UK Government

1. UK Government • Target – Increase % of population accumulating 30 mins of mod. Physical activity on 5 or more days a week • Active commuting could contribute to these targets • Limited info on how to increase this behaviour

2. Transtheoretical Model- 4 Core constructs • Stages of Change • Process of Change • Self- Efficacy • Decision Balance

3. Stages of Change(Marcus, Rossi et al., 1992) • Pre-contemplation • Contemplation • Preparation • Action • Maintenance

4. 5 Experiential; Consciousness raising Dramatic relief Self re-evaluation Social liberation Environmental re-evaluation 5 Behavioural; Self- liberation Counter conditioning Stimulus control Reinforcement management Helping relationships Processes of Change

5. Self- Efficacy and Decision Balance • - a person’s confidence that they can overcome typical barriers to exercise • - weighing up the pro’s and con’s of changing a particular behaviour

6. Purpose of the Study • To determine if a self help intervention, based on the transtheoretical model, could increase active commuting behaviour in a worksite setting

7. The Intervention • Targeted contemplators (those thinking about it) & preparers (irregular active commuters) • Invited participants to undertake a decisional balance process • Suggested ways of enhancing self- efficacy for active commuters • Emphasised processes of change

8. The Workplaces • 3 Institutions were used: • Acute hospital trust (~ 4,000 employees) • University (~ 4,000 employees) • Health Board (~ 350 employees)

9. Participants • Interested participants completed a screening questionnaire to identify their SOC for active commuting • Contemplators and Preparers were sent a baseline questionnaire that measured; • SOC for active commuting • Seven day recall of physical activity • Perceived physical & mental functioning measured by SF- 36 Those who returned the questionnaire consented to their involvement in the study

10. Assigned to either the control (n= 145) or… Told the pack would be forwarded in 6 months Intervention group (n= 150) Received “Walk in to Work Out” pack immediately Contained booklet with written interactive materials based on the TTM of behaviour change, educational & practical information on: Choosing routes Personal safety Shower and cycle storage Useful contacts Intervention

11. Control group N= 92 after 6 months N= 79 after 12 months Intervention group N= 102 after 6 months N= 87 after 12 months Response Power Calculations suggested that a minimum of 270 participants N=295 for this study so they could carry out stats analysis

12. Focus groups • After 6 month responses had been received, there were focus groups for sub-samples of walkers and cyclists who had progressed or regressed in active commuting SOC • 5 groups • All discussions lasted ~1hr and were recorded • Typed verbatim transcripts were analysed (using methods by Miles & Huberman) • Data obtained examined for participants motivation and barriers for active commuting

13. Stats Analysis • Comparisons between those that progressed over the first 6 months in SOC for active commuting and those that did not pro’/regress were made • Used a stepwise logistic regressions on the main effects & interactions of the three potential explanatory variables (age/gender/distance travelled to work) as well as study group (control/intervention) • The logarithm of the time spent walking to work per week at 6 months was modelled by means of an analysis of covariance on study group and the logarithm of the time spent walking to work at the start of the study • Other tests (sample t tests) measured the 95% confidence intervals for the population changes in each of the SF-36 variables and processes of change (start- 6 months)

14. Results • Baseline questionnaires from 295 participants (control= 150 & Intervention= 145) were received • Mean age = 38 (ranged 19- 69yrs) • 186 were women, 109 were men • Most in SECs 1 and 2 (n=224, i.e. in professional/managerial categories) • 207 participants travelled between 2-10 miles to work and travelled by car

15. Results (cont.) • SOC for active commuting; • Response rate at 6months was 66% (n=194), • Over 6months, a significantly larger percentage of the intervention group (49% n=50) progressed to a higher stage of active commuting compared to control group (31% n=29), • Further analysis demonstrated that distance travelled/gender/age/and any interactions of these did not significantly influence the probability of improvement in active commuting SOC over first 6months

16. Walking; Analysis of the 7day recall of PA data showed a significantly greater average time per week spent walking to work for those in the intervention group compared to control, significant increase in the average time spent walking to work per week, in the intervention group, among those who already walked to work (increase from 52mins/wk @baseline to 79mins/wk @ 6months) compared to control (increase from 50mins to 60mins) Cycling; The intervention was not successful in increasing cycling, Only 18 participants reported cycling to work at 6months No differences in the reported average weekly mins of cycling between the two groups Results (cont.)

17. The SF-36 is a multi-purpose, short-form health survey with only 36 questions. It yields an 8-scale profile of functional health and well-being scores as well as psychometrically-based physical and mental health summary measures and a preference-based health utility index. • the SF-36 has proven useful in surveys of general and specific populations • been documented in nearly 4,000 publications • Developments have been made SF-12 and a 2nd version produced SF-36v2 • The questionnaire items chosen also represent indicators of health, including: • behavioural function and dysfunction, • distress and well-being, • objective reports and subjective ratings, • and favourable and unfavourable self-evaluations of general health status (Ware et al., 1993).

