Acute Bidirectional Relations Between Affect, Physical Feeling States, and Activity-Related Behaviors Among Older Adults: An Ecological Momentary Assessment Study

The Within-Subject Association of Physical Behavior and Affective Well-Being in Everyday Life: A Systematic Literature Review

BACKGROUND

The interplay of physical activity (PA) with affective well-being (AWB) is highly critical to both health behaviors and health outcomes. Current prominent theories presume AWB to be crucial for PA maintenance, and PA is evidenced to foster mental health. However, thus far, PA-AWB associations have mainly been researched in laboratory settings and with interventional designs, but the everyday life perspective had not been focused on, mostly due to technological limitations. In the course of digitization, the number of studies using device-based methods to research the within-subject association of physical activity and affective well-being (PA-AWB) under ecological valid conditions increased rapidly, but a recent comprehensive systematic review of evidence across populations, age groups, and distinct AWB components remained inconclusive.

OBJECTIVES

Therefore, we aimed to firstly review daily-life studies that assessed intensive longitudinal device-based (e.g., electronic smartphone diaries and accelerometry) and real-time PA-AWB data, secondly to develop and apply a quality assessment tool applicable to those studies, and thirdly to discuss findings and draw implications for research and practice.

METHODS

To this end, the literature was searched in three databases (Web of Science, PubMed, Scopus) up to November 2022. The systematic review followed the PRISMA guidelines and had been pre-registered (PROSPERO id: CRD42021277327). A modified quality assessment tool was developed to illustrate the risk of bias of included studies.

RESULTS

The review of findings showed that, in general, already short PA bouts in everyday life, which clearly differ from structured exercise sessions, are positively associated with AWB. In particular, feelings of energy relate to incidental (non-exercise and unstructured) activity, and PA-AWB associations depend on population characteristics. The quality assessment revealed overall moderate study quality; however, the methods applied were largely heterogeneous between investigations. Overall, the reviewed evidence on PA-AWB associations in everyday life is ambiguous; for example, no clear patterns of directions and strengths of PA-AWB relationships depending on PA and AWB components (such as intensity, emotions, affect, mood) emerged.

CONCLUSIONS

The reviewed evidence can fuel discussions on whether the World Health Organization's notion "every move counts" may be extended to everyday life AWB. Concurrently, the PA-AWB relationship findings endorse prominent theories highlighting the critical role of AWB in everyday PA engagement and maintenance. However, the review also clearly highlights the need to advance and harmonize methodological approaches for more fine-grained investigations on which specific PA/AWB characteristics, contextual factors, and biological determinants underly PA-AWB associations in everyday life. This will enable the field to tackle pressing challenges such as the issue of causality of PA-AWB associations, which will help to shape and refine existing theories to ultimately predict and improve health behavior, thereby feeding into precision medicine approaches.

Daily sampling frequency and sampling duration affect reliability of person-level estimates of physical activity outcomes: Optimizing Ecological Momentary Assessment studies of physical activities

Studies on the interrelationship between physical activity (PA) behaviors and EMA-assessed constructs should use measures with high reliability of both the EMA-assessed constructs and the time-matched accelerometry-assessed PA behavior. The aim of this paper is to evaluate how the reliability of accelerometry-assessed PA outcomes is affected by different EMA sampling schemes. Emulating relevant sampling schemes in EMA studies, multiple random samples of real-world accelerometer data (measured via activPAL worn for ∼7 days) were drawn that varied in the number of daily samples (3, 5, and 7 daily samples) and in the duration of each sample (5 min, 60 min, and 120 min), totaling 9 sampling schemes. The reliability of the resulting PA outcomes was estimated by correlating weekly aggregates of the sampled data with the true parameter values (weekly aggregates of all data). A total of 4231 days were analyzed from 619 participants (mean age 45 ± 16 years; 73.3 % female; 72.7 % Non-Hispanic White). At the lowest sampling duration (5 min), none of the sampling schemes reached the threshold for acceptable reliability (reliabilities ranged from 0.20 to 0.67). Using 120 min sample duration resulted in reliable person-level PA estimates (ranges 0.77 to 0.97) except for the time spent in sedentary behavior (rel = 0.68), and for minimum (rel = 0.66), and maximum (rel = 0.63) PA intensity. These three PA outcomes consistently yielded lower levels of reliability across all sampling schemes. Holding constant the total time covered in a day, sampling schemes that used more frequent samples with shorter duration resulted in greater reliability compared to sampling schemes that used less frequent samples with longer duration. Overall, the results are consistent with sampling theory - reliability increased as more time was covered. However, our results also suggested interactive effects of reliability based on sampling frequency, duration, and PA outcome. Researchers should be aware that the reliability of accelerometer-derived PA outcomes can vary depending on the sampling design of EMA studies.

