Netflix and Move 2: Exploring the feasibility of breaking up sitting time in the evening with regular activity breaks

Participants will complete a 7 day baseline period followed by a two-week intervention period and two-week follow up period. INTRODUCTORY SESSION The introductory session will take place at the Department of Human Nutrition Mellor Laboratories (University of Otago, Dunedin. New Zealand), where the research assistant will: 1. Measure height, weight, and blood pressure (in triplicate 1 min apart; after 15-min seated rest) using standardised procedures. If blood pressure is greater than 140/90 mmHg and participants have not already obtained medical clearance, then they will be asked to contact their GP to gain clearance to participate in the study. 2. Discuss the participant’s typical evening to identify the period in which the participant is mostly sedentary (e.g., 1700 to 2100 hours), and the time the participant usually consumes their evening meal. 3. Fit participants with two activity monitors: an ActiGraph GT3+ accelerometer, which they will be asked to wear on their non-dominant wrist, and an ActivPal3 which is attached to the midpoint of the front of the right thigh with adhesive dressing. Participants will be instructed to wear both activity monitors continuously (24 hours a day) for a seven-day period to assess usual sleep and physical activity patterns. 4. Explain the wear time diary to the participant in which they will record times either accelerometer was removed (such as when showering or playing contact sport), time participating in physical activity (as some static activities such as cycling on a stationary bike are not captured accurately) and sleep information (time attempted sleep, time woke up). 5. Fit participants with a Freestyle Libre Pro iQ continuous glucose monitor (CGM) which will allow for a non-invasive measurement of glycaemic response every 15 minutes. In the wear time diary participants will also be asked to keep an estimated diet record of all food and drink consumed during the defined evening sedentary period, as well as a record of their large evening meal if it was outside of this time period. INTERVENTION After completing the seven-day baseline period participants will attend a second session at Mellor Laboratories to return the accelerometer and have the CGM removed. During this visit the research assistant will: 1. Instruct participants to complete the Pittsburgh Sleep Quality Index questionnaire to assess baseline self-perceived sleep quality. 2. Briefly discuss the evidence around prolonged sitting as a risk factor and the benefits associated with taking regular activity breaks. 3. Assist participants to download the Stretch Minder application (Better Primates Lab Limited, Hong Kong) on to their mobile device and guide the participant though the use of the application including showing links to the activity breaks exercise videos. 4. Program the application to provide alerts to complete activity breaks every 30 min during the specified evening sedentary period, for the next two-weeks (for example, if a participant identified 1700 to 2100 h as the period in which they habitually engage in sedentary time in the evening, this would be entered into the Stretch Minder Mobile application so that alerts would begin at 1700, and continue every 30-min until 2100 h, every night, for two-weeks). As this is a paid application, participants will be provided with an app store voucher to activate a one-month subscription, (participants will be guided to switch off the auto renewal to avoid further subscription fees). 5. Develop an individualised contingency plan which involves participants identifying potential barriers they may face when implementing the activity breaks and strategies to overcome these barriers. 6. Fit participants with new activity monitors (ActiGraph GT3+ and ActivPal3), and a new CGM to wear continuously over the 2-week intervention period. Wear time and information about food and beverage consumption will be monitored in the same manner as the baseline period. 7. Provide participants with a booklet which will include the contingency plan and space for participants to record 1) sleep/wake and wear time, 2) evening meal, beverage, and snack consumption and 3) what helped or hindered them to performing breaks each day. During the personalised evening period participants will receive alerts on their mobile phone from the Stretch Minder application. Before beginning the activity break, participants will be able to select one, three-minute exercise video to complete (of light-moderate intensity). Available exercise videos built into the Stretch Minder app will be restricted to those that include simple body weight resistance exercises (e.g., squats, calf raises and lunges), therefore excluding static stretching or movements designed to be done while sitting at a desk such as neck rotations. The exercise videos depict the exercises participants should complete, so they can follow along. Additionally, the videos contain a timer and the ability to mute the instructions so that breaks could be completed without the audio instruction interrupting television viewing. This overcomes one of the reported barriers to performing the activity breaks reported from our previous work. Participants will receive two follow up phone calls during the two-week intervention period (on day three and day seven). During these calls the research assistant will discuss how the participant is finding the intervention and to revisit any contingency plans, if needed. After the two-week period participants will attend a visit to Mellor Laboratories to return all equipment including the accelerometer, sleep, wear time and evening food diary and CGM and to complete the final Pittsburgh Sleep Quality and COM-B questionnaires. FOLLOW UP PERIOD At the end of the 2-week intervention period, participants will be reminded to use the StretchMinder mobile application over the next two weeks (weeks 3 and 4). Together with the research assistant, participants will revise their contingency plan to discuss the key factors that hindered them to perform the activity breaks during the 2-week active intervention period and encouraged to use strategies that they identified as helpful over the previous two weeks. Application engagement will be measured as the average number of time per week the application is opened and an activity breaks video is started. This information will be provided from the developers of the Mobile Application via a Data Sharing Agreement, and with consent from the participants QUALITATIVE FEEDBACK At the end of the follow up period participants will participate in a face-to-face semi-structured interview where they will be asked about their overall experience completing the activity breaks at home. Questions will explore participants’ experiences of the intervention, what helped and what hindered them to perform the intervention and what was missing from the intervention as it is currently designed. Questions will specifically ask what supported or hindered their ability to perform the breaks, explore the use of the mobile application during the intervention, and during the follow up period, as well as asking participants to reflect on potential positive and/or negative outcomes experienced from performing the activity breaks (Appendix I). Interviews will be recorded, and transcripts analyzed using inductive thematic analysis (Braun & Clarke, 2006). At the end of the interview participants will be provided with a $100 supermarket voucher in recognition of the actual or reasonable costs associated with participating in this study.