Efficacy of theory-based interventions to promote physical activity. A meta-analysis of randomised controlled trials

Comparing positive versus negative intrinsic rewards for predicting physical activity habit strength and frequency during a period of high stress

The experience of positive intrinsic rewards (enjoyment) from physical activity (PA) is known to promote PA habit formation and maintenance. Negative intrinsic rewards (stress reduction) may also be associated with PA habit, particularly during a major stressor and when individual-level anxiety is higher. Multi-level models tested the following hypotheses using weekly survey data from a convenience sample (snowball sampling) of adults (N = 580; 91% White, 77% Female, mean age = 41 years) over the 8 weeks of the first COVID-19 lockdown in the UK: negative intrinsic rewards will be independently and statistically more strongly related to PA habit strength and frequency than positive intrinsic rewards; and, the relationship between negative intrinsic rewards and PA habit strength and frequency will be stronger for those with higher anxiety. Counter to the hypotheses, positive intrinsic rewards were more strongly associated with PA habit strength over time than negative intrinsic rewards (fixed effect = 0.27, p < 0.001 versus fixed effect = -0.05, p = 0.23, respectively), and there was a main effect of anxiety (but no interaction with negative rewards) on PA habit strength (fixed effect = -0.03, p = 0.03). The findings suggest that interventions aimed at increasing and maintaining PA habit strength might best focus on cultivating positive intrinsic rewards (enjoyment) from PA, even in the presence of substantial stressors and individual-level anxiety.

Psychometric evaluation of Liking and Wanting implicit association tests for physical activity and recreational screen use

Interest in the implicit processing of activity behaviors has been growing, but the psychometric properties of its measurement are often overlooked. This study examined the reliability and validity of two implicit association tests (IATs) designed to assess implicit affective and motivational processes. In the first session, 101 college students completed a Liking-IAT, a Wanting-IAT, and a survey on their attitudes and intentions regarding physical activity and sedentary screen-based recreational activities. One week later, participants reported their engagement in these activities, and 34 of them completed the IATs again. The psychometric evaluation revealed high split-half correlation coefficients and significant correlations with behavioral attitudes and intentions for both the IATs, indicating good split-half reliability and convergent validity. The Liking IAT but not the Wanting IAT demonstrated satisfactory test-retest reliability over a one-week interval and predictive potential for weekend physical activity and screen time. Divergence in psychometric performances suggests underlying differences in corresponding implicit processes, highlighting the need for further investigation into the temporal validity, sensitivity to change, and the interplay of various implicit processes.

Developing an Evidence- and Theory-Informed Mother-Daughter mHealth Intervention Prototype Targeting Physical Activity in Preteen Girls of Low Socioeconomic Position: Multiphase Co-Design Study

BACKGROUND

Preteen girls of lower socioeconomic position are at increased risk of physical inactivity. Parental support, particularly from mothers, is positively correlated with girls' physical activity levels. Consequently, family-based interventions are recognized as a promising approach to improve young people's physical activity. However, the effects of these interventions on girls' physical activity are often inconsistent, with calls for more rigorous, theory-informed, and co-designed family-based interventions to promote physical activity in this cohort.

OBJECTIVE

This study aimed to use co-design methods to develop an evidence- and theory-informed mother-daughter mobile health intervention prototype targeting physical activity in preteen girls.

METHODS

The intervention prototype was developed in accordance with the United Kingdom Medical Research Council framework, the Behaviour Change Wheel, the Theoretical Domains Framework, and the Behaviour Change Techniques Ontology. The Behaviour Change Intervention Ontology was also used to annotate the intervention characteristics. The co-design process incorporated three phases: (1) behavioral analysis, (2) the selection of intervention components, and (3) refinement of the intervention prototype. Throughout these phases, workshops were conducted with preteen girls (n=10), mothers of preteen girls (n=9), and primary school teachers (n=6), with additional input from an academic advisory panel.

RESULTS

This 3-phase co-design process resulted in the development of a theory-informed intervention that targeted two behaviors: (1) mothers' engagement in a range of supportive behaviors for their daughters' physical activity and (2) daughters' physical activity behavior. Formative research identified 11 theoretical domains to be targeted as part of the intervention (eg, knowledge, skills, and beliefs about capabilities). These were to be targeted by 6 intervention functions (eg, education, persuasion, and modeling) and 27 behavior change techniques (eg, goal setting and self-monitoring). The co-design process resulted in a mobile app being chosen as the mode of delivery for the intervention.

CONCLUSIONS

This paper offers a comprehensive description and analysis of using co-design methods to develop a mother-daughter mobile health intervention prototype that is ready for feasibility and acceptability testing. The Behaviour Change Wheel, Theoretical Domains Framework, and Behaviour Change Techniques Ontology provided a systematic and transparent theoretical foundation for developing the prototype by enabling the identification of potential pathways for behavior change. Annotating the Behaviour Change Intervention Ontology entities represents the intervention characteristics in a detailed and structured way that supports improved communication, replication, and implementation of interventions.

Uncovering the roles of automatic attitudes and controlled processes in the regulation of physical activity behavior in children

Despite substantial research efforts to increase engagement in physical activity (PA), children are not sufficiently active. Dual-process theories suggest that PA behavior regulation occurs through both controlled (i.e., reflective, conscious) and automatic (i.e., non-reflective, less conscious) processes. Automatic processes depend on affective valuations and attitudes towards PA and have been shown to predict PA behavior. However, their role in PA behavior regulation in children remains unclear. Therefore, the current study investigated the unique association of automatic attitudes towards PA on self-reported seven-day PA recall, after accounting for the effects of known controlled precursors of PA (i.e., explicit attitudes, PA self-efficacy, and PA intentions). In a cross-sectional design, 69 children (age = 10.8 ± 0.6 years) completed the Single-Category Implicit Association Task (SC-IAT) and self-reported measures of PA and controlled precursors of PA. In a hierarchical regression analysis, controlled processes accounted for 28.3 % of the variance in PA behavior. Although the bivariate association between automatic attitudes and PA was not significant, the association between them became significant but negative in the fully adjusted model (b = -1.70; p = 0.025). The fully adjusted model accounted for 35.0 % of the variance in PA. In summary, the findings indicated that both controlled and automatic processes predicted PA in children, although the association with automatic attitudes was not in the expected direction in the adjusted model. Future studies are warranted to further understand the role of automatic processes in the regulation of PA behavior in children.

The effectiveness of digital physical activity interventions in older adults: a systematic umbrella review and meta-meta-analysis

BACKGROUND

Physical activity is important for healthy ageing, however most older adults are inactive. Numerous reviews with a range of inclusion criteria have been conducted on digital interventions to promote physical activity in older adults, and a synthesis of these is needed. Therefore, the objective of this study is to conduct an umbrella review and meta-meta-analysis on the effectiveness of digital interventions to promote physical activity in older adults.

METHODS

Nine databases were searched from January 2010 to December 2023. Systematic reviews and meta-analyses of primary studies using digital physical activity interventions to target healthy older adults or clinical populations of older adults with a self-reported or device measured physical activity outcome were eligible for inclusion.

RESULTS

In total, 22 systematic reviews and meta-analyses covering 185 primary research papers were eligible for inclusion. The total number of participants across all primary studies was 28,198. Most (21, 95%) reviews and meta-analyses were rated as having a low or critically low AMSTAR-2 confidence rating. Of the 22 included systematic reviews, 13 (59%) conducted a meta-analysis and 10 (45%) conducted a narrative synthesis. Most systematic reviews with a narrative synthesis found strong evidence for a positive effect or moderate evidence for a positive effect for physical activity outcomes (7/9, 78%) and steps (3/3, 100%). The meta-meta-analysis of primary papers included in meta-analyses demonstrated a significant moderate effect for steps and a significant small effect for total PA and MVPA. The strength of effect did not vary by intervention components (activity tracker, app-based, SMS/phone, web-based, and face-to-face), population (primary or secondary prevention), control group (none, other digital intervention, or non-digital intervention), or outcome measurement (self-reported or device measured). Only 3 (14%) reviews included longer term follow up outcomes after the end of the intervention, with mixed results.

CONCLUSIONS

Evidence from 22 reviews and meta-analyses suggests that digital physical activity interventions are effective at increasing physical activity in older adults. Further primary research is needed in adults 65 years and over exclusively, and with longer-term follow up of physical activity outcomes. Future reviews should include a published protocol and interpret results according to risk-of-bias.

Behavior change theory and behavior change technique use in cancer rehabilitation interventions: a secondary analysis

BACKGROUND

There is limited evidence depicting ways that behavioral theory and techniques have been incorporated into cancer rehabilitation interventions. Examining their use within cancer rehabilitation interventions may provide insight into the active ingredients that can maximize patient engagement and intervention effectiveness.

AIM

This secondary analysis aimed to describe the use of behavior change theory and behavior change techniques (BCTs) in two previously conducted systematic reviews of cancer rehabilitation interventions.

DESIGN

Secondary analysis of randomized controlled trials (RCTs) drawn from two systematic reviews examining the effect of cancer rehabilitation interventions on function and disability.

SETTING

In-person and remotely delivered rehabilitation interventions.

POPULATION

Adult cancer survivors.

METHODS

Data extraction included: behavior change theory use, functional outcome data, and BCTs using the Behavior Change Technique Taxonomy (BCTTv1). Based on their effects on function, interventions were categorized as "very", "quite" or "non-promising". To assess the relative effectiveness of coded BCTs, a BCT promise ratio was calculated (the ratio of promising to non-promising interventions that included the BCT).

RESULTS

Of 180 eligible RCTs, 25 (14%) reported using a behavior change theory. Fifty-four (58%) of the 93 BCTs were used in least one intervention (range 0-29). Interventions reporting theory use utilized more BCTs (median=7) compared to those with no theory (median=3.5; U=2827.00, P=0.001). The number of BCTs did not differ between the very, quite, and non-promising intervention groups (H(2)=0.24, P=0.85). 20 BCTs were considered promising (promise ratio >2) with goal setting, graded tasks, and social support (unspecified) having the highest promise ratios.