Within-Person Associations of Accelerometer-Assessed Physical Activity With Time-Varying Determinants in Older Adults: Time-Based Ecological Momentary Assessment Study

BACKGROUND

Despite the availability of physical activity (PA) interventions, many older adults are still not active enough. This might be partially explained by the often-limited effects of PA interventions. In general, health behavior change interventions often do not focus on contextual and time-varying determinants, which may limit their effectiveness. However, before the dynamic tailoring of interventions can be developed, one should know which time-dependent determinants are associated with PA and how strong these associations are.

OBJECTIVE

The aim of this study was to examine within-person associations between multiple determinants of the capability, opportunity, motivation, and behavior framework assessed using Ecological Momentary Assessment (EMA) and accelerometer-assessed light PA, moderate to vigorous PA, and total PA performed at 15, 30, 60, and 120 minutes after the EMA trigger.

METHODS

Observational data were collected from 64 healthy older adults (36/64, 56% men; mean age 72.1, SD 5.6 y). Participants were asked to answer a time-based EMA questionnaire 6 times per day that assessed emotions (ie, relaxation, satisfaction, irritation, and feeling down), the physical complaint fatigue, intention, intention, and self-efficacy. An Axivity AX3 was wrist worn to capture the participants' PA. Multilevel regression analyses in R were performed to examine these within-person associations.

RESULTS

Irritation, feeling down, intention, and self-efficacy were positively associated with subsequent light PA or moderate to vigorous PA at 15, 30, 60, or 120 minutes after the trigger, whereas relaxation, satisfaction, and fatigue were negatively associated.

CONCLUSIONS

Multiple associations were observed in this study. This knowledge in combination with the time dependency of the determinants is valuable information for future interventions so that suggestions to be active can be provided when the older adult is most receptive.

Physical activity and cognitive function: moment-to-moment and day-to-day associations

BACKGROUND

The beneficial effect of acute physical exercise on cognitive performance has been studied in laboratory settings and in long-term longitudinal studies. Less is known about these associations in everyday environment and on a momentary timeframe. This study investigated momentary and daily associations between physical activity and cognitive functioning in the context of everyday life.

METHODS

Middle-aged adults (n = 291, aged 40-70) were asked to wear accelerometers and complete ecological momentary assessments for eight consecutive days. Processing speed and visual memory were assessed three times per day and self-rated evaluations of daily cognition (memory, thinking, and sharpness of mind) were collected each night. The number of minutes spent above the active threshold (active time) and the maximum vector magnitude counts (the highest intensity obtained) before each cognitive test and at a daily level were used as predictors of momentary cognitive performance and nightly subjective cognition. Analyses were done with multilevel linear models. The models were adjusted for temporal and contextual factors, age, sex, education, and race/ethnicity.

RESULTS

When participants had a more active time or higher intensity than their average level within the 20 or 60 minutes prior to the cognitive test, they performed better on the processing speed task. On days when participants had more active time than their average day, they rated their memory in the evening better. Physical activity was not associated with visual memory or self-rated thinking and sharpness of mind.

CONCLUSIONS

This study provides novel evidence that outside of laboratory settings, even small increases in physical activity boost daily processing speed abilities and self-rated memory. The finding of temporary beneficial effects is consistent with long-term longitudinal research on the cognitive benefits of physical activity.

Momentary within-subject associations of affective states and physical behavior are moderated by weather conditions in real life: an ambulatory assessment study

BACKGROUND

Physical behavior (PB) is a key lifestyle factor in regulating and preventing diseases across the lifespan. Researchers identified affective, cognitive, and contextual factors like weather conditions, as significant contributors in determining if individuals are physically active. However, there is scarce empirical evidence about potential associations between PB and affective states influenced by weather conditions in daily life. Therefore, we explored if weather conditions moderated the within-subject association between momentary affective states and subsequent PB.

