networking, research

Walking for wellbeing

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A couple of weeks ago I attended a workshop about ‘walking for wellbeing’ in Glasgow.  It was run by the Scottish Insight Institute, who promote collaboration and engagement between researchers and other sectors, such as public, business and third sector, there is a bit more information about the organisation here:  bit.ly/1piwhxC

I found out about the workshop via some of the academics I follow on Twitter, and immediately knew that the second workshop in the series would be very useful for my research, as it focussed on measurement of walking and walking and affect. Incredibly relevant to my PhD! So I booked a flight to Glasgow for the day and got up at the ludicrously early hour of 4am, yawn.

There was a great mix of people from different organisations present, all with an interest in either walking, wellbeing, or both walking and wellbeing. I didn’t have a chance to talk to everyone there, but there were people from NHS organisations, other researchers in physical activity, people involved in green spaces and planning, those coordinating different types of walking groups, and people from different charities such as Arthritis Care.

One unique aspect of this workshop was that sedentariness was discouraged! Everyone was asked to give a standing ovation to all the speakers, before and after their talks. Group discussions were carried out whilst standing. Activities involving walking were also woven into the day, which was a real bonus in avoiding that post-lunch sleepy slump usually experienced at such events (particularly when you had to get up at 4am). ALL events should use this format; as well as being energising it was also great for being able to chat to a variety of people you didn’t otherwise manage to meet.

The day started off with some discussion around what walking for wellbeing actually meant, and everyone had a slightly different take on definitions of both concepts, depending on their background.  There were lots of common themes, however, such as walking for health and happiness, social aspects of walking, pleasant environments, enjoyment and purpose.

Next up, David Rowe talked about how and why we measure walking.  This was basically an extended ‘it depends’ discussion, because it very much depends who the walker is and why they are being studied.

Reasons for measuring walking ranged from the individual (for example, challenging yourself to complete a certain number of steps per day) to group or population-related motives (e.g. urban planning, transport, monitoring outcomes of interventions).

For the ‘how’ of walking measurement, pros and cons of different methods were discussed.  I found this fascinating, because I’ve seen from talking to my participants that using self-report questionnaires for measuring physical activity is problematic (though I’m stuck with this method for my first study). With walking being integrated into daily life to a greater extent than more structured forms of exercise, accurate measurement is even more of an issue.

Some of the methods David touched on were attendance records, diaries, questionnaires, pedometers, accelerometers, mobile apps and pedestrian counts. Again, which method is preferred depends on who is being studied and why (and how much you’re willing to spend!) For example, studying an elderly housebound population would be difficult using a GPS method because this relies on outdoor activity, whereas pedometers could also be problematic if they don’t register very small numbers of steps, or a shuffling gait.

Even when you have chosen what seems to be a suitable measurement method, David has done some extensive work showing large differences between different models of the same measurement device.  That’s before you contend with individual differences, or considerations such as weather/season/day of week.  As always with measurement, the key is to pick the best possible tool which will answer your question as well as it possibly can, whilst acknowledging the limitations of that tool.

As a postscript to this part of the day, I recently found a really useful looking toolkit online from the Medical Research Council, discussing different ways of measuring physical activity. There is a handy discussion of the pros and cons of several different methods and further references are given

http://dapa-toolkit.mrc.ac.uk/physical-activity-assessment/index.html

The activity for this part of the day was a walk round the block wearing a pedometer. The hills in that part of Glasgow are pretty steep! We then had to estimate how many steps we had taken and how far we had walked, as a way of illustrating some of the problems inherent in measuring walking. My step count was wayyyyyy off but I guessed the distance quite accurately (comes from running with a running watch so often I think). I wasn’t alone in having no idea of how many steps we had taken, with estimates varying wildly across the group. David also did a quick and dirty analysis of the results and showed us that even though we had all walked the same route, there were big differences in the number of steps counted by the pedometer, showing the importance of measuring distance rather than number of steps (which can be converted).

Refreshed by our quick walk (honestly, I am a big fan of this ‘netwalking’!), we then turned to Paddy Ekkekakis’s talk. Paddy is an expert in the area of affect and physical activity, and his 2011 review paper of the research in this area was invaluable to me when I first became interested in the subject of how we can help people enjoy physical activity more. He was also an excellent speaker-very engaging and clear.  He started off with some alarming statistics on how many people actually meet the recommended 30 minutes of at least moderate intensity exercise 5 times a week in different countries. US: 3.5%, Canada: 4.8%, UK: 6% for men, 4% for women. He made the argument that physical activity is associated for many with displeasure, not helped by media portrayals of exercise in a negative light and self-help books promising weight loss without exercise.

