Pilot study testing the effects of a multicomponent intervention for increasing moderate-intensity physical exercise

Physical inactivity has been associated with several health problems, including diabetes, obesity, and heart disease. Although many of these health problems are preventable through regular exercise, a small percentage of the adult population engages in the recommended levels. Reinforcement-based interventions have been implemented successfully to promote physical activity, but studies targeting moderate or vigorous physical exercise using behavior-analytic interventions are scarce. The purpose of the current study was to investigate the feasibility of a multicomponent intervention that provided monetary incentives for increasing running, jogging, or brisk walking distance for five adults. The intervention lasted 6 weeks and comprised weekly goal setting, feedback, public posting, and group contingencies. The results of the study suggest that the intervention may be feasible and effective at increasing moderate physical activity to levels recommended by the federal guidelines, but further research is warranted.

Increasing selection of and engagement in physical activity in children with autism spectrum disorder

Children with autism spectrum disorder (ASD) engage in reduced levels of physical activity relative to neurotypical children. Researchers conducted 2 studies to 1) evaluate the influence of the number of physical activity options and effort on choice and 2) develop a token-based intervention to increase physical activity engagement and evaluate whether the opportunity to access the intervention supported responding similar to physical or sedentary activity alone. Four children with ASD participated. Additional physical activity options alone did not increase physical activity selection, but increased effort reduced selection of sedentary activity. Tokens increased physical activity for 2 participants. A combination of physical and sedentary activities maintained as much as or more responding than either activity in isolation for all participants. Limitations and potential areas of future research on choice and physical activity are discussed.

Parents Are People Too: Implementing Empirically Based Strategies During Daily Interactions

The outcomes of the COVID-19 pandemic have resulted in decision-making related to in-person versus remote behavior-analytic service delivery. For those service providers who shifted from delivering in-person therapy to remote consultation, parents have presumably, at least at times, assumed a role similar to a registered behavior technician (RBT). We suggest that behavior analysts recommend two empirically based strategies to parents that they could incorporate into their daily lives during service disruptions: environmental enrichment and differential reinforcement of alternative behavior. We provide examples of naturally occurring contexts during which parents could integrate these procedures: (1) self-care or daily living activities, (2) physical activity, and (3) preferred learning activities. We support selecting these strategies and their application during exemplar contexts under the premise that they do not result in additional time expenditure, afford parents opportunities to complete essential (household, work-related, or personal) tasks, and still result in therapeutic gains.

Leveraging applied behavior analysis research and practice in the service of public health

Human behavior plays a central role in all domains of public health. Applied behavior analysis (ABA) research and practice can contribute to public health solutions that directly address human behavior. In this paper, we describe the field of public health, identify points of interaction between public health and ABA, summarize what ABA research has already contributed, and provide several recommendations for how ABA research and practice could continue to promote public health outcomes. A clearer focus on behavior and widespread adoption of research designs and interventions informed by the ABA literature could lead to better public health outcomes. Reciprocally, better integration of public health goals and strategies into ABA research, harnessing of technology, and more collaboration would help diversify and disseminate our applied science and could yield more effective and scalable interventions to prevent and treat public health problems.

Behavior-Analytic Approaches to the Management of Diabetes Mellitus: Current Status and Future Directions

Diabetes mellitus is the seventh leading cause of death in the United States, requiring a series of complex behavior changes that must be sustained for a lifetime (e.g., counting carbohydrates, self-monitoring blood glucose, adjusting insulin). Although complex, all of these tasks involve behavior, making them amenable targets for behavior analysts. In this article, the authors describe interventions that have focused on antecedent, consequent, multicomponent, and alternate procedures for the management of diabetes, highlighting ways in which technology has been used to overcome common barriers to the use of these intensive, evidence-based interventions. Additional variables relevant to poorly managed diabetes (e.g., delay discounting) are also discussed. Future research and practice should focus on harnessing continued advances in information technology while also considering underexplored behavioral technologies for the effective treatment of diabetes, with a focus on identifying sustainable, long-term solutions for maintaining proper diabetes management. Practical implementation of these interventions will depend on having qualified behavior analysts working in integrated primary care settings where the interventions are most likely to be used, which will require interdisciplinary training and collaboration.

The Use of Self-Monitoring and Technology to Increase Physical Activity: A Review of the Literature

The current obesity epidemic and inactive lifestyles of many Americans lead to health problems for millions of Americans and in turn, millions of dollars in medical bills. One aspect of this problem is the lack of physical activity that people engage in. Self-monitoring techniques have been used in the past to increase physical activity. However, there has not been a systematic review of the literature on this research to date. Furthermore, as technology that is user-friendly and assists in self-monitoring physical activity becomes more available to the public, it is important to investigate its use when used in conjunction with self-monitoring. The purpose of this review was to determine how self-monitoring techniques and technology have been applied to increase physical activity across multiple populations. A systematic review of the literature identified 19 articles. Results indicated that the majority of studies used more than one type of self-monitoring intervention. The most popular type of technology used with self-monitoring were fitness trackers. Future research should continue to examine the most effective methodologies that produce lasting behavior change in physical activity.

