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Journal of Primary Health Care Journal of Primary Health Care Society
Journal of The Royal New Zealand College of General Practitioners
RESEARCH ARTICLE (Open Access)

Exercise and motivational text messaging to support physical activity behaviour change in a population with obstructive sleep apnoea: a feasibility study

Sarah Rhodes https://orcid.org/0000-0002-7403-708X 1 * , Debra Waters 2 , Ben Brockway 3 , Margot Skinner 1
+ Author Affiliations
- Author Affiliations

1 School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin 9016, New Zealand.

2 Department of Medicine/School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin 9016, New Zealand.

3 Department of Medicine, University of Otago, 201 Great King Street, Dunedin, New Zealand.

* Correspondence to: sarah.rhodes@otago.ac.nz

Handling Editor: Tim Stokes

Journal of Primary Health Care 14(4) 318-325 https://doi.org/10.1071/HC22033
Published: 14 July 2022

© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Introduction: Patients with obstructive sleep apnoea (OSA) commonly present in primary care. Increasing physical activity reduces symptoms and severity of OSA. Low motivation is a barrier to physical activity in adults with OSA.

Aim: To investigate the feasibility and acceptability of an exercise and personalised text messaging programme to enhance motivation and support physical activity behaviour change in adults with OSA.

Methods: Participants were recruited from the local Sleep Clinic. Exclusion criteria were unstable angina, and/or poorly controlled hypertension. The intervention comprised three groups, who received either individual exercise prescription, personalised text messages or both over a 24-week period. Participants were allocated to one of the three groups. The primary outcome was feasibility of study design including participant recruitment and retention. Secondary outcomes were a change in 6-min walk distance and exercise self-efficacy over time.

Results: Thirty participants were recruited, 17 male and 13 female, with a mean age of 54.6 years. The study design appears feasible and the outcome measures used were acceptable to participants. Recruitment and retention rates were lower than anticipated. A trend towards increased functional exercise capacity was identified in all three groups, along with a corresponding increase in exercise self-efficacy over time.

Discussion: Exercise and personalised text messaging both appear to offer an acceptable and feasible means to increase physical activity in adults with OSA. A larger scale trial may provide justification for physiotherapist input to support patients with OSA to address physical inactivity.

Keywords: behaviour change, health promotion, motivation, obstructive sleep apnoea, physical activity, physiotherapy, sleep health, telehealth.


References

[1]  Paine SJ, Harris RB, Mihaere KM. Managing obstructive sleep apnoea and achieving equity: implications for health services. N Z Med J 2011; 124 97–104.
| 21946641PubMed |

[2]  Epton MJ, Kelly PT, Shand BI, et al. Development and outcomes of a primary care-based sleep assessment service in Canterbury, New Zealand. NPJ Prim Care Respir Med 2017; 27 26
Development and outcomes of a primary care-based sleep assessment service in Canterbury, New Zealand.Crossref | GoogleScholarGoogle Scholar | 28424459PubMed |

[3]  Dobrosielski DA, Papandreou C, Patil SP, et al. Diet and exercise in the management of obstructive sleep apnoea and cardiovascular disease risk. Eur Respir Rev 2017; 26 160110
Diet and exercise in the management of obstructive sleep apnoea and cardiovascular disease risk.Crossref | GoogleScholarGoogle Scholar | 28659501PubMed |

[4]  Mônico-Neto M, Moreira Antunes HK, dos Santos RVT, et al. Physical activity as a moderator for obstructive sleep apnoea and cardiometabolic risk in the EPISONO study. Eur Respir J 2018; 52 1701972
Physical activity as a moderator for obstructive sleep apnoea and cardiometabolic risk in the EPISONO study.Crossref | GoogleScholarGoogle Scholar | 30093572PubMed |

[5]  Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993; 328 1230–5.
The occurrence of sleep-disordered breathing among middle-aged adults.Crossref | GoogleScholarGoogle Scholar | 8464434PubMed |

[6]  Rhodes S, Waters D, Brockway B, et al. Physical activity behaviour and barriers to activity in adults at high risk of obstructive sleep apnoea. J Prim Health Care 2020; 12 257–64.
Physical activity behaviour and barriers to activity in adults at high risk of obstructive sleep apnoea.Crossref | GoogleScholarGoogle Scholar | 32988447PubMed |

[7]  Loprinzi PD, Cardinal BJ. Association between biologic outcomes and objectively measured physical activity accumulated in ≥ 10-minute bouts and < 10-minute bouts. Am J Health Promot 2013; 27 143–51.
Association between biologic outcomes and objectively measured physical activity accumulated in ≥ 10-minute bouts and < 10-minute bouts.Crossref | GoogleScholarGoogle Scholar | 23286590PubMed |

[8]  Eldridge SM, Chan CL, Campbell MJ, et al. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. Pilot Feasibility Stud 2016; 2 64
CONSORT 2010 statement: extension to randomised pilot and feasibility trials.Crossref | GoogleScholarGoogle Scholar | 27965879PubMed |

[9]  Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991; 14 540–5.
A new method for measuring daytime sleepiness: the Epworth sleepiness scale.Crossref | GoogleScholarGoogle Scholar | 1798888PubMed |

[10]  Azagra-Calero E, Espinar-Escalona E, Barrera-Mora J-M, et al. Obstructive sleep apnea syndrome (OSAS). Review of the literature. Med Oral Patol Oral Cir Bucal 2012; 17 e925–9.
Obstructive sleep apnea syndrome (OSAS). Review of the literature.Crossref | GoogleScholarGoogle Scholar | 22549673PubMed |

