Editor's Choice: Dual-process model of older adults' sedentary behavior: an ecological momentary assessment study

Automatic processes moderate the association between reflective processes and movement behavior: A cross-sectional study

Dual-process theories postulate that both reflective and automatic processes regulate health behavior. Further research is required to test the basic postulates of dual-process theories. We investigated the direct associations and moderating effect between automatic processes and multiple indicators of reflective processes on various levels of physical activity and sedentary behavior assessed using accelerometry in adults who were not participating in regular physical exercise programs. This cross-sectional study included 257 adults. Each participant completed a computerized test for automatic associations, a set of questions assessing reflective processes, a seven-day assessment using accelerometers to determine their levels of physical activity and sedentary behavior. The results showed a direct relationship between perceived benefits (B = 15.90, p = 0.043), perceived cons (B = -12.81, p = 0.034), decisional intention (B = -0.07, p = 0.049) with light physical activity, and self-efficacy with daily steps (B = 485.71, p = 0.008). There was a positive association between intention strength and daily steps when implicit associations favored physical activity (b = 623.36, LLCI = 79.09, ULCI = 1167.62, p = 0.025); a negative association between self-efficacy and sedentary behavior when implicit associations favored sedentary behavior (b = -25.73, LLCI = -49.77, ULCI = -1.70, p = 0.035); and a positive association between intention strength and sedentary behavior when implicit associations favored physical activity (b = 34.18, LLCI = 8.81, ULCI = 59.56, p = 0.008). These findings underscore the importance of considering the interplay between reflective and automatic processes in shaping movement behavior.

Sitting vs. standing: an urgent need to rebalance our world

During their activities of daily living, humans run, walk, stand, sit and lie down. Recent changes in our environment have favored sedentary behavior over more physically active behavior to such a degree that our health is in danger. Here, we sought to address the problem of excessive time spent seated from various theoretical viewpoints, including postural control, human factors engineering, human history and health psychology. If nothing is done now, the high prevalence of sitting will continue to increase. We make a case for the standing position by demonstrating that spending more time upright can mitigate the physiological and psychological problems associated with excessive sitting without lowering task performance and productivity. The psychological literature even highlights potential benefits of performing certain tasks in the standing position. We propose a number of recommendations on spending more time (but not too much) in the standing position and on more active, nonambulatory behaviors. There is a need to inform people about (i) harmful consequences of excessive sitting and (ii) benefits of spending more time performing active, nonambulatory behaviors. One clear benefit is to reduce detrimental health consequences of excessive sitting and to provide potential additional benefits in terms of productivity and performance.

Why do people sit? A framework for targeted behavior change

To improve health and wellbeing, it is crucial that people regularly interrupt their sitting. In this paper, we propose a framework for examining and changing sitting behavior that addresses two key steps in the process towards developing effective interventions. First, we suggest that research should move away from its current focus on sitting time, which is an outcome of behavior. Rather, researchers should focus on stand-to-sit and sit-to-stand transitions, which are discrete units of behavior. Second, drawing on goal hierarchy models, we suggest that people rarely engage in stand-to-sit and sit-to-stand transitions for the purpose of being in a sitting or standing position; rather, we suggest that these transitions are means to higher-order goals (e.g., to complete work tasks, to watch television, to eat dinner). To improve adherence to and effectiveness of sitting behavior interventions, intervention designers should aim to increase the frequency of sit-to-stand (and stand-to-sit) transitions. To achieve this aim, intervention designers should capitalize on the higher-order goals that are typically served by these transitions. We suggest four concrete intervention strategies to increase sit-to-stand transitions in congruence with people's everyday goals. We also describe the implications of our framework for theory and methods in sitting behavior research.

Within-person association of volitional factors and physical activity: Insights from an ecological momentary assessment study

OBJECTIVE

Current health behavior models of physical activity (PA) suggest that not all PA intentions are translated into actual PA behavior, resulting in a significant intention-behavior gap (IBG) of almost 50%. These models further suggest that higher self-efficacy and specific planning can aid in decreasing this gap. However, as most evidence stems from between-person (trait level), questionnaire-based research, it is unclear how large short-term IBGs are, how self-efficacy and planning covary within-persons across time and whether they similarly predict smaller IBGs. It is likely that day-to-day changes in circumstances and barriers affect these variables thus the applicability of theoretical models is uncertain. Here, within-person prospective analyses of ecological momentary assessment (EMA) data can provide insights.

