Advancing Physical Activity Theory: A Review and Future Directions

Feasibility and Acceptability of a Mobile Health Exercise Intervention for Inactive Adults: 3-Arm Randomized Controlled Pilot Trial

BACKGROUND

Objective monitoring of self-directed physical activity (PA) is a common approach used in both fitness and health settings to promote exercise behavior, but adherence has been poor. Newer mobile health (mHealth) technologies could be a cost-effective approach to broadening accessibility and providing support for PA behavior change; yet, the optimal method of delivery of such interventions is still unclear.

OBJECTIVE

This study aimed to determine the feasibility and acceptability of an mHealth exercise intervention delivered in combination with objective monitoring in 3 ways: health education emails, asynchronous exercise videos, or synchronous videoconference exercise classes.

METHODS

Physically inactive (<30 min/wk) adults (cisgender women aged 31.5, SD 11.3 years, cisgender men aged 34.1, SD 28.9 years, and nonbinary individuals aged 22.0, SD 0 years) were randomized (1:1:1) to 8 weeks of increasing PA behavioral support: level 1 (health education+objective monitoring, n=26), level 2 (asynchronous contact, level 1+prerecorded exercise videos, n=30), or level 3 (synchronous contact, level 1+videoconference group exercise, n=28). Participants used a heart rate monitor during exercise and a mobile app for interaction. Primary outcomes were feasibility (accrual, retention, and adherence) and acceptability (user experience survey). Secondary outcomes assessed at baseline and 8 weeks included resting heart rate, self-reported PA, and quality of life. The exercise dose was evaluated throughout the intervention.

RESULTS

Between August 2020 and August 2021, 204 adults were screened for eligibility. Out of 135 eligible participants, 84 (62%) enrolled in the study. Retention was 50% (13/26) in level 1, 60% (18/30) in level 2 and 82% (23/28) in level 3, while adherence was 31% (8/26) in level 1, 40% (12/30) in level 2 and 75% (21/28) in level 3. A total of 83% (70/84) of the study sample completed the intervention, but low response rates (64%, 54/84) were observed postintervention at week-8 assessments. Program satisfaction was highest in participants receiving exercise videos (level 2, 80%, 8/10) or exercise classes (level 3, 80%, 12/15), while only 63% (5/8) of level 1 reported the program as enjoyable. Level 3 was most likely to recommend the program (87%, 13/15), compared to 80% (8/10) in level 2 and 46% (5/8) in level 1. Self-reported PA significantly increased from baseline to intervention in level 3 (P<.001) and level 2 (P=.003), with no change in level 1. Level 3 appeared to exercise at higher doses throughout the intervention.

CONCLUSIONS

Only the videoconference exercise class intervention met feasibility criteria, although postintervention response rates were low across all groups. Both videoconference and prerecorded videos had good acceptability, while objective monitoring and health education alone were not feasible or acceptable. Future studies are needed to examine the effectiveness of videoconference exercise interventions on health-related outcomes during nonpandemic times and how asynchronous interventions might maximize adherence.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05192421; https://clinicaltrials.gov/study/NCT05192421.

Novel Characterization of Socioecological Determinants of Health in Rural Alabama

INTRODUCTION

Socioecological determinants of health (SEDOHs) influence disparities in surgical outcomes. However, SEDOHs are challenging to measure, limiting our ability to address disparities. Using a validated survey (SEDOH-88), we assessed SEDOHs in three rural communities in Alabama. We hypothesized that SEDOHs would vary significantly across sites but measuring them would be acceptable and feasible.

MATERIALS AND METHODS

This was a retrospective review of a prospectively maintained database involving surgical patients who completed the SEDOH-88 and a secondary survey assessing it's acceptability or feasibility from August 2021 to July 2023. Included patients underwent endoscopic, minimally invasive, or open surgery at three rural hospitals: Demopolis (DM), Alexander City (AC), and Greenville (GV).

RESULTS

The 107 participants comprised 48 (44.9%) from DM, 27 (25.2%) from AC, and 32 (29.9%) from GV, respectively. The median age was 64 y, and 65.6% were female. When comparing DM to AC and GV by individual factors, DM had the largest Black population (78.7 versus 22.2 versus 48.3%, P < 0.001) and more often required help reading hospital materials (20.5 versus 3.7 versus 10.3%, P = 0.007). When comparing DM to AC and GV by structural and environmental factors, DM had more Medicaid enrollees (27.3 versus 3.7 versus 6.9%, P = 0.033) and lacked fresh produce (18.2 versus 25.9 versus 39.3%, P = 0.033) and internet access (63.6 versus 100.0 versus 86.2%, P < 0.001). The SEDOH-88 had an overall 90.9% positive acceptability and feasibility score.

CONCLUSIONS

SEDOHs varied significantly across rural communities regarding individual (race or health literacy), structural (insurance), and environmental-level factors (nutritious food or internet access). The high acceptability and feasibility of the SEDOH-88 shows it's potential utility in identifying targets for future disparity-reducing interventions.

Contextualising flexible nonlinear periodization as a person-adaptive behavioral model for exercise maintenance

There is a growing focus on developing person-adaptive strategies to support sustained exercise behaviour, necessitating conceptual models to guide future research and applications. This paper introduces Flexible nonlinear periodisation (FNLP) - a proposed, but underdeveloped person-adaptive model originating in sport-specific conditioning - that, pending empirical refinement and evaluation, may be applied in health promotion and disease prevention settings. To initiate such efforts, the procedures of FNLP (i.e., acutely and dynamically matching exercise demand to individual assessments of mental and physical readiness) are integrated with contemporary health behaviour evidence and theory to propose a modified FNLP model and to show hypothesised pathways by which FNLP may support exercise adherence (e.g., flexible goal setting, management of affective responses, and provision of autonomy/variety-support). Considerations for future research are also provided to guide iterative, evidence-based efforts for further development, acceptability, implementation, and evaluation.

Injunctive norms as social pressures: Does autonomy support moderate the relationship between injunctive norms and autonomy satisfaction in physical activity?

