title: An Interactive Computer Session to Initiate Physical Activity in Sedentary Cardiac Patients: Randomized Controlled Trial.
abstract: BACKGROUND
  Physical activity (PA) improves many facets of health. Despite this, the majority of American adults are insufficiently active. Adults who visit a physician complaining of chest pain and related cardiovascular symptoms are often referred for further testing. However, when this testing does not reveal an underlying disease or pathology, patients typically receive no additional standard care services. A PA intervention delivered within the clinic setting may be an effective strategy for improving the health of this population at a time when they may be motivated to take preventive action.
  
  
  OBJECTIVE
  Our aim was to determine the effectiveness of a tailored, computer-based, interactive personal action planning session to initiate PA among a group of sedentary cardiac patients following exercise treadmill testing (ETT).
  
  
  METHODS
  This study was part of a larger 2x2 randomized controlled trial to determine the impact of environmental and social-cognitive intervention approaches on the initiation and maintenance of weekly PA for patients post ETT. Participants who were referred to an ETT center but had a negative-test (ie, stress tests results indicated no apparent cardiac issues) were randomized to one of four treatment arms: (1) increased environmental accessibility to PA resources via the provision of a free voucher to a fitness facility in close proximity to their home or workplace (ENV), (2) a tailored social cognitive intervention (SC) using a "5 As"-based (ask, advise, assess, assist, and arrange) personal action planning tool, (3) combined intervention of both ENV and SC approaches (COMBO), or (4) a matched contact nutrition control (CON). Each intervention was delivered using a computer-based interactive session. A general linear model for repeated measures was conducted with change in PA behavior from baseline to 1-month post interactive computer session as the primary outcome.
  
  
  RESULTS
  Sedentary participants (n=452; 34.7% participation rate) without a gym membership (mean age 58.57 years; 59% female, 78% white, 12% black, 11% Hispanic) completed a baseline assessment and an interactive computer session. PA increased across the study sample (F1,441=30.03, P<.001). However, a time by condition interaction (F3,441=8.33, P<.001) followed by post hoc analyses indicated that SC participants exhibited a significant increase in weekly PA participation (mean 45.1, SD 10.2) compared to CON (mean -2.5, SD 10.8, P=.004) and ENV (mean 8.3, SD 8.1, P<.05). Additionally, COMBO participants exhibited a significant increase in weekly PA participation (mean 53.4, SD 8.9) compared to CON (P<.001) and ENV (P=.003) participants. There were no significant differences between ENV and CON or between SC and COMBO.
  
  
  CONCLUSIONS
  A brief, computer-based, interactive personal action planning session may be an effective tool to initiate PA within a health care setting, in particular as part of the ETT system.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT00432133, http://clinicaltrials.gov/ct2/show/NCT00432133 (Archived by WebCite at http://www.webcitation.org/6aa8X3mw1).
authors: Implementation and Systems Science Laboratory, Department of Human, Nutrition, Foods, and Exercise, Virginia Tech, Roanoke, VA, United States. falmeida@vt.edu.
authors: Fabio A
authors: http://orcid.org/0000-0002-2404-0694
authors: FA
authors: Almeida
authors: Renae L
authors: http://orcid.org/0000-0001-9642-7727
authors: RL
authors: Smith-Ray
authors: David A
authors: http://orcid.org/0000-0002-6592-1041
authors: DA
authors: Dzewaltowski
authors: Russell E
authors: http://orcid.org/0000-0003-4218-3231
authors: RE
authors: Glasgow
authors: Rebecca E
authors: http://orcid.org/0000-0002-9011-0689
authors: RE
authors: Lee
authors: Deborah S K
authors: http://orcid.org/0000-0002-9594-9790
authors: DS
authors: Thomas
authors: Stanley
authors: http://orcid.org/0000-0002-4750-7672
authors: S
authors: Xu
authors: Paul A
authors: http://orcid.org/0000-0003-2261-9886
authors: PA
authors: Estabrooks
mesh_terms: D000368:Aged; D015928:Cognitive Behavioral Therapy; D015444:Exercise; D005080:Exercise Test; D005260:Female; D020446:Fitness Centers; D006331:Heart Diseases / Q000175:diagnosis*; D006801:Humans; D020407:Internet; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D040242:Risk Reduction Behavior; D057185:Sedentary Behavior; D016896:Treatment Outcome; D014584:User-Computer Interface
keywords: behavioral research; cardiovascular diseases; exercise, physical; human computer interaction; interactive media; treadmill test