Concurrent and lagged relations between momentary affect and sedentary behavior in middle-aged women

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.

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.

Screen-based and non-screen-based sedentary behaviors are differentially associated with affective states in older adults

Excessive sedentary behavior (SB) contributes to poor affective and physical feeling states, which is particularly concerning for older adults who are the most sedentary sector of the population. Specific types of SB have been shown to differentially impact health in cross-sectional and longitudinal studies, with screen-based SB more negatively impacting aspects of mental health. This study used Ecological Momentary Assessment (EMA), a real-time, intensive longitudinal data capture methodology, to examine the differential impact of screen-based behaviors on momentary affective responses during SB in naturalistic settings. A diverse sample of older adults (pooled across 2 studies) completed an EMA protocol for 8-10 days with six randomly delivered, smartphone assessments per day. At each EMA prompt, participants reported their current activity, whether they were sitting while doing that activity, and affective states. Multilevel models assessed whether screen-based (vs. non-screen-based) behavior moderated affective response during SB. At the within-person level, older adults experienced less positive affect during SB when engaged in a screen-based behavior compared to a non-screen-based SB (B = -0.10, p < 0.01). At the between-person level, positive associations between SB and negative affect (B = 0.79, p = 0.03) were stronger if participants reported engaging in screen-based behaviors for a greater proportion of prompts. Among older adults, screen-based SB may lead to poorer affective states compared to non-screen-based SB. Interventions aiming to reduce SB in this population should consider targeting reductions in screen-based SB as means to improve affective states.

A Longitudinal Examination of Real-World Sedentary Behavior in Adults with Schizophrenia-Spectrum Disorders in a Clinical Trial of Combined Oxytocin and Cognitive Behavioral Social Skills Training

Sedentary behavior contributes to a shortened life expectancy in individuals with schizophrenia-spectrum disorders (SSDs), highlighting the need for effective interventions to improve health. This study examined whether reduced ecological momentary assessment (EMA) measures of sedentary activities were observed in individuals with SSDs who participated in a 24-week randomized trial of cognitive behavioral social skills training (CBSST) and either intranasal oxytocin or placebo (NCT01752712). Participants (n = 57) were prompted with EMA surveys seven times per day for seven days during the baseline, 12-week, and 24-week timepoints to sample sedentary behavior ratings, positive and negative affect, interpersonal interactions, and interpersonal interaction appraisals. Results revealed that sedentary behavior and social interactions did not significantly change over the 24-week clinical trial; however, positive and negative affect and defeatist interaction appraisals improved with treatment, and oxytocin produced modest additional improvements in these EMA outcomes. Greater momentary positive affect was significantly associated with greater activity and greater frequency of interactions. Overall, CBSST was effective at improving functioning, momentary affect, and defeatist interaction appraisals, although it did not reduce sedentary behavior; therefore, targeting these factors is not sufficient to reduce sedentary behavior, and adjunct interventions are needed.

Momentary affective response to bouts of moderate-to-vigorous physical activity predicts changes in physical activity and sedentary behavior during behavioral weight loss

BACKGROUND

Affective responses are posited to be key predictors of the uptake and maintenance of health behaviors. However, few studies have examined how individuals' affective response to physical activity, as well as the degree to which their affect response changes, may predict changes in physical activity and sedentary time during behavioral weight loss treatment.

PURPOSE

The current study examined how baseline momentary affective response (i.e., stress and anxiety) to moderate-to-vigorous physical activity (MVPA) and the degree of pre--post intervention change in this response predicted change in daily sedentary, light, and MVPA time during a three-month internet-based weight loss program.

METHODS

Women with overweight/obesity (final N=37) completed 14-day ecological momentary assessment (EMA) protocols with objective measurement of physical activity (i.e., bout-related MVPA time) before and after the intervention.

RESULTS

Women who had more reinforcing responses to MVPA (i.e., greater reductions in anxiety and stress response following MVPA bouts) at baseline had greater increases in overall MVPA at the end of the intervention. Those who had greater anxiety reductions after MVPA bouts at baseline also evidenced less sedentary time at the end of the intervention. Changes in affective responses across the intervention were not related to changes in physical activity levels.

