I couldn't find any pictures of NOM-TV or Dutch television programming, so this post has pictures of Dutch food instead. This is "Koffie verkeerd," the Dutch equivalent of "café au lait"

Sedentary behaviour is a growing problem in our society, and one that is now getting the media attention it deserves. It even has it’s own organization – the Sedentary Behaviour Research Network. Some researchers have tried to tackle this issue by promoting exercise while watching TV, although this approach has its critics.

Part of the problem with sedentary behaviour is that our lifestyle and environment encourage it. We live in the so called “information age.” Rather than being active and mobile, we spend most of our day at a computer or desk. This has ramifications not only when we are young, but also for when we get older.

The Dutch government decided to try and tackle this issue by introducing an initiative called “The Netherlands on the Move!” (NOM), along as with a TV show called “The Netherlands on the Move-TV!” (NOM-TV). This program was aimed at encouraging those above the age of 55 to become more active by showing exercises they can do in front of the TV in the comfort of their own house. The show is broadcast at 6:45am and 9:10am, is 15 minutes long, and shows two personal trainers leading five people through a series of exercises, and is watched by an estimated 137,000 people daily. All in all, an interesting and healthy program.

But the question is: what stops people from participating? It’s only 15 minutes, in your own home, once a day. That’s not an unreasonable amount of time, and, in theory, quite attainable. These researchers investigated the effect of perceived competence on participation in NOM-TV; the idea being that if you believe you can do it, you are more likely to.

More after the jump.

"Snert," which is Dutch Pea Soup

What did they do?

They put out advertisements for the research study on NOM-TV, as well as through NOM partner agencies (such as the Dutch Heart Foundation). People were encouraged to go to a website and fill out a questionnaire about their perceived skills and abilities and whether or not they participated in the study. Recruitment was conducted from May 18th to June 30th, 2009. During this time they had 1737 people completed the questionnaire. However, of these, only 1349 filled out all the information.

What did they find?

As they predicted, they found that frequent participants in the NOM-TV program expressed higher levels of enjoyment and competence and reported lower tension and pressure.

So what does this all mean?

I’m actually surprised they found the findings they did; not because I disagree with them, but because of the sample they drew from. I would expect those who participate in a home-based, voluntary program first thing in the morning to be more confident and healthier than those who do not participate.

If you want to be optimistic, you could conclude that their findings suggest that future interventions should encourage people to participate, and, as the authors suggest, personalize the program by having participants internalize those goals.

Frankly, I’m not convinced by their findings. They 1) recruited those who had access to the internet and knew how to use it (it was an online survey), 2) only those who were motivated would respond and 3) restricted their analyses to those who had less than 8 pieces of missing data. Each of those steps would remove those who didn’t participate in the program or who didn’t want to answer for personal reasons. In epidemiologic terms, I’m concerned about selection bias in their sampling approach, as their respondents would not represent the underlying population who watch the show to begin with.

With that in mind, I was surprised they they still found an association between regular participants and non-regular participants in NOM-TV and suspect it may be an artifact of a large sample size rather than a meaningful association (Type 1 error – concluding an association exists where one does not). So my concerns may be unfounded, and the true relationship may be even larger than what they found.

"Oliebollen," a Dutch pastry eaten on New Year's Eve

And what now?

Despite my criticisms above, their underlying theory makes sense and fits with the existing literature. I would be interested to see what barriers exist among those who do not participate – the vast majority of their sample participated every time or nearly every time (77.6%). Those people aren’t interesting – what is interesting is why the remaining 22.4% are not participating, and those who did not participate in the study at all. What is stopping them? How do they differ from respondents to the survey? What can be done to make them do 15 minutes of exercise a day?

It’s an intriguing study, and their theory is appropriate. Future work in this area should provide some concrete areas that can be targeted for change and encourage more people to participate in NOM-TV.

For those interested, the article is Open Access, and is available at the Journal Of Obesity.

ResearchBlogging.orgMeis, J., Kremers, S., & Bouman, M. (2012). Television Viewing Does Not Have to Be Sedentary: Motivation to Participate in a TV Exercise Program Journal of Obesity, 2012, 1-8 DOI: 10.1155/2012/752820

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