METHODS

Utilizing ambulatory assessment, 79 participants completed electronic diaries about their affective states (i.e., valence, energetic arousal, and calmness) up to six times a day over five days, and their PB (i.e., physical activity and sedentariness) was simultaneously recorded via accelerometers. Weather conditions (i.e., temperature and precipitation) recorded near participants' locations served as moderators in the multilevel analyses.

RESULTS

We confirmed earlier findings associating affective states with PB. Increased valence and energetic arousal were positively associated with physical activity (β = 0.007; p < .001), whereas calmness predicted lower levels of physical activity (β = -0.006; p < .001). Higher levels of calmness showed a positive association with sedentary behavior (β = 0.054; p = .003). In addition, we revealed a significant positive association between temperature, as a momentary weather condition, and physical activity (β = 0.025; p = .015). Furthermore, we showed that the association of affective states and physical activity was moderated by temperature. Higher temperatures enhanced the positive effects of valence on physical activity (β = .001, p = .023) and attenuated the negative effects of calmness on physical activity (β = .001, p = .021). Moreover, higher temperatures enhanced the positive effects of valence on reduced sedentary behavior (β = -0.011, p = .043).

CONCLUSIONS

Temperature alterations appeared to have an impact on subsequent physical activity. Furthermore, temperature alterations moderated the influence of affective states on conducted physical activity. This might offer the opportunity for just-in-time adaptive interventions to intervene in individually appropriate environmental conditions for promoting physical activity.

Essential Role of Social Context and Self-Efficacy in Daily Paretic Arm/Hand Use After Stroke: An Ecological Momentary Assessment Study With Accelerometry

OBJECTIVE

To determine the momentary effect of social-cognitive factors, in addition to motor capability, on post-stroke paretic arm/hand use in the natural environment.

DESIGN

A 5-day observational study in which participants were sent 6 Ecological Momentary Assessment (EMA) prompts/day.

SETTING

Participants' daily environment.

PARTICIPANTS

Community-dwelling, chronic stroke survivors with right-dominant, mild-moderate upper extremity paresis (N=30).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Time duration of bimanual and unimanual paretic arm/hand use indexed by accelerometry; social-cognitive factors (social context, self-efficacy, mood) captured by EMA; motor capability of the paretic limb measured by Fugl-Meyer Upper Extremity Motor Assessment (FM).

RESULTS

After accounting for participants' motor capability, we found that momentary social context (alone or not) and self-efficacy significantly predicted post-stroke paretic arm/hand use behavior in the natural environment. When participants were not alone, paretic arm/hand movement increased both with and without the less-paretic limb (bimanual and unimanual movements, P=.018 and P<.001, respectively). Importantly, participants were more likely to use their paretic arm/hand (unimanually) if they had greater self-efficacy for limb use (P=.042). EMA repeated-measures provide a real-time approach that captures the natural dynamic ebb and flow of social-cognitive factors and their effect on daily arm/hand use. We also observed that people with greater motor impairments (FM<50.6) increase unimanual paretic arm/hand movements when they are not alone, regardless of motor capability.

CONCLUSIONS

In addition to motor capability, stroke survivors' momentary social context and self-efficacy play a role in paretic arm/hand use behavior. Our findings suggest the development of personalized rehabilitative interventions which target these factors to promote daily paretic arm/hand use. This study highlights the benefits of EMA to provide real-time information to unravel the complexities of the biopsychosocial (ie, motor capability and social-cognitive factors) interface in post-stroke upper extremity recovery.

Within-Person Temporal Associations Among Self-Reported Physical Activity, Sleep, and Well-Being in College Students

OBJECTIVE

A holistic understanding of the naturalistic dynamics among physical activity, sleep, emotions, and purpose in life as part of a system reflecting wellness is key to promoting well-being. The main aim of this study was to examine the day-to-day dynamics within this wellness system.

METHODS

Using self-reported emotions (happiness, sadness, anger, anxiousness) and physical activity periods collected twice per day, and daily reports of sleep and purpose in life via smartphone experience sampling, more than 28 days as college students ( n = 226 young adults; mean [standard deviation] = 20.2 [1.7] years) went about their daily lives, we examined day-to-day temporal and contemporaneous dynamics using multilevel vector autoregressive models that consider the network of wellness together.