CONCLUSIONS

While there was a wide range of BCTs utilized, they were rarely based on theoretically-proposed pathways and the number of BCTs reported was not related to intervention effectiveness.

CLINICAL REHABILITATION IMPACT

Clinicians should consider basing new interventions upon a relevant behavior change theory. Intentionally incorporating the BCTs of goal setting, graded tasks, and social support may improve intervention efficacy.

Behavior Change Techniques in Physical Activity Interventions Targeting Overweight and Obese Children and Adolescents: A Systematic Review

Substantial evidence globally confirms the benefits of physical activity (PA) interventions for the physical and mental health of overweight and obese children and adolescents. However, current research has yet to determine which behavior change techniques (BCTs) are most effective in PA interventions for this population. This systematic review aims to evaluate the application of BCTs in PA interventions for overweight and obese children and adolescents and to identify the most effective BCTs using the promise ratio. Five electronic databases (PubMed, Embase, Cochrane Central, Web of Science, and PsycINFO) were searched up to 31 May 2024, to identify intervention studies meeting the eligibility criteria for promoting PA in the target population. Thirteen studies were included (nine randomized controlled trials and four quasi-experimental studies). The quality of the included studies was assessed using a revised version of the Cochrane Risk of Bias tool and the Risk of Bias in Non-randomized Studies tool. Among the 24 BCTs implemented, the most frequently applied were goal setting (behavior), instruction on how to perform the behavior, feedback on behavior, and self-monitoring of behavior. Action planning, social support, and material incentives showed the most significant potential to promote PA. These findings provide valuable insights for designing future PA interventions for this group, with the potential to improve health outcomes and enhance PA participation among obese children and adolescents.

Predicting physical activity behavior among university students using the multi-process action control framework

Most university students do not engage in enough physical activity (PA) despite the known physical and mental health benefits. Action control theories such as the Multi-Process Action Control (M-PAC) framework have been proposed to better understand the translation of intentions into action by incorporating post-intentional processes. However, the explanatory power of the M-PAC framework beyond traditional social cognitive constructs has received limited attention. This study examined the predictive utility of the M-PAC framework for explaining variance in self-reported and device-measured PA behavior among university students. A total of 2418 undergraduate students (Mean age = 19.1 ± 1.73 [SD] years) completed an online survey that included a self-reported measure of moderate-to-vigorous PA (MVPA) as well as constructs outlined in the M-PAC framework: instrumental and affective attitudes, perceived capability and opportunity, behavioral regulation, habit and identity. A subsample (n = 376) also wore an ActiGraph wGT3x-BT accelerometer on their non-dominant wrist for seven full days to assess MVPA. Robust linear regression models were computed to investigate associations between M-PAC framework constructs and PA behavior. Findings showed the M-PAC framework explained as high as 14.3 % and 37.9 % of the variance in device-measured and self-reported MVPA, respectively. Regulatory (behavioral regulation), and reflexive (habit and identity) processes were significant predictors of self-reported MVPA when examining the full M-PAC framework, whereas the role identity dimension of PA identity was the only significant predictor of device-assessed MVPA. Taken together, these results reinforce the importance of post-intentional processes, specifically role identity, in understanding PA behavior among university students.

Applying theories, models, and frameworks to help genetic counselors and students achieve clinical and professional goals

Some genetic counselors (GCs) may find theories, models, and frameworks (TMFs) useful in clinical skills selection and when reflecting on or evaluating genetic counseling practice. This paper aims to demonstrate how TMFs can be used to postulate how different skills may impact patients'/clients' decisions, behaviors, and outcomes and consider how multiple TMFs can inform the use of various skills or strategies to achieve different goals. Additionally, we provide examples of TMFs that may help GCs in nonclinical aspects of their work, such as implementing and evaluating new interventions or service delivery models. To guide the selection of appropriate TMFs, we provide a set of questions to consider and include examples of skills and approaches that align with different TMFs. While TMFs provide a structured approach and valuable guidance that may help advance genetic counseling practice, they have certain limitations. Additional research is necessary to determine the effectiveness of using TMFs to guide clinical practice and improve patient/client outcomes.

Determinants of exercise adherence in sedentary middle-aged and older adults

Regular exercise positively impacts neurocognitive health, particularly in aging individuals. However, low adherence, particularly among older adults, hinders the adoption of exercise routines. While brain plasticity mechanisms largely support the cognitive benefits of exercise, the link between physiological and behavioral factors influencing exercise adherence remains unclear. This study aimed to explore this association in sedentary middle-aged and older adults. Thirty-one participants underwent an evaluation of cortico-motor plasticity using transcranial magnetic stimulation (TMS) to measure changes in motor-evoked potentials following intermittent theta-burst stimulation (iTBS). Health history, cardiorespiratory fitness, and exercise-related behavioral factors were also assessed. The participants engaged in a 2-month supervised aerobic exercise program, attending sessions three times a week for 60 min each, totaling 24 sessions at a moderate-to-vigorous intensity. They were divided into Completers (n = 19), who attended all sessions, and Dropouts (n = 12), who withdrew early. Completers exhibited lower smoking rates, exercise barriers, and resting heart rates compared to Dropouts. For Completers, TMS/iTBS cortico-motor plasticity was associated with better exercise adherence (r = -.53, corrected p = .019). Exploratory hypothesis-generating regression analysis suggested that post-iTBS changes (β = -7.78, p = .013) and self-efficacy (β = -.51, p = .019) may predict exercise adherence (adjusted-R2 = .44). In conclusion, this study highlights the significance of TMS/iTBS cortico-motor plasticity, self-efficacy, and cardiovascular health in exercise adherence. Given the well-established cognitive benefits of exercise, addressing sedentary behavior and enhancing self-efficacy are crucial for promoting adherence and optimizing brain health. Clinicians and researchers should prioritize assessing these variables to improve the effectiveness of exercise programs.

Behavior change techniques to increase physical activity among older adults living in long-term care facilities: A systematic review

Despite the health benefits of physical activity, many older adults living in long-term care facilities lead sedentary lifestyles and do not meet minimum physical activity recommendations. Determining the behavior change techniques (BCTs) used in physical activity interventions can help us understand the underlying mechanisms by which behavioral change is achieved. The purpose of this systematic review was to identify and evaluate BCTs in physical activity interventions for the elderly residents. Six electronic databases were searched and 15 eligible studies were retained. Nine promising BCTs associated with physical activity promotion among elderly residents were identified: credible source, social support (unspecified), goal setting (outcome), goal setting (behavior), demonstration of the behavior, instruction on how to perform a behavior, self-monitoring of behavior, self-monitoring of outcome(s) of behavior, and adding objects to the environment. Future research is encouraged to select and tailor these BCTs to the specific needs and preferences of the target population.

Predicting Adolescents' Leisure-Time Physical Activity Levels: A Three-Wave Prospective Test of the Integrated Model of Self-Determination Theory and the Theory of Planned Behavior

A three-wave prospective study was conducted to provide a better understanding of the ability of the integrated model of self-determination theory (SDT) and the theory of planned behavior (TPB) to predict future physical activity (PA) engagement among adolescents. Nearly 2500 secondary school students from China were recruited to test the hypothesized pathway from autonomous motivation from SDT at baseline (T1) through the constructs of TPB one month later (T2) on leisure-time PA levels of secondary school students three months later (T3). The findings revealed that the structural equation models yielded excellent fit indices with χ2 = 1858.989, df = 257, CFI = 0.936, TLI = 0.926, RMSEA = 0.050 [90% CI = 0.048 to 0.052], and SRMR = 0.032. In particular, autonomous motivation at T1 was positively associated with attitude (R2 = 0.160), subjective norms (R2 = 0.160), and perceived behavioral control (PBC) (R2 = 0.173) at T2 (β = 0.395 to 0.414, p < 0.001) and subsequently associated with intention at T2 (R2 = 0.875, β = 0.112 to 0.478, p < 0.001). T2 intention was positively associated with leisure-time PA levels (R2 = 0.004) at T3. Our findings contribute to a better understanding of the motivational mechanisms and social cognition processes involved in predicting adolescents' leisure-time PA levels among adolescents.

Exercise for peri- and postmenopausal women: Recommendations from synergistic alliances of women's medicine and health psychology for the promotion of an active lifestyle

Adopting healthy behaviors is a multifaceted and complex process that poses significant challenges for individuals. Despite awareness of the detrimental effects of certain behaviors on health, many individuals continue to engage in risky practices. Traditional medical advice and prescriptions, while well intentioned, often fall short in fostering lasting lifestyle changes. Although individuals may also have good intentions, solely relying on doctor's counsel does not ensure successful lifestyle adjustments. One primary reason for this limitation is the lack of specialized expertise in behavioral modification among gynecologists and healthcare providers. Health psychologists are specialized professionals capable of effectively guiding and assisting individuals in modifying health-related behaviors. Their expertise in behavior change strategies and psychological interventions proves invaluable in empowering individuals to embrace healthier lifestyles and contributes to people's well-being. This paper emphasizes the importance of collaborative efforts between medical professionals, such as gynecologists, and health psychologists to promote healthy behaviors among peri- and postmenopausal women and enhance women's health. By forging integrative alliances, they can develop comprehensive and tailored interventions. By bridging the gap between medical advice and behavior modification, this collaborative effort has the potential to ensure a more effective intervention process. This holistic approach not only addresses women's specific health needs but also fosters sustainable behavior change when promoting healthy behaviors among middle-aged women. The ultimate goal of such a synergy is to improve women's health outcomes and contribute to a healthier society overall.