18. SF-36 • A comparison of the subscales of the SF-36 from baseline to 6months showed that those in the intervention group improved their scores significantly more than those in control group on 3 of the 8 subscales. • Mental Health subscale; • Mean scores 72 to 76 at 6months whereas mean scores were 73 and 71 in control group • Vitality subscale; • Mean change in intervention group was from 57 to 64 yet the control group mean scores were 61 at both points • General Health subscale; • Mean scores were 71 and rose to 76 in intervention group and in control group mean scores of 75 to 73 • These changes indicate enhanced perceptions of physical & mental health functioning (for intervention grp.)

19. 5 Experiential; Consciousness raising Dramatic relief Self re-evaluation Social liberation Environmental re-evaluation 5 Behavioural; Self-liberation Counter conditioning Stimulus control Reinforcement management Helping relationships Processes of Change

20. Results (cont.) • Processes of behaviour change; • No differences between intervention and control groups or between those who had progressed in SOC versus those who had not progressed (in relation to the TTM), • Most frequently used processes were; • Self Liberation • Counter conditioning • Self re-evaluation • Least used; • Stimulus control • Helping relationships

21. Focus groups-walkers; had progressed/regressed in active commuting SOC, Both groups listed similar barriers to active commuting, The differences between the groups who managed to maintain walking had developed coping strategies, E.g. Buying waterproofs/rucksacks Walking from work rather than to work when time pressure was apparent Focus groups-cyclists; Barriers were related to cycling environment E.g. Pollution Other road users Cycle locking facilities Cycle paths state Safety Results (cont.)

22. Focus groups also showed that workplaces did little to encourage active commuting • Also participants stated that the interactive tasks were useful and that the maps and distance charts were very useful.

23. Results (cont.) • Response rate at 12 months was 56% n=166 • Control group received intervention pack at 6months • 46% (n=31) of control group progressed from the stage of active commuting behaviour change recorded at 12months was similar to that of the intervention group after 6months (49%, n=50) • 25% of intervention group had changed their active commuting to action/maintenance at 12 months • So, they were regularly actively commuting

24. Discussion • “Walk in to Work Out “ pack was effective in increasing walking some, if not all of the journey to work over 6months • Also, the intervention group reported increased perceptions of physical & mental health functioning • Intervention group achieved more than double the increase in walking done by control group at 6months

25. Those that changed their behaviours did so by; • Getting off bus early • Walking to next bus stop • Declining regular lifts in other’s cars • Using public transport more • Parking further away than normal • Park at end of cycle route, then cycle to work • Sell your car!! • 25% of initial intervention group, who were contemplating/preparing to actively commute at baseline, were regularly actively commuting 12months after receiving intervention pack

26. After the study a number of design amendments were made to the pack • Reprinted the pack (Health Education Board for Scotland) • Readily available for free for Scottish workplaces from local health promotion departments • “Walk in to Work Out” pack is a cheap and effective way of achieving recently set population targets for physical activity and the environment (The Scottish Office, Department of the Environment Transport and the Regions) • Intervention was unsuccessful in increasing cycling • Likely to generalise to cities similar to Glasgow (that have cycle routes/maps but limited separation from traffic) • May be more of a success in rural areas (future research?)

27. Increased cycling is unlikely to occur by the provision of cycle routes alone (Wardman et al) • Proposed action in 3 areas may increase success; • Promotion of individual & social behaviour change • Promotion of organisational change • Implementation of situational/environmental measure • Title of the pack may have played a part too • No adverse effects from the pack’s use • No gender/age/distance to work effects • Suggests pack can be widely used

28. BUT… • As 186 (T=295) of the participants were women, perhaps this form of activity is more appealing to women • The processes of change did not explain movement in active commuting behaviour change at 6months • Need further research to comprehend the processes involved in starting/maintaining active commuting • Maybe there are other processes that influence this behaviour change; • Family/work constraints?? • Safer routes??

29. Support • The results support those of Vuori et al (1994), • Found 7% increase in active commuting from an intervention (Finnish workforce) • Not randomised controlled trial • Included management support/fitness testing/environmental change • Also recorded higher levels of active commuting before the intervention and environment was different to Glasgow’s

30. Limitations • The sample (majority women, with cars in SEC1 and 2) means the ability to generalise the results is difficult • BUT, a key target was car owners (active commuting) • And women were also a target group (increase PA) • After ‘deeper’ lab tests, found that journeys to and from work are of sufficient duration and intensity for health/fitness gains • 44% dropped out by 12months of the study (common finding)

31. Conclusions • The intervention should be used by workplaces to promote active commuting • Specific to that workplace • Further research should focus on how to raise awareness of active commuting and how to assist people in maintaining this behaviour

32. Any questions???