JMIR Publications

ABSTRACT

Background:

Healthy lifestyle behaviors, including a balanced diet, regular physical activity, adequate sleep, avoiding tobacco, moderating alcohol consumption, and stress management, are associated with reduced risk of chronic disease and improved well-being. In recent years, digital interventions have emerged as cost-effective platforms for promoting these behaviors, yet few have been integrated into service delivered by certified exercise practitioners (CEPs) or focused on multiple domains of health.

Objective:

This study evaluated the effectiveness, compliance, and validity of the Food, Exercise, Sleep and Stress (FESS) web-based questionnaire as an adjunct to traditional face-to-face services provided by CEPs.

Methods:

A two-arm, pre-post intervention design was conducted with 41 participants (23 female) with a median age of 65 years (interquartile range 58-70) were recruited from CEP clinics in South Australia. Participants were randomized to complete the FESS questionnaire either three times per week (3-day group, n=21) or daily (Everyday group, n=20) for 12 weeks. The questionnaire tracked health behaviors across four domains and provided health tips and advice. Outcomes were assessed using the assessment version of the FESS questionnaire at baseline, and at 6 and 12 weeks. Effectiveness of the FESS questionnaire was evaluated using Friedman’s ANOVA with Wilcoxon signed-rank post-hoc tests. Group differences were assessed by calculating changes in questionnaire responses from baseline to 6 and 12 weeks, analyzed with the Mann-Whitney U test. Compliance was assessed by calculating the proportion of completed FESS questionnaires relative to the total number of questionnaires prescribed for each participant by intervention arm. Validity of the exercise domain was evaluated by comparing self-reported physical activity and sedentary time from daily FESS responses with concurrent accelerometer-derived measures in a subsample of participants.

Results:

Positive or no changes were observed across most behaviors, with significant improvements in vegetable consumption, water intake, stress, and sleep. Group comparisons indicated greater improvements in stress and sleep behaviors in the Everyday group; however, compliance was higher in the 3-day group. Compliance declined over time in both groups. Accelerometer validation showed low rates of overreporting exercise (5.1%) and underreporting sedentary behavior (18.6%).

Conclusions:

The FESS questionnaire demonstrated feasibility and effectiveness in supporting positive lifestyle changes, particularly in diet, stress, and sleep, when integrated into CEP services. While daily use may enhance outcomes, reduced compliance highlights the importance of flexible engagement strategies. These findings suggest that CEP services may benefit from embedding structured digital tools into traditional face-to-face interactions, as such tools can provide education, promote reflection and accountability between sessions, and address a broader range of lifestyle factors to enhance the care that CEPs deliver.