JMIR Publications

ABSTRACT

Background:

Physical activity (PA) is associated with health benefits such as fewer depressive symptoms. Little is known about whether and how web- and print-based PA interventions work in comparison to a waiting list control group, especially in older individuals.

Objective:

Are interventions delivered in a web- or print mode effective with regard to self-reported PA, stage of change, social-cognitive determinants of PA, and feelings of loneliness and symptoms of depression? Is subjective age a mediator and stage of change a moderator of the effect?

Methods:

n=589 and n=242 older adults 60+ years were recruited and allocated to a print-based or a web-based intervention or assigned to a waiting list control group (WLCG) within two community-based intervention trials over 10 weeks. Missing value imputation using an Expectation Maximization algorithm was applied. Pooled frequency analyses, MANOVA and moderated mediation analyses were conducted.

Results:

Among the 91 individuals not meeting the endurance training recommendation regarding PA based on self-report, more individuals became active if they were exposed to the web-based intervention (47 out of 59=79.7%) or received the print-based intervention (20/25=80.0%) vs. WLCG (5/7=71.4%; difference was not significant with Chi²(df=2)=0.273, p=.872). Of the 630 individuals meeting the recommendation regarding PA prior to the study, more individuals remained active if they were exposed to the web-based intervention (396/411=96.4%) or WLCG (141/150=94.0%) compared to the ones receiving the print-based intervention (63/69=91.3%). A significant difference was observed favoring the two intervention groups over and above the WLCG with F(19, 701)= 4.778; p<.001; Eta²=.098 and a significant interaction of time and group with F(19, 701)= 2.778; p<.001; Eta²=.070 for the predictors of behavior. The effect of the interventions on subjective age, loneliness and symptoms of depression revealed that both between-groups effects (F(3, 717)=8.668; p<.001; Eta²=.018) and the interaction of group and time were significant (F(3, 717)=6.101; p<.001; Eta²=.025). Both interventions had a significant direct effect on symptoms of depression in comparison to WLCG: WEBc’-path=-0.86 [-1.58, -0.13], SE=0.38; PRINTc’-path=-1.96 [-2.99, -0.92], SE=0.53 (validating the previous analyses). Furthermore, subjective age showed a significant effect on symptoms of depression: Sageb-path=0.14 [0.05, 0.23], SE=0.05. An indirect effect of the intervention on symptoms of depression via subjective age was only present for participants who were in actor stage and received the web-based intervention: WEBab-path=-0.14 [-0.34, -0.01], SE=0.09.

Conclusions:

The web-based intervention appears to be as effective as the print-based intervention. Both modes of delivery might help older individuals to remain or become active: Therefore, they may benefit in terms of successful aging and may have fewer symptoms of depression. Clinical Trial: German Registry of Clinical Trials, 11 July 2016, number: DRKS00010052 (PROMOTE I) & German Registry of Clinical Trials, 10 January 2019, number: DRKS00016073 (PROMOTE II)