A 12-week lifestyle intervention for middle-aged, overweight men who are supporters of local sporting clubs

Abstract

Objective: To evaluate the effectiveness of a 12-week lifestyle program for changes in healthy lifestyle knowledge, health perceptions and body composition of middle-aged, overweight men.

Methods: A participatory, action-based experimental design was employed with a convenience sample (n = 24) of middle-aged men who were supporters of either a local rugby league or rugby union club. Participants attended an introductory session and baseline testing in week one, participated in once-weekly group circuit exercise and lifestyle education sessions for 10 weeks and attended post-testing and project evaluation in week 12.

Results: Fourteen participants completed the project. Healthy lifestyle knowledge did not improve significantly. As a combined group there were significant improvements in both physical and mental components of the SF12 questionnaire and in waist girth. The rugby league cohort achieved significant improvement in the SF12 physical component, weight, BMI and waist girth. The rugby union cohort achieved significant improvement in the SF12 mental component and waist girth. Participants reported a variety of health improvement and lifestyle changes following the project and reported appreciation at the involvement of the sporting club.

Conclusions: The men’s lifestyle program resulted in significant improvement in body composition, resulting in a reduction in obesity-related disease risk in some participants.

• Community exercise
• health education
• men
• obesity
• participatory action research

Introduction

According to the 2011–2012 Australian Health Survey [1], 70.3% of Australian adult men were classified as overweight or obese based on their self-reported height and weight data, 18.2% reported smoking daily and 29.1% reported exceeding alcohol consumption guidelines. These prevalence were greater than that reported by Australian adult females. Furthermore, only 4.5% of Australian adult men reported meeting daily fruit and vegetable intake guidelines, 62.4% reported being sedentary or having low physical activity levels and 60.3% reported a waist girth that is classified as ‘at risk’ [1]. Physical inactivity and poor nutrition, overweight/obesity, smoking and excessive alcohol consumption are all known risk factors for chronic disease [2] and it is therefore not surprising given the higher rate of risk factor presence in Australian males that they also report greater prevalence of heart disease (5.1%) and diabetes (4.3%) than females, and also have a 5 year shorter life expectancy [1]. Combined with this is the evidence that adult males are less likely to participate in health services than women [3].

Mosca and colleagues [4] reported that the top priorities for lifestyle change in middle-aged men were to increase exercise and to improve nutrition, followed by managing stress, weight loss, medication compliance and reducing smoking [4]. Lifestyle interventions that include physical activity and nutrition modifications have been shown to be effective at reducing the prevalence and severity of chronic disease risk factors in males [5,6], however, barriers to short-term and long-term participation are frequently reported. Common barriers for men participating in healthy lifestyle interventions include lack of time, access and motivation [7,8]; while Mosca and colleagues report the top five men’s barriers to lifestyle change as time, stress, self-esteem, knowledge and skills [4]. In an attempt to improve men’s health and to combat some of the barriers, the ‘Football Fans in Training (FFIT)’ weight management, physical activity and healthy-living program were established in Scotland [9]. This program comprised of twelve-weeks of exercise and education and was delivered by Scottish Premier League Football coaches to middle-aged, overweight men. The program resulted in improvements in a variety of health and well-being measures. The involvement of the Football clubs was reported as a major motivator for initial recruitment and ongoing participation [9].

The aim of the current project therefore was to trial a similar men’s healthy lifestyle program in Australia with involvement of two different football codes, rugby league and rugby union. Specifically, the project aim was to evaluate the effectiveness of a pilot 12-week lifestyle program with respect to changes in healthy lifestyle knowledge, health perceptions and body composition, in middle-aged overweight men. It was hypothesized that improvements in healthy lifestyle knowledge, health perceptions and body composition would be evident following the 12-week intervention, and that the involvement of the football clubs would be identified as a contributing motivator for participants.

Methods

A participatory, action-based, pilot experimental study was employed with a convenience sample of middle-aged men residing in an outer-regional city in Queensland, Australia.

Participants and participant recruitment

Potential participants were contacted via emailed newsletters to members and hard copy flyers posted at the sporting venue by two sporting organizations in northern Queensland, Australia. The sporting clubs had provided written support for the project and provided the facilities for the program. The target cohort consisted of middle-aged (35–65 years) men who reported having a Body Mass Index (BMI) greater than 25 kg·m⁻² or a waist girth greater than 94 cm; and that were affiliated with one of the two participating sporting clubs as members or supporters, but not as players.