Branching Out: Finding Success in New Areas of Practice

In recent years, researchers and practitioners in behavior analysis have called for expanding the application of the science to new, socially relevant areas. The authors of this article work in the areas of applied animal behavior and organizational behavior management, and we are often asked for guidance and mentoring to help behavior analysts transition into our domains. Here, we offer actionable guidance for bridging the gap between behavior analysis graduate training and career paths that are not yet common for behavior analysts. Working in new practice areas involves a great deal of problem solving without much support. Thus, obtaining high-quality, in-depth training in behavior analysis is essential. We recommend building competence in a new area of practice by finding a mentor or community of practice and then seeking paid employment in that area as soon as possible. Finally, when one begins to work in a new area, it is essential to be realistic and humble. We offer practical advice for implementing each of these suggestions.

Behavioral Approaches to Weight Management for Health and Wellness

Obesity has become a public health crisis associated with serious health problems. It is a problem that is, by and large, remarkably simple: you gain weight as a result of consuming more calories than you burn. Applied behavior analysis and behavior therapy have produced a range of methods and technologies well-suited to address the problems of overeating and physical inactivity. These methods and technologies, and the conceptual foundations underpinning them, are the focus of this article.

Goal-setting And Achievement In Activity Tracking Apps: A Case Study Of MyFitnessPal

Activity tracking apps often make use of goals as one of their core motivational tools. There are two critical components to this tool: setting a goal, and subsequently achieving that goal. Despite its crucial role in how a number of prominent self-tracking apps function, there has been relatively little investigation of the goal-setting and achievement aspects of self-tracking apps.

Here we explore this issue, investigating a particular goal setting and achievement process that is extensive, recorded, and crucial for both the app and its users’ success: weight loss goals in MyFitnessPal. We present a large-scale study of 1.4 million users and weight loss goals, allowing for an unprecedented detailed view of how people set and achieve their goals. We find that, even for difficult long-term goals, behavior within the first 7 days predicts those who ultimately achieve their goals, that is, those who lose at least as much weight as they set out to, and those who do not. For instance, high amounts of early weight loss, which some researchers have classified as unsustainable, leads to higher goal achievement rates. We also show that early food intake, self-monitoring motivation, and attitude towards the goal are important factors. We then show that we can use our findings to predict goal achievement with an accuracy of 79% ROC AUC just 7 days after a goal is set. Finally, we discuss how our findings could inform steps to improve goal achievement in self-tracking apps.

Dietary Intake and Physical Activity Assessment: Current Tools, Techniques, and Technologies for Use in Adult Populations

Accurate assessment of dietary intake and physical activity is a vital component for quality research in public health, nutrition, and exercise science. However, accurate and consistent methodology for the assessment of these components remains a major challenge. Classic methods use self-report to capture dietary intake and physical activity in healthy adult populations. However, these tools, such as questionnaires or food and activity records and recalls, have been shown to underestimate energy intake and expenditure as compared with direct measures like doubly labeled water. This paper summarizes recent technological advancements, such as remote sensing devices, digital photography, and multisensor devices, which have the potential to improve the assessment of dietary intake and physical activity in free-living adults. This review will provide researchers with emerging evidence in support of these technologies, as well as a quick reference for selecting the "right-sized" assessment method based on study design, target population, outcome variables of interest, and economic and time considerations.

THEME INFORMATION

This article is part of a theme issue entitled Innovative Tools for Assessing Diet and Physical Activity for Health Promotion, which is sponsored by the North American branch of the International Life Sciences Institute.

Data presentation options to manage variability in physical activity research

This paper presents seven tactics for managing the variability evident in some physical activity data. High levels of variability in daily step-count data from pedometers or accelerometers can make typical visual inspection difficult. Therefore, the purpose of the current paper is to discuss several strategies that might facilitate the visual interpretation of highly variable data. The seven strategies discussed in this paper are phase mean and median lines, daily average per week, weekly cumulative, proportion of baseline, 7-day moving average, change point detection, and confidence intervals. We apply each strategy to a data set and discuss the advantages and disadvantages.