Effectiveness of pedometer-based walking programmes in improving some modifiable risk factors of stroke among community-dwelling older adults: a systematic review, theoretical synthesis and meta-analysis

BACKGROUND

Pedometer-based walking programs hold promise as a health promotion strategy for stroke prevention in community-dwelling older adults, particularly when targeted at physical activity-related modifiable risk factors. The question arises: What is the effectiveness of pedometer-based walking program interventions in improving modifiable stroke risk factors among community-dwelling older adults?

METHOD

Eight databases were searched up to December 2nd, 2023, following the Preferred Reporting Items for Systematic Review and Meta-Analysis protocol. Inclusion criteria focused on randomized controlled trials (RCTS) involving community-dwelling older adults and reported in English. Two independent reviewers utilized Physiotherapy Evidence Database (PEDro) tool to extract data, assess eligibility, evaluate study quality, and identify potential bias. Standardized mean difference (SMD) was employed as summary statistics for primary -physical activity level -and secondary outcomes related to cardiovascular function (blood pressure) and metabolic syndrome, including obesity (measured by body mass index and waist circumference), fasting blood sugar, glycated hemoglobin, high-density lipoprotein cholesterol (HDL-C), and triglycerides. A random-effects model was used to generate summary estimates of effects.

RESULTS

The review analyzed eight studies involving 1546 participants aged 60-85 years, with 1348 successfully completing the studies. Across these studies, pedometer-based walking programs were implemented 2-3 times per week, with sessions lasting 40-60 minutes, over a duration of 4-26 weeks. The risk of bias varied from high to moderate. Our narrative synthesis revealed positive trends in HDL-C levels, fasting blood sugar, and glycated hemoglobin, suggesting improved glycemic control and long-term blood sugar management. However, the impact on triglycerides was only marginal. Primary meta-analysis demonstrated significantly improved physical activity behavior (SMD=0.44,95%CI:0.26, 0.61,p=<0.00001;I2=0%;4 studies; 532 participants) and systolic blood pressure (SMD=-0.34,95%CI:-0.59,-0.09;p=<0.008;I2=65%,2 studies;249 participants), unlike diastolic blood pressure (SMD=0.13,95%CI:-0.13,-0.38,p=0.33; I2=91%; 2 studies; 237 participants). Interventions based on social cognitive, self-efficacy, and self-efficiency theory(ies), and social cognitive theory applied in an ecological framework, were linked to successful physical activity behavior outcomes.

CONCLUSION

Pedometer-based walking programs, utilizing interpersonal health behavior theory/ecological framework, enhance physical activity behavior and have antihypertensive effects in community-dwelling older adults. While they do not significantly affect diastolic blood pressure, these programs potentially serve as a primary stroke prevention strategy aligning with global health goals.

TRIAL REGISTRATION

Registration Number: INPLASY202230118.

You don't know why you (don't) exercise: The relationship between automatic processes and physical activity (or sedentary behavior): A meta-analysis

OBJECTIVES

This meta-analysis aimed to examine the relationship between automatic processes and behavior as well as their moderators.

METHODS

There were 126 effect sizes (Fisher's Z) extracted from 55 independent research studies involving 10,432 participants. Meta-analyses were conducted using Comprehensive Meta-Analysis Version 3.3. Univariate meta-regression models were used to analyze underlying moderators.

RESULTS

Meta-analysis after correction found that automatic processes could significantly and positively predict behavior, but the effect size was small (Fisher's Z = 0.057, p < 0.001, 95% CI [0.043, 0.070]).

CONCLUSIONS

Different components of automatic processes, task reliability, and study design moderated the relationship between automatic processes and behavior. Future research could explore automatic measures at a neurophysiological level or use population-matched stimuli for specific populations to improve measure validity. In addition, future research should accumulate evidence on how to reduce sedentary behavior.

Theory-based interventions aimed at promoting physical activity in pregnant women: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVES

The objectives were to assess (i) the quality of theory implementation, (ii) the application of behavior change techniques, and (iii) the effectiveness of theory-based interventions in promoting physical activity in pregnant women and improving maternal and neonatal outcomes.

METHODS

A systematic search was conducted across 8 databases (Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, EMBASE, MEDLINE, APA PsycINFO, PubMed, SPORTDiscus, and Web of Science) to identify randomized controlled trials published from database inception to 8 July 2023. The Cochrane risk-of-bias 2.0 tool was used to evaluate the quality of the included studies. The theory coding scheme was used to measure the quality of theory implementation, and behavior change techniques were coded according to behavior change taxonomy (version 1). The meta-analysis was performed using RevMan 5.3. The Grading of Recommendations, Assessment, Development, and Evaluation Approach was used to assess the certainty of evidence.

RESULTS

Eleven studies met the study criteria. Nine studies were based on one theory, while two studies were based on a combination of two theories. The quality of theory implementation was generally moderate. A total of 24 unique behavior change techniques were extracted. The most commonly used types of behavior change techniques were 'instruction on how to perform the behavior' (n = 9), 'goal setting' (behavior) (n = 8), 'action planning' (n = 7), and 'information about health consequences' (n = 7). Theory-based interventions significantly improved moderate-to-vigorous physical activity (standardized mean difference (SMD) = 0.17, 95 % confidence interval (CI) [0.04, 0.30], P = 0.01; moderate certainty of evidence), reduced the average gestational weight gain per week (mean difference (MD) = -0.06, 95 % CI [-0.11, -0.01], P = 0.02; moderate certainty of evidence), and decreased the incidence of gestational diabetes mellitus (risk ratio (RR) = 0.64, 95 % CI [0.46, 0.89], P = 0.008; high certainty of evidence). However, the effects of theory-based interventions on total physical activity, total gestational weight gain and the incidence of gestational hypertension and preterm delivery were unclear (P > 0.05).

CONCLUSIONS

(i) Most of the studies exhibited a moderate level of theory implementation quality. (ii) The use of theories varies, but common behavior change techniques were found across studies. (iii) Theory-based interventions can improve physical activity and maternal and neonatal outcomes and appear to be safe. Appropriate health behavior theories and behavior change techniques should be fully utilized in future interventions.

REGISTRATION

PROSPERO: CRD42023440886.

TWEETABLE ABSTRACT

Theory-based interventions can improve physical activity and maternal and neonatal outcomes and appear to be safe. Appropriate health behavior theories and behavior change techniques should be fully utilized in the development of future interventions.

Self-determined motivational health coaching ('SAMI') during outpatient treatment to promote physical activity of people with serious mental illness: a pilot controlled trial

BACKGROUND

Brief motivational coaching, integrated into health care; seems promising to address physical inactivity of people with serious mental illness (SMI).

AIMS

To test the impact of a self-determined health coaching approach (the "SAMI" intervention) during outpatient mental health treatment on moderate-to-vigorous physical activity (MVPA) of people with SMI.

METHODS

Adults (mean age = 41.9, SD = 10.9) with an ICD-10 diagnosis of mental illness were semi-randomized to the SAMI-intervention group (IG) or control group (CG). The IG received 30 minutes of health coaching based on the self-determination theory (SDT). MVPA and sedentary time (ST) were measured with the International Physical Activity Questionnaire - short form (IPAQ-SF) and symptoms of mental illness with the Brief Symptom Inventory (BSI-18), each at baseline and follow-up (3-4 months). Differences in primary (MVPA) and secondary (ST, BSI-18) outcomes were evaluated using negative binomial regressions and general linear models.

RESULTS

In the IG (n = 30), MVPA increased from 278 (interquartile range [IQR] = 175-551) to 435 (IQR = 161-675) min/week compared to a decrease from 250 (IQR = 180-518) to 155 (IQR = 0-383) min/week in the CG (n = 26; adjusted relative difference at follow-up: Incidence Rate Ratio [IRR] = 2.14, 95% CI: 1.17-3.93, p = 0.014). There were no statistically significant differences in ST and BSI-18.

CONCLUSIONS

Brief self-determined health coaching during outpatient treatment could increase post-treatment MVPA in people with SMI, potentially up to a clinically relevant level. However, great uncertainty (for all outcomes) weakens the assessment of clinical relevance.

Applying behavioral change theories to optimize pulmonary rehabilitation in COPD patients: A review

This review meticulously evaluates the integration of behavioral change theories into pulmonary rehabilitation programs for chronic obstructive pulmonary disease (COPD) management, addressing the critical need for enhanced patient compliance and improved therapeutic outcomes. With COPD posing significant global health challenges, characterized by high morbidity and mortality rates, the manuscript underscores the potential of Self-Determination Theory, Social Cognitive Theory, the Transtheoretical Model, the Health Belief Model, and the Theory of Planned Behavior to foster meaningful health behavior changes among patients. Through a comprehensive literature analysis, it reveals how each model contributes to understanding patient behaviors in pulmonary rehabilitation contexts, advocating for their systematic application to craft more effective, patient-centered interventions. Despite the proven efficacy of these theories in various health domains, their current underutilization in pulmonary rehabilitation underscores a gap between theoretical knowledge and clinical practice. The review calls for an interdisciplinary approach that bridges this gap, highlighting the urgency of developing actionable, theory-based behavioral intervention plans. By doing so, it aims to advance COPD management strategies, ultimately improving the quality of life for individuals living with this debilitating disease.

Co-construct, implement and evaluate a multi-level intervention to prevent a sedentary lifestyle in children-Study protocol of the CIPRES study

BACKGROUND

A sedentary lifestyle is commonly associated with a higher risk of chronic disease development. Among school-aged children from European countries, screen-time represents a significant portion of sedentary time with 39.8% of children spending more than 2h/day in front of a screen on average. Therefore, effective solutions to reduce sedentary behavior (SB) must be found. Multilevel interventions based on the socio-ecological model (SEM) are particularly relevant to take into account influences of the social environment on individuals' SB. Moreover, the trans-contextual model (TCM) can offer complementary levers for individuals' behavior change. The CIPRES study is a theory-based multilevel intervention designed to decrease the SB in French primary school children aged 8-10 years. The present paper describes the protocol of a randomized controlled study to evaluate the effectiveness of the CIPRES multilevel intervention on SB.