Objective: Despite the usefulness of social norms for changing behaviour, injunctive norms (i.e., perceptions of what others approve) from significant others tend to be a weak predictor of physical activity (PA) engagement. A potential explanation is that injunctive norms encompass pressuring social influence that undermines autonomous PA engagement. This study examined whether injunctive norms from significant others undermine individuals' autonomy satisfaction during the pursuit of PA engagement, and whether this effect is moderated by the degree to which significant others offer concurrent autonomy support. Design: Online questionnaires. Measures: Participants' perceptions of injunctive norms and autonomy support from significant others, autonomy satisfaction, behaviour regulation, PA intentions, and weekly PA frequency were assessed at baseline (N = 497) and after two weeks (N = 351). Results: Autonomy support positively related to autonomy satisfaction, whereas injunctive norms were negatively related to autonomy satisfaction. Though the statistical significance of interaction effects was inconsistent across results, simple slopes suggested that the negative relationship between injunctive norms and autonomy satisfaction was attenuated at higher levels of autonomy support in models focusing on influence from parents and friends. Conclusion: When promoting others' PA, communicating direct social expectations/pressures may be ineffective.

Exploring How Active and Insufficiently Active Individuals Respond to Specific and Non-Specific Physical Activity Goals

Purpose: This study aimed to extend understanding of goal setting in physical activity (PA) by exploring qualitatively active and insufficiently active individuals' experiences of pursuing specific and non-specific goals. Methods: Twelve active (Mage = 25.00 years) and nine insufficiently active (Mage = 24.33 years) adults were interviewed after participating in three 6-minute walking tests, during which they pursued specific and non-specific (open and DYB) goals and completed a no-goal control condition. Content analysis was used to examine each subgroup independently, before a between-group comparison to explore similarities and differences in experiences was undertaken. Results: Several strategies were employed to enhance trustworthiness. Our analysis was organised into seven categories: (1) perception of challenge; (2) perceived control; (3) performance satisfaction; (4) motivational intensity; (5) enjoyment; (6) self-efficacy; and (7) strategies for pursuing goals. Our findings suggest that active participants responded more positively to specific goals, with differences in the cognitions experienced before, during, and after the goal conditions. Conversely, insufficiently active participants responded more positively to non-specific goals, with differences in the cognitions experienced before, during, and after the goal conditions and more negatively to specific goals. Conclusion: Findings extend understanding of specific and non-specific goals in PA and underline the need to consider goal specificity in the prescription of PA for certain population groups most in need of intervention.

Exercise as the sum of our choices between behavioral alternatives: The Decisional Preferences in Exercising (DPEX) test

Exercising can be theorized as the result of choosing one behavior over alternative behaviors. The Decisional Preferences in Exercising (DPEX) test is a computerized, easy-to-use, publicly available (open source Python code: https://osf.io/ahbjr/) and highly adaptive research tool based on this rationale. In the DPEX, participants are asked to choose between two images by pressing a key on the computer keyboard, one showing a physical exercise and the other showing a non-exercise behavioral alternative in a series of trials. Combinations are randomly assembled from two definable pools of stimuli trial-per-trial. The test can be scored either based on a crossed random effects model (facilitating the use of different stimulus material in different studies without compromising the comparability of test scores) or with a simple proportion score. Data from diverse study samples (N = 451) showed strong correlations of DPEX scores with past and future exercise behavior (r = 0.42 and 0.47 respectively) as well as with affective experiences with exercise (e.g., 'pleasure-displeasure': r = 0.47). DPEX test scores discriminated between exercisers and non-exercisers according to receiver operating curve (ROC) analysis. The DPEX may be used to examine research questions derived from dual process theories, the effects of psychological states on behavioral choices can be tested, or the effects of behavior change interventions can be evaluated. The DPEX helps to avoid common method bias in the assessment of exercise behavior, for example, when psychological variables are measured with questionnaires.

A control system model of capability-opportunity-motivation and behaviour (COM-B) framework for sedentary and physical activity behaviours

Objective

Theoretical frameworks are essential for understanding behaviour change, yet their current use is inadequate to capture the complexity of human behaviour such as physical activity. Real-time and big data analytics can assist in the development of more testable and dynamic models of current theories. To transform current behavioural theories into more dynamic models, it is recommended that researchers adopt principles such as control systems engineering. In this article, we aim to describe a control system model of capability-opportunity-motivation and behaviour (COM-B) framework for reducing sedentary behaviour (SB) and increasing physical activity (PA) in adults.

Methods

The COM-B model is explained in terms of control systems. Examples of effective behaviour change techniques (BCTs) (e.g. goal setting, problem-solving and social support) for reducing SB and increasing PA were mapped to the COM-B model for illustration.

Result

A fluid analogy of the COM-B system is presented.

Conclusions

The proposed integrated model will enable empirical testing of individual behaviour change components (i.e. BCTs) and contribute to the optimisation of digital behaviour change interventions.

Translating Physical Activity Intentions into Behavior: Reflective, Regulatory, and Reflexive Processes

The purpose of this article was to review predictors of the physical activity (PA) intention-behavior relationship. The review provides evidence for the hypothesis that reflective (consciously deliberated expectations of PA), regulatory (tactics used to enact intentions), and reflexive (stimulus-based associative motivation) processes represent independent determinants of translating PA intentions into action, yet differ in relative contribution across time and circumstance.

Building on Existing Classifications of Behavior Change Techniques to Classify Planned Coping Strategies: Physical Activity Diary Study

BACKGROUND

When trying to be more physically active, preparing for possible barriers by considering potential coping strategies increases the likelihood of plan enactment. Digital interventions can support this process by providing personalized recommendations for coping strategies, but this requires that possible coping strategies are identified and classified. Existing classification systems of behavior change, such as the compendium of self-enactable techniques, may be reused to classify coping strategies in the context of physical activity (PA) coping planning.

OBJECTIVE

This study investigated whether coping strategies created by a student population to overcome barriers to be physically active can be mapped onto the compendium of self-enactable techniques and which adaptations or additions to the frameworks are needed.

METHODS

In total, 359 Flemish university students created action and coping plans for PA for 8 consecutive days in 2020, resulting in 5252 coping plans. A codebook was developed iteratively using the compendium of self-enactable techniques as a starting point to code coping strategies. Additional codes were added to the codebook iteratively. Interrater reliability was calculated, and descriptive statistics were provided for the coping strategies.

