Supporting physical activity behaviour change in adults with obstructive sleep apnoea
Background: Low physical activity represents a potentially modifiable risk factor in the management of obstructive sleep apnoea (OSA). The benefits to this population of being more physically active include improved apnoea severity and reduced risk of hypertension, cardiovascular disease, type 2 diabetes and obesity. There is currently little available information regarding the type and level of physical activity undertaken in adults with diagnosed OSA. Moreover, potential barriers to activity have not been explored. Beyond provision of continuous positive airway pressure to manage periods of apnoea, there is limited support available to address lifestyle factors in this population. Aim: The aim of this thesis was to establish physical activity levels in a cohort of adults with OSA, determine barriers to activity and explore the feasibility of supporting a change in physical activity behaviour in this cohort. Methods: An initial literature review on physical activity in the population with OSA formed the basis for an exploratory study to determine physical activity levels in a cohort of 60 participants at risk of OSA, recruited from the local Sleep Clinic. Physical activity levels were compared with current World Health Organization guidelines. Levels of inactivity, time engaged in sedentary behaviour and barriers to activity were ascertained. A second literature review explored the use of text messaging as a means of motivation to support physical activity behaviour. A focus group and individual interviews were then conducted to determine the acceptability of motivational text messaging to end users with OSA. Using these findings an intervention study was developed to establish the feasibility of a text messaging intervention in conjunction with personalised exercise prescription to increase physical activity behaviour and increase exercise self-efficacy in a cohort of 30 participants recruited from the Clinic. Individual interviews with a cohort of the participants were then undertaken in an effort to understand the benefits and limitations of the intervention from the participants’ perspective. Results: From the initial cohort 37% did not meet World Health Organization guidelines for weekly physical activity. This group demonstrated higher rates of hypertension, type 2 diabetes and obesity, and higher levels of sedentary behaviour. Low motivation and pain were the main barriers to activity in those not meeting the physical activity guidelines; 91% reported wanting to be more active. Text messaging was considered an acceptable form of motivation by end-users. The feasibility study showed that text messages offered the potential to support the uptake of physical activity in adults with OSA. Conclusion: Low levels of physical activity represent an additional risk factor in those at risk of OSA. In our study, although there was recognition of the benefits of being active, lack of motivation was a barrier. A physical activity intervention using telehealth as a motivational component offers a potentially feasible method of supporting physical activity behaviour change in adults with OSA. Addressing lifestyle factors in this population offers a previously unmet need, which could contribute to reducing associated health risks.
Advisor: Skinner, Margot; Waters, Debra; Brockway, Ben
Degree Name: Doctor of Philosophy
Degree Discipline: School of Physiotherapy
Publisher: University of Otago
Keywords: Physiotherapy; Physical activity; Obstructive sleep apnoea; Behaviour change; Motivation; Telehealth
Research Type: Thesis