Behavior Change with Fitness Technology in Sedentary Adults: A Review of the Evidence for Increasing Physical Activity

Physical activity is closely linked with health and well-being; however, many Americans do not engage in regular exercise. Older adults and those with low socioeconomic status are especially at risk for poor health, largely due to their sedentary lifestyles. Fitness technology, including trackers and smartphone applications (apps), has become increasingly popular for measuring and encouraging physical activity in recent years. However, many questions remain regarding the effectiveness of this technology for promoting behavior change. Behavior change techniques such as goal setting, feedback, rewards, and social factors are often included in fitness technology. However, it is not clear which components are most effective and which are actually being used by consumers. We discuss additional strategies not typically included in fitness technology devices or apps that are promising for engaging inactive, vulnerable populations. These include action planning, restructuring negative attitudes, enhancing environmental conditions, and identifying other barriers to regular physical activity. We consider which strategies are most conducive to motivating behavior change among sedentary adults. Overall, fitness technology has the potential to significantly impact public health, research, and policies. We suggest ways in which app developers and behavior change experts can collaborate to develop successful apps. Advances are still needed to help inactive individuals determine how, when, where, and with whom they can increase their physical activity.

Dutch Young Adults Ratings of Behavior Change Techniques Applied in Mobile Phone Apps to Promote Physical Activity: A Cross-Sectional Survey

Background

Interventions delivered through new device technology, including mobile phone apps, appear to be an effective method to reach young adults. Previous research indicates that self-efficacy and social support for physical activity and self-regulation behavior change techniques (BCT), such as goal setting, feedback, and self-monitoring, are important for promoting physical activity; however, little is known about evaluations by the target population of BCTs applied to physical activity apps and whether these preferences are associated with individual personality characteristics.

Objective

This study aimed to explore young adults’ opinions regarding BCTs (including self-regulation techniques) applied in mobile phone physical activity apps, and to examine associations between personality characteristics and ratings of BCTs applied in physical activity apps.

Methods

We conducted a cross-sectional online survey among healthy 18 to 30-year-old adults (N=179). Data on participants’ gender, age, height, weight, current education level, living situation, mobile phone use, personality traits, exercise self-efficacy, exercise self-identity, total physical activity level, and whether participants met Dutch physical activity guidelines were collected. Items for rating BCTs applied in physical activity apps were selected from a hierarchical taxonomy for BCTs, and were clustered into three BCT categories according to factor analysis: “goal setting and goal reviewing,” “feedback and self-monitoring,” and “social support and social comparison.”

Results

Most participants were female (n=146), highly educated (n=169), physically active, and had high levels of self-efficacy. In general, we observed high ratings of BCTs aimed to increase “goal setting and goal reviewing” and “feedback and self-monitoring,” but not for BCTs addressing “social support and social comparison.” Only 3 (out of 16 tested) significant associations between personality characteristics and BCTs were observed: “agreeableness” was related to more positive ratings of BCTs addressing “goal setting and goal reviewing” (OR 1.61, 95% CI 1.06-2.41), “neuroticism” was related to BCTs addressing “feedback and self-monitoring” (OR 0.76, 95% CI 0.58-1.00), and “exercise self-efficacy” was related to a high rating of BCTs addressing “feedback and self-monitoring” (OR 1.06, 95% CI 1.02-1.11). No associations were observed between personality characteristics (ie, personality, exercise self-efficacy, exercise self-identity) and participants’ ratings of BCTs addressing “social support and social comparison.”

Conclusions

Young Dutch physically active adults rate self-regulation techniques as most positive and techniques addressing social support as less positive among mobile phone apps that aim to promote physical activity. Such ratings of BCTs differ according to personality traits and exercise self-efficacy. Future research should focus on which behavior change techniques in app-based interventions are most effective to increase physical activity.

The Walking Interventions Through Texting (WalkIT) Trial: Rationale, Design, and Protocol for a Factorial Randomized Controlled Trial of Adaptive Interventions for Overweight and Obese, Inactive Adults

BACKGROUND

Walking is a widely accepted and frequently targeted health promotion approach to increase physical activity (PA). Interventions to increase PA have produced only small improvements. Stronger and more potent behavioral intervention components are needed to increase time spent in PA, improve cardiometabolic risk markers, and optimize health.

OBJECTIVE

Our aim is to present the rationale and methods from the WalkIT Trial, a 4-month factorial randomized controlled trial (RCT) in inactive, overweight/obese adults. The main purpose of the study was to evaluate whether intensive adaptive components result in greater improvements to adults' PA compared to the static intervention components.

METHODS

Participants enrolled in a 2x2 factorial RCT and were assigned to one of four semi-automated, text message-based walking interventions. Experimental components included adaptive versus static steps/day goals, and immediate versus delayed reinforcement. Principles of percentile shaping and behavioral economics were used to operationalize experimental components. A Fitbit Zip measured the main outcome: participants' daily physical activity (steps and cadence) over the 4-month duration of the study. Secondary outcomes included self-reported PA, psychosocial outcomes, aerobic fitness, and cardiorespiratory risk factors assessed pre/post in a laboratory setting. Participants were recruited through email listservs and websites affiliated with the university campus, community businesses and local government, social groups, and social media advertising.

