Hockey Fans in Training: a Pilot Pragmatic Randomized Controlled Trial
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Hockey Fans in Training: A Pilot Pragmatic Randomized Controlled Trial ROBERT J. PETRELLA1,2,3, DAWN P. GILL1,2,4, GUANGYONG ZOU5,6, ASHLEIGH DE CRUZ1,2, BRENDAN RIGGIN3, CASSANDRA BARTOL1,2, KAREN DANYLCHUK3, KATE HUNT7, SALLY WYKE8, CINDY M. GRAY8, CHRISTOPHER BUNN8, and MERRICK ZWARENSTEIN1,2,5 1Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, CANADA; 2Lawson Health Research Institute, London, Ontario, CANADA; 3School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, CANADA; 4School of Health Studies, Faculty of Health Sciences, Western University, London, Ontario, CANADA; 5Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, CANADA; 6Robarts Clinical Trials, Robarts Research Institute, Western University, London, Ontario, CANADA; 7MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UNITED KINGDOM; and 8Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UNITED KINGDOM ABSTRACT PETRELLA, R. J., D. P. GILL, G. ZOU, A. DE CRUZ, B. RIGGIN, C. BARTOL, K. DANYLCHUK, K. HUNT, S. WYKE, C. M. GRAY, C. BUNN, and M. ZWARENSTEIN. Hockey Fans in Training: A Pilot Pragmatic Randomized Controlled Trial. Med. Sci. Sports Exerc., Vol. 49, No. 12, pp. 2506–2516, 2017. Introduction: Hockey Fans in Training (Hockey FIT) is a gender-sensitized weight loss and healthy lifestyle program. We investigated 1) feasibility of recruiting and retaining overweight and obese men into a pilot pragmatic randomized controlled trial and 2) potential for Hockey FIT to lead to weight loss and improvements in other outcomes at 12 wk and 12 months. Methods: Male fans of two ice hockey teams (35–65 yr; body mass index Q28 kgImj2) located in Ontario (Canada) were randomized to intervention (Hockey FIT) or comparator (wait-list control). Hockey FIT includes a 12-wk active phase (weekly, coach-led group meetings including provision of dietary information, practice of behavior change techniques, and safe exercise sessions plus incremental pedometer walking) and a 40-wk minimally supported phase (smartphone app for sustaining physical activity, private online social network, stan- dardized e-mails, booster session/reunion). Measurement at baseline and 12 wk (both groups) and 12 months (intervention group only) included clinical outcomes (e.g., weight) and self-reported physical activity, diet, and self-rated health. Results: Eighty men were recruited in 4 wk; trial retention was 980% at 12 wk and 975% at 12 months. At 12 wk, the intervention group lost 3.6 kg (95% confidence interval, j5.26 to j1.90 kg) more than the comparator group (P G 0.001) and maintained this weight loss to 12 months. The intervention group also demonstrated greater improvements in other clinical measures, physical activity, diet, and self-rated health at 12 wk; most sustained to 12 months. Conclusions: Results suggest feasible recruitment/retention of overweight and obese men in the Hockey FIT program. Results provide evidence for the potential effectiveness of Hockey FIT for weight loss and improved health in at-risk men and, thus, evidence to proceed with a definitive trial. Key Words: MEN_S HEALTH, OVERWEIGHT/OBESITY, LIFESTYLE INTERVENTION, PHYSICAL ACTIVITY, HEALTH PROMOTION, WEIGHT LOSS he worldwide prevalence of overweight (defined as a Address for correspondence: Robert J. Petrella, M.D., Ph.D., Centre for body mass index (BMI) of 25.0–29.9 kgImj2) and Studies in Family Medicine, Western Centre for Public Health and Family obesity (defined as a BMI of Q30.0 kgImj2) is high Medicine, Western University, 2nd Floor, 1465 Richmond St., London, T ON, Canada N6G 2M1; E-mail: [email protected]. and continuing to increase (25). It has been projected that Submitted for publication March 2017. there will be 65 million more obese adults in the United Accepted for publication July 2017. States by 2030, which also translates to increased rates of 0195-9131/17/4912-2506/0 many preventable chronic diseases and increased economic MEDICINE & SCIENCE IN SPORTS & EXERCISEÒ burden (41). In 2011, the combined medical costs associated Copyright Ó 2017 The Author(s). Published by Wolters Kluwer Health, Inc. with treatment of chronic diseases resulting from obesity on behalf of the American College of Sports Medicine. This is an open-access were estimated to increase by $48–66 billion per year in the article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is per- United States alone (41). missible to download and share the work provided it is properly cited. The In 2009–2010, the prevalence of overweight and