RESULTS

Interrater reliability was moderate (Cohen κ=0.72) for the coded coping strategies. Existing self-enactable techniques covered 64.6% (3393/5252) of the coded coping strategies, and added coping strategies covered 28.52% (n=1498). The remaining coping strategies could not be coded as entries were too vague or contained no coping strategy. The added classes covered multiple ways of adapting the original action plan, managing one's time, ensuring the availability of required material, and doing the activity with someone else. When exploring the data further, we found that almost half (n=2371, 45.1%) of the coping strategies coded focused on contextual factors.

CONCLUSIONS

The study's objective was to categorize PA coping strategies. The compendium of self-enactable techniques addressed almost two-thirds (3393/5252, 64.6%) of these strategies, serving as valuable starting points for classification. In total, 9 additional strategies were integrated into the self-enactable techniques, which are largely absent in other existing classification systems. These new techniques can be seen as further refinements of "problem-solving" or "coping planning." Due to data constraints stemming from the COVID-19 pandemic and the study's focus on a healthy Flemish student population, it is anticipated that more coping strategies would apply under normal conditions, in the general population, and among clinical groups. Future research should expand to diverse populations and establish connections between coping strategies and PA barriers, with ontologies recommended for this purpose. This study is a first step in classifying the content of coping strategies for PA. We believe this is an important and necessary step toward digital health interventions that incorporate personalized suggestions for PA coping plans.

Dual processing approach to sedentary behavior and physical activity in the workplace

Regular physical activity is an important health promoting behavior. Yet, many adults live sedentary lifestyles, especially during their workday. The current study applies an extended theory of planned behavior model, incorporating affective attitudes and instrumental attitudes, along with habit, to predict limiting sedentary behavior and physical activity within an office environment. Theory of planned behavior constructs and habit were assessed with an online survey on a sample of 180 full-time office workers, with self-reported behavior assessed 1 week later (Mage = 25.97, SDage = 10.24; 44 males, 134 females, and 2 nonbinary). Model fit was indicated by BRMSEA (M = 0.057, SD = 0.023), B γ^ (M = 0.984, SD = 0.010) and BCFI (M = 0.959, SD = 0.026), accounting for 46.1% of variance in intention, 21.6% of variance in sedentary behavior, and 17.4% of variance in physical activity behavior. A Bayesian structural equation model revealed direct effects of instrumental attitudes and perceived behavioral control on intention to limit sedentary behavior, direct effects of intention and perceived behavioral control on limiting sedentary behavior, and direct effects of perceived behavioral control and habit on engaging in physical activity. The current study indicates intentions to be active in the office are primarily driven by beliefs about the benefits of activity and individuals' perceived level of control, rather than normative or affective beliefs. As behavior was predicted by both intention and habit, findings also indicate office-based activity is likely not always a consciously driven decision. These findings may have implications for improving activity levels in this highly sedentary population.

Attraction toward physical activity as a moderator of socio-cognitive predictors of physical activity

Previous research highlighted gaps between socio-cognitive factors (e.g., intentions, social norms) and physical activity (PA) participation. Recently, researchers have asserted that considering affective processes may help bridge this gap. Leveraging the affective-reflective theory of physical inactivity and exercise, this study examined whether individuals' attraction toward PA moderated the relationship between PA intentions and behaviors, and the relationship between social norms and PA intentions. Analysis of online survey data (NT1 = 582; NT2 = 327) provided evidence that social norms more strongly predicted PA intentions under conditions of lower attraction to PA. However, the results differed depending on how intentions were measured: Moderation was found for intention strength as the outcome, but no moderation was found for decisional intention as the outcome. The intentions-behavior relationship, despite nonsignificant interaction terms, showed patterns of positive moderation based on changes in simple slopes: Intentions more strongly predicted PA behavior at time 2 under conditions of higher attraction to PA. The findings align with recent theorizing that emphasizes the role of affect-related determinants when understanding and promoting PA. Practically, these results suggest that intervention strategies should differ according to the individuals' current levels of attraction toward PA.

Ways into physical (in)activity: The role of critical life events and transitions in the reconstructions of young adults

BACKGROUND

Physical activity (PA), sport, and exercise levels generally tend to fluctuate or decline from childhood to adulthood. Life events and transitions may have a positive or negative impact on these behaviors. However, most research in this regard is quantitatively framed and we know little about why and how life events and transitions affect PA-related behaviors.

OBJECTIVES

The aim of this study is to understand when, why, and how individuals change their daily PA, sport, and exercise behaviors and related attitudes in the context of life events and transitions and what underlying dynamics promote these changes from a subjective perspective.

METHODS

Forty-six young inactive adults (33 women) aged between 20 and 40 years from the iReAct study participated in a mixed-method biographical mapping, which combines a semi-structured interview with a drawing activity to explore subjective experiences of life events, transitions, and PA-related behaviors across the life span. To analyze data, we conducted a reflexive thematic analysis.

RESULTS

We developed three overarching themes that reflect the underlying dynamics which are associated with the occurrence of critical life events and transitions and lead to subsequent changes in daily PA and sport and exercise behavior: (1) The finitude of temporal resources; (2) The plasticity of priorities and motives; and (3) The (in)conveniences of context.

CONCLUSION

Our results illustrate that there is not a straight causal link between life events and behavior. Rather, critical life events and transitions can have a tremendous impact on temporal resources, individual priorities and motives, and contextual factors, such as the physical and infrastructural environment and social settings and relationships. Consequently, more or less extensive changes in those circumstances can lead to individual adaptations in daily PA or sport and exercise and related attitudes, as they require individuals to re-balance behavioral patterns.

Motivational Message Framing Effects on Physical Activity Dynamics in a Digital Messaging Intervention: Secondary Analysis

BACKGROUND

Digital smartphone messaging can be used to promote physical activity to large populations with limited cost. It is not clear which psychological constructs should be targeted by digital messages to promote physical activity. This gap presents a challenge for developing optimal content for digital messaging interventions.

OBJECTIVE

The aim of this study is to compare affectively framed and social cognitively framed messages on subsequent changes in physical activity using dynamical modeling techniques.