RESULTS

Network analyses revealed that higher physical activity on a given day predicted an increase of happiness the next day. Higher sleep quality on a given night predicted a decrease in negative emotions the next day, and higher purpose in life predicted decreased negative emotions up to 2 days later. Nodes with the highest centrality were sadness, anxiety, and happiness in the temporal network and purpose in life, anxiety, and anger in the contemporaneous network.

CONCLUSIONS

Although the effects of sleep and physical activity on emotions and purpose in life may be shorter term, a sense of purpose in life is a critical component of wellness that can have slightly longer effects, bleeding into the next few days. High-arousal emotions and purpose in life are central to motivating people into action, which can lead to behavior change.

Using Ecological Momentary Assessments and Fitbit Data to Examine Daily Associations Between Physical Activity, Affect and Alcohol Cravings in Patients with Alcohol Use Disorder

BACKGROUND

Preliminary studies show that structured physical activity (PA) interventions can reduce negative affect and alcohol use in patients recovering from alcohol use disorder (AUD). The current study tested whether the association between PA, affect, and alcohol cravings can be observed in patients' natural environments (i.e., without a structured intervention) as well.

METHOD

Twenty-five participants with AUD completed 3 weeks of ecological momentary assessment (EMA) monitoring and wore Fitbit devices to measure physical activity directly after discharge from partial hospitalization treatment for AUD. PA was operationalized as total steps and consecutive 10-min bouts of moderate-intensity exercise (100 steps/minute).

RESULTS

Only 56% of participants engaged in any bouts of moderate-intensity physical activity throughout the 3-week study period (mode = 1 bout), and participants logged an average of 8183 steps/day (SD = 5560). Daily steps were associated with a higher positive affect and lower alcohol cravings, and with higher positive affect the next day, but the effects were very small. No relationships were observed between PA and affect or alcohol cravings at the hourly level except a random effect signifying that bouts of PA were either positively associated or not associated with negative affect in the next hour for different participants.

CONCLUSIONS

Overall, results suggest that naturalistic PA may be beneficial for a small subset of patients in recovery from AUD, but the majority did not engage in regular exercise or experience improvements in affect and cravings as a result of PA.

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

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

Digital phenotyping in depression diagnostics: Integrating psychiatric and engineering perspectives

Depression is a serious medical condition and is a leading cause of disability worldwide. Current depression diagnostics and assessment has significant limitations due to heterogeneity of clinical presentations, lack of objective assessments, and assessments that rely on patients' perceptions, memory, and recall. Digital phenotyping (DP), especially assessments conducted using mobile health technologies, has the potential to greatly improve accuracy of depression diagnostics by generating objectively measurable endophenotypes. DP includes two primary sources of digital data generated using ecological momentary assessments (EMA), assessments conducted in real-time, in subjects' natural environment. This includes active EMA, data that require active input by the subject, and passive EMA or passive sensing, data passively and automatically collected from subjects' personal digital devices. The raw data is then analyzed using machine learning algorithms to identify behavioral patterns that correlate with patients' clinical status. Preliminary investigations have also shown that linguistic and behavioral clues from social media data and data extracted from the electronic medical records can be used to predict depression status. These other sources of data and recent advances in telepsychiatry can further enhance DP of the depressed patients. Success of DP endeavors depends on critical contributions from both psychiatric and engineering disciplines. The current review integrates important perspectives from both disciplines and discusses parameters for successful interdisciplinary collaborations. A clinically-relevant model for incorporating DP in clinical setting is presented. This model, based on investigations conducted by our group, delineates development of a depression prediction system and its integration in clinical setting to enhance depression diagnostics and inform the clinical decision making process. Benefits, challenges, and opportunities pertaining to clinical integration of DP of depression diagnostics are discussed from interdisciplinary perspectives.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Examining the day-level impact of physical activity on affect during the early months of the COVID-19 pandemic: An ecological momentary assessment study