METHODS

The CIPRES study is a cluster-randomized controlled trial comparing intervention vs control groups. A total of 700 children are targeted for inclusion, distributed in four municipalities considered as clusters. The study consists of two successive phases: 1) co-building of a SB prevention intervention by using a participatory approach involving representatives of each level of the SEM (e.g., children, parents, staff from municipalities, teachers) and 2) implementation and evaluation of the intervention. The intervention will last for 6 weeks in each involved class. Primary outcome will be the sedentary time of children per week, assessed by accelerometry. In addition, children and their parents will be asked to fill out questionnaires concerning children's physical activity level, screen time, quality-of-life and variables of the TCM.

DISCUSSION

This study will give information on the effectiveness of a theory-based intervention, involving multiple levels of actors in the co-construction and the implementation of the intervention, that may interest schools and public health officers looking for innovative sedentary prevention programs.

Acceptability and Feasibility of the Telehealth Bariatric Behavioral Intervention to Increase Physical Activity Before Bariatric Surgery: A Single-Case Experimental Study (Part I)

BACKGROUND

Physical activity (PA) can play an important role in optimizing metabolic/bariatric surgery (MBS) outcomes. However, many MBS patients have difficulty increasing PA, necessitating the development of theory-driven counseling interventions. This study aimed to (1) assess the feasibility and acceptability of the TELEhealth BARIatric behavioral intervention (TELE-BariACTIV) trial protocol/methods and intervention, which was designed to increase moderate-to-vigorous intensity physical activity (MVPA) in adults awaiting MBS and (2) estimate the effect of the intervention on MVPA.

METHODS

This trial used a repeated single-case experimental design. Twelve insufficiently active adults awaiting MBS received 6 weekly 45-min PA videoconferencing counseling sessions. Feasibility and acceptability data (i.e., refusal, recruitment, retention, attendance, and attrition rates) were tracked and collected via online surveys, and interviews. MVPA was assessed via accelerometry pre-, during, and post-intervention.

RESULTS

Among the 24 patients referred to the research team; five declined to participate (refusal rate = 20.8%) and seven were ineligible or unreachable. The recruitment rate was 1.2 participants per month between 2021-09 and 2022-07. One participant withdrew during the baseline phase, and one after the intervention (retention rate = 83.3%). No participant dropouts occurred during the intervention and 98.6% of sessions were completed. Participants' anticipated and retrospective acceptability of the intervention was 3.2/4 (IQR, 0.5) and 3.0/4 (IQR, 0.2), respectively. There was a statistically significant increase in MVPA [Tau-U = 0.32(0.11; 0.51)] from pre- to post-intervention.

CONCLUSION

Despite a low recruitment rate, which could be explained by circumstances (COVID-19 pandemic), results support feasibility, acceptability, and preliminary efficacy of the TELE-Bari-ACTIV intervention for increasing MVPA in patients awaiting MBS.

School-based physical activity interventions: which intervention characteristics are associated with participation and retention? A meta-analysis

OBJECTIVE

Many school-based intervention studies are conducted to increase students' physical activity (PA). Recruitment and retention problems potentially impact the robustness of RCT findings. We conducted a meta-analysis to summarize recruitment and retention rates in long-term secondary school-based PA intervention studies and examined associated participant and intervention characteristics.

METHODS

Web of Science, Pubmed, Medline, and PsychInfo were searched until March 20th 2023. We included studies on secondary school-based PA interventions ≥12 weeks, aimed at typically developing adolescents. We abstracted number of schools and students invited, randomized, and participating at follow-up to calculate pooled recruitment and retention rates; participant and intervention characteristics were abstracted to execute subgroup or meta-regression analyses.

RESULTS

Recruitment rates were 51% for invited schools and 80% for invited students, the retention for schools was almost 100% and for students 91%. Interventions with fixed and flexible components, executed in Asia and South America, and from later publication years had higher student recruitment rates. Students' retention rates were lower for interventions which had flexible components, were theory/model-based, used an accelerometer, had a longer intervention duration, and included more females.

CONCLUSION

Recruitment and retention rates in school-based PA interventions are high. Some participant and intervention characteristics influence these rates: flexibility of the intervention, theory/model-based intervention, accelerometer use, intervention duration, continent, and number of females. Researchers should consider these characteristics in intervention development to achieve optimal balance between intervention effectiveness, recruitment, and retention.

Intervention Strategies to Address Barriers and Facilitators to a Healthy Lifestyle Using the Behaviour Change Wheel: A Qualitative Analysis of the Perspectives of Postpartum Women

Postpartum women experience unique barriers to maintaining healthy lifestyles after birth. Theory-based behaviour change techniques and intervention strategies can be integrated into postpartum lifestyle interventions to enable women to overcome barriers to change. This study aims to explore barriers and facilitators to engaging in healthy postpartum lifestyle behaviours and develop intervention strategies for integration in a postpartum lifestyle intervention using the Behaviour Change Wheel (BCW). Semi-structured interviews were conducted with women up to two years postpartum (n = 21). Interviews were thematically analysed, themes were mapped to the Capability, Opportunity, and Motivation Model of Behaviour Change and intervention strategies were developed using the BCW. Findings suggest that women face barriers and facilitators within capability (sleep deprivation, mental exhaustion, ability to plan), opportunity (support of friends, partners and extended families) and motivation (challenges with prioritising self, exercise to cope with stress). Intervention strategies included supporting behaviour regulation and sleep to enhance capability, engaging partners, strengthening peer support to create opportunities and highlighting the mental health benefits of healthy lifestyles to inspire motivation. Integrating targeted evidence-based behaviour change strategies into postpartum lifestyle interventions may support women in overcoming commonly reported barriers to a healthy lifestyle.

The effect of nurse-led motivational interviewing based on the trans-theoretical model on promoting physical activity in healthy older adults: A randomized controlled trial

AIM

The aim of this study was to evaluate the effect of motivational interviewing based on the trans-theoretical model promoting physical activity in older adults.

METHODS

A randomized controlled trial study was conducted with 117 older adults (intervention group: 58, and control group: 59) between April and November 2019. The data were collected via a questionnaire, trans-theoretical model scales, the Physical Activity Scale for the Elderly, the Katz Activities of Daily Living scale and a pedometer. The 24-week intervention consisted of regular motivational interviewing. The control group received usual care at the family health centre.

RESULTS

Following the intervention, the Intervention Group showed significant improvements Exercise Processes of Change Scale, Exercise Self-Efficacy Scale and Perceived Benefits of the Decisional Balance Scale for Exercise. There was a significant difference between the groups in terms of stages of change. In the Intervention Group, 81.5% were in the contemplation stage in the pre-test, while in the post-test, 70.4% had transitioned to the action stage. In contrast, in the control group, 62.5% were in the contemplation stage initially, but in the post-test, only 9.3% had reached the action stage. The mean number of step counts increased significantly in favour of the Intervention Group, as did the Physical Activity Scale for the Elderly total score.

CONCLUSION

The trial indicated that after the trans-theoretical model-based motivational interviewing, the stages of change among the older adults improved, as did their exercise behaviours. It is recommended that the trans-theoretical model and motivational interviewing be used by nurses to improve healthy lifestyle stage behaviours in older adults.

Social-media based Health Education plus Exercise Programme (SHEEP) to improve muscle function among community-dwelling young-old adults with possible sarcopenia in China: A study protocol for intervention development

Possible sarcopenia refers to low muscle strength. Prevalence of possible sarcopenia is estimated to be significantly higher in community-dwelling older adults than that of confirmed or severe sarcopenia. However, there are currently far fewer non-pharmacological intervention strategies for possible sarcopenia than for sarcopenia in the community. Meanwhile, one type of non-pharmacological intervention in sarcopenic area, health education, is under-researched, and older people's awareness about sarcopenia is extremely low, necessitating an immediate dissemination tool for prevention. Social media may be a potential, scalable, low-cost tool for this. This study protocol outlines how a social media-based multicomponent intervention will be co-designed with stakeholders to address this evidence gap. Guided by the Medical Research Council's framework, the proposed research covers two phases that employ a co-design approach to develop a theory-based multicomponent intervention to increase sarcopenia prevention in the community. The participants will be recruited from young-old adults (60~69) with possible sarcopenia in the community of Changsha, China. Maximum sample size will be 45 participants in total, with 18~25 participants in the development phase and 15~20 participants in the pre-test phase. During two rounds of focus groups with older adults, a social-media based intervention strategy will be developed from a theory-based conceptual model and an initial intervention plan formulated by the research group. After this, there will be a three-week pre-test phase, followed by a semi-structured interview to further modify the theory-based conceptual model and the social-media based intervention strategy. The focus of the data analysis will be on thematic analysis of qualitative data primarily derived from the group interview and the semi-structured interview with key stakeholders.

Towards a qualitative theory of the interruption of eating behavior change

The poor maintenance of eating behavior change is one of the main obstacles to minimizing weight regain after weight loss during diets for non-surgical care of obese or overweight patients. We start with a known informal explanation of interruption in eating behavior change during severe restriction and formalize it as a causal network involving psychological variables, which we extend with energetic variables governed by principles of thermodynamics. The three core phenomena of dietary behavior change, i.e., non-initiation, initiation followed by discontinuation and initiation followed by non-discontinuation, are expressed in terms of the value of the key variable representing mood or psychological energy, the fluctuation of which is the result of three causal relationships. Based on our experimental knowledge of the time evolution profile of the three causal input variables, we then proceed to a qualitative analysis of the resulting theory, i.e., we consider an over-approximation of it which, after discretization, can be expressed in the form of a finite integer-based model. Using Answer Set Programming, we show that our formal model faithfully reproduces the three phenomena and, under a certain assumption, is minimal. We generalize this result by providing all the minimal models reproducing these phenomena when the possible causal relationships exerted on mood are extended to all the other variables (not just those assumed in the informal explanation), with arbitrary causality signs. Finally, by a direct analytical resolution of an under-approximation of our theory, obtained by assuming linear causalities, as a system of linear ODEs, we find exactly the same minimal models, proving that they are also equal to the actual minimal models of our theory since these are framed below and above by the models of the under-approximation and the over-approximation. We determine which parameters need to be person-specific and which can be considered invariant, i.e., we explain inter-individual variability. Our approach could pave the way for universally accepted theories in the field of behavior change and, more broadly, in other areas of psychology.

