新型网络健康行为工具整合到认证运动从业者服务中的行为改变与依从性结局：一项为期十二周的双臂随机前后对照试验

文献信息

中文摘要

背景： 健康的生活方式行为，包括均衡饮食、规律身体活动、充足睡眠、避免烟草、适度饮酒以及压力管理，与降低慢性病风险和改善幸福感相关。近年来，数字干预已成为促进这些行为的高成本效益平台，但很少有干预被整合到由认证运动从业者（CEP）提供的服务中，或聚焦于多个健康领域。
目的： 本研究旨在考察在将食物、运动、睡眠和压力（FESS）网络问卷作为CEP提供的传统面对面服务的辅助手段实施期间健康行为的变化，并比较两种提示频率下的这些变化。
方法： 采用双臂随机前后干预设计，纳入41名参与者（23名女性），中位年龄为65岁（IQR 58-70），从CEP诊所招募。参与者被随机分配为每周完成FESS问卷3次（3天组，n=21）或每天完成（每日组，n=20），持续12周。该问卷追踪4个领域的健康行为并提供健康提示。结局使用FESS问卷的评估版在基线以及第6周和第12周进行评估。使用Friedman ANOVA及Wilcoxon符号秩事后检验考察FESS问卷应答随时间的变化。通过计算从基线到第6周和第12周问卷应答的变化，并使用Mann-Whitney U检验进行分析，评估提示频率之间的组间差异。依从性通过计算每个干预组内每位参与者完成的FESS问卷数占其被规定问卷总数的比例来评估。运动领域的效度通过将每日FESS应答中的自我报告身体活动和久坐时间与一部分参与者的加速度计测量结果进行比较来评估。
结果： 在大多数行为中观察到积极变化或无变化，其中蔬菜摄入、饮水量、压力和睡眠有显著改善。组间比较显示，每日组在压力和睡眠行为方面的变化更大；然而，3天组的依从性更高。两组依从性均随时间下降。运动领域的加速度计验证显示，运动过度报告率较低（3/59，5.1%），久坐行为低报率较低（11/59，18.6%）。
结论： FESS问卷显示出可行性，并且在整合到CEP服务中时与观察到的健康行为变化相关，尤其是在饮食、压力和睡眠方面。虽然每日使用与更大的观察变化相关，但依从性降低凸显了灵活参与策略的重要性。这些初步发现表明，CEP服务可能受益于将结构化数字工具嵌入传统的面对面互动中，因为此类工具可能支持教育、促进两次会话之间的反思和责任感，并有助于在常规CEP照护中关注更广泛的生活方式因素。需要进一步的对照研究来证实这些发现。

英文摘要

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 services delivered by certified exercise practitioners (CEPs) or focused on multiple domains of health.
OBJECTIVE: This study aimed to examine changes in health behaviors during implementation of the Food, Exercise, Sleep, and Stress (FESS) web-based questionnaire as an adjunct to traditional face-to-face services provided by CEPs and compare these changes across 2 prompting frequencies.
METHODS: A 2-arm, randomized pre-post intervention design was conducted with 41 participants (23 women), with a median age of 65 (IQR 58-70) years, who were recruited from CEP clinics. Participants were randomized to complete the FESS questionnaire either 3 times per week (3-day group, n=21) or daily (everyday group, n=20) for 12 weeks. The questionnaire tracked health behaviors across 4 domains and provided health tips. Outcomes were assessed using the assessment version of the FESS questionnaire at baseline and at 6 and 12 weeks. Changes in FESS questionnaire responses were examined over time using Friedman ANOVA with Wilcoxon signed-rank post hoc tests. Group differences between prompting frequencies were assessed by calculating changes in questionnaire responses from baseline to 6 and 12 weeks and analyzing them using 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 within each intervention arm. Validity of the exercise domain was evaluated by comparing self-reported physical activity and sedentary time from daily FESS responses with 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 larger changes 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 of the exercise domain showed low rates of overreporting exercise (3/59, 5.1%) and underreporting sedentary behavior (11/59, 18.6%).
CONCLUSIONS: The FESS questionnaire demonstrated feasibility and was associated with observed changes in health behaviors, particularly in diet, stress, and sleep, when integrated into CEP services. While daily use was associated with larger observed changes, reduced compliance highlights the importance of flexible engagement strategies. These preliminary findings suggest that CEP services may benefit from embedding structured digital tools into traditional face-to-face interactions, as such tools may support education, promote reflection and accountability between sessions, and facilitate attention to a broader range of lifestyle factors within routine CEP care. Further controlled studies are required to confirm these findings.