Engaging in physical activity (PA) may be a promising approach to mitigate the effects of the COVID-19 pandemic and related restrictions on daily affect. The study used ecological momentary assessment (EMA) to examine the within-subject associations of day-level PA with same-day evening affect. Interactions between daily PA and overall stress related to COVID-19 predicting evening affect were also examined. Adults living in the U.S. (N = 157, M _age = 31.7, 84.1% female) participated in a 28-day smartphone-based EMA study during the early months of the pandemic (April - June 2020). Evening EMA surveys assessed daily PA minutes, momentary positive activated and deactivated affect, and momentary negative activated and deactivated affect. An online questionnaire assessed demographics. Multi-level linear regression models assessed day-level associations between PA and evening affect, controlling for age, sex, income, body mass index, employment status, and morning affect. There were N = 2,409 person-days in the analysis. Baseline COVID-19 stress was not associated with daily PA minutes (p = .09) or positive-activated affect (p = .14), but was associated with lower positive-deactivated affect (p < .001) and greater negative-activated and negative-deactivated affect (ps < .001) in the evenings. On days when individuals reported more PA than usual, they reported greater positive-activated and positive-deactivated affect, and lower negative-activated and negative-deactivated affect in the evening (ps < .001). The interaction of day-level PA and COVID-19 stress predicting evening positive-activated, positive-deactivated, negative-activated, and negative-deactivated affect was not significant (ps > .05). During the early months of the pandemic, adults experienced improved evening affect on days when they engaged in more PA. However, data did not show that PA counteracts detrimental effects of the COVID-19 pandemic on evening affect. Public health efforts should strategically promote and address barriers to PA during the pandemic.

Momentary associations between stress and physical activity among children using ecological momentary assessment

Chronic and acute stress may have a detrimental effect on children's physical activity. Research on stress as a predictor of children's physical activity has mostly focused on stress between children, rather than how children's within-day variation in stress may predict physical activity. The current study assessed the within- and between-effects of stress on subsequent physical activity in three different time windows using ecological momentary assessment (EMA) and accelerometry. Children (N = 190; M_{Baseline Age} =10.1±0.9, 53% female, 56% self-identified Hispanic/Latino) completed six semi-annual assessment bursts across three years. During each burst, participants responded to up to seven (weekend) or three (weekday) randomly prompted EMA surveys on smartphones for seven days and wore a waist-worn accelerometer. Multi-level structural equation modeling examined within- and between-subjects effects of stress as a predictor of children's subsequent moderate-to-vigorous physical activity (MVPA) in the 15, 30, and 60 minutes following the EMA prompt. Latent variables were created for within- and between-subjects stress were comprised of three EMA stress items. Higher than average levels of stress (within-subjects) significantly predicted lower MVPA in the subsequent 15, 30 and 60 minutes (ps < .05). Between-subjects stress was not significantly associated with subsequent MVPA (ps > .05). Results indicate that elevated momentary stress predicts less subsequent MVPA. These findings suggest that within-day fluctuations in stress may be a barrier for children engaging in physical activity. Childhood physical activity promotion and interventions should consider the role of children's stress, aim to reduce the stress children experience throughout the day, and incorporate stress coping strategies.

Social and Physical Context Moderates Older Adults' Affective Responses to Sedentary Behavior: An Ecological Momentary Assessment Study

OBJECTIVES

Older adults engage in excessive sedentary behaviors which holds significant health implications. Examining affect responses during sedentary behavior is not well understood despite the wealth of evidence linking affect and motivation. Contextual influences (i.e., social, physical) likely influence affective responses during sedentary behavior and therefore warrant further investigation.

METHODS

Older adults (n=103, Mage=72, Range: 60-98) participated in a 10-day study where they were received 6 randomly timed, smartphone-based Ecological Momentary Assessment (EMA) prompts/day. Participants reported their affect, current behavior, and context at each EMA prompt. Participants also wore an activPAL accelerometer to measure their sedentary behavior duration. Separate multilevel models examined the extent to which the context influences affective responses during self-report sedentary (vs. non-sedentary) behaviors.

RESULTS

The social context moderated the association between sedentary behavior and negative affect. The physical context moderated the association between sedentary behavior and positive affect.

DISCUSSION

Interventions should consider the context of behaviors when designing interventions to reduce sedentary behavior as some contextual factors may attenuate, while other contexts may exacerbate, associations between activity-related behaviors and indicators of well-being.