Planning Individual and Population-Based Interventions in Global Health: Applying the DEA-A Framework to Promote Behavioral, Emotional, and/or Cognitive Change among Stakeholders

Addressing health challenges that impact human well-being requires a comprehensive, interdisciplinary approach that would be at the crossroad of population-based prevention and individual-level clinical care, which is in line with a Global Health perspective. In the absence of a unifying theoretical framework to guide such interventions, a Dynamic Ecosystem Adaptation through the Allostasis (DEA-A) framework has been proposed, emphasizing the functional adaptation of individuals and organizations in symbiosis with their living ecosystem. While a conceptual model has been presented, this methodological contribution aims at illustrating the practical application of the DEA-A framework for planning Global Health interventions. The methodology combines Intervention Mapping and Cognitive and Behavioral Theory, extended to the ecosystem. Practical guidelines and supporting tools are provided to help public health providers and clinicians in establishing a functional ecosystem diagnosis of the issue; defining not only behavioral, but also emotional and cognitive change objectives (allostasis targets) expected for each stakeholder; and designing intervention plans targeting determinants of these allostasis. The discussion addresses implementation and evaluation perspectives of interventions based on the DEA-A framework, emphasizing the importance of considering change in its processual and ecosystem complexity. Lastly, encouragements for a deeper understanding of individual and ecosystem homeostasis/allostasis processes are made in order to promote more functional interventions.

Feasibility of Project Mentor: A Mentoring Program Based on Self-Determination Theory for Adolescents Classified as Overweight

Purpose: This study examined the feasibility of Project Mentor, a mentoring program based on self-determination theory (SDT) for youth classified as overweight or obese. Methods: In Study 1, youth (N = 23) ranging from 12-18 years of age were randomly assigned to a mentoring intervention or wait-list control condition. Study 2 served as a replication sample and consisted of N = 38 youth who participated in the mentoring program. As part of a process evaluation, attendance and exercise heart rate were monitored to assess whether participants exercised at a moderate-to-vigorous level as intended. Mentees also rated whether mentors created a need-supportive environment. For outcome evaluation, basic need satisfaction, behavioral regulation, fitness, and body composition were assessed at pre, post, and follow-up. Results: Across both studies, participants attended over 80% of the exercise sessions and exercised at a moderate to vigorous intensity level. Mentees also perceived that mentors created a need-supportive environment. Post-test and follow-up basic need scores were higher than baseline values and autonomous motivation increased for mentoring program participants. Effect sizes were generally moderate to large in magnitude based on partial eta-squared and Cohen d. Aerobic fitness (i.e., Vo2peak) showed a moderate to large increase at post-test that was partially maintained at follow-up. Body composition changes were nonsignificant and small in magnitude. Participants in the wait-list control reported showed small changes or decreases across SDT related constructs, fitness, and body composition across both studies. Conclusions: Results across both studies support the feasibility of a mentoring program focused on CARE (competence, autonomy, relatedness, and enjoyment).

Using Directed Acyclic Graphs (DAGs) to Determine if the Total Causal Effect of an Individual Randomized Physical Activity-Promoting Intervention is Identifiable

Physical activity promotion is a best buy for public health because it has the potential to help individuals feel better, sleep better, and perform daily tasks more easily, in addition to providing disease prevention benefits. There is strong evidence that individual-level theory-based behavioral interventions are effective for increasing physical activity levels in adult populations but causal inference from these interventions often is unclearly articulated. A directed acyclic graph (DAG) can be, but rarely is, used to determine if the causal effect of an individual-level theory-based physical activity-promoting intervention is identifiable (e.g. stripped of any spurious association). The primary objective of the current study was to demonstrate how a DAG can be used to determine if the total causal effect of an individual randomized physical activity-promoting intervention is identifiable. The demonstration was based on the Well-Being and Physical Activity study (ClinicalTrials.gov, identifier: NCT03194854). Annotated files from DAGitty and Mplus are provided.

Revisiting the Transtheoretical Model for Physical Activity: A Large-Scale Cross-Sectional Study on Japanese-Speaking Adults

BACKGROUND

The Transtheoretical Model (TTM) has been the basis of health promotion programs, which are, for example, used to tailor behavioral interventions according to the stages of change. Empirical studies have shown that the TTM effectively describes the processes of behavioral adaptation to acquire healthier lifestyles; however, it has been argued that TTM-based interventions are not superior to non-TTM-based interventions for promoting physical activity (PA). Evidence has also highlighted some inconsistencies with theoretical assumptions, especially regarding how each process-of-change strategy emerges across the stages.

PURPOSE

Therefore, we investigated (a) how well the TTM describes the distributional characteristics of PA levels as well as other relevant variables (e.g., process of change, self-efficacy) across stages, and (b) how predictive the TTM variables are of PA levels within each stage.

METHODS

We analyzed data from 20,573 Japanese-speaking adults who completed online questionnaires on PA and TTM variables.

RESULTS

The results replicated previous findings that stage membership is associated with PA, the process of change, decisional balance, and self-efficacy, albeit with inconclusive evidence of temptations. Regression analyses revealed that some processes of change (self-reevaluation, reinforcement management, and self-liberation) were more predictive of PA in pre-active stages than in post-action stages; self-efficacy was predictive of PA only in the maintenance stage but not in the other stages.

CONCLUSIONS

Overall, the data support the theoretical assumptions of the TTM, but the stage specificity of the active processes may not always be consistent with the theory.

Transtheoretical Model for Exercise: Measure Redevelopment and Assessing the Role of Barriers in a Diverse Population

PURPOSE

To redevelop and improve Transtheoretical Model (TTM) exercise measures for Black and Hispanic/Latinx adults. The redeveloped scales will address barriers to exercise potentially relevant to populations of color in the United States (US).

DESIGN

Cross-sectional, split-half measure development.

SETTING

Online survey in the US.

SUBJECTS

450 Black and/or Hispanic/Latinx adults.

MEASURES

Demographics, exercise engagement (IPAQ-SF), stage of change (SOC), decisional balance (DCBL), self-efficacy (SE), and barriers to exercise.

ANALYSIS

Split-half exploratory (EFA) and confirmatory factor analyses (CFA) were executed to establish measurement structure and fit, followed by multivariate analyses to assess constructs by SOC.

RESULTS

EFA/CFA for DCBL revealed three factors (α = .85, .70, .75) which represented Pros of exercise, Cons of exercise related to time and safety, and Cons of exercise related to physical or emotional discomfort. Model fit was adequate (CFI = .89). For SE, two factors (α = .85, .77) resulted with good model fit (CFI = .91). These factors reflected self-efficacy to exercise when confronted with generally challenging situations, and self-efficacy to exercise when specifically experiencing affective difficulties, such as depression or anxiety. Lastly, a novel Barriers measure resulted in three factors (α = .82, .77, .76), representing barriers encountered due to family responsibilities, work obligations, and health challenges, with good model fit (CFI = .95). Shifts in the core TTM constructs by SOC largely mapped onto the theoretical trends expected under the TTM.

CONCLUSION

This study produced systematically developed TTM exercise measures for Black and Hispanic/Latinx adults in the US that address and incorporate important barriers to exercise. This research represents an important step forward in broadening the inclusion of diverse populations to TTM measure development processes and may lead to a better understanding of relevant factors impeding exercise engagement in the US.

Breaking barriers to rehabilitation: the role of behavior change theories in overcoming the challenge of exercise-related behavior change

BACKGROUND

Promoting exercise-related behavior change in rehabilitation is a challenge. The lack of integration between rehabilitation program prescriptions, behavior change interventions, and behavioral change theories is profound. Using behavior change theories properly is crucial for better adherence and promoting positive outcomes. Therefore, it is essential to bring theories that support the understanding of exercise-related behavioral change to the attention of rehabilitation practitioners.

OBJECTIVE

This masterclass article aims to provide the theoretical background of theories and strategies for exercise behavior change within the physical therapy context based on acknowledged behavioral change theoretical models.

METHODS

This is a narrative review that examines six behavior theories; five of them well-established, and a new (and promising) theory that has exhibited the most favorable outcomes in rehabilitation settings. The development process for this masterclass included conversations between authors, reviewing behavior theories, summarizing and discussing the theories' concepts and strategies for physical therapy.

RESULTS

The included theories were self-determination theory, social-cognitive theory, the transtheoretical model, the theory of planned behavior, the health belief model, and the unifying theory of physical activity. Each theory offers a unique perspective on exercise behavior change within rehabilitation, exploring constructs such as motivation, self-efficacy, stages of change, behavioral intention, perceived threat, and the core elements of physical activity expression.

CONCLUSION

These theoretical models provide a foundation for understanding and developing strategies for promoting exercise behavior change in rehabilitation. Knowing and using these theories is important for respecting the patient's individuality.

Acceptability and Usability of a Theory-Driven Intervention via Email to Promote Physical Activity in Women Who Are Overweight or Obese: Substudy Within a Randomized Controlled Trial

BACKGROUND

Insufficient physical activity (PA) and excess weight increase illness risk for women. Face-to-face interventions can increase PA levels; however, they are often inaccessible. With growing interest in digital interventions, a Self-Determination Theory (SDT)-driven intervention was developed and delivered via email to promote PA in women who were insufficiently active and overweight or obese.