METHODS

35 healthy participants (aged 23-67) completed four EMA-based questionnaires every day for three weeks. Each prompt assessed PA (retrospectively, "since the last EMA prompt"); PA intentions, planning specificity, self-efficacy, and intrinsic motivation (prospectively, "until the next EMA prompt") and momentary affect. Generalized logistic mixed-effect modeling was used to test predictors of PA.

RESULTS

Across the 2341 answered EMA prompts, PA intentions were not enacted in 25% of the episodes (IBG). In episodes with given intentions, PA likelihood increased with higher levels of self-efficacy, planning specificity, and intrinsic motivation. The latter two also positively predicted PA duration and intensity.

CONCLUSIONS

Short-term intention behavior gaps seem to be smaller than what is known from more long-term studies, most likely as individuals can anticipate the actual circumstances of PA. Further, current health behavior models show validity in explaining within-person dynamics in IBGs across time. Knowing the relevance of planning specificity, self-efficacy and intrinsic motivation for day-to-day variations in PA enactment can inform respective real-time mHealth interventions for facilitating PA.

Studying Movement-Related Behavioral Maintenance and Adoption in Real Time: Protocol for an Intensive Ecological Momentary Assessment Study Among Older Adults

BACKGROUND

Older adults struggle to maintain newly initiated levels of physical activity (PA) or sedentary behavior (SB) and often regress to baseline levels over time. This is partly because health behavior theories that inform interventions rarely address how the changing contexts of daily life influence the processes regulating PA and SB or how those processes differ across the behavior change continuum. Few studies have focused on motivational processes that regulate the dynamic nature of PA and SB adoption and maintenance on microtimescales (ie, across minutes, hours, or days).

OBJECTIVE

The overarching goal of Project Studying Maintenance and Adoption in Real Time (SMART) is to determine the motivational processes that regulate behavioral adoption versus maintenance over microtimescales, using a dual process framework combined with ecological momentary assessment and sensor-based monitoring of behavior. This paper describes the recruitment, enrollment, data collection, and analytics protocols for Project SMART.

METHODS

In Project SMART, older adults engaging in at least 30 minutes of moderate-to-vigorous intensity PA per week complete 3 data collection periods over 1 year, with each data collection period lasting 14 days. Across each data collection period, participants wear an ActiGraph GT3X accelerometer (ActiGraph, LLC) on their nondominant waist and an ActivPAL micro4 accelerometer (PAL Technologies, Ltd) on their anterior thigh to measure PA and SB, respectively. Ecological momentary assessment questionnaires are randomly delivered via smartphone 10 times per day on 4 selected days in each data collection period and assess reflective processes (eg, evaluating one's efficacy and exerting self-control) and reactive processes (eg, contextual cues) within the dual process framework. At the beginning and end of each data collection period, participants complete a computer-based questionnaire to learn more about their typical motivation for PA and SB, physical and mental health, and life events over the course of the study.

RESULTS

Recruitment and enrollment began in January 2021; enrollment in the first data collection period was completed by February 2022; and all participants completed their second and third data collection by July 2022 and December 2022, respectively. Data were collected from 202 older adults during the first data collection period, with approximate retention rates of 90.1% (n=182) during the second data collection period and 88.1% (n=178) during the third data collection period. Multilevel models and mixed-effects location scale modeling will be used to evaluate the study aims.

CONCLUSIONS

Project SMART seeks to predict and model the adoption and maintenance of optimal levels of PA and SB among older adults. In turn, this will inform the future delivery of personalized intervention content under conditions where the content will be most effective to promote sustained behavior change among older adults.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/47320.

