The effect of a program to improve men’s sedentary time and physical activity: The European Fans in Training (EuroFIT) randomized controlled trial

Wyke, Sally, Bunn, Christopher, Andersen, Eivind, Silva, Marlene, Van Nassau, Femke, McSkimming, Paul, Kolovos, Spyros, Gill, Jason, Gray, Cindy, Hunt, Kate, Anderson, Annie, Bosmans, Judith, Jelsma, Judith, Kean, Sharon, Lemyre, Nicolas, Loudon, David, Macaulay, Lisa, Maxwell, Douglas, McConnachie, Alex, Mutrie, Nanette, Nijhuis-van der Sanden, M., Pereira, Hugo, Philpott, Matthew, Roberts, Glyn, Rooksby, John, Røynesdal, Øystein, Sattar, Naveed, Sorensen, Marit, Teixeira, Pedro, Treweek, Shaun, Van Achterberg, Theo, Van De Glind, Irene, Van Mechelen, Willem and Van Der Ploeg, Hidde (2019) The effect of a program to improve men’s sedentary time and physical activity: The European Fans in Training (EuroFIT) randomized controlled trial. PLoS Medicine, 16 (2). e1002736. ISSN 1549-1277

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Abstract

Background
Reducing sitting time as well as increasing physical activity in inactive people is beneficial for their health. This paper investigates the effectiveness of the European Fans in Training (EuroFIT) program to improve physical activity and sedentary time in male football fans delivered through the professional football setting.

Methods and Findings
1113 men aged 30-65 with self-reported Body Mass Index (BMI) ≥27 kg/m2) took part in a randomized controlled trial in fifteen professional football clubs in England, the Netherlands, Norway, and Portugal. Recruitment was between September 19, 2015 and February 2, 2016. Participants consented to study procedures and provided usable activity monitor baseline data. They were randomized, stratified by club, to either the EuroFIT intervention or a 12-month waiting list comparison group. Follow-up measurement was post-programme and 12 months after baseline.

EuroFIT is a 12-week, group-based, program delivered by coaches in football club stadia in 12 weekly 90-minute sessions. Weekly sessions aimed to improve physically active, sedentary time, diet and maintain changes long term. A pocket-worn device (SitFIT) allowed self-monitoring of sedentary time and daily steps and a game-based app (MatchFIT) encouraged between session social support.
Primary outcome (objectively measured sedentary time and physical activity) measurements were obtained for 83% and 85% of intervention and comparison participants. Intention to treat analyses showed a baseline-adjusted mean difference in sedentary time at 12 months of -1.6 minutes/day (97.5%CI -14.3 to 11.0; p=0.77), and in step counts of 678 steps/day (97.5%CI 309 to 1048; p<0.001) in favor of the intervention. There were significant improvements in diet, weight, wellbeing, self-esteem, vitality and biomarkers of cardiometabolic health in favor of the intervention group, but not in quality of life. There was a 0.95 probability of EuroFIT being cost-effective compared to the comparison group if society is willing to pay £1.50 per extra step/day, a maximum probability of 0.61 if society is willing to pay £1,800 per minute less sedentary time/day and 0.13 probably if willing to pay £30,000 per Quality Adjusted Life Year (QALY).

It was not possible to blind participants to group allocation. Men attracted to the program already had quite high levels of physical activity at baseline (8372 steps/day) which may have limited room for improvement. Although participants came from across the socio-economic spectrum a majority were well-educated and in paid work. There was an increase in recent injuries and in upper and lower joint pain scores post program. In addition, although the EQ-5D-5L is now the preferred measure for cost-effectiveness analyses across Europe, baseline scores were high (0.93), suggesting a ceiling effect for QALYs.

Conclusion
Participation in EuroFIT led to improvements in physical activity, diet, body weight and biomarkers of cardiometabolic health, but not in sedentary time at 12 months. Within trial analysis suggests it is not cost-effective in the short-term for QALYs due to a ceiling effect in quality of life. Nevertheless, decision makers may consider the incremental cost for increase in steps worth the investment.

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