OBJECTIVE

This substudy explores users' perspectives about the acceptability and usability of the intervention, which was coupled with a wearable activity monitor and PA recommendations.

METHODS

A 3-arm, parallel group, randomized controlled trial (unblinded) was conducted in Ontario, Canada. Recruitment occurred from September 2018 to March 2019 via advertising through social media, web-based boards, and posters in publicly accessible areas. In total, 47 women with a BMI of ≥25 kg/m2 who were not meeting the Canadian PA guidelines were randomly assigned to 1 of 3 arms (arm 1: n=15, 32%; arm 2: n=16, 34%; arm 3: n=16, 34%). This substudy focused on the 15 participants allocated to the main intervention arm. Participants received an automated intervention consisting of (1) 6 weekly emails, (2) a Polar Electro Inc A300 activity monitor (with access to the Polar Flow website and companion smartphone app), and (3) a copy of the Canadian PA guidelines for adults. Emails were developed using SDT and designed to enhance autonomous motivation by fostering the psychological needs of competence, autonomy, and relatedness. Well-established motivational and behavior change techniques were embedded in the emails to promote needs satisfaction. After the intervention (ie, 7 weeks after randomization), participants were invited to complete a web-based acceptability and usability survey containing open-ended and closed-ended questions; responses were analyzed using descriptive and content analyses, respectively.

RESULTS

The analyses included data from 93% (14/15) of the women (age: mean 33.4, SD 7.5; range 24-44 years; BMI: mean 31.3, SD 5.8 kg/m2; range 25-40.5 kg/m2) who received the main intervention and completed the postintervention survey. Open-ended responses indicated that participants were generally satisfied with the intervention and appreciated that emails prompted self-reflection, kept them on track and accountable, provided informational support, and were nonpressuring. Furthermore, they suggested that the monitor was "enjoyable" and "helpful"; quantitative data corroborated this, as 71% (10/14) said that the monitor was "very valuable/absolutely valuable," 71% (10/14) would "very probably/definitely" still use one, and 86% (12/14) wore it for ≥5 days per week for ≥8 hours per day and checked it "occasionally/frequently/very frequently." Potential threats to acceptability included "long" and "text-heavy" emails; lack of personal contact; and cumbersome, unaesthetic monitors.

CONCLUSIONS

Results suggest that this SDT-driven, email-delivered intervention may be an acceptable low-contact approach to promote PA in women who are overweight or obese and insufficiently active; however, improvements are warranted and studies ascertaining its effectiveness are needed.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03601663; http://clinicaltrials.gov/ct2/show/NCT03601663.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1177/20552076221093134.

Potential associations between behavior change techniques and engagement with mobile health apps: a systematic review

Introduction

Lack of engagement is a common challenge for digital health interventions. To achieve their potential, it is necessary to understand how best to support users' engagement with interventions and target health behaviors. The aim of this systematic review was to identify the behavioral theories and behavior change techniques being incorporated into mobile health apps and how they are associated with the different components of engagement.

Methods

The review was structured using the PRISMA and PICOS frameworks and searched six databases in July 2022: PubMed, Embase, CINAHL, APA PsycArticles, ScienceDirect, and Web of Science. Risk of bias was evaluated using the Cochrane Collaboration Risk of Bias 2 and the Mixed Methods Appraisal Tools.

Analysis

A descriptive analysis provided an overview of study and app characteristics and evidence for potential associations between Behavior Change Techniques (BCTs) and engagement was examined.

Results

The final analysis included 28 studies. Six BCTs were repeatedly associated with user engagement: goal setting, self-monitoring of behavior, feedback on behavior, prompts/cues, rewards, and social support. There was insufficient data reported to examine associations with specific components of engagement, but the analysis indicated that the different components were being captured by various measures.

Conclusion

This review provides further evidence supporting the use of common BCTs in mobile health apps. To enable developers to leverage BCTs and other app features to optimize engagement in specific contexts and individual characteristics, we need a better understanding of how BCTs are associated with different components of engagement.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42022312596.

Key Considerations When Addressing Physical Inactivity and Sedentary Behaviour in People with Asthma

People with asthma tend to be less physically active and more sedentary than people without asthma. This narrative review aimed to present key considerations when addressing physical inactivity and sedentary behaviour in people with asthma by identifying barriers and facilitators, determinants and correlates, and intervention approaches. Using a search strategy, electronic databases were searched for relevant studies. Data extracted from studies were qualitatively synthesised. A total of 26 studies were included in the review. Six studies reported asthma symptoms as a barrier to physical activity, while four studies reported having a supportive network as a physical activity facilitator. Across studies, physical activity correlates/determinants were pulmonary function, exercise capacity, body mass index, dyspnoea, psychological health, and asthma control. Interventions that effectively improved physical activity in the short term were a step-based prescription programme, a weight loss programme incorporating aerobic and resistance training, and a weight loss lifestyle intervention, while a high-intensity interval training pulmonary rehabilitation program was effective in the long term. The collective findings suggest that a personalised physical activity programme incorporating different strategies is needed. There was minimal evidence to provide recommendations to optimise sedentary behaviour in asthma, and more research is needed on the topic.

Comparing the Effectiveness of a Web-Based Application With a Digital Live Seminar to Improve Safe Communication for Pregnant Women: 3-Group Partially Randomized Controlled Trial

BACKGROUND

Medical internet interventions such as asynchronous apps and synchronous digital live seminars can be effective behavior change interventions. The research question of this study was whether digital interventions based on the Health Action Process Approach can improve pregnant women's safe communication and patient safety in obstetric care.

OBJECTIVE

This study aims to compare a digital live seminar with a web-based application intervention and a passive control group and to identify which social cognitive variables determine safe communication behavior and patient safety.

METHODS

In total, 657 pregnant women were recruited, and hereof, 367 expectant mothers from 2 German university hospitals participated in the pre-post study (live seminar: n=142; web-based app: n=81; passive control group: n=144). All interventions targeted intention, planning, self-efficacy, and communication of personal preferences. The 2.5-hour midwife-assisted live seminar included exercises on empathy and clear communication. The fully automated web-based application consisted of 9 consecutive training lessons with the same content as that of the live seminar.

RESULTS

Controlled for sociodemographic characteristics, repeated measures analyses of covariance revealed that pregnant women significantly improved their self-reported communication behavior in all groups. The improvement was more pronounced after the digital live seminar than after the web-based application (P<.001; ηp2=0.043). Perceived patient safety improved more for pregnant women participating in the live seminar than for those participating in the web-based application group (P=.03 ηp2=0.015). A regression analysis revealed that social cognitive variables predicted safe communication behavior.

CONCLUSIONS

Overall, the web-based application intervention appeared to be less effective than the digital live training in terms of communication behavior. Application interventions addressing communication behaviors might require more face-to-face elements. Improving intention, coping planning, and coping self-efficacy appeared to be key drivers in developing safe communication behavior in pregnant women. Future research should include social learning aspects and focus on the practical application of medical internet interventions when aiming to improve pregnant women's communication and patient safety in obstetrics.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03855735; https://clinicaltrials.gov/ct2/show/NCT03855735.

The AHAWOMEN project: study protocol of a multi-design research for exploring HAPA predictors of exercise in postmenopausal women

BACKGROUND

The postmenopausal period can represent an opportunity for women to improve their health and well-being. The Active and Healthy Ageing in Women during early postmenopause (AHAWOMEN) study aims to identify the key determinants of an active lifestyle among middle-aged women, with a focus on the stages and the social-cognitive variables outlined in the Health Action Process Approach (HAPA) model, a theoretical framework for understanding health behaviour change. We expected that HAPA factors and processes of intention creation (motivational phase) and action adoption (volitional phase) will be significant predictors of exercise initiation and maintenance, supporting both the HAPA tenets and the efficacy of HAPA-based interventions.

METHODS/DESIGN

This study was approved by the authors' Institutional Review Committee. Postmenopausal women aged between 45 and 65 years will voluntarily participate. The participants will be allocated to one of three groups: Intervention-Initiators (n = 100, random allocation), Control-Sedentary (n = 100, random allocation) or Control-Active (n = 100, non-random allocation). The intervention group will engage in a supervised exercise programme lasting at least 3 months, supplemented with a HAPA-based intervention for behaviour change. The sedentary control group will not receive any intervention to change their physical activity, while the active control group will consist of women who are already regularly adhering to an active lifestyle. Study variables will be measured at baseline and postintervention phases, as well as at 1, 3, 6 and 12-month follow-ups. The predictors of exercise behaviour in the different phases of the behavioural change process will be explored and compared within and between groups throughout the study. These analyses will help identify the factors that determine the adoption of a healthy active behaviour. Additionally, the effectiveness of the model and the intervention for changing active behaviour will be evaluated.

DISCUSSION

This paper describes the rationale, development and methods used in the AHAWOMEN project. Supporting women who intend to become active can help them to translate their goals into sustainable action. Verifying that the HAPA predictions are applicable to postmenopausal women's adoption of exercise would provide the basis for designing effective interventions for promoting healthy and active ageing that are also tailored to the experiences of middle-aged women.

TRIAL REGISTRATION

ISRCTN16251361. Registration date: 01/06/2023 (retrospectively registered).

Association between physical activity education and prescription during prenatal care and maternal and fetal health outcomes: a quasi-experimental study

BACKGROUND

Physical activity (PA) during pregnancy is associated with healthy gestational weight gain (GWG) and a reduced risk of developing gestational diabetes (GD), gestational hypertension (GHT) and fetal macrosomia. However, in Canada, less than 20% of pregnant women meet PA recommendations. This study assessed associations between an intervention including PA education by prenatal nurses and a PA prescription delivered by physicians and fetal and maternal outcomes.