CONCLUSIONS

Findings suggest initial levels of affective reinforcement from MVPA bouts predict future change in MVPA and sedentary time during behavioral weight loss. Future work is needed to examine the utility of more precisely targeting affective responses to physical activity to optimize intervention approaches.

The context matters - not all prolonged sitting bouts are equally related to momentary affective states: an ambulatory assessment with sedentary-triggered E-diaries

Background

Sedentary behaviors (SB) and especially prolonged sitting bouts are highly prevalent in daily life and studies indicated an association with an increased risk for several non-communicable diseases. Consequently, guidelines to reduce SB were developed. At the same time, an in-depth knowledge regarding SB such as where, what and with whom people spend time sedentary as well as correlates such as affective states of prolonged sitting bouts, is still lacking. A more differentiated view on SB is necessary to identify detrimental and modifiable sedentary bouts. We addressed this gap by conducting an ambulatory assessment study including accelerometer and sedentary-triggered e-diaries that captures data during prolonged sitting bouts (> 20 min). We investigated how contextual factors of prolonged sitting bouts are associated with momentary affective states.

Method

Four studies were combined with a final sample of 308 participants (50.3% female, M_age, 27.4, range, 17–66). SB was assessed objectively with thigh-worn accelerometers for four to five days. Whenever a participant was sitting for 20 or 30 min the accelerometer triggered questions assessing social (not alone vs. alone) and environmental (leisure vs. working) factors as well as momentary affective states (valence, energetic arousal and calmness). Multilevel analyses were used to examine within-person associations between different contexts and mood during prolonged sitting.

Results

Momentary affective states varied significantly due to different social and environmental contexts (p_s < 0.001): Sitting together with others was associated with higher levels of valence and energetic arousal. Furthermore, sitting during leisure time was associated with higher levels of valence and calmness and lower levels of energetic arousal. Significant interaction analyses revealed that participants had the highest ratings while sitting during leisure episodes together with others.

Conclusion

Findings showed that prolonged sitting bouts differ regarding their association with affect. Sitting with others, sitting during leisure time and especially sitting during leisure time and with others, was associated with higher levels of momentary affective states, respectively. Thus, SB guidelines should focus on reducing those SB episodes that are associated with lower levels of affect, for example during working episodes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01170-3.

Racial Discrimination, Sedentary Time, and Physical Activity in African Americans: Quantitative Study Combining Ecological Momentary Assessment and Accelerometers

Background

A growing number of studies indicate that exposure to social stress, such as perceived racial discrimination, may contribute to poor health, health behaviors, and health disparities. Increased physical activity (PA) may buffer the impact of social stress resulting from racial discrimination. However, to date, data on the relationship between racial discrimination and PA have been mixed. Part of the reason is that the effect of perceived racial discrimination on PA has primarily been examined in cross-sectional studies that captured retrospective measures of perceived racial discrimination associated with individuals’ current PA outcomes. The association between real-time perceived racial discrimination and PA among African Americans remains unclear.

Objective

The purpose of this study is to examine the relationship among demographic, anthropometric and clinical, and psychological factors with lifetime racial discrimination and examine the within- and between-person associations between daily real-time racial discrimination and PA outcomes (total energy expenditure, sedentary time, and moderate-to-vigorous PA patterns) measured by ecological momentary assessment (EMA) and accelerometers in healthy African Americans.

Methods

This pilot study used an intensive, observational, case-crossover design of African Americans (n=12) recruited from the community. After participants completed baseline surveys, they were asked to wear an accelerometer for 7 days to measure their PA levels. EMA was sent to participants 5 times per day for 7 days to assess daily real-time racial discrimination. Multilevel models were used to examine the within- and between-person associations of daily racial discrimination on PA.

Results

More EMA-reported daily racial discrimination was associated with younger age (r=0.75; P=.02). Daily EMA-reported microaggression was associated with depressive symptoms (r=0.66; P=.05), past race-related events (r=0.82; P=.004), and lifetime discrimination (r=0.78; P=.01). In the within-person analyses, the day-level association of racial discrimination and sedentary time was significant (β=.30, SE 0.14; P=.03), indicating that on occasions when participants reported more racial discrimination than usual, more sedentary time was observed. Between-person associations of racial discrimination (β=−.30, SE 0.28; P=.29) or microaggression (β=−.34, SE 0.36; P=.34) with total energy expenditure were suggestive but inconclusive.