Next was a whistlestop tour through definitions of affective constructs-core affect, emotions and moods-and some important distinctions between these if you are to measure the thing you think you are measuring. Core affect is the most basic common element; a generalised, free-floating part of conscious awareness, which underpins emotions and moods. Emotions are short-term affective states requiring a cognitive appraisal of a stimulus, with other components including attention, behavioural expressions and physiological changes. Moods also require a cognitive appraisal, however this may be of something less specific or obvious (for example something which happened a while ago, or something general like concern for the future), which is in keeping with the longer-term, usually less intense nature of moods compared with emotions.

Why are these definitions important? Well, if you are going to measure an aspect of ‘wellbeing’, then you need to know just which aspect you are measuring, as well as choosing an appropriate measurement tool. Ekkekakis gave examples of studies where a measure had been used ‘because that’s what everyone else uses’ or ‘because so-and-so used it and said it was ok’ (I’m paraphrasing here). Often, however, the measure was ill-chosen in light of what the research question was. For example, if you are using a short-term intervention such as a walk in a forest, then it makes little sense to measure ‘mood’ before and after the walk, because moods can last for days. Ekkekakis also touched on the history of some affective measures and how this may affect their suitability for use in physical activity. One example used, the POMS (now called the Profile of Mood States) started out as the Psychiatric Outpatient Mood Scale, used to study a drug treatment. You can see the origins of this in the rather Eeyorish categories used in the scale: tension, depression, anger, vigour, fatigue, and confusion. Other measures of affect were also discussed, along with consideration of ‘activation’, since many measures ignore low activation or arousal states such as relaxation or serenity (surely important in walking for wellbeing?)

The take-home message from this part of the talk was: choose your measurement tool wisely and justify why you are using it. Or, more memorably: don’t be a sheep! This is similar to David Rowe’s take-home message: it depends. Inform yourself about what you want to measure and some of the different methods of measuring it, choose the best one for your question and justify your choice.

After this, we were able to use an affective measure in anger (no pun intended) as we were off for another netwalking opportunity and had to use the Feeling Scale and Felt Arousal Scale to rate how we felt before and after the walk. It was interesting using the Feeling Scale myself, as this is the measure I’m currently using with my participants during exercise. Given my participants are running around parks and roads whilst I ask them how they are feeling during the exercise session, a very quick and easy verbal method is obviously required. Not much time for long-winded paper-based questionnaires or even complicated verbally-administered ones. I’m also asking them to briefly describe why they are feeling that way, as there has been little exploratory work like this outside the lab and I’d like to find out what reasons people ascribe to their feelings in a more natural environment. I’m also asking people when they first begin with a running group and about 2 months later, as I want to know whether the way people feel during exercise changes with experience. It’s early days in the study so far, but so far it has been fascinating going back to visit participants and seeing how much they have changed.

Back to the workshop, and for this part Ekkekakis presented a huge amount of information on the relationship between physical activity and affect.  This blog is already turning into a tome, so I’ll summarise the key points quickly! There is evidence to show that how people feel during physical activity is related to their subsequent physical activity levels; the more pleasant people find physical activity, the more likely they are to continue doing it. I know, it’s rocket science this stuff isn’t it? Intensity of physical activity is important, however, because people generally tend to find high intensity physical activity unpleasant, which means if you expect people to take up vigorous exercise then they are less likely to continue with it. This is one reason why walking is such an ideal form of physical activity, as it sidesteps the ‘no pain, no gain’ ethos so prevalent in media and cultural messages.  In search of a quick fix to obtain fast results, the message about physical activity needing to be pleasant is lost, to the detriment of people making long term changes in their physical activity levels.  Additionally, if people are very overweight or very unfit, the intensity level at which physical activity becomes unpleasant can be very low indeed. This is an  even stronger argument for starting such people off at a low intensity level to maximise pleasure.

Ekkekakis included loads more information, but each of his slides alone could justify an entire blog entry, so I’ll leave it there.  There was a question and answer session at the end of the day, and there was a huge variety of questions reflecting the varied backgrounds of the workshop attendees.  I think the best part of meeting people from different backgrounds was seeing how research is useful to so many people in slightly different ways. Some people were in need of information on how to select a suitable tool for measuring physical activity, some people were more interested in the wellbeing part of the workshop and understanding how physical activity and affect are related. I’m sure, however, that everyone left the workshop informed and inspired. I certainly did! Thanks very much to Nanette and the others involved in organising.

 

 

(Photo is of the fantastic lion in George Square, from Flickr (Damingo@Glasgow) under CC licence bit.ly/1k0LcHA)

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