METHODS

This is a quasi-experimental study. Two groups of women who received their prenatal care at the obstetrics clinic of a university hospital were created. In the first group, 394 pregnant women followed at the clinic received standard care. In the second group, 422 women followed at the clinic received standard care supplemented with education on the relevance of PA during pregnancy and a prescription for PA. Data for both study groups were obtained from the medical records of the mothers and their newborns. Logistic regressions were used to compare the odds of developing excessive GWG, GD, GHT, and fetal macrosomia between the two study groups.

RESULTS

The addition of PA education and PA prescription to prenatal care was associated with 29% lower odds of developing excessive GWG (adjusted odds ratios (OR) 0.71, 95% confidence intervals (CI) 0.51-0.99), 73% lower odds of developing GHT (0.27, 0.14-0.53), 44% lower odds of fetal macrosomia (> 4 kg) (0.56, 0.34-0.93), and 40% lower odds of being large for gestational age (0.60, 0.36-0.99). The intervention was not associated with a difference in odds of developing GD (0.48, 0.12-1.94).

CONCLUSIONS

The inclusion of education and prescription of PA as part of routine prenatal care was associated with improvements in maternal and fetal health outcomes, including significantly lower odds of GWG, GHT and macrosomia.

The Transtheoretical model's processes of change in the heart of a physical activity intervention: A series of n-of-1

The objectives were a) to test whether a Processes of Change (POC)-personalized Transtheoretical model (TTM)-based intervention could increase physical activity (PA) among inactive adults, and b) to examine whether the intervention increased the level of TTM theoretical constructs. The following hypotheses were formulated: 1) PA levels will be significantly higher during and after the intervention in comparison to baseline measures; 2) the level of targeted POCs will increase during the intervention; 3) non targeted POCs will stay stable, and 4) self-efficacy and decisional balance levels will increase during the intervention. A series of N-of-1 with A (1 to 2-week)-B(10-week)-A'(2-week) design were conducted with 12 inactive adults. Behavioral counselors used behavior change techniques to target TTM constructs and supervise PA. Interventions were individualized based on the 5 POCs with the lowest pre-intervention level. Device-based and subjective PA along with TTM measures were collected weekly online. PA data were analyzed with piecewise linear models. A visual analysis was run to examine the TTM constructs. Device, self-reported and TTM data were available for five, seven and five participants, respectively. A significant self-reported PA increase for six participants was found during the phase B and A2. A significant device-measured PA increase was observed in two participants during the study. A substantial increase of targeted POC from baseline for all participants with available data was observed. This study provides the first evidence of behavioral and psychological effects of a POC-personalized TTM-based intervention in inactive adults.

Effectiveness of multilevel interventions based on socio-ecological model to decrease sedentary time in children: a systematic review of controlled studies

Objectives

Preventive actions of sedentary behavior (SB) based on the socio-ecological model are needed among children and young adolescents. The aim of this systematic review is to ascertain the effectiveness of multilevel interventions (i.e., involving consideration of at least two interventional levels) in reducing sedentary time (ST) in children aged 5-12 years.

Methods

Adhering to PRISMA guidelines, a systematic literature search was conducted in three databases (PsyInfo, PubMed and ERIC) until July 2021.

Results

30 trials met the eligibility criteria and were included. They showed acceptable (< 8, n = 18) and high (≥ 8, n = 12) methodological quality. Among studies targeting 2 (n = 2), 3 (n = 19) and 4 levels (n = 9), 1 (50%), 9 (47%) and 7 (78%) were effective and reported significant reduction of ST, respectively.

Conclusion

Interventions tend to be more effective when they involve 4 levels, using both agentic and structural strategies (targeting intrinsic determinants, in the organizational environment of the child). Findings underline the relevance of multilevel strategies to reduce ST in children, but also raise issues about operationalization of the socio-ecological perspective.

Systematic review registration

PROSPERO, identifier: CRD42020209653.

Development and evaluation of a school-based physical literacy intervention for children in Germany: protocol of the PLACE study

Introduction

Fueled by the COVID-19 pandemic, the physical activity behavior of children has reached a concerning level nowadays. By empowering individuals to be physically active throughout the life course, the concept of physical literacy has recently gained increasing attention and adopts a holistic-integrative perspective on PA promotion. Although the field has successively attempted to translate the conceptual ideas of physical literacy into interventions, the theoretical base is heterogeneous and is often lacking within interventions. Furthermore, several countries, including Germany, have not equally adopted the concept yet. Therefore, the goal of the present study protocol is to describe the development and evaluation approach of a PL intervention ("PLACE") for children in grades three and four within the German all-day schooling system.

Methods

The physical literacy intervention cultivates explicit theory-content links and comprises 12 heterogeneous sessions (each 60-90 min in length). The study contains three different phases with two initial pilot studies and a subsequent main study. The two pilot studies take a mixed-methods character by drawing on quantitative pre-post-designs as well as interviews with children (in groups). In the main study, we will longitudinally compare the course of PL values (five outcome domains: physical, affective, cognitive, social, behavioral) between two study arms: school classes of children are either assigned to an intervention condition (regular physical education and health care plus PL intervention) or to a control condition (regular physical education and health care only).

Discussion

The findings of this study will provide evidence on how to structure a multicomponent intervention in Germany based on the PL concept. In summary, the results will report on the effectiveness of the intervention and, therefore, decide whether to scale-up the intervention.

Recommending Physical Activity for People with Intellectual Disabilities: The Relevance of Public Health Guidelines, Physical Activity Behaviour and Type of Contact

People with an intellectual disability (ID) often exhibit more sedentary behaviour and are less physically active than the general population. While previous public health guidelines on physical activity (PA) did not specifically address the needs of people with an ID, the recent updates now include this population, with recommendations similar to those for the general population. However, it is unclear whether the information about these guidelines has reached the broader public and what factors may influence their implementation. To investigate these issues, an online survey was conducted in Austria, Germany and Switzerland, which examined the (a) PA recommendation for people with an ID, (b) awareness of current guidelines, (c) participants' own PA behaviour (IPAQ-SF) and (d) specific contact with people with an ID. Participants (n = 585) recommended similar levels of PA for people with an ID as for the general population, but knowledge of the guidelines did not affect their recommendation. However, participants' own PA behaviour and context-specific contact (e.g., in family or at work) were associated with the recommended PA levels. Therefore, promoting the relevance of PA and fostering contact with people with an ID might be suitable ways to increase PA in people with an ID.

Leveraging Mobile Technology for Public Health Promotion: A Multidisciplinary Perspective

Health behaviors are inextricably linked to health and well-being, yet issues such as physical inactivity and insufficient sleep remain significant global public health problems. Mobile technology-and the unprecedented scope and quantity of data it generates-has a promising but largely untapped potential to promote health behaviors at the individual and population levels. This perspective article provides multidisciplinary recommendations on the design and use of mobile technology, and the concomitant wealth of data, to promote behaviors that support overall health. Using physical activity as anexemplar health behavior, we review emerging strategies for health behavior change interventions. We describe progress on personalizing interventions to an individual and their social, cultural, and built environments, as well as on evaluating relationships between mobile technology data and health to establish evidence-based guidelines. In reviewing these strategies and highlighting directions for future research, we advance the use of theory-based, personalized, and human-centered approaches in promoting health behaviors.

Relationships between Obesity, Exercise Preferences, and Related Social Cognitive Theory Variables among Breast Cancer Survivors

Breast cancer survivors with obesity have an increased risk of cancer recurrence, second malignancy, and comorbidities. Though physical activity (PA) interventions are needed, investigation of the relationships between obesity and factors influencing PA program aspects among cancer survivors remain understudied. Thus, we conducted a cross-sectional study examining associations amongst baseline body mass index (BMI), PA program preferences, PA, cardiorespiratory fitness, and related social cognitive theory variables (self-efficacy, exercise barriers interference, social support, positive and negative outcome expectations) from a randomized controlled PA trial with 320 post-treatment breast cancer survivors. BMI was significantly correlated with exercise barriers interference (r = 0.131, p = 0.019). Higher BMI was significantly associated with preference to exercise at a facility (p = 0.038), lower cardiorespiratory fitness (p < 0.001), lower walking self-efficacy (p < 0.001), and higher negative outcome expectations (p = 0.024), independent of covariates (comorbidity score, Western Ontario and McMaster Universities osteoarthritis index score, income, race, education). Those with class I/II obesity reported a higher negative outcome expectations score compared with class III. Location, walking self-efficacy, barriers, negative outcome expectations, and fitness should be considered when designing future PA programs among breast cancer survivors with obesity.

Effects of a family-based lifestyle intervention on co-physical activity and other health-related outcomes of fathers and their children: the 'Run Daddy Run' intervention

BACKGROUND

Fathers are important in establishing healthy behaviors in their children, but are rarely engaged in lifestyle programs. Focusing on physical activity (PA) of both fathers and their children by engaging them together in PA (i.e. "co-PA") is therefore a promising novel strategy for interventions. The study aim was to investigate the effect of the 'Run Daddy Run' on co-PA and PA of fathers and their children, and secondary outcomes such as weight status and sedentary behaviour (SB).

METHODS

This study is a non-randomized controlled trial (nRCT), including 98 fathers and one of their 6 to 8 years old children (intervention = 35, control = 63). The intervention was implemented over a 14-week period, and consisted of six (inter)active father-child sessions and an online component. Due to COVID-19, only 2/6 sessions could be implemented as planned, the remaining sessions were delivered online. In November 2019-January 2020 pre-test measurements took place, and post-test measurements in June 2020. Additional follow-up test was conducted in November 2020. PA (i.e. LPA, MPA, VPA and volume) of fathers and children were objectively measured using accelerometry, co-PA and the secondary outcomes were questioned using an online questionnaire.

