Sheffield Obesity Trial SHOT

1
Sheffield Obesity Trial - SHOT

• Effects of exercise therapy upon domains
• of self-esteem in obese adolescents.
• Dr Robert Copeland

2
Aims

• H1 exercise therapy would lead to improvements in
  participants physical self-perceptions and
  self-esteem
• Only study worldwide to date that has included an
  equal contact exercise-placebo group.

3
Development of the grant

• A small pilot study determine the content and
  design for the exercise therapy intervention
• Children and adolescents not-eligible for the
  trial input into the design of exercise room.

4
Recruitment

• Referral from Sheffield Childrens Hospital or
  via community and media advert
• Medical clearance provided by members of
  Sheffield Children's Hospital
• At baseline no significant difference between
  referral route.

5
Research Design

• RCT - focus on social and psychological
  well-being
• Not a weight-loss study - although we did monitor
  BMI
• Randomised to three Groups
• Exercise Counselling
• Attention Placebo Control (body conditioning)
• Usual Care Control.
• 6-week home programme

6
Exercise Counselling

• Exercise 3 x week for an 8-week period
• 1 hour session that was one-to-one
• Moderate Intensity Aerobic Exercise - emphasis on
  fun
• Processes of change from the Trans-theoretical
  Model (Prochaska DiClemente, 1983).

7
Exercise Counselling

• Consciousness raising
• we focused upon educating the kids about health
  and exercise
• Outcome expectations
• tried to increase kids beliefs about the effects
  of exercise
• Decisional Balance
• We get kids to think about the barriers or things
  that are stopping them from being active.

8
Exercise Counselling cont.

• Increase Self-esteem
• Focused on helping kids overcome barriers and
  experience benefits of exercise
• Social support
• Helped kids to find others to exercise with
• Reward and reinforcement
• reinforced positive changes and identified
  rewards - had a positive effect on their
  self-esteem.

9
Counselling Cont.

• Goal setting
• We tried to teach kids in very simple terms the
  importance of setting achievable goals
• Cues for action
• Encourage kids to think about cues that can
  prompt them to do exercise
• Self-monitoring
• We ask kids to keep a diary of their physical
  activity and eating and encouraged them to
  reflect on their own progress.

10
Who took part?

• 81 adolescents (36 males, 45 females), mean age
  13 yrs
• 78 were obese 22 morbidly obese
• White children, 82.7, with 9.9 Black 7.4
  South Asian
• 52 from most deprived areas of South Yorkshire

11
What were they like at start?

• In comparison with healthy child populations
  (Biddle et al., 1993) self-esteem scores were
  low.
• Very low scores for physical activity
• 22 participants (27) reported experienced
  suicidal thoughts as measured by the CDI (Kovacs,
  1992).

12
Adherence Attendance

• Only one participant withdrew from the exercise
  therapy/placebo condition
• 6 usual care controls failed to return for the
  8-week assessment.
• Adherence was high 89 of exercise therapy and
  83 exercise-placebo participants attended at
  least 80 of intervention sessions.

13
Assessments

• Baseline, 8-week, post Home Programme (week-14),
  Exit point (week-28)
• Physical Self Perceptions
• Self perceptions - self esteem
• Depression
• Affect
• Aerobic Fitness
• Physical Activity
• BMI
• Participants were interviewed at the end of the
  eight-week intervention and again after the home
  programme.

14
Group Differences in Physical Self Worth Over
time

• Differences equate to improvements of between 5.3
  6.5 in favour of exercise therapy.

15
Group Differences in Physical Activity Over Time

• Significant differences equate to improvements of
  between 4.8 - 5.8 for exercise therapy.

16
What did the kids say?

• I can actually exercise if I want to it isn't
  as hard as I thought.
• It made me feel better about myself.
• I feel pleased that I've actually done it. It's
  like "yeah", I've done it.
• I don't have to stop as often when I'm doing
  exercise nowhow does that make you
  feel?....Brilliant!

17
What did we learn?

• Exercise therapy positively influence self-esteem
  and physical activity
• Attention effects are important consideration
• Learning the skills to sustain Physical Activity
  is essential
• Obese adolescents are motivated enough to
  exercise, when provided with support and
  opportunities.

18
What did we learn?

• Combine exercise, mastery experiences and
  cognitive therapy
• Moderate intensity, short bouts of exercise
  appears efficacious
• Enjoyable for those taking part.
• A range of exercise modalities

19
Research Implications

• Important to focus / observe the psychological
  and social well-being effects of treatment on
  young people who are obese - not just weight loss
• Precise estimates of the observed effects of
  exercise therapy are required in pragmatic
  settings
• Clarify the mechanisms that might be responsible
  for promoting change in psychological wellbeing
  in obese children and adolescents.