Conclusions

Concurrent use of EMA and accelerometers is a feasible method to examine the relationship between racial discrimination and PA in real time. Examining daily processes at the within-person level has the potential to elucidate the mechanisms of which racial discrimination may have on health and health behaviors and to guide the development of personalized interventions for increasing PA in racial ethnic minorities. Future studies with a precision health approach, incorporating within- and between-person associations, are warranted to further elucidate the effects of racial discrimination and PA.

International Registered Report Identifier (IRRID)

RR2-10.1002/nur.22068

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.

A multi-study approach to refining ecological momentary assessment measures for use among midlife women with elevated risk for cardiovascular disease

BACKGROUND

Ample evidence indicates that everyday perceptions of the social environment can affect health behaviors; these include social comparisons (i.e., self-evaluations compared to others) and positive versus negative social interactions. However, relations between social perceptions and healthy behaviors have received little attention among specific medical populations for whom an improved understanding of behavioral determinants could inform updates to tailored interventions. Research methods that capture and differentiate between stable, person-level differences and dynamic, within-person variability in these relations would be particularly useful, both for identifying their nature in daily life and informing improvements to tailored interventions.

METHODS

We conducted a series of three formative research studies to adapt and test the measures and instructions for an ecological momentary assessment (EMA) protocol with midlife women who had elevated risk for cardiovascular disease (CVD; e.g., current diagnosis of hypertension, type 2 diabetes). Study 1 involved a pilot test of initial EMA items, sent to participants' smartphones 5 times per day for 7 days (N=13; M_Age =47, M_BMI =33.7 kg/m²), as well as brief exit interviews to identify points of confusion and suggestions for improvement. Study 2 used 1-hour, individual qualitative interviews with a new sample to elicit women's perceptions of revised items and identify additional opportunities for refinement (N=10, M_Age =52, M_BMI =29.8 kg/m²). In Study 3, a new sample of participants completed 7 days of EMA with revised items and instructions (5 times per day; N=13, M_Age =50, M_BMI =33.4 kg/m²).

RESULTS

Item performance in Study 3, including the frequencies of reporting social comparisons and interactions, was compared to that in Study 1 using multilevel modeling; these tests showed meaningful improvement in reporting patterns between Studies 1 and 3 (e.g., changes of d=0.33-0.75 where appropriate).

CONCLUSIONS

Together, findings from this series of studies demonstrate the utility of a multi-study approach to refining EMA methods for use with midlife women who have elevated CVD risk, which may generalize to other populations of interest.

Smartphone-Based Ecological Momentary Assessment of Well-Being: A Systematic Review and Recommendations for Future Studies

Feelings of well-being and happiness fluctuate over time and contexts. Ecological Momentary Assessment (EMA) studies can capture fluctuations in momentary behavior, and experiences by assessing these multiple times per day. Traditionally, EMA was performed using pen and paper. Recently, due to technological advances EMA studies can be conducted more easily with smartphones, a device ubiquitous in our society. The goal of this review was to evaluate the literature on smartphone-based EMA in well-being research in healthy subjects. The systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Searching PubMed and Web of Science, we identified 53 studies using smartphone-based EMA of well-being. Studies were heterogeneous in designs, context, and measures. The average study duration was 12.8 days, with well-being assessed 2-12 times per day. Half of the studies included objective data (e.g. location). Only 47.2% reported compliance, indicating a mean of 71.6%. Well-being fluctuated daily and weekly, with higher well-being in evenings and weekends. These fluctuations disappeared when location and activity were accounted for. On average, being in nature and physical activity relates to higher well-being. Working relates to lower well-being, but workplace and company do influence well-being. The important advantages of using smartphones instead of other devices to collect EMAs are the easier data collection and flexible designs. Smartphone-based EMA reach far larger maximum sample sizes and more easily add objective data to their designs than palm-top/PDA studies. Smartphone-based EMA research is feasible to gain insight in well-being fluctuations and its determinants and offers the opportunity for parallel objective data collection. Most studies currently focus on group comparisons, while studies on individual differences in well-being patterns and fluctuations are lacking. We provide recommendations for future smartphone-based EMA research regarding measures, objective data and analyses.