METHODS

We conducted a secondary analysis of data collected from a digital messaging intervention in insufficiently active young adults (18-29 years) recruited between April 2019 and July 2020 who wore a Fitbit smartwatch for 6 months. Participants received 0 to 6 messages at random per day across the intervention period. Messages were drawn from 3 content libraries: affectively framed, social cognitively framed, or inspirational quotes. Person-specific dynamical models were identified, and model features of impulse response and cumulative step response were extracted for comparison. Two-way repeated-measures ANOVAs evaluated the main effects and interaction of message type and day type on model features. This early-phase work with novel dynamic features may have been underpowered to detect differences between message types so results were interpreted descriptively.

RESULTS

Messages (n=20,689) were paired with valid physical activity monitoring data from 45 participants for analysis. Received messages were distributed as 40% affective (8299/20,689 messages), 39% social-cognitive (8187/20,689 messages), and 20% inspirational quotes (4219/20,689 messages). There were no statistically significant main effects for message type when evaluating the steady state of step responses. Participants demonstrated heterogeneity in intervention response: some had their strongest responses to affectively framed messages, some had their strongest responses to social cognitively framed messages, and some had their strongest responses to the inspirational quote messages.

CONCLUSIONS

No single type of digital message content universally promotes physical activity. Future work should evaluate the effects of multiple message types so that content can be continuously tuned based on person-specific responses to each message type.

Promoting physical activity-related health competence to increase leisure-time physical activity and health-related quality of life in German private sector office workers

BACKGROUND

Office workers (OWs) are at risk of low levels of health-enhancing physical activity (HEPA) and impaired health-related quality of life (HRQOL). Interventions based on physical activity-related health competence (PAHCO) aim to facilitate long-term changes in HEPA and HRQOL. However, these assumptions rely on the changeability and temporal stability of PAHCO and have not been tested empirically. This study therefore aims to test the changeability and temporal stability of PAHCO in OWs within an interventional design and to examine the effect of PAHCO on leisure-time PA and HRQOL.

METHODS

Three hundred twenty-eight OWs (34% female, 50.4 ± 6.4 years) completed an in-person, three-week workplace health promotion program (WHPP) focusing on PAHCO and HEPA. The primary outcome of PAHCO as well as the secondary outcomes of leisure-time PA and HRQOL were examined at four measurement points over the course of 18 months in a pre-post design by employing linear mixed model regressions.

RESULTS

PAHCO displayed a substantial increase from the baseline to the time point after completion of the WHPP (β = 0.44, p < 0.001). Furthermore, there was no decrease in PAHCO at the first (p = 0.14) and the second follow-up measurement (p = 0.56) compared with the level at the end of the WHPP. In addition, the PAHCO subscale of PA-specific self-regulation (PASR) had a small to moderate, positive effect on leisure-time PA (β = 0.18, p < 0.001) and HRQOL (β = 0.26, p < 0.001). The subscale of control competence for physical training (CCPT) also had a positive small to moderate effect on HRQOL (β = 0.22, p < 0.001).

CONCLUSION

The results substantiate PAHCO's theoretical characteristics of changeability and temporal stability, and underline the theoretically postulated effects on leisure-time PA and HRQOL. These findings highlight the potential of PAHCO for intervention development, which can be assumed to foster long-term improvements in HEPA and HRQOL in OWs.

TRIAL REGISTRATION

The study was retrospectively registered in the German Clinical Trials Register, which is an approved Primary Register in the WHO network, at the 14/10/2022 (DRKS00030514).

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.

Predictors of Physical Activity Behavior Transitions in Children and Adolescents: A Systematic Review Based on a Transtheoretical Model

Background

The transtheoretical model (TTM) views individual behavioral change as a nonlinear, dynamic process, which is consistent with the complex nature of physical activity (PA) in children and adolescents. However, within this theoretical framework, the elements that facilitate the behavioral change in PA in children and adolescents need to be further explored.

Objective

A systematic review of research related to TTM-based exploration of the elements of behavioral change in PA in children and adolescents, an analysis of the strengths and weaknesses in practice, and an outlook for future research.

Materials and Methods

After computer searches of the CNKI, Wan-Fang, VIP, WOS, PubMed, and EBSCO databases, two researchers independently screened articles, extracted information, and evaluated the quality of the articles.

Results

A total of 25 articles (26 studies) of medium- to high-quality were included in the systematic review. The meta-analysis included 30,106 children and adolescents aged 11.24 to 17.7 years. The counter-conditioning and self-liberation of the process of change, self-efficacy and decisional balance are key elements that facilitate the transition of the PA stage in children and adolescents. Extramodel psychological variables such as exercise motivation play a moderate to large role in the PA stage transition. In addition, VPA is an important discriminator of PA stage transition in children and adolescents.

Conclusion

It is recommended that interventions be designed according to the key elements of behavioral change in order to better facilitate the PA stage transition of children and adolescents.

Physical Activity Tracker Application in Promoting Physical Activity Behavior among Older Adults: A 24-month Follow-Up Study

Objectives

To investigate whether and how PA tracker application use supports PA behavior among older adults during the first 24 months of use. Methods: The changes in PA levels (i.e., time spent in different PA intensities) and between PA categories (i.e., low, moderate, or high based on total PA) were examined between three different time points: before taking the application into use (t0), after 12 months of use (t1), and after 24 months of use (t2). The data was collected by using the International Physical Activity Questionnaire modified for the elderly (IPAQ-E). Results: A statistically significant increase was observed in walking (χ2 (2) = 29.741, p < .001), moderate PA (χ2 (2) = 6.327, p = .042), and total PA levels (χ2 (2) = 11.489, p = .003). The increase was observed between t0 and t1 as well as between t0 and t2. The overall changes between PA categories were statistically significant between t0 and t1 (χ2 (3) = 15.789, p = .001) as well as between t0 and t2 (χ2 (3) = 14.745, p = .002). There were more increasingly active (moved to a higher PA category) than decreasingly active (moved to a lower PA category) participants. Discussion: Overall, the results indicate that PA tracker application use can promote PA behavior among older adults. Stakeholders that work with PA programs and PA promotion, as well as individual users, can utilize digital wellness technologies in supporting PA promotion, especially in exceptional times, like the COVID-19 pandemic, when health care restrictions prevent general gatherings.

