High risks of inactive and sedentary lifestyles: Inactive and sedentary lifestyles are pandemic. In the WHO European Region, physical inactivity (failure to meet current activity guidelines) accounts for around a million deaths per year (about 10% of the total), 8.3 million disability-adjusted life-years and causes 5.5% of the burden of disease from coronary heart disease, 6.8% from type 2 diabetes, 9.3% from breast cancer, and 9.8% from colon cancer.
High levels of sedentary behaviour (waking time spent sitting/reclining with low energy expenditure) are also associated with adverse health outcomes and all-cause mortality . High levels of sedentary behaviour and low physical activity are associated with other risk factors for ill health such as poor diet and obesity.
High costs: In 2006, physical inactivity costs the EU €150-300 per citizen each year, accounting for around 1.5-3.0% for the health care budget; in 2010, obesity was responsible for up to 8% of EU health care costs.
High risk groups participate less: A critical issue is that existing health promotion programmes, even when effective, reach only a small proportion of the population. There are large gender imbalances in recruitment (only between 10% and 30% of participants are men), and participants tend to be “well-educated” (i.e. relatively high SES). Programmes tailored specifically to attract men and to low-SES groups are urgently needed.
EuroFIT’s key innovation is to harness the personal connection, loyalty and attachment many men feel to football and their club to attract them to health-promoting lifestyle change programmes delivered in top-flight European football clubs.
EuroFIT’s overall aim is to establish, extend, promote and enhance the social partnerships which provide the milieu for delivery of an innovative public health programme. We will design, deliver and evaluate a culturally- and gender- sensitised lifestyle programme for men supported by enhanced social partnerships and innovative technologies for self-monitoring and social networking/support, to be delivered in top European football clubs, and future-proof Eurofit for wide-scale replication, implementation and adaptation across Europe. In short, EuroFIT will investigate the power of social innovation to improve levels of physical activity, sedentary behaviour and diet in adult men.
We have four specific objectives:
The EuroFIT programme: We will develop two technologies to integrate within the EuroFIT programme. The first is a novel device (SitFIT) that allows self-monitoring of objectively measured sedentary time and physical activity through real-time feedback. SitFIT will be a low-cost device with an integrated display. The second is a game-based mobile-phone app, MatchFIT, in which players form ‘teams’ to participate in an ‘alternative MatchFIT league’ which mirrors fixtures in real football leagues. These technologies will be integrated into the new lifestyle change programme, EuroFIT, to be delivered in football club grounds by club coaches. EuroFIT will target improvements in physical activity, sedentary time and eating habits/diet.
The results of an RCT of EuroFIT: a two-arm, individually randomised, pragmatic, controlled trial of EuroFIT delivered in 15 top-flight football clubs in Portugal, Norway, the Netherlands and UK will investigate whether the EuroFIT programme can help participants achieve an increase of at least 1000 steps per day (about 10 minutes on average per day, or 70 minutes per week) of moderate intensity (3 METs) activity and an average decrease of at least 25 minutes per day spent expending less than 1.5 MET at least 12 months after their participation in EuroFIT. Secondary outcomes will investigate whether involvement with EuroFIT: a) reduces body weight by at least 5% at 12 months if baseline BMI is =25; b) reduces waist circumference at 12 months; c) improves eating habits at 12 months; d) reduces blood pressure at 12 weeks and 12 months; e) reduces risk of cardiovascular disease at 12 months, as measured by blood based biomarkers; f) increases positive affect and self-esteem, and improves quality of life at 12 weeks and 12 months; g) has the potential to provide a cost-effective use of resources.
Experiences of the EuroFIT programme and views of wider relevance: We will extend the value of the randomised controlled trial by investigating the the full range of benefits (both anticipated and unanticipated) and harms that participants experienced and investigate whether changes men made were extended to family members and to wider social networks. We will also investigate what modifications would be needed to make EuroFIT attractive to women, families and other groups.
Replication of EuroFIT beyond the randomised controlled trial: EuroFIT will overcome the ‘know-do’ gap in the implementation of public health programmes by developing detailed, validated guidelines on how to replicate and implement the programme in settings that have not delivered EuroFIT as part of the evaluative research. The guidelines will be firmly embedded in experience and mean it is much more likely to be effective for sporting organisations across Europe to take up the approach.
We expect to launch the SitFIT device and the MatchFIT app on the open market during or soon after the project. The SitFIT device will be the world’s first self-monitoring sedentary behaviour sensor and as such will have widespread application to other programmes to reduce sedentary behaviour. The MatchFIT app will be the first of a series of team-based exercise games that has potential application to other sports and team-based approaches to increasing physical activity.
All EuroFIT programme materials and coach training materials will be available for download under a Creative Commons license which means that the techniques for long-term behaviour change used in the programme will be widely available for application in other programmes.