Combining Behavioral Economics-Based Incentives With the Anchoring Strategy: Protocol for a Randomized Controlled Trial

BACKGROUND

Chronic (ie, long-term) elevated stress is associated with a number of mental and physical health conditions. Mindfulness meditation mobile apps are a promising tool for stress self-management that can overcome several barriers associated with in-person interventions; however, to date, poor app-based intervention adherence has limited the efficacy of these mobile health tools. Anchoring, or pairing, a new behavior with an existing routine has been shown to effectively establish habits that are maintained over time, but this strategy typically only works for those with high initial motivation and has yet to be tested for maintaining meditation with a mobile app.

OBJECTIVE

This study will test novel combinations of behavioral economics-based incentives with the anchoring strategy for establishing and maintaining adherence to an effective dose of meditation with a mobile app.

METHODS

This 16-week study will use a 5-arm, parallel, partially blinded (participants only), randomized controlled design. We will implement a fractional factorial study design that varies the use of self-monitoring messages and financial incentives to support participants' use of their personalized anchoring strategy for maintaining adherence to a ≥10 minute-per-day meditation prescription during an 8-week intervention period, followed by an 8-week postintervention observation period. Specifically, we will vary the use of self-monitoring messages of either the target behavior (ie, meditation tracking) or the outcome associated with the target behavior (ie, mood symptom tracking). We will also vary the use of financial incentives conditional on either meditation at any time of day or meditation performed at approximately the same time of day as participants' personalized anchors.

RESULTS

Continuous meditation app use data will be used to measure weekly meditation adherence over the 16-week study period as a binary variable equal to 1 if participants complete ≥10 minutes of meditation for ≥4 days per week and 0 otherwise. We will measure weekly anchoring plan adherence as a binary variable equal to 1 if participants complete ≥10 minutes of meditation within +1 or -1 hour of the timing of their chosen anchor on ≥4 days per week and 0 otherwise. In addition to these primary measures of meditation and anchoring plan adherence, we will also assess the secondary measures of stress, anxiety, posttraumatic stress disorder, sleep disturbance, and meditation app habit strength at baseline, week 8, and week 16.

CONCLUSIONS

This study will fill an important gap in the mobile health literature by testing novel intervention approaches for establishing and maintaining adherence to app-based mindfulness meditation. If successful, this study will identify an accessible and scalable stress self-management intervention that can help combat stress in the United States.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05217602; https://clinicaltrials.gov/ct2/show/NCT05217602.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/39930.

Associations Between Social Cognitive Determinants and Movement-Related Behaviors in Studies using Ecological Momentary Assessment Methods: A Systematic Review (Preprint)

BACKGROUND

The social cognitive framework is a long-standing framework within physical activity promotion literature to explain and predict movement-related behaviors. However, applications of the social cognitive framework to explain and predict movement-related behaviors have typically examined the relationships between determinants and behavior across macrotimescales (eg, weeks and months). There is more recent evidence suggesting that movement-related behaviors and their social cognitive determinants (eg, self-efficacy and intentions) change across microtimescales (eg, hours and days). Therefore, efforts have been devoted to examining the relationship between social cognitive determinants and movement-related behaviors across microtimescales. Ecological momentary assessment (EMA) is a growing methodology that can capture movement-related behaviors and social cognitive determinants as they change across microtimescales.

OBJECTIVE

The objective of this systematic review was to summarize evidence from EMA studies examining associations between social cognitive determinants and movement-related behaviors (ie, physical activity and sedentary behavior).

METHODS

Studies were included if they quantitatively tested such an association at the momentary or day level and excluded if they were an active intervention. Using keyword searches, articles were identified across the PubMed, SPORTDiscus, and PsycINFO databases. Articles were first assessed through abstract and title screening followed by full-text review. Each article was screened independently by 2 reviewers. For eligible articles, data regarding study design, associations between social cognitive determinants and movement-related behaviors, and study quality (ie, Methodological Quality Questionnaire and Checklist for Reporting Ecological Momentary Assessment Studies) were extracted. At least 4 articles were required to draw a conclusion regarding the overall associations between a social cognitive determinant and movement-related behavior. For the social cognitive determinants in which a conclusion regarding an overall association could be drawn, 60% of the articles needed to document a similar association (ie, positive, negative, or null) to conclude that the association existed in a particular direction.