Gastroenterologist and Patient Attitudes Toward Yoga as a Therapy for Irritable Bowel Syndrome: An Application of the Theory of Planned Behaviour

Objectives

To identify irritable bowel syndrome (IBS) patients' attitudes, subjective norms, perceived control and intention to practice yoga and gastroenterologists' attitudes and current yoga recommendations for their patients with IBS.

Methods

Gastroenterologists and IBS patients completed online surveys including Theory of Planned Behaviour (TPB) constructs. Among IBS patients, multiple linear regression determined the multivariate associations between TPB variables and intention to practice yoga while controlling for significant socio-demographic variables. Gastroenterologists were asked about their attitudes and current yoga recommendations for patients with IBS. Chi-square analyses examined associations between gastroenterologists' demographics and recommending yoga. Binomial logistic regression described associations between attitude variables and current yoga recommendations.

Results

For patients (n = 109), controllability (β = 0.5, P < 0.001), affective attitude (β = 0.4, P < 0.05) and self-efficacy (β = 0.3, P < 0.05) were significantly associated with intention to do yoga in the regression model. TPB variables explained 34% of the variance in patients' intentions to practice yoga. The binomial regression analysis revealed that gastroenterologists (n = 79) who have confidence in recommending yoga (39%) were seven times more likely to recommend it (odds ratio = 7.3, P = 0.002) and those who agreed yoga improves IBS symptom severity (54%) were 10 times more likely to recommend yoga (odds ratio = 10.1, P < 0.001). Most (86%) wanted more evidence to support efficacy of yoga for IBS and 44% asked for more knowledge on how to refer a patient.

Conclusion

Controllability, affective attitude and self-efficacy predicted IBS patients' intentions to practice yoga. Although gastroenterologists believed yoga is safe and beneficial for IBS patients, most do not recommend yoga due to lack of confidence and scientific evidence.

Students’ Motivational and Emotional Experiences in Physical Education across Profiles of Extracurricular Physical Activity: The Influence in the Intention to Be Active

This study examined the relationship between extracurricular physical activity (PA) levels and students’ motivational and emotional experience during physical education (PE) classes and how this psychological experience can predict the intention to be physically active. The sample consisted of 811 Spanish secondary education students (371 boys and 440 girls) aged between 11 and 17 years (M = 13.15, SD = 1.16). Students completed questionnaires about their PA levels, their intention to be physically active, and their motivational and emotional experience during PE classes. A cluster analysis was used to classify the students according to their level of extracurricular PA. Based on a regression analysis, the variables enjoyment, pride, hopelessness, competence, satisfaction, and autonomous motivation played the highest role, predicting the intention to be physically active in the future. Statistical differences were found among the different PA profiles in these variables during the PE classes (MANCOVA). In conclusion, hours of PA outside school have a high relationship with the students’ emotional and motivational experience in their PE classes, which is related with the intention to practise PA in the future. A series of strategies have been proposed at both the institutional level and the teacher level to improve the PE psychological experience of those students who practise less extracurricular PA.

Associations Between Smartphone Use for Physical Activity by South Korean College Students and Behavioral Change Constructs of the Transtheoretical Model

We examined associations between smartphone uses to assist physical activity (PA) and change constructs of the transtheoretical model (TTM) among Korean college students. Our participants were 242 college students who completed a cross-sectional survey of their smartphone use, PA, and TTM constructs. We applied Poisson regression models to test the associations between stages of change and smartphone PA use frequencies in four categories over the previous week: 1= watching PA instruction videos; 2 = tracking PA; 3 = searching and booking sites for PA; and 4 = finding and making appointments with PA partners. The associations between these smartphone uses and participants' self-efficacy, decisional balance, processes of change, and PA were tested via ordinary least squares regression models. Results were that participants in the precontemplation and maintenance stages were the least and most frequent users of the smartphones in all four categories, respectively. Category one usage was positively associated with participants' scores on pros (β = .22, p = .004), cognitive processes of change (β = .30, p < .001), and behavioral processes of change (β = .28, p < .001). Category two usage was positively associated with PA (β = .06, p = .048). While category three usage was not significantly associated with any TTM constructs except for stages of change, category four usage was positively associated with self-efficacy (β = .28, p < .001), pros (β = .30, p < .001), cognitive processes of change (β = .31, p < .001), behavioral processes of change (β = .06, p <. 001), and PA (β = .45, p < .001). These findings suggest that (a) active college students are likely to take advantage of smartphone to assist their PA, and (b) smartphones can help motivate college students toward regular PA.

Embracing biodegradable bags: effects of ethical self-identity on consumer buying behavior

Purpose

This study aims to predict ethical self-identity’s effect on consumer buying behavior of biodegradable bags. Moreover, a moderated mediation model is tested by analyzing the mediating role of attitude and the moderating role of religiosity to investigate buying behavior. Few studies have been conducted to explore moderated mediation to predict consumer behavior based on belief congruence and planned behavior theories, according to previous literature, indicating a literature gap in consumer behavior studies. Accordingly, the moderating role of religiosity in the relationship between ethical self-identity and purchase intention in the context of biodegradable bags was used to contribute to the consumer behavior literature.

Design/methodology/approach

The population of the study included literate consumers who are aware of biodegradable bags and keen to buy them. The data were collected from consumers of twin cities (Rawalpindi/Islamabad) via purposive sampling. The data were collected from 310 consumers five-time lags.

Findings

The findings suggest that ethical self-identity influences the buying behavior of consumers toward biodegradable bags. In this study, the theory of planned behavior provides greater implications to predict consumer buying behavior because the subjective norm, perceived behavioral control and attitude were found to have a significant influence on purchase intention, which further predicts the actual consumer behavior.

Research limitations/implications

The study’s sample was limited to one geographical area and the sample was limited to only biodegradable bags. Future studies may go for a cross-comparison of industries or multiple environment-friendly products to enhance the generalizability of the research.