Rationale and Design of the Women's Health And Daily Experiences Project: Protocol for an Ecological Momentary Assessment Study to Identify Real-Time Predictors of Midlife Women's Physical Activity

BACKGROUND

Midlife women are at an elevated risk for cardiovascular disease (CVD) and associated mortality. Those who have additional risk conditions such as obesity or hypertension report specific barriers to engaging in cardioprotective behaviors such as physical activity (PA). Considerable effort has been devoted to understanding PA determinants and designing interventions for midlife women, although with suboptimal success, as increasing PA could meaningfully attenuate CVD risk. An updated approach to understanding PA among midlife women could improve upon existing resources by focusing on novel psychosocial influences on PA in this population (ie, body satisfaction, social interactions, social comparisons, mood state) and within-person relations between these influences and PA in the natural environment.

OBJECTIVE

The overarching goal of Project WHADE (Women's Health And Daily Experiences) is to use an ecological momentary assessment (EMA) approach to capture ecologically valid relations between midlife women's psychosocial experiences and PA as they engage in their normal daily activities. The primary aim of the study is to identify within-person psychosocial predictors of variability in PA (ie, experiences associated with higher vs lower PA for a given individual).

METHODS

Midlife women (aged 40-60 years) with one or more additional risk markers for CVD (eg, hypertension) will be recruited from primary care clinics and the general community (target n=100). Eligible women will complete an initial survey and a face-to-face baseline session before engaging in a 10-day EMA protocol. Psychosocial experiences will be assessed using a brief self-report via a smartphone 5 times per day, and PA will be assessed throughout waking hours using a research-grade monitor. Participants will return for a brief exit interview at the end of 10 days. Multilevel models that address the nested structure of EMA data will be used to evaluate the study aims.

RESULTS

Recruitment and enrollment are ongoing, and a total of 75 women have completed the protocol to date. Data collection is expected to be completed in Fall 2020.

CONCLUSIONS

Project WHADE is designed to identify naturally occurring psychosocial experiences that predict short-term variability in midlife women's PA. As such, the results of this study should advance the current understanding of PA among midlife women by providing further insight into within-person psychosocial influences on PA in this group. In the future, this information could help inform the design of interventions for this population.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/19044.

Accuracy of Sedentary Behavior-Triggered Ecological Momentary Assessment for Collecting Contextual Information: Development and Feasibility Study

BACKGROUND

Sedentary behavior has received much attention in the scientific community over the past decade. There is growing evidence that sedentary behavior is negatively associated with physical and mental health. However, an in-depth understanding of the social and environmental context of sedentary behavior is missing. Information about sedentary behavior, such as how everyday sedentary behavior occurs throughout the day (eg, number and length of sedentary bouts), where, when, and with whom it takes place, and what people are doing while being sedentary, is useful to inform the development of interventions aimed at reducing sedentary time. However, examining everyday sedentary behavior requires specific methods.

OBJECTIVE

The purpose of this paper is (1) to introduce sedentary behavior-triggered Ecological Momentary Assessment (EMA) as a methodological advancement in the field of sedentary behavior research and (2) to examine the accuracy of sedentary behavior-triggered EMA in 3 different studies in healthy adults. Moreover, we compare the accuracy of sedentary behavior-triggered EMA to simulations of random-trigger designs.

METHODS

Sedentary behavior-triggered EMA comprises a continuous assessment of sedentary behavior via accelerometers and repeated contextual assessments via electronic diaries (ie, an application on a smartphone). More specifically, the accelerometer analyzes and transfers data regarding body position (a sitting or lying position, or an upright position) via Bluetooth Low Energy (BLE) to a smartphone in real time and triggers the deployment of questionnaires. Each time a participant spends a specified time (eg, 20 minutes) in a sedentary position, the e-diary triggers contextual assessments. To test the accuracy of this method, we calculated a percentage score for all triggered prompts in relation to the total number of bouts that could trigger a prompt.

