A lifestyle intervention in airline pilots to enhance health and fitness

The overall intervention duration was 4 months. The intervention commenced with a one-hour individual face-to-face consultation session with an experienced health coach (with over 20 years’ experience) at the airline medical unit. In this initial consultation session, the pilots’ barriers, facilitators, and motivations to health behaviour change were assessed with validated methods, which were factored into the development of an individualised health programme. Further, personalised collaborative goal setting was carried out for the pilot with assistance from the health coach, establishing appropriate outcome, performance, and process goals 30 for (a) sleep hygiene, (b) healthy eating, and (c) physical activity. Sleep hygiene represents a range of behavioural and environmental practices which support restorative sleep. An evidence-based sleep hygiene checklist, was developed specifically for this study and the contents were derived from previous sleep hygiene and stimulus control studies. At the time of the initial consultation session, pilots completed the sleep hygiene checklist and Pittsburgh Sleep Quality Index (PSQI). Findings from these assessments were discussed between the health coach and participant, with suboptimal PSQI component scores and unachieved sleep hygiene strategies factored into collaborative establishment of sleep priorities. Thereafter, participants collaboratively set personalised sleep hygiene goals with support from the health coach. Examples of sleep hygiene strategies included implementation of regular sleep and wake times, perform and pre-bed relaxation routine, dim lights and avoid screen time within 30 minutes before bed etc. Evidence-based healthy dietary behaviours which support a healthy bodyweight were delivered through individualized advice and educational materials. Healthy eating principles included limiting processed foods and enhancing whole food consumption, “adding colour” via consumption of fruit and vegetables and choosing nutrient dense foods, and reducing white carbohydrates, refined carbohydrates and added sugar (for example, energy dense food). At baseline participants completed a 24-hour dietary recall, of which findings were used to identify suboptimal dietary behaviours and healthy eating priorities. Relative to participant baseline behaviors, collaborative individualized goals were collaboratively established (for example; adding colourful whole foods to meals; replace high glycaemic index (GI) foods with low GI options; replace processed breakfast cereal with egg and vegetable omelette). Prescribed dose of fruit was equal to or greater than 2 servings and vegetables was equal to or greater than 3 serves per day. Congruent with the participant’s perceived barriers, facilitators and motivations to exercise, personalized physical activity prescription was established with the application of the frequency, intensity, time, and type (FITT) principles, and progression to attainment of sufficient moderate-to-vigorous physical activity (MVPA) to meet guidelines appropriate to individual capabilities. A minimum dose of weekly MVPA at commencement of the intervention was 150 minutes per week, such as 3x50 minute activity sessions or 5x30 minute activity sessions. Frequency and time of PA sessions were tailored to participant weekly time availability. Intensity was tailored based on participant physical activity experience, physical fitness, and goal orientation. Type of PA was customized to the individual’s modality preferences for cardiovascular (such as walking, running, or cycling) and strengthening (for example, resistance equipment and/or bodyweight exercises) PA. Physical activity progression self-monitoring was indicated, and participants were advised to implement small progressive changes in PA during the intervention (such as; increase session duration; perform more repetitions; perform greater intensity; or accomplish more weekly bouts). Weekly emails and a mid-intervention phone call were utilised as reminders to participants to safely and feasibly increase their activity throughout the intervention. A mid-intervention (week 8, approximately 10 minutes duration) phone call was conducted to support intervention adherence and monitor progress. The phone call consisted of a semi-structured interview focused on reviewing progress and compliance to individual goals for sleep hygiene, healthy eating, and physical activity established during the baseline consultation. Advice was provided where necessary, consistent with that which was provided at the pre-test. Throughout the intervention, weekly health education posts were delivered to participants via email. The emails consisted of educational blog posts of varying topics related to sleep health, healthy nutrition, physical activity, and supporting a healthy immune system, congruent with evidence-based methods previously described. During lockdowns enacted due to the global pandemic, content was tailored to the pandemic conditions, including strategies for physical activity at home, healthy recipes, and immune system health information. Educational content was derived from health authorities via publicly available information from the World Health Organization and the Centers for Disease Control and Prevention. Intervention adherence was monitored via weekly logging of daily fruit and vegetable intake, average hours of sleep per night and weekly moderate to vigorous exercise session frequency and duration recording.