Practical implications

This study provides useful insights to the companies of consumer-based brands to use eco-friendly practices from production to packaging and consumption. Environment-friendly consumers are ready to pay a premium price for environment-friendly products, which encourages decision-makers companies to cater to this niche market. Moreover, companies can focus on factors that influence their decision-making, such as ethical and moral values of responsibility, while planning their advertising strategies. Furthermore, the positioning of the environmental or consumer personal care products should be done by considering the personal disposition factors because they reinforce the actual behavior of employees.

Social implications

For researchers, this research opens new avenues for predicting consumers’ buying behavior by applying the theory of planned behavior in the plastic bag industry. This study provides useful insights to the companies of consumer-based brands to use eco-friendly practices from production to packaging and consumption.

Originality/value

The proclivity to buy biodegradable bags increased over time, providing opportunities to the companies to offer environmentally friendly products to an increasing number of customers. However, personal deposition factors, such as religiosity and consumer views, are less well understood in terms of predicting actual behavior. Few studies have been conducted to explore moderated mediation to predict consumer behavior based on belief congruence and planned behavior theories, according to previous literature, indicating a literature gap in consumer behavior studies.

Multi-Process Action Control in Physical Activity: A Primer

The gap between the decision to engage in physical activity and subsequent behavioral enactment is considerable for many. Action control theories focus on this discordance in an attempt to improve the translation of intention into behavior. The purpose of this mini-review was to overview one of these approaches, the multi-process action control (M-PAC) framework, which has evolved from a collection of previous works. The main concepts and operational structure of M-PAC was overviewed followed by applications of the framework in physical activity, and concluded with unanswered questions, limitations, and possibilities for future research. In M-PAC, it is suggested that three layered processes (reflective, regulatory, reflexive) build upon each other from the formation of an intention to a sustained profile of physical activity action control. Intention-behavior discordance is because of strategic challenges in goal pursuit (differences in outcome vs. behavioral goals; balancing multiple behavioral goals) and automatic tendencies (approach-avoidance, conservation of energy expenditure). Regulatory processes (prospective and reactive tactics) are employed to hold the relationship between reflective processes and behavior concordant by countering these strategic challenges and automatic tendencies until the development of reflexive processes (habit, identity) begin to co-determine action control. Results from 29 observational and preliminary experimental studies generally support the proposed M-PAC framework. Future research is needed to explore the temporal dynamic between reflexive and regulatory constructs, and implement M-PAC interventions in different forms (e.g., mobile health), and at different levels of scale (clinical, group, population).

Gender-Specific Impact of Self-Monitoring and Social Norm Information on Walking Behavior Among Chinese College Students Assessed Using WeChat: Longitudinal Tracking Study

BACKGROUND

Walking is a simple but beneficial form of physical activity (PA). Self-monitoring and providing information about social norms are the 2 most widely used "mobile health (mHealth)" strategies to promote walking behavior. However, previous studies have failed to discriminate the effect of self-monitoring from the combination of the 2 strategies, and provide practical evidence within Chinese culture. Some essential moderators, such as gender and group identity, were also overlooked.

OBJECTIVE

We aimed to investigate the effectiveness of social norm and self-monitoring interventions for walking behavior and assess the moderating effects of gender and group identity, which could guide optimal mHealth intervention projects in China.

METHODS

In 2 longitudinal tracking studies (study 1, 22 days; study 2, 31 days), Chinese college students wore trackers for at least 8 hours per day (MASAI 3D Pedometer and Xiaomi Wristband 2) to record their daily step counts in baseline, intervention, and follow-up stages. In each study, participants (study 1: n=117, 54% female, mean age 25.60 years; study 2: n=180, 51% female, mean age 22.60 years) were randomly allocated to 1 of the following 3 groups: a self-monitoring group and 2 social norm intervention groups. In the 2 intervention groups and during the intervention stage, participants received different social norm information regarding group member step rankings corresponding to their grouping type of social norm information. In study 1, participants were grouped by within-group member PA levels (PA consistent vs PA inconsistent), and in study 2, participants were grouped by their received gender-specific social norm information (gender consistent vs gender inconsistent). Piece-wise linear mixed models were used to compare the difference in walking steps between groups.

RESULTS

In study 1, for males in the self-monitoring group, walking steps significantly decreased from the baseline stage to the intervention stage (change in slope=-1422.16; P=.02). However, additional social norm information regardless of group consistency kept their walking unchanged. For females, social norm information did not provide any extra benefit beyond self-monitoring. Females exposed to PA-inconsistent social norm information even walked less (slope during the intervention=-122.18; P=.03). In study 2, for males, a similar pattern was observed, with a decrease in walking steps in the self-monitoring group (change in slope=-151.33; P=.08), but there was no decrease in the 2 social norm intervention groups. However, for females, gender-consistent social norm information decreased walking steps (slope during the intervention=-143.68; P=.03).

CONCLUSIONS

Both gender and group identity moderated the effect of social norm information on walking. Among females, social norm information showed no benefit for walking behavior and may have exerted a backfire effect. Among males, while walking behavior decreased with self-monitoring only, the inclusion of social norm information held the level of walking behavior steady.

Physical Activity Maintenance: A Critical Narrative Review and Directions for Future Research

A clear rationale can be made for promoting long-term regular physical activity (PA), yet despite some attempts to operationalize "maintenance," no robust definition has been agreed upon, beyond arbitrary time frames of regular PA. This has likely impaired the advancement of theory and practice. The purpose of this critical narrative review was to first overview the conception of maintenance and co-requisite theoretical constructs in theories used in PA research. Our subsequent aims were to engage in a critical analysis of this literature to propose a working definition of PA maintenance followed by recommendations for future research. Relevant behavioral theories were parsed for references to maintenance or maintenance-specific constructs and constructs most likely associated with maintenance were overviewed from a recent systematic review. Based on this information, we suggest PA maintenance be operationalized as a process marked by a shift in the mechanisms of action determining behavioral performance, that engender greater perceived behavioral enactment efficiency. We suggest that maintenance should not be considered an absolute state of behavioral performance (e.g., a stage), as some constructs that were critical to behavioral performance during initiation will still be critical during PA continuation. Based on this definition, we propose a method of falsifiability hypothesis testing of theoretical constructs that may determine the maintenance process. Finally, the review concludes with suggestions for future research using this operationalization of maintenance including measure development, tests of latency to reach the peak maintenance process, validating constructs critical to determining maintenance, exploration of the contextual and individual moderators of maintenance formation, and the development of an omnibus dynamic model of initiation, continuation, and maintenance in PA behavior change.

