Using goal setting, self-monitoring, and feedback to increase calorie expenditure in obese adults

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.

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.

Using heart rate as a physical activity metric

Physical activity (PA) is critical for a healthy lifestyle. The current study assessed heart rate (HR) as a primary measure of moderate and vigorous PA with four typically developing children. First, individualized HR assessments were conducted to determine moderate and vigorous HR zones. Next, participants engaged in various exercises at a local YMCA facility (i.e., biking, elliptical, basketball, and exergame boxing) to determine how HR during these activities aligned with their individualized HR zones. During exercise bouts, HR was typically above moderate, but below vigorous HR zones for all participants. Additionally, exercises that restricted range of motion (i.e., biking and elliptical) engendered generally lower HR than exercises with greater range of motion. Vocal instructions to exercise at vigorous levels were effective at increasing HR to vigorous levels for one participant. The advantages of using HR as a metric of PA during assessment and intervention are discussed.

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.

Prevention of Cardiovascular Disease

Cardiovascular disease remains the leading cause of death in the United States and worldwide. Prevention of cardiovascular disease is an achievable goal. A rigorous 2010 analysis by the World Health Organization suggests that reducing risk factors in young adults and maintaining an optimum risk profile through age 50 could prevent 90% of atherosclerotic cardiovascular disease events. Misinformation and poor implementation of proven preventive strategies, misplaced fears of medications, or incorrect understanding of ideal dietary and lifestyle choices all contribute to poor risk profiles. Every patient deserves an individualized prescription for cardiovascular disease prevention incorporating strategies to control modifiable cardiovascular risk factors.

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.

Recommended Dietary Pattern to Achieve Adherence to the American Heart Association/American College of Cardiology (AHA/ACC) Guidelines: A Scientific Statement From the American Heart Association

In 2013, the American Heart Association and American College of Cardiology published the “Guideline on Lifestyle Management to Reduce Cardiovascular Risk,” which was based on a systematic review originally initiated by the National Heart, Lung, and Blood Institute. The guideline supports the American Heart Association’s 2020 Strategic Impact Goals for cardiovascular health promotion and disease reduction by providing more specific details for adopting evidence-based diet and lifestyle behaviors to achieve those goals. In addition, the 2015–2020 Dietary Guidelines for Americans issued updated evidence relevant to reducing cardiovascular risk and provided additional recommendations for adopting healthy diet and lifestyle approaches. This scientific statement, intended for healthcare providers, summarizes relevant scientific and translational evidence and offers practical tips, tools, and dietary approaches to help patients/clients adapt these guidelines according to their sociocultural, economic, and taste preferences.

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.

Goal setting as a health behavior change strategy in overweight and obese adults: a systematic literature review examining intervention components

OBJECTIVE

This paper describes goal setting components used for behavior change specific to diet and physical activity in community-based interventions targeting overweight and obese adults.

METHODS

A systematic literature review was conducted. Studies were evaluated using the S.T.A.R.T. (Specificity, Timing, Acquisition, Rewards and feedback, and Tools) criteria which were developed for the purposes of this paper in order to elucidate which intervention features elicit optimal health behavior outcomes.

RESULTS

Eighteen studies were included. Based on the S.T.A.R.T. criteria, it was determined that developing specific goals that are in close proximity, involve the participant in acquisition, and incorporate regular feedback, are common features in this context.

CONCLUSION

Goal setting can be useful for effecting health behavior changes in this population. However, as different intervention components were often implemented concurrently (e.g., education sessions, self-monitoring records), it was not possible to ascertain which were responsible for positive changes independently.

PRACTICE IMPLICATIONS

Goal setting shows promise as a tool that can be incorporated into weight reduction programs by health care professionals and researchers. Studies are warranted to identify the specific mechanisms through which individuals with overweight or obesity can apply the S.T.A.R.T. criteria with respect to goal setting for the purposes of weight loss.

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.