RESULTS

Based on the accelerometer recordings, 29.3% (5062/17278) of all sedentary bouts were classified as moderate-to-long (20-40 minutes) and long bouts (≥ 41 minutes). On average, the accuracy by participant was 82.77% (3339/4034; SD 21.01%, range 71.00-88.22%) on the study level. Compared to simulations of random prompts (every 120 minutes), the number of triggered prompts was up to 47.9% (n=704) higher through the sedentary behavior-triggered EMA approach. Nearly 40% (799/2001) of all prolonged sedentary bouts (≥ 20 minutes) occurred during work, and in 57% (1140/2001) of all bouts, the participants were not alone.

CONCLUSIONS

Sedentary behavior-triggered EMA is an accurate method for collecting contextual information on sedentary behavior in daily life. Given the growing interest in sedentary behavior research, this sophisticated approach offers a real advancement as it can be used to collect social and environmental contextual information or to unravel dynamic associations. Furthermore, it can be modified to develop sedentary behavior-triggered mHealth interventions.

Daily Sedentary Behavior Predicts Pain and Affect in Knee Arthritis

BACKGROUND

Sedentary behavior (SB), which has been linked with numerous adverse health outcomes, is prevalent among adults with osteoarthritis (OA). The associations between SB and daily physical and psychological health outcomes for OA patients, however, have received little attention.

PURPOSE

Using accelerometer and self-report data, the current study examined how the amount of time OA patients spent in SB was associated with their pain and affect in daily life, independent of physical activity.

METHODS

Over 22 days, 143 older adults (mean age = 65 years) with knee OA wore an accelerometer to measure SB and physical activity, and also reported their pain and affect three times a day using a handheld computer. Multilevel analyses were conducted to examine the prospective within-person associations between SB and subsequent pain or affect within the same day and across days, independent of physical activity.

RESULTS

The time spent in SB daily predicted less pain but worse affect at the end of that day, above and beyond the effects of physical activity, as well as demographics and individual differences in general health and depression. Moreover, cross-day lagged analyses indicated that time spent in SB on 1 day predicted higher negative affect the next morning. Finally, the average level of SB was also associated with worse average affect at the between-person level.

CONCLUSIONS

SB may be related to less pain in the short term but detract from patients' emotional well-being. Future intervention should aim to reduce daily SB to improve OA patients' emotional well-being.

mHealth technology for ecological momentary assessment in physical activity research: a systematic review

OBJECTIVE

To systematically review the publications on ecological momentary assessment (EMA) relating to physical activity (PA) behavior in order to classify the methodologies, and to identify the main mHealth technology-based tools and procedures that have been applied during the first 10 years since the emergence of smartphones. As a result of this review, we want to ask if there is enough evidence to propose the use of the term "mEMA" (mobile-based EMA).

DESIGN

A systematic review according to PRISMA Statement (PROSPERO registration: CRD42018088136).

METHOD

Four databases (PsycINFO, CINALH, Medline and Web of Science Core Collection) were searched electronically from 2008 to February 2018.

RESULTS

A total of 76 studies from 297 potential articles on the use of EMA and PA were included in this review. It was found that 71% of studies specifically used "EMA" for assessing PA behaviors but the rest used other terminology that also adjusted to the inclusion criteria. Just over half (51.3%) of studies (39) used mHealth technology, mainly smartphones, for collecting EMA data. The majority (79.5%) of these studies (31 out of 39) were published during the last 4 years. On the other hand, 58.8% of studies that only used paper-and-pencil were published during the first 3 years of the 10-year period analyzed. An accelerometer was the main built-in sensor used for collecting PA behavior by means of mHealth (69%). Most of the studies were carried out on young-adult samples, with only three studies in older adults. Women were included in 60% of studies, and healthy people in 82%. The studies lasted between 1 and 7 days in 57.9%, and between three and seven assessments per day were carried out in 37%. The most popular topics evaluated together with PA were psychological state and social and environmental context.