Cognitive-bias modification intervention to improve physical activity in patients following a rehabilitation programme: protocol for the randomised controlled IMPACT trial

INTRODUCTION

Being physically active is associated with a wide range of health benefits in patients. However, many patients do not engage in the recommended levels of physical activity (PA). To date, interventions promoting PA in patients mainly rely on providing knowledge about the benefits associated with PA to develop their motivation to be active. Yet, these interventions focusing on changing patients' conscious goals have proven to be rather ineffective in changing behaviours. Recent research on automatic factors (eg, automatic approach tendencies) may provide additional targets for interventions. However, the implementation and evaluation of intervention designed to change these automatic bases of PA are rare. Consequently, little is known about whether and how interventions that target automatically activated processes towards PA can be effective in changing PA behaviours. The Improving Physical Activity (IMPACT) trial proposes to fill this knowledge gap by investigating the effect of a cognitive-bias modification intervention aiming to modify the automatic approach towards exercise-related stimuli on PA among patients.

METHODS AND ANALYSIS

The IMPACT trial is a single-centre, placebo (sham controlled), triple-blinded, phase 3 randomised controlled trial that will recruit 308 patients enrolled in a rehabilitation programme in the Division of General Medical Rehabilitation at the University Hospital of Geneva (Switzerland) and intends to follow up them for up to 1 year after intervention. Immediately after starting a rehabilitation programme, patients will be randomised (1:1 ratio) to receive either the cognitive-bias modification intervention consisting of a 12-session training programme performed over 3 weeks or a control condition (placebo). The cognitive-bias modification intervention aims to improve PA levels through a change in automatic approach tendencies towards PA and sedentary behaviours. The primary outcome is the sum of accelerometer-based time spent in light-intensity, moderate-intensity and vigorous-intensity PA over 1 week after the cognitive-bias modification intervention (in minutes per week). Secondary outcomes are related to changes in (1) automatic approach tendencies and self-reported motivation to be active, (2) physical health and (3) mental health. Sedentary behaviours and self-reported PA will also be examined. The main time point of the analysis will be the week after the end of the intervention. These outcomes will also be assessed during the rehabilitation programme, as well as 1, 3, 6 and 12 months after the intervention for secondary analyses.

ETHICS AND DISSEMINATION

The study will be conducted in accordance with the Declaration of Helsinki. This trial was approved by the Ethics Committee of Geneva Canton, Switzerland (reference number: CCER2019-02257). All participants will give an informed consent to participate in the study. Results will be published in relevant scientific journals and be disseminated in international conferences.

TRIAL REGISTRATION DETAILS

The clinical trial was registered at the German clinical trials register (reference number: DRKS00023617); Pre-results.

Does Becoming Fit Mean Feeling (f)it? A Comparison of Physiological and Experiential Fitness Data From the iReAct Study

Regular exercise fosters fitness-enhancing benefits. We assume that exercise interventions become successful and sustainable if physiological benefits of exercise are also subjectively perceivable. The goal of this study was to examine how young inactive adults physiologically respond to an exercise intervention and how those responses are subjectively experienced. Furthermore, we aimed to assess whether the sequence of two distinct endurance-based exercise modes has an impact on physiological and subjectively experienced physical fitness. Thirty-one young inactive adults were assessed for this substudy of the larger iReAct study. Participants were randomly assigned to a high-intensity interval training (HIIT) or a moderate-intensity continuous training (MICT) group for 6 weeks and subsequently switched groups for a second training period. Physiological fitness data was collected at baseline, follow-up I, and follow-up II using a graded cardiopulmonary exercise test. Subjectively reconstructed (i.e., retrospective constructions) experiences relating to physical fitness were assessed at follow-up II using a biographical mapping method. A repeated-measures one-way ANOVA on each training group was performed to see whether physiological and subjectively experienced fitness differed across training periods. The rate of change between all variables was calculated for the first and the second training period in order to compare the agreement between physiological and subjective fitness improvements. Participants increased their fitness across the intervention period both physiologically and subjectively. However, the rate of change depended on the sequence of the two training modes. While VO_2max increased significantly in both training periods in the MICT-HIIT sequence, a significant increase in VO_2max in the HIIT-MICT sequence was only observed in the HIIT period. Participants similarly perceived those increases subjectively in their exercise-related physical fitness, although they experienced a significant decrease in the second period of the HIIT-MICT sequence. For subjectively perceived physical fitness relating to everyday activities, significant increases were only observed for the first period of the MICT-HIIT sequence. Young inactive adults can improve both their physiological and their subjectively perceived fitness through regular exercise. However, exercise modes and their sequence can make a substantial difference regarding measured and perceived physical fitness. Additionally, despite a favorable tendency toward HIIT over MICT, inter- and intra-individual variability, particularly in the subjective experiences of fitness, reiterates the necessity of individualized approaches to exercise.

Self-Efficacy, Outcome Expectations, Group Social Support, and Adherence to Physical Activity in African American Women

BACKGROUND

African American women have lower levels of leisure time physical activity compared to White American women. Interventions to improve physical activity have mixed benefits for African American women, even when guided by theory. Understanding how theoretical constructs used in physical activity interventions relate to changing behavior may provide direction for more successful interventions.

OBJECTIVE

The study aimed to examine the relationships among social cognitive constructs (self-efficacy, social support from group behavioral meetings, outcome expectations/realizations), and change in physical activity from baseline to 48 weeks in African American women participating in a lifestyle physical activity program.

METHODS

A secondary data analysis of longitudinal data using a correlational design was conducted using data from a 48-week physical activity randomized controlled trial (RCT). The RCT included a group behavioral meeting component with one of three telephone intervention conditions (no calls, personal motivation calls, or automated motivational calls) randomly assigned across six community healthcare sites. The participants were 260 sedentary, midlife African American women with no major signs or symptoms of cardiovascular disease who completed baseline and 48-week assessments of the RCT. Measures included self-efficacy for change in overcoming barriers to physical activity at 24 weeks, physical and psychological outcome realizations at 24 weeks, social support from group behavioral meetings at 24 weeks, and physical activity (self-report and device-measured) change from baseline to 48 weeks.