[11]  ATS Statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002; 166 111–7.
ATS Statement: guidelines for the six-minute walk test.Crossref | GoogleScholarGoogle Scholar | 12091180PubMed |

[12]  Middleton A, Fritz SL, Lusardi M. Walking speed: the functional vital sign. J Aging Phys Act 2015; 23 314–22.
Walking speed: the functional vital sign.Crossref | GoogleScholarGoogle Scholar | 24812254PubMed |

[13]  Hamilton A, Balnave R, Adams R. Grip strength testing reliability. J Hand Ther 1994; 7 163–70.
Grip strength testing reliability.Crossref | GoogleScholarGoogle Scholar | 7951708PubMed |

[14]  Leong DP, Teo KK, Rangarajan S, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet 2015; 386 266–73.
Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study.Crossref | GoogleScholarGoogle Scholar | 25982160PubMed |

[15]  Teo TW, Mong Y, Ng SS. The repetitive five-times-sit-to-stand test: its reliability in older adults. Int J Ther Rehabil 2013; 20 122–30.
The repetitive five-times-sit-to-stand test: its reliability in older adults.Crossref | GoogleScholarGoogle Scholar |

[16]  Aadland E, Ylvisåker E. Reliability of the Actigraph GT3X+ accelerometer in adults under free-living conditions. PLoS One 2015; 10 e0134606.
Reliability of the Actigraph GT3X+ accelerometer in adults under free-living conditions.Crossref | GoogleScholarGoogle Scholar | 26274586PubMed |

[17]  Weaver TE, Laizner AM, Evans LK, et al. An instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep 1997; 20 835–43.
An instrument to measure functional status outcomes for disorders of excessive sleepiness.Crossref | GoogleScholarGoogle Scholar | 9415942PubMed |

[18]  Kroenke K, Spitzer RL, Williams JBW. The PHQ-9. J Gen Intern Med 2001; 16 606–13.
The PHQ-9.Crossref | GoogleScholarGoogle Scholar | 11556941PubMed |

[19]  Ware JE, Kosinski M, Dewey JE, et al. SF-36 health survey: manual and interpretation guide. Boston: The Health Institute, New England Medical Center; 1993.

[20]  Sechrist KR, Walker SN, Pender NJ. Development and psychometric evaluation of the exercise benefits/barriers scale. Res Nurs Health 1987; 10 357–65.
Development and psychometric evaluation of the exercise benefits/barriers scale.Crossref | GoogleScholarGoogle Scholar | 3423307PubMed |

[21]  Marcus BH, Simkin LR. The transtheoretical model: applications to exercise behavior. Med Sci Sports Exerc 1994; 26 1400–4.
The transtheoretical model: applications to exercise behavior.Crossref | GoogleScholarGoogle Scholar | 7837962PubMed |

[22]  Resnick B, Jenkins LS. Testing the reliability and validity of the self-efficacy for exercise scale. Nurs Res 2000; 49 154–9.
Testing the reliability and validity of the self-efficacy for exercise scale.Crossref | GoogleScholarGoogle Scholar | 10882320PubMed |

[23]  Ashton LM, Hutchesson MJ, Rollo ME, et al. Motivators and barriers to engaging in healthy eating and physical activity. Am J Mens Health 2017; 11 330–43.
Motivators and barriers to engaging in healthy eating and physical activity.Crossref | GoogleScholarGoogle Scholar | 27923963PubMed |

[24]  Justine M, Azizan A, Hassan V, et al. Barriers to participation in physical activity and exercise among middle-aged and elderly individuals. Singapore Med J 2013; 54 581–6.
Barriers to participation in physical activity and exercise among middle-aged and elderly individuals.Crossref | GoogleScholarGoogle Scholar | 24154584PubMed |

[25]  Wahlich C, Beighton C, Victor C, et al. ‘You started something … then I continued by myself’: a qualitative study of physical activity maintenance. Prim Health Care Res Dev 2017; 18 574–90.
‘You started something … then I continued by myself’: a qualitative study of physical activity maintenance.Crossref | GoogleScholarGoogle Scholar | 28774352PubMed |

[26]  Laustsen S, Oestergaard LG, van Tulder M, et al. Telemonitored exercise-based cardiac rehabilitation improves physical capacity and health-related quality of life. J Telemed Telecare 2020; 26 36–44.
Telemonitored exercise-based cardiac rehabilitation improves physical capacity and health-related quality of life.Crossref | GoogleScholarGoogle Scholar | 30134780PubMed |

[27]  Bohannon RW, Crouch R. Minimal clinically important difference for change in 6-minute walk test distance of adults with pathology: a systematic review. J Eval Clin Pract 2017; 23 377–81.
Minimal clinically important difference for change in 6-minute walk test distance of adults with pathology: a systematic review.Crossref | GoogleScholarGoogle Scholar | 27592691PubMed |

[28]  Williams SL, French DP. What are the most effective intervention techniques for changing physical activity self-efficacy and physical activity behaviour—and are they the same? Health Educ Res 2011; 26 308–22.
What are the most effective intervention techniques for changing physical activity self-efficacy and physical activity behaviour—and are they the same?Crossref | GoogleScholarGoogle Scholar | 21321008PubMed |