RESULTS

A total of 24 articles including 1891 participants were eligible for the review. At the day level, intentions and self-efficacy were positively associated with physical activity. No other associations could be determined because of conflicting findings or the small number of studies investigating associations.

CONCLUSIONS

Future research would benefit from validating EMA assessments of social cognitive determinants and systematically investigating associations across different operationalizations of key constructs. Despite the only recent emergence of EMA to understand social cognitive determinants of movement-related behaviors, the findings indicate that daily intentions and self-efficacy play an important role in regulating physical activity in everyday life.

TRIAL REGISTRATION

PROSPERO CRD42022328500; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=328500.

Bidirectional Associations Between Physical Activity and Pain Among Older Adults: An Ecological Momentary Assessment Study

This paper examines the within-day, bidirectional associations between physical activity and self-reported pain among older adults. Older adults (N = 104; range: 60-98 years) participated in a 10-day Ecological Momentary Assessment (EMA) study. Participants received six EMA prompts/day with a single item assessing pain. Participants wore an activPAL monitor measuring step counts. At the within-person level, on occasions when participants took more steps than usual in the 30 min before the EMA prompt, they were more likely to experience pain at the prompt (β^02=0.0003, p < .03). At the between-person level, greater step counts in the 30 min before the EMA prompt, on average, were associated with less pain on occasions when pain was experienced (β^01=-0.0005, p < .04). Pain was not related to subsequent stepping. Bidirectional associations between physical activity and pain were not documented, but physical activity did appear to be related to subsequent pain.

Temporal stability of behavior, temporal cue-behavior associations, and physical activity habit strength among mothers with school-aged children

Objective: PA habits reflect stable, consistent patterns in behaviours that are performed automatically in response to temporal or contextual cues. Mothers face multiple demands and complex schedules related to parenting. This study examined how subject-level mean, variability, and slopes in device-measured moderate-to-vigorous physical activity (MVPA) over three different timescales were associated with mothers' PA habits. Methods and Measures: Mothers (n = 125; Mage=41.4 years) completed six measurement periods across three years. Each measurement period consisted of seven days of accelerometry. MVPA minutes were processed across hours, days, and measurement periods. PA habits were assessed in the last measurement period. Results: Subject-level means of MVPA at all timescales were positively associated with stronger PA habits (βs = 0.42-0.48, ps<.01). Subject-level variability in day-level MVPA was positively associated with habits (β = 0.39, p=.01). Furthermore, mothers who engaged in higher mean day-level MVPA had a more positive association between subject-level variability in day-level MVPA and habit strength compared to mothers with lower mean day-level MVPA overall (β = 0.28, p=.04). Mothers who had steeper increases in MVPA across measurement periods (i.e. subject-level slope) reported stronger habits (β = 0.43; p = 0.03). Conclusion: Flexibly adjusting daily PA levels may be a necessary strategy to maintain habits in the face of parenting demands.

Within-person examination of the exercise intention-behavior gap among women in midlife with elevated cardiovascular disease risk

Engaging in moderate-to-vigorous intensity physical activity (MVPA) is important for protecting cardiovascular health among women in midlife (i.e., ages 40-60), particularly if they have already developed conditions that increase their risk for cardiovascular disease (e.g., hypertension). Although the gap between MVPA intentions and behavior is well documented in other populations, little is known about the intention-behavior gap in this at-risk group - particularly as it plays a role in daily life. The present study employed an ecological momentary assessment design to examine the relation between women's MVPA intentions and behavior in the subsequent 3 hours, as well as momentary moderators of this relation (i.e., affective states and body satisfaction). Surveys sent to women's smartphones 5 times per day for 10 days while they wore ActiGraph GT3X waistband accelerometers. Women achieved their exercise intentions at only 13% of occasions on which they set intentions. Although the most common intended exercise was walking, women engaged in more minutes of MVPA after setting intentions to do yoga or Pilates than any other type of exercise (sr = 0.25). Multilevel models showed a modest within-person relation between minutes of intended MVPA and observed MVPA in the next 3 hours (sr = 0.20). This relation was moderated within-person by the reported extent of positive affect (particularly contentment) and body satisfaction (srs = 0.35 and 0.28, respectively). Findings extend knowledge about the physical activity intention-behavior gap to an at-risk population of women and identify positive affect and body satisfaction as potential contextual influences for this group, which could inform improvements to existing interventions (e.g., delivering intervention content at times with lower-than-usual body satisfaction).