RESULTS

In a hierarchical regression model predicting change in self-reported time spent in weekly moderate-vigorous physical activity at 48 weeks, psychological outcome realizations at 24 weeks were significant positive predictors. In a hierarchical regression model for change in device-measured daily steps at 48 weeks, a self-efficacy change at 24 weeks was a significant positive predictor.

DISCUSSION

Attention should be given to increasing self-efficacy to overcome physical activity barriers and achieve self-identified physical and psychological outcomes in physical activity programs.

The Theory of Effort Minimization in Physical Activity

Although the automatic attraction to effort minimization has been evidenced in multiple fields, its potential role in explaining the pandemic of physical inactivity has been overlooked. The theory of effort minimization in physical activity (TEMPA) fills this gap. TEMPA seeks to obtain a more accurate understanding of the neuropsychological determinants of movement-based behaviors.

Effective Learning Support Towards Sustainable Student Learning and Well-Being Influenced by Global Pandemic of COVID-19: A Comparison Between Mainland China and Taiwanese Students

The novel coronavirus disease that emerged at the end of 2019 began threatening the health and lives of millions of people after a few weeks. However, social and educational problems derived from COVID-19 have changed the development of individuals and the whole country. This study examined the learning method of Taiwanese versus mainland China college students, and evaluated the relationship between learning support mechanism and subjective well-being from a social cognition theory perspective. In this study, a total of 646 Taiwanese questionnaires and 537 mainland China questionnaires were collected to compare the two sample groups in development of students' subjective well-being. The results showed that social capital and learning support had significant positive correlations with self-efficacy, student employability and well-being and self-efficacy and student employability had significant positive correlations with well-being in Taiwanese sample. In mainland China sample, except paths among social capital, learning support, student employability and well-being, all paths were significant and positive related. Finally, based on the conclusions this study proposed some suggestions specific to theoretical mode for future study.

Association between physical activity and mortality in end-stage kidney disease: a systematic review of observational studies

BACKGROUND

End-stage Kidney Disease patients have a high mortality and hospitalization risk. The association of these outcomes with physical activity is described in the general population and in other chronic diseases. However, few studies examining this association have been completed in end-stage Kidney Disease patients, raising the need to systematically review the evidence on the association of physical activity with mortality and hospitalization in this population.

METHODS

Electronic databases (EBSCO, Scopus and Web of Science) and hand search were performed until March 2020 for observational studies reporting the association of physical activity with mortality or hospitalization in adult end-stage Kidney Disease patients on renal replacement therapy (hemodialysis, peritoneal dialysis and kidney transplant). Methodological quality of the included studies was assessed using the Quality in Prognosis Studies tool. The review protocol was registered in PROSPERO (CRD42020155591).

RESULTS

Eleven studies were included: six in hemodialysis, three in kidney transplant, and two in hemodialysis and peritoneal dialysis patients. Physical activity was self-reported, except in one study that used accelerometers. All-cause mortality was addressed in all studies and cardiovascular mortality in three studies. Nine studies reported a significant reduction in all-cause mortality with increased levels of physical activity. Evidence of a dose-response relationship was found. For cardiovascular mortality, a significant reduction was observed in two of the three studies. Only one study investigated the association of physical activity with hospitalization.

CONCLUSIONS

Higher physical activity was associated with reduced mortality in end-stage Kidney Disease patients. Future studies using objective physical activity measures could strengthen these findings. The association of physical activity with hospitalization should be explored in future investigations.

Associations among physical activity tracking, physical activity motivation and level of physical activity in young adults

Whether physical activity (PA) tracking devices are associated with PA motivation in young adults is largely unknown. We compared total PA minutes per week, total minutes walking/week, meeting moderate-to vigorous PA guidelines, and past-year activity tracking across motivation cluster profiles among 799 young adults. Participants with "self-determined" profiles reported the highest total PA minutes/week followed by participants with "low intrinsic," "controlled self-determined," and "high external" profiles. A behavior regulation profile X activity tracking frequency interaction was not significant. Behavior regulation profiles may need to be considered in PA interventions using activity trackers.

The Effect of Teacher Autonomy Support on Leisure-Time Physical Activity via Cognitive Appraisals and Achievement Emotions: A Mediation Analysis Based on the Control-Value Theory

Analyzing students' emotional experience in physical education (PE) is of crucial importance as it may fill an important gap in research examining the role of PE for students' leisure-time physical activity (PA). Based on the control-value theory of achievement emotions, the purpose of this study was to test the assumption that multi-dimensional autonomy support of the PE teacher may affect students' leisure-time PA via their appraisals of control and value and achievement emotions experienced in PE. Variance-based structural equation modelling was used to test the proposed model in a sample of 1030 students aged between 11 and 18 years (M = 13.4, SD = 1.48) stemming from schools with the lowest educational level among secondary schools in Germany. The results indicated that in particular cognitive autonomy support positively predicted students' self-efficacy and intrinsic value. Whereas appraisals of self-efficacy were negatively related to the experience of anxiety, intrinsic value was a major positive predictor of enjoyment. Enjoyment, in turn, was of substantial relevance for leisure-time PA. The findings offer a meaningful contribution in understanding students' emotional experiences and remind PE teachers of their opportunity to adopt an autonomy-supportive teaching style to positively influence the emotions of their students.

Vicarious Experience in Multi-Ethnic Study of Atherosclerosis (MESA) Is Associated with Greater Odds of Attaining the Recommended Leisure-Time Physical Activity Levels

BACKGROUND

Social cognitive theory posits that observing similar others succeed (i.e., vicarious experience) can improve self-efficacy. However, there are very limited data on the utility of vicarious experience in promoting physical activity (PA). This analysis examined the association between vicarious experience and leisure-time PA (LTPA) in the Multi-Ethnic Study of Atherosclerosis (MESA).

METHODS

Cross-sectional analysis of MESA participants who completed exam 5. LTPA and neighborhood factors were self-reported. Neighborhood factors were converted into aesthetic, walking, and safety scores. Group comparative analyses evaluated differences in variables of interest