Exercise as it relates to Disease/The use of text messages to decrease sedentary behaviour in University students

This wiki presents an analysis of an article titled Increasing non- sedentary behaviours in university students using text messages: randomised controlled trial by Cotton et al 2016.

What is the background to this research?
The World Health Organisation (WHO) defines physical activity as ‘any bodily movement produced by skeletal muscles that requires energy expenditure.’2 Physical activity has long been known to have positive benefits for improving quality of life.3 The Australian government Department of Health states that ‘being physically active and limiting your sedentary behaviour every day is essential for health and wellbeing'.4 They have developed guidelines surrounding this concept. These guidelines include:

•	Any physical activity is better than nothing. Start by doing some then build up to the recommended amount.

•	Be active on most, preferably all days of the week

•	Accumulate 2.5 – 5 hrs of moderate intensity physical activity or 1.25-2.5 hrs of vigorous intensity or a combination of both

•	Include muscle strengthening at least twice a week

It is estimated that sedentary behaviour (sitting for >6hrs per day) increases the risk of death within 15 years by 40% when compared to someone of the same age who has a more active lifestyle (sitting < 3hrs).5 It is known that a large percentage of university population are not as physically active as recommendations suggest.5,6,7 There are a number of contributing factors to this including: time required for study and assessment tasks, work and recovering after a big night partying. Within this population, there appears to be a shortage of evidence on ways to counteract this lack of physical activity.8 It has been proposed that the use of technology students are already familiar with, could encourage physical activity.1

Where is the research from?
Emma Cotton (BA, MA) and Harry Prapavessis (BA, MA, PhD). Exercise and Health Psychology Laboratory, School of Kinesiology. Western University, London, ON, Canada. The target population was University students from the same institution. Given the research was undertaken within the university setting, this indicates that the researchers are sensitive to the expectations of the students. This can also provide a biased view. This bias can affect the timing of text messages sent, the wording of messages and questionaries. All of this bias can skew the results in a direction the researches wish to go. As this research is a pilot study, the results are only a small indication of what information could be gathered if a wider study (such as a RCT across multiple tertiary institutions) was undertaken.

What kind of research is this?
This is a pilot randomised control study. This type of study provides valuable information regarding the feasibility of a study looking at reducing sedentary behaviour in university students. As a pilot study, there are fewer study participants than a full-scale trial, it also allows for alterations to be made to a full-scale trial.

What did the research involve?
Students campus wide were emailed invitations to participate in the research, an advertisement appeared in the universities newspaper. Interested participants completed a baseline questionnaire. 82 students met the inclusion criteria and were randomised to either control or intervention group. There were 41 participants in each group. The control group received 2 text messages daily that were unrelated to sedentary behaviour. The intervention group received 2 text messages daily related to sedentary behaviour (this included tips, recommendations and challenges). Physical activity was measured by questionnaires at 2, 4 and 6 weeks. All questionnaires contained the same questions. After the last questionnaire was completed participants no longer received text messages.

What were the basic results?
There is small to moderate evidence favouring the intervention group at 6 weeks in relation to break frequency, length, standing, light and moderate intensity physical activity. Significant evidence favoured the intervention group for sitting less and self-efficacy beliefs. Higher self-efficacy beliefs had a significant positive influence on breaks, standing and physical activity. These particular results can be directly applied to the university population within this institution, and perhaps even universities with similar structures and types of student populations in Canada.

What conclusions can we take away from this research?
In the short term at least, the use of text messages can have a positive impact on the sedentary lifestyle of university students in one university in Canada. This is not limited to sitting time, but other areas including; standing, break times, break frequency, self-efficacy and light – moderate physical activity. In order for these results to be applied to a greater population, there needs to be a larger randomised controlled trial take place. There are some alterations that could make the study more accurate, such as the use of an activity tracker and including a greater population of students from a number of tertiary institutions.

Practical advice
Although the use of text messages has shown some benefits within this population, this is not likely to be a feasibly long term solution. It is possible to install computer software/apps that can provide popups at set intervals to encourage breaks. There are many different types depending on your individual requirements. These include: Stand up! The work break timer, randomly remind me, awareness, workrave and healthier work reminder.9 There are also a number of activity trackers/watches that provide reminders and track work-rest periods. Given the amount of time some students are forced to spend studying in order to complete their degree (and how easy it is to lose track of time), this could be a feasible option. During class times, lecturers could also use one of these types of programs to allow students standing breaks. Students could also arrange to send each other group messages or set reminders on social media or set up social activities times to encourage each other to participate in physical activity. This could be in the form of a regular walk around the block to a gym class to a social sporting team or even entering competitions such as local iron man events.