Momentary intentions and perceived behavioral control are within-person predictors of sedentary leisure time: preliminary findings from an ecological momentary assessment study in adolescents

Previous studies among adolescents conceptualize behavioral cognitions [e.g., intentions and perceived behavioral control (PBC)] as stable trait-like factors despite evidence suggesting they vary momentarily. We examined whether intentions and PBC momentarily relate to subsequent sedentary time during non-school periods. Healthy adolescents (N = 15, ages 11-15) reported their intentions and PBC regarding sedentary leisure behaviors via ecological momentary assessment (EMA) up to seven times/day for 14 days. Sedentary time in the two hours following each EMA prompt was measured by ActivPAL accelerometers. When participants reported greater sedentary intentions (within-person β = 1.1, 95% CI 0.2, 2.1, p = 0.0213) and sedentary PBC (within-person β = 1.7, 95% CI 0.6, 2.8, p = 0.0029), they accumulated greater sedentary time. This demonstrates that sedentary intentions and PBC are acutely associated with sedentary time among adolescents. Our findings highlight the potential for implementing just-in-time activity interventions among adolescents during at-risk periods within the day, characterized by deviations from one's usual intentions and PBC levels.

Determinants of Virtual Exercise Equipment Use: An Integrated Model Investigation

BACKGROUND

Given the limited research on behavioral determinants of using virtual exercise machines to engage in exercise during the COVID-19 pandemic, this study applied an integrated behavior change model to identify behavioral determinants using these machines.

METHOD

Adult owners of livestreaming virtual exercise equipment (N = 123) completed measures of social cognition, planning, motivation, virtual exercise machine features, and sociostructural variables at an initial occasion (T1) and 4 weeks later (T2). Hypothesized relations among model constructs were tested using a cross-lagged structural equation model with past behavior and sociostructural variables as covariates.

RESULTS

Autonomous motivation predicted intentions and habit indirectly via attitudes and perceived behavioral control at T1; virtual exercise machine features predicted intention and habit indirectly via social cognition constructs at T1; and intention and habit at T1 predicted exercise behavior at T2.

CONCLUSIONS

This study supports social cognition constructs and virtual features as predictors of exercise using virtual exercise machines.

Dynamics of Loneliness Among Older Adults During the COVID-19 Pandemic: Pilot Study of Ecological Momentary Assessment With Network Analysis

OBJECTIVE

The COVID-19 pandemic has had potentially severe psychological implications for older adults, including those in retirement communities, due to restricted social interactions, but the day-to-day experience of loneliness has received limited study. We sought to investigate sequential association, if any, between loneliness, activity, and affect.

METHODS

We used ecological momentary assessment (EMA) with dynamic network analysis to investigate the affective and behavioral concomitants of loneliness in 22 residents of an independent living sector of a continuing care retirement community (mean age 80.2; range 68-93 years).

RESULTS

Participants completed mean 83.9% of EMA surveys (SD = 16.1%). EMA ratings of loneliness were moderately correlated with UCLA loneliness scale scores. Network models showed that loneliness was contemporaneously associated with negative affect (worried, anxious, restless, irritable). Negative (but not happy or positive) mood tended to be followed by loneliness and then by exercise or outdoor physical activity. Negative affect had significant and high inertia (stability).

CONCLUSIONS

The data suggest that EMA is feasible and acceptable to older adults. EMA-assessed loneliness was moderately associated with scale-assessed loneliness. Network models in these independent living older adults indicated strong links between negative affect and loneliness, but feelings of loneliness were followed by outdoor activity, suggesting adaptive behavior among relatively healthy adults.