RESULTS

Significant intervention effects were found for co-PA (+ 24 min./day in the intervention compared to the control group, p = 0.002), and MPA of the father (+ 17 min./day, p = 0.035). For children, a significant increase in LPA (+ 35 min./day, p < 0.001) was found. However, an inverse intervention effect was found for their MPA and VPA (-15 min./day, p = 0.005 and - 4 min./day, p = 0.002, respectively). Also decreases in fathers' and children's SB were found (-39 min./day, p = 0.022 and - 40 min./day, p = 0.003, respectively), but no changes in weight status, the father-child relationship, and the PA-family health climate (all p > 0.05).

CONCLUSION

The Run Daddy Run intervention was able to improve co-PA, MPA of fathers and LPA of children, and decreasing their SB. Inverse intervention effects were however found for MPA and VPA of children. These results are unique given their magnitude and clinical relevance. Targeting fathers together with their children might be a novel and potential intervention strategy to improve overall physical activity levels, however, further efforts should however be made to target children's MPA and VPA. Last, replicating these findings in a randomized controlled trial (RCT) is recommended for future research.

TRIAL REGISTRATION NUMBER

This study is registered as a clinical trial (clinicaltrials.gov, ID number: NCT04590755, date: 19/10/2020).

Barriers and facilitators to diet, physical activity and lifestyle behavior intervention adherence: a qualitative systematic review of the literature

BACKGROUND

Consuming a balanced diet and regular activity have health benefits. However, many adults have a difficult time adhering to diet and activity recommendations, especially in lifestyle interventions. Adherence to recommendations could be improved if common facilitators and barriers are accounted for in intervention design. The aim of this systematic review was to understand perceived barriers and facilitators to lifestyle (diet and/or activity) intervention guidelines.

METHODS

This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Studies included relied on qualitative methods to explore the barriers and facilitators healthy adults ([Formula: see text] 18 years) experienced in lifestyle interventions. Google Scholar, Cochrane Reviews, Medline, PubMed, and Web of Science were searched from January 2005 to October 2021. Main themes from each paper were thematically analyzed and reported as a barrier or facilitator to adherence at the individual, environment or intervention level using inductively derived themes. Study quality was assessed using the Critical Appraisal Skills Programme.

RESULTS

Thirty-five papers were included. Of these, 46% were conducted in North America and the majority had more female participants (86% in mixed-sex studies, 26% females only). Similar themes emerged across all three levels as facilitators and barriers. At the individual level, attitudes, concern for health and physical changes. At the environmental level, social support, social accountability, changeable and unchangeable aspects of the community. Finally, delivery and design and content at the intervention level. An additional facilitator at the intervention level included fostering self-regulation through Behavior Change Taxonomies (BCT).

CONCLUSIONS

Lifestyle interventions that foster self-regulatory skills, opportunities for social engagement and personalization of goals may improve behaviour adherence. This can be achieved through inclusion of BCT, tapering off of intervention supports, identification of meaningful goals and anticipated barriers with participants.

An individualized mobile health intervention to promote physical activity in adults with obstructive sleep apnea: An intervention mapping approach

Objective

Combining continuous positive airway pressure with physical activity (PA) might be a promising strategy to treat obstructive sleep apnea (OSA). This article describes how intervention mapping (IM) can guide the development, content, and mechanisms of action of a mobile application to promote PA in adults with OSA.

Methods

To develop the program, the IM approach was followed. This article presents the first three steps of IM to develop a mixed intervention (with interventionists and a digital application) aiming to: (1) assess patients' health problems and needs in a literature review to determine their expectations and perceived facilitators and barriers to PA behavior change and thus select the determinants of behavior; (2) formulate the expected intervention outcomes and objectives to be met to achieve the overall program goals; and (3) select and implement the behavior change techniques (BCTs) to achieve the change objectives.

Results

The literature review identified the relevant determinants (e.g., self-efficacy, coping, planning, and habit) of PA behavior using the health action process approach and multiprocess action control. These results were used to specify the program outcomes for PA adapted to physical, psychological, and social parameters. Overall, 11 performance objectives and 30 change objectives were defined. Lastly, BCTs and practical applications were identified.

Conclusions

The study provides a theoretical and methodological basis for researchers and practitioners given the current paucity of evidence-based PA interventions for adults with OSA. It addresses the lack of BCTs (framing and prompts/cue techniques) and meaningful behavioral determinants (identity and habit) in most interventions.

Promotion of physical activity-related health competence using digital workplace-based health promotion: protocol for a controlled before-and-after study

Physical activity (PA) has a high potential to prevent chronic diseases. At the same time, many people in Germany do not achieve PA recommendations due to trends such as digitalisation and the COVID-19 pandemic and, as a result, working from home. There is a need for location-independent and time-independent interventions. Based on the model of physical activity-related health competence (PAHCO), a study design was developed for a digitally conducted, controlled, before-and-after-study targeting office workers. The intervention group receives video-based instructions with exercises that can be performed directly at the desk, complemented by anatomical explanations and advice on PA based on the PAHCO model. The control group only receives the exercises. The intervention period is 5 weeks. Follow-up is conducted after 3 months. The trial shall comprise 294 participants per group whose PA is recorded via questionnaire and online PA diary. Their PAHCO and health-related quality of life are also assessed. The present study aims to increase the health-enhancing PA of office workers independent of time and location. Trial registration number is DRKS00028053.

Effect of the Active Aging-in-Place-Rehabilitation Nursing Program: A Randomized Controlled Trial

(1) Background: It is of great importance to promote functional capacity and positive lifestyles, since they contribute to preventing the progression of frailty among the older adults. The aim of this study was to evaluate the effect of active aging-in-place−rehabilitation nursing program (AAP-RNP) on the functional capacity and lifestyles of frail older adults. (2) Methods: This was a single-blinded, two-group, randomized, controlled trial of 30 frail older people enrolled at a Health-care unit in Portugal between 2021 and 2022. The duration of the program was 12 weeks, and the sessions took place at the participants’ homes. We used as instruments the Tilburg Frailty Indicator; Fried frailty phenotype; Senior Fitness Test battery; Barthel Index; Lawton Index; handgrip strength measurement; Tinetti Index; Individual lifestyle profile; and Borg’s perception of effort. (3) Results: Post-program, there was an improvement in multidimensional and physical frailty, functional capacity, balance, and perceived exertion (p < 0.05) in the experimental group. Among the older adults’ lifestyles, we observed significant improvements in physical activity habits, relational behavior, and stress management. (4) Conclusions: Rehabilitation nurses have a relevant role, and the AAP-RNP seems to be effective in improving functional capacity and lifestyles in frail older adults.

Assessing basic and higher-level psychological needs satisfied through physical activity

Background

There has been increasing interest in the extent to which the fulfillment of psychological needs is associated with physical activity engagement. However, a vast majority of studies consider only basic psychological needs such as relatedness, competence, and autonomy-with higher-level psychological needs such as challenge, creativity, and spirituality rarely being addressed. The aim of this study was to examine the preliminary reliability (i.e., internal consistency) and validity (i.e., discriminant, construct, and predictive) of a multi-dimensional scale to assess a range of basic and higher-level psychological needs satisfied through physical activity.

Methods

A sample of 75 adults (ages 19-65 years, 59% female, 46% White) completed a baseline questionnaire measuring 13 psychological needs subscales (i.e., physical comfort, safety, social connection, esteem from others, individual esteem, learning, challenge, entertainment, novelty, creativity, mindfulness, aesthetic appreciation, and morality), exercise enjoyment, and exercise vitality. Participants then completed 14 days of accelerometer monitoring of physical activity and ecological momentary assessment of affective responses during physical activity sessions in daily life.

Results

Internal consistency reliability was acceptable (>0.70) for all subscales except for mindfulness, aesthetic appreciation, and morality. Ten of the 13 subscales exhibited discriminant validity by differentiating between engagement (vs. no engagement) in at least one physical activity type (e.g., brisk walking and yoga/Pilates). All the subscales, except physical comfort and esteem from others, were associated with at least one of the construct validation criteria (e.g., exercise enjoyment, affective response during exercise). Five of the subscales were associated with at least one of the predictive validation criteria (i.e., light, moderate, vigorous intensity activity measured by accelerometer).

Conclusion

Having the capacity to assess whether one's current physical activity is failing to fulfill various psychological needs-combined with recommendations about which types of activities may satisfy those needs-may address an important gap in physical activity promotion.

Analysis of Healthy Coping Feedback Messages from Diabetes Mobile Apps: Validation Against an Evidence-Based Framework

BACKGROUND

In this study, we focused on Healthy Coping, a key principle of ADCES7 Self-Care Behaviors^® (ADCES7^®) that enables people with diabetes to achieve health goals for self-care. We aimed to validate Healthy Coping-related feedback messages from diabetes mobile apps against the framework based on behavioral change theories.

METHODS

We searched apps using the search terms: "diabetes," "blood sugar," "glucose," and "mood" from iTunes and Google Play stores. We entered a range of values on 3 Healthy Coping domains: (1) diabetes-related measures including blood glucose, blood pressure, HbA1c, weight, (2) physical exercise/activity, and (3) mood to generate feedback messages. We used a framework by adopting validated behavioral change theory-based models to evaluate the feedback messages against 3 dimensions of timing, intention, and content (feedback purpose and feedback response). The feedback purposes in this study were categorized into 7 purposes; warning, suggestion, self-monitoring, acknowledging, reinforcement, goal setting, and behavior contract.

RESULTS

We identified 1,749 apps from which 156 diabetes mobile apps were eligible and generated 473 feedback messages. The majority of generated feedback messages were related to blood sugar measurement. Only feedback messages on blood sugar under diabetes-related measures and mood domains encompassed all 7 feedback purposes under the content dimension.

CONCLUSIONS

Many feedback messages neither supported Healthy Coping domains nor followed the behavioral theory-based framework. It is important that feedback messages be structured around the dimensions of the behavioral theory-based framework to promote behavior change. Furthermore, our framework had the generalizability that can be used in other clinical areas.