obesity APPLIED SCIENCES work cannot be changed in any way or used commercially without per- combined in the United States was disproportionately higher mission from the journal. in middle-age men compared with women of the same age DOI: 10.1249/MSS.0000000000001380 (79.5% in men vs 66% in women 40–59 yr of age) (11). In 2506 Canada in 2011, the national prevalence of overweight and online social network platform including only group mem- obesity in adults (age, Q18 yr) was also higher in men bers and their coaches (13). compared with women (overweight, 40.1% in men vs 27.1% In the current study, our primary objective was to examine in women; obese, 19.5% in men vs 17.1% in women) (39). the feasibility of recruiting and retaining men in Hockey FIT A recent meta-analysis including studies from four different and the acceptability of the research procedures. Although continents provides additional evidence for increased burden there is strong evidence from FFIT that affiliation with in men where results showed that men had higher all-cause professional football clubs provides a powerful draw to en- mortality for every additional five BMI points greater than gage men in a lifestyle change program, it was unclear 25 kgImj2 (relative to 22.5 to G25 kgImj2) compared with whether the same would be true with hockey in a North women (35). American setting. We hypothesized that 1) it would be fea- Excess body weight is a risk factor for chronic diseases sible to recruit and retain men who are overweight or obese including Type 2 diabetes, cardiovascular disease, osteoar- into the Hockey FIT program, and 2) trial procedures would thritis, and cancer (18). Physical inactivity and poor diet are be acceptable to most men. Secondary objectives were to associated with obesity and are key risk factors contributing determine the potential for Hockey FIT (vs control) to lead to chronic disease burden (3). Health care costs associated to weight loss and improvements in other health behaviors with obesity increase significantly when combined with and health-related outcomes by 12 wk and whether improve- other lifestyle or behavioral risk factors, including physical ments could be retained 12 months later. We hypothesized that inactivity (1). Furthermore, evidence suggests that poor diet Hockey FIT would lead to weight loss and improvements in is the lifestyle risk factor that contributes the most economic health behaviors and other health-related outcomes in the short burden (33). term, and that these improvements would be maintained in the Interventions combining physical activity (PA), diet, and longer term—providing support for the potential effectiveness behavior change techniques have the strongest evidence for of the Hockey FIT program. long-term weight change in men (30). Unfortunately, men are a hard-to-reach population who are often underrepre- sented in lifestyle weight loss interventions (26). Factors METHODS attracting men to participate in chronic disease prevention Trial Design and management programs (i.e., lifestyle, weight manage- ment, or health promotion programs) include a group com- The full study protocol has been published elsewhere ponent with like-minded men, the presence of some form of (14). Briefly, we conducted a pilot, pragmatic randomized competition, the use of humor to discuss sensitive health controlled trial (pRCT; parallel groups, stratified by site) in issues, and the inclusion of both dietary and PA components Ontario, Canada. Eighty male fans of two ice hockey teams (12). Recent research has further supported the need to tailor from the Ontario Hockey League (40 men from each of programs to men to improve uptake and effectiveness (31). London and Sarnia) were recruited and randomized to either Research has shown that men may be more willing to par- intervention (Hockey FIT) or comparator (wait-list control). ticipate in PA that is linked to sport, athleticism, and com- Follow-up occurred at 12 wk (both groups) and 12 months petition (4). Directly in line with these findings, studies have (intervention group only to explore the sustainability of _ shown that weight management interventions situated in long-term change). Western University s Health Sciences professional sports settings have been highly successful in men Research Ethics Board approved this study, and all partici- (4,16,20). These settings are traditionally male-dominated pants provided written informed consent. The trial was environments, which may help to offset the threat that ‘‘weight registered on February 26, 2015, with ClinicalTrials.gov management’’ may pose to men’s identities