptability to exercise referral populations, or implementation feasibility within exercise referral services.

Objective:

This study aimed to determine the feasibility and acceptability of implementing an activity monitoring device within the Welsh National Exercise Referral Scheme, to inform a decision on whether and how to proceed to an effectiveness trial.

Methods:

Pilot randomized controlled trial with embedded mixed-methods process evaluation and exploratory economic analysis. Adults (N=156) were randomized to intervention (plus usual practice) (n=88) or usual practice only (n=68). Usual practice was a 16-week structured exercise programme. The intervention group additionally received an accelerometry-based activity monitor (MyWellnessKey) and associated web platform (MyWellnessCloud). Primary outcomes were predefined progression criteria assessing acceptability and feasibility of the intervention and proposed evaluation. Postal questionnaires were completed at baseline (time 0: T0), 16 weeks after T0 (T1), and 12 months after T0 (T2). Routine data were accessed at the same time-points. A subsample of intervention participants and scheme staff were interviewed following initiation of intervention delivery and at the end of the study.

Results:

Participants were on average 56.6 (SD 16.3) years old and mostly female (101/156) and white (150/156). Only two of five progression criteria were met; recruitment and randomisation methods were acceptable to participants and contamination was low. However, recruitment and retention rates (11.3% and 67.3% respectively) fell substantially short of target criteria (20% and 80%), and disproportionally recruited those from the least deprived quintile. Only 57.4% of intervention participants reported receipt of the intervention (below the 80% progression threshold). Less than half reported the intervention to be acceptable in the T2 questionnaire. Participant and staff interviews revealed barriers to intervention delivery and engagement related to the device design which impacted uptake and context-specific technological challenges which made it difficult to integrate the technology into the service. Routinely collected health economic measures had substantial missing data, suggesting other methods for collecting these should be used in future.

Conclusions:

To our knowledge, this is the first study to evaluate short- and long-term feasibility and acceptability of integrating wearable technologies into community-based exercise referral schemes. The findings highlight some device- and context-specific barriers to doing this in routine practice, with typical exercise referral populations. Key criteria for progression to a full scale evaluation were not met. Clinical Trial: The trial is registered with the International Standard Randomised Control Trial Number Register (ISRCTN85785652).