Twenty-four males (13 via the rugby union club and 11 via the rugby league club) were recruited for project participation and fourteen participants (seven from each club) completed both the pre- and post-project evaluations and therefore were included for analysis. All participants provided written informed consent to participate in the project and completed an adult pre-exercise screening tool (Exercise and Sports Science Australia) in consultation with an Accredited Exercise Physiologist. Ethics approval for the project was granted by the James Cook University Human Ethics Committee (approval H4594) in accordance with the Declaration of Helsinki.

Intervention

This pilot project was influenced by the ‘FFIT’ program run in Scotland [10]. Participants volunteered to participate in a 12 week program that consisted of a program introduction and baseline testing in week one, once-weekly group exercise circuits and education sessions during weeks 2 through 11, and post-testing, project evaluations and a final motivational session in week 12. The once-weekly exercise and education session was carried out at the affiliated sporting club facility in the mornings (6:30am–8am) for the rugby league cohort and in the evenings (5:30 pm–7pm) for the rugby union cohort. The exercise sessions each ran for 45 min and consisted of a 5 min dynamic warm-up, 10 min brisk walk, 20 min circuit and 10 min cool-down including static stretching, and were designed and facilitated by an Exercise Scientist, and pre-approved by an Accredited Exercise Physiologist. During each session, one or two Sport and Exercise Science University students assisted with exercise supervision. The exercise sessions were consistent between cohorts, were designed to progressively increase in intensity in accordance with participant improvements in fitness, and were performed on the training oval at each sporting venue. An example exercise session has been included in Table 1. Immediately following the exercise session, participants attended a 45 minute education session held in the sporting venue clubhouse or boardroom. Each education session was presented by a Medical Practitioner or Health Provider and was supervised by a Registered Nurse with an overview provided in Table 2. The education sessions were designed to be interactive, were based on men’s health issues and participants were provided with information flyers/handouts to take home.

Table 1. Example group exercise session performed by both cohorts.

Duration	Component	Description
5 min	Warm-up	Brisk walk with dynamic stretches – high knees, lunges and arm swings
10 min	Cardiovascular	Brisk walk around the training oval
20 min	Circuit	In pairs, nine stations, two cycles, 60 s per station with a 15 s transition between stations
		Stations:
		Skipping
		Shoulder press
		Step ups
		Lateral raises
		Floor hip extensions
		Tricep dips
		Calf raises
		Squats
		Medicine ball pass
		At the transition between the two cycles, participants perform sit-ups variations for 60 s
10 min	Cool-down	5 min walk around training oval plus 5 minutes of static stretches for all major muscle groups

Table 2. Overview of program education sessions.

Week	Topic	Presenter(s)
1	Introduction and information on the health effects of being overweight	Research team*
2	Goal setting and staying motivated	Motivational speaker
3	Better choices of eating	Dietitian
4	How to be more active and foot care	Accredited Exercise Physiologist and Podiatrist
5	Sexual health	Medical Practitioner
6	Who is who in the health system and how to access the right services	Occupational Therapist
7	Work and life balance	Population health project officer
8	Controlling your risk factors	Alcohol, Tobacco and Other Drugs speaker
9	Stress and fatigue management	Life Coach
10	Workplace health and healthy sleep	Occupational Therapist and Registered Nurse
11	Quality use of medicine and alternative therapies	Pharmacist
12	How to stay motivated	Sporting club representative, research team*

*The research team included a General Practitioner, Registered Nurse, Accredited Exercise Physiologist, Sport and Exercise Scientist and a population health project officer.

In addition to the scheduled once-weekly exercise and education session, participants were encouraged to undertake at least 30 min of walking (or equivalent physical activity) daily, and were provided with a pedometer (to keep after the project) and steps diary to assist with this recommendation, although this was not analyzed due to missing data. Participants were also given a tape measure to keep so that they could continue to monitor their waist girth. At program completion, participants were also given an example exercise program to be completed in their own time in order to promote continued exercise behavior.

Measures and data collection

At program commencement (week 1) and conclusion (week 12), participants completed a seven-item men’s health quiz to assess their knowledge of men’s health issues and the SF12 health survey [11] to evaluate physical and mental condition. The SF12 survey results were scored as per a freely available website tool [12] and reported as an overall physical component summary and mental component summary. Participants were also measured for height and weight and waist girth. The height and weight measures were used to calculate BMI. During the week 12 evaluation session, participants were invited to participate in a focus group and were asked to comment on a variety of questions including perceived improvements, lifestyle modifications, support structures, future project delivery and impact of the involvement of the sporting club.

Data analysis

Pre- and post-lifestyle intervention measures were reported as means and standard deviations and were analyzed via paired samples t-tests to determine if any significant differences occurred across the two time points. All statistical analysis was carried out with IBM SPSS version 19 with the alpha statistical significance level set at p < 0.05. The focus group responses were collated into themes for reporting and discussion.

Results

Of the 24 participants, 14 completed both evaluation sessions. On average, the participants who attended both the pre- and post-evaluation sessions also attended eight weekly sessions as a combined cohort. The rugby league and rugby union cohort average number of sessions attended were nine and eight weekly sessions, respectively. Of the 10 participants who did not attend both evaluation sessions, the average session attendance for the duration of the program was two sessions. Self-reported reasons for non-attendance included work commitments and travel. When the baseline measures were compared between the 14 participants that completed the program and the 10 participants that did not, there were no significant statistical differences, indicating that healthy lifestyle knowledge, perception of health, age or body composition were unlikely factors explaining non-attendance.

Healthy lifestyle knowledge did not significantly improve following the project (11.2 ± 1.7 versus 12.0 ± 0.9 correct answers, p = 0.076), although seven participants achieved a higher number of correct answers.

As a combined cohort (n = 14) by week twelve, there was a significant improvement in both the SF12 PCS (by 6.3 points) and MCS (by 5.1 points), and a significant 6% reduction in average waist girth of 7.9 cm. The rugby league cohort reported significant improvement in the average SF12 physical component summary of 10.6 points, and significant reductions (between 2% and 6% improvement) in average weight, BMI and waist girth measures of 2.5 kg, 0.9 kg·m⁻² and 6.7 cm, respectively. The rugby union cohort reported significant improvement in the SF12 mental component summary of 8.4 points and a 7% significant reduction in average waist girth by 9.1 cm. The pre- and post-data for the SF12, weight, BMI and waist girth measures are provided in Table 3.

Table 3. Mean (and standard deviation) pre- and post-health perceptions and body composition results for participants (n = 14) of a twelve week healthy lifestyle program.

	Rugby league cohort (n = 7)			Rugby Union cohort (n = 7)			Combined cohorts (n = 14)
Variable	Pre	Post	p Value	Pre	Post	p Value	Pre	Post	p Value
SF12 PCS	39.9 ± 6.1	50.5 ± 4.2*	0.003	45.8 ± 10.9	46.6 ± 9.9	0.782	42.4 ± 9.2	48.7 ± 7.3*	0.596
SF12MCS	53.6 ± 9.1	56.0 ± 3.7	0.506	49.1 ± 5.7	57.5 ± 3.8*	0.026	51.6 ± 7.9	56.7 ± 3.7*	0.419
Weight (kg)	105.5 ± 12.8	103.0 ± 11.6*	0.034	125.4 ± 19.3	124.6 ± 15.2	0.748	115.5 ± 18.8	113.8 ± 17.1	0.628
BMI (kg·m^−2)	34.6 ± 3.0	33.7 ± 2.5*	0.024	38.5 ± 5.0	37.8 ± 3.3	0.397	36.5 ± 4.4	35.8 ± 3.6	0.202
Waist girth (cm)	116.4 ± 11.1	109.7 ± 11.1*	0.015	127.0 ± 10.5	117.9 ± 6.7*	0.031	121.7 ± 11.8	113.8 ± 9.8*	0.001

SF12PCS = physical component summary; SF12MCS = mental component summary.

* = significantly different to pre-measures (p < 0.05).

Focus group sessions carried out at the post-testing session revealed a variety of perceived health improvements and lifestyle changes. The health improvements were themed as having more energy/feeling more active (n = 5), better sleep (n = 1), better flexibility (n = 1) and not feeling sore in the mornings (n = 1). The lifestyle changes were themed as more exercise/being more physically active (n = 5), more workplace activity (n = 2), decreased alcohol consumption (n = 2), decreased caffeine consumption (n = 2), increased water ingestion (n = 1), more time with partner/family (n = 2) and altered food intake (n = 3). Seven participants reported positive support and participation by family members in both exercise and nutrition lifestyle modifications. Participants reported appreciation at using the football club facilities as the venue and the involvement of the club in the recruitment process.

Discussion

Approximately 60% of participants completed the project and those who completed attended an average of two-thirds of the exercise and education sessions. Non-attendance was attributed to work commitments and travel, however, this may not have captured all of the reasons for non-attendance, as participants were not required to provide a reason due to the voluntary nature of the project. Despite the sessions being held in the early morning and in the early evening to avoid the typical working day, some of the participants were employed as shift workers and therefore were still unable to attend various sessions. The Scottish FFIT program also reported non-attendance due to work commitments with over three-quarters of participants completing the twelve-week program [9,10]. While there may not be a specific time of day to suit all participants, a potential strength of lifestyle intervention programs such as the current project is the education to participants about how to integrate physical activity into their daily life irrespective of working hours.

There was no statistical improvement in correct answers attained for the men’s healthy lifestyle knowledge quiz following the 12-week project. This may be because the knowledge quiz was fact-based whereas the education sessions emphasized practical applications and strategies for improved health and lifestyle. Despite no obvious improvement in healthy lifestyle knowledge, the participants did report making changes to the physical activity, nutrition, sleep and social aspects of their lifestyle, which is indicative of knowledge-based behavior change. Other men’s healthy lifestyle education programs have similarly reported participant perceptions of the educational benefits of the program, however did not attempt to assess change in knowledge [10,13].

At program commencement, five participants were rated as class I obesity, eight were rated at class II obesity and one was rated at class III obesity [14]. Regarding waist girth, at baseline one participant was rated as low risk, four participants were rated as high risk and nine at very high risk [15]. Following completion of the program, two participants moved from class II obesity down to class I obesity, one participant moved from waist girth-based high risk to low risk and six participants moved from waist girth-based very high risk down to high risk. Therefore, for half of the participants, the improvements in body composition were clinically significant as they resulted in a down shift in disease risk [15].

Both cohorts achieved a significant post-program reduction in waist girth of between 6 and 9 cm, which is similar to the girth reduction reported in other men’s lifestyle intervention projects [6,13], however, only the rugby league cohort demonstrated a significant reduction in weight and BMI. The weight and BMI reduction of the rugby league cohort is clinically significant as it resulted in a down-shift of obesity classification for several participants, despite the actual reduction in weight and BMI being approximately half of that reported by previous men’s health interventions [6,9,13]. It is not clear why one group reported weight and BMI reductions while the other did not. This finding may be related to a combination of the higher standard deviation (statistical influence) reported for the rugby union cohort and the different time of day of exercise (biological influence), with the rugby union group completing evening exercise sessions, however, this requires further investigation that is beyond the scope of this project. Dunn and colleagues [16] reported no significant reduction in weight following completion of a 6-month exercise lifestyle program, however, this was likely due to the intervention not addressing nutritional modifications.

Focus groups completed at the last session of the 12-week program provided important information about lifestyle changes made by the participants and also suggestions for future larger scale programs. Participants reported anecdotal changes to a variety of physical activity, nutrition and health behaviors. Notable were the reported increase in leisure-time physical activity and work-based physical activity behaviors such as the implementation of family walks, kicking the football around with the kids, using the stairs instead of the lift and walking around work instead of asking for a ride. Notable nutrition-based changes included drinking more water and drinking less caffeine-based and alcoholic drinks and eating low glycemic index foods. When participants were asked if there should be a fee associated with the program, there was a mixed response. Some participants felt that cost would be a barrier while others reported that an upfront payment might increase commitment and attendance. Participants felt that twelve weeks was a suitable length to maintain participation, however, advised that future programs should avoid spanning the school holidays where participation may be reduced due to family and travel commitments. Morning was a preferred time of day for the sessions, however, the wet grass (winter dew) associated with this time of day was a concern to some participants. Ideas for enhanced future participant recruitment included newspaper advertising and worksite advertising, however this would remove the emphasis of the football club membership aspect of the project and indeed, participants reported appreciation for the affiliation of the project with the sporting club.

Conclusion

The 12-week men’s healthy lifestyle project resulted in significant improvement in some body composition measures, resulting in a reduction in obesity-related disease risk in some participants. Future projects should consider quantifying the lifestyle behavior modifications and changes in healthy lifestyle knowledge that coincide with exercise and education-based community project in order to clearly elucidate the mechanisms for health change.

Declaration of interest

The authors report no declarations of interest.

The authors have no financial disclosures or funding sources to disclose.

Acknowledgements

The authors would like to acknowledge the involvement of the North Queensland Cowboys Rugby League Club and the Townsville and District Rugby Union Club, the presenters of the education sessions and Ryan Harris and Jordan Young for their assistance with the delivery of the exercise sessions.