CONCLUSIONS

We have classified the EMA methodologies used for assessing PA behaviors. A total of 71% of studies used the term "EMA" and 51.3% used mHealth technology. Accelerometers have been the main built-in sensor used for collecting PA. The change of trend in the use of tools for EMA in PA coincides with the technological advances of the last decade due to the emergence of smartphones and mHealth technology. There is enough evidence to use the term mEMA when mHealth technology is being used for monitoring real-time lifestyle behaviors in natural situations. We define mEMA as the use of mobile computing and communication technologies for the EMA of health and lifestyle behaviors. It is clear that the use of mHealth is increasing, but there is still a lot to be gained from taking advantage of all the capabilities of this technology in order to apply EMA to PA behavior. Thus, mEMA methodology can help in the monitoring of healthy lifestyles under both subjective and objective perspectives. The tendency for future research should be the automatic recognition of the PA of the user without interrupting their behavior. The ecological information could be completed with voice messages, image captures or brief text selections on the touch screen made in real time, all managed through smartphone apps. This methodology could be extended when EMA combined with mHealth are used to evaluate other lifestyle behaviors.

Positive and negative well-being and objectively measured sedentary behaviour in older adults: evidence from three cohorts

Background

Sedentary behaviour is related to poorer health independently of time spent in moderate to vigorous physical activity. The aim of this study was to investigate whether wellbeing or symptoms of anxiety or depression predict sedentary behaviour in older adults.

Method

Participants were drawn from the Lothian Birth Cohort 1936 (LBC1936) (n = 271), and the West of Scotland Twenty-07 1950s (n = 309) and 1930s (n = 118) cohorts. Sedentary outcomes, sedentary time, and number of sit-to-stand transitions, were measured with a three-dimensional accelerometer (activPAL activity monitor) worn for 7 days. In the Twenty-07 cohorts, symptoms of anxiety and depression were assessed in 2008 and sedentary outcomes were assessed ~ 8 years later in 2015 and 2016. In the LBC1936 cohort, wellbeing and symptoms of anxiety and depression were assessed concurrently with sedentary behaviour in 2015 and 2016. We tested for an association between wellbeing, anxiety or depression and the sedentary outcomes using multivariate regression analysis.

Results

We observed no association between wellbeing or symptoms of anxiety and the sedentary outcomes. Symptoms of depression were positively associated with sedentary time in the LBC1936 and Twenty-07 1950s cohort, and negatively associated with number of sit-to-stand transitions in the LBC1936. Meta-analytic estimates of the association between depressive symptoms and sedentary time or number of sit-to-stand transitions, adjusted for age, sex, BMI, long-standing illness, and education, were β = 0.11 (95% CI = 0.03, 0.18) and β = − 0.11 (95% CI = − 0.19, −0.03) respectively.

Conclusion

Our findings indicate that depressive symptoms are positively associated with sedentary behavior. Future studies should investigate the causal direction of this association.

The Influence of Daily Stress on Sedentary Behavior: Group and Person (N of 1) Level Results of a 1-Year Observational Study

OBJECTIVE

The purpose of this study, which used mobile technologies to continuously collect data for 1 year, was to examine the association of psychological stress with objectively measured sedentary behavior in adults at both the group (e.g., nomothetic approach) and individual (e.g., idiographic approach) level.

METHODS

Data were collected in an observational study of healthy adults (n = 79) residing in the New York City metro area who were studied for 365 days from 2014 to 2015. Sedentary behavior was objectively measured via accelerometry. A smartphone-based electronic diary was used to assess level of stress ("Overall, how stressful was your day?" 0-10 scale) and sources of stress.

RESULTS

The end-of-day stress rating was not associated with total sedentary time (B = -1.34, p = .767) at the group level. When specific sources of stress were evaluated at the group level, argument-related stress was associated with increased sedentariness, whereas running late- and work-related stress were associated with decreased sedentariness. There was a substantial degree of interindividual variability in the relationship of stress with sedentary behavior. Both the level and sources of stress were associated with increased sedentariness for some, decreased sedentariness for others, and had no effect for many (within-person variance p < .001).

CONCLUSIONS

These findings suggest that the influence of stress on sedentary behavior varies by source of stress and from person to person. A precision medicine approach may be warranted to target reductions in sedentary time, although further studies are needed to confirm the observed findings in light of study limitations including a small sample size and enrollment of participants from a single, urban metropolitan area.