RESULTS

This study has completed data collection as of December 2014, but data cleaning and preliminary analyses are still in progress. We expect to complete analysis of the main outcomes in late 2015 to early 2016.

CONCLUSIONS

The Walking Interventions through Texting (WalkIT) Trial will further the understanding of theory-based intervention components to increase the PA of men and women who are healthy, insufficiently active and are overweight or obese. WalkIT is one of the first studies focusing on the individual components of combined goal setting and reward structures in a factorial design to increase walking. The trial is expected to produce results useful to future research interventions and perhaps industry initiatives, primarily focused on mHealth, goal setting, and those looking to promote behavior change through performance-based incentives.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02053259; https://clinicaltrials.gov/ct2/show/NCT02053259 (Archived by WebCite at http://www.webcitation.org/6b65xLvmg).

Increasing physical activity of children during school recess

Physical activity is crucial for children's health. Fitbit accelerometers were used to measure steps of 6 elementary students during recess. The intervention included reinforcement, self-monitoring, goal setting, and feedback. Steps taken during the intervention phase (M = 1,956 steps) were 47% higher than in baseline (M = 1,326 steps), and the percentage of recess spent in moderate-to-vigorous physical activity was higher during intervention (M = 25%) than in baseline (M = 4%). These methods successfully increased steps during recess and could be used to increase steps in other settings.

The current state of physical activity assessment tools

Physical activity (PA) is a behavior that involves bodily movements resulting in energy expenditure. When assessing PA, the goal is to identify the frequency, duration, intensity, and types of behaviors performed during a period of time. Self-report measures of PA include administration of questionnaires and completion of detailed diaries and/or brief logs. Direct measures include motion sensors such as accelerometers, pedometers, heart-rate monitors, and multiple-sensor devices. The PA assessment period can range from a few hours to a lifetime depending on the tools used. Considerations when selecting a PA tool should include the literacy requirements of a tool, the purpose for assessing PA, the recall or time period to measure, the validity evidence of an assessment tool for the populations measured, and the generalizability of the results to diverse populations.

Maintaining high activity levels in sedentary adults with a reinforcement-thinning schedule

Physical inactivity is a leading cause of mortality. Reinforcement interventions appear to be useful for increasing activity and preventing adverse consequences of sedentary lifestyles. This study evaluated a reinforcement-thinning schedule for maintaining high activity levels. Sedentary adults (N = 77) were given pedometers and encouraged to walk ≥10,000 steps per day. Initially, all participants earned rewards for each day they walked ≥10,000 steps. Subsequently, 61 participants were randomized to a monitoring-only condition or a monitoring-plus-reinforcement-thinning condition, in which frequencies of monitoring and reinforcing walking decreased over 12 weeks. The mean (± SD) percentage of participants in the monitoring-plus-reinforcement-thinning condition who met walking goals was 83% ± 24% and was 55% ± 31% for participants in the monitoring-only condition, p < .001. Thus, monitoring plus reinforcement thinning maintained high rates of walking when it was in effect; however, groups did not differ at a 24-week follow-up. Monitoring plus reinforcement thinning, nevertheless, hold potential to extend benefits of reinforcement interventions at low costs.

Preliminary efficacy of prize-based contingency management to increase activity levels in healthy adults

An estimated 30% of Americans meet the criteria for obesity. Effective, low-cost interventions to increase physical activity are needed to prevent and treat obesity. In this study, 11 healthy adults wore Fitbit accelerometers for 3 weeks. During the initial baseline, subjects earned prize draws for wearing the Fitbit. During intervention, percentile schedules were used to calculate individual prize-draw criteria. The final week was a return to baseline. Four subjects increased step counts as a result of the intervention. A bout analysis of interresponse times revealed that subjects increased overall step counts by increasing daily minutes active and within-bout response rates and decreasing pauses between bouts of activity. Strategies to improve effectiveness are suggested, such as modification of reinforcement probability and amount and identification of the function of periods of inactivity.

Assessing and increasing physical activity

Increasing physical activity is a crucial component of any comprehensive approach to combat the growing obesity epidemic. This review summarizes recent behavioral research on the measurement of physical activity and interventions aimed at increasing physical activity and provides directions for future research.

Behavioral assessment of physical activity in obese preschool children

We measured changes in physical activity in 2 obese preschool children when a package intervention was evaluated in a reversal design. Physical activity was measured via direct observation and pedometers. Although the intervention produced only modest increases in activity, the results provide preliminary concurrent validation for the dependent measures used, in that the two measures covaried and a similar degree of change was observed with each across baseline and intervention phases.