An online mental health informed physical activity intervention for emergency service workers and their families: A stepped-wedge trial (Preprint)

Abstract

Emergency service workers are at an increased risk of experiencing poor mental health due to prolonged, repeated exposure to potentially traumatic events. Promoting healthy lifestyle behaviours including physical activity and diet may help to mitigate some the consequences of emergency service work.

This study aimed to evaluate the impact of an online physical activity and diet intervention on levels of psychological distress among emergency service workers and their nominated support partner e.g., spouse, family member close friend.

We delivered a 10-week physical activity program via a private Facebook group. The Facebook group was co-facilitated by exercise physiologists, a dietitian and peer-facilitators. Weekly modules on overcoming barriers to exercise, self-monitoring of activity and nutrition were delivered. Participants could also join weekly group telehealth calls and were provided with a physical activity tracking device. A stepped-wedge design was applied to compare levels of psychological distress (Kessler-6) during baseline, to intervention by comparing slopes of change. Visual inspection of the data was used to identify the location for a knot point. Then separate slopes were modelled for a) baseline; b) intervention slope 1; c) intervention slope 2; d) change in level of knot points. Secondary outcomes included a pre-post assessment of mental health symptoms, physical activity levels, quality of life, social support to exercise, sleep quality and suicidal ideation.

In total, N=90 participants (n=47 emergency service workers and n=43 support partners) were recruited in 4 separate cohorts (mean age 42.3(SD=11.5) years, 51% male). Levels of psychological distress did not change significantly during the baseline (control) slope, while during the first 6 weeks of intervention (intervention slope 1) levels reduced significantly. The interaction between baseline and intervention slopes were significant, b=-0.351, p = 0.003, (i.e., the trajectories of change were significantly different) and improvements plateaued until the 4-week follow up (intervention slope 2). Participation was associated with improvements in mental health symptoms, weekly minutes of physical activity, sedentary time and quality of life. Retention in the intervention was high (92%).

A 10-week physical activity intervention delivered via social media is feasible and effective in improving psychological distress among emergency service workers and their support partners. Future research should consider investigating the factors mediating changes in health behaviours and outcomes.

Australian New Zealand Clinical Trials Registry (ACTRN): 12619000877189.

RR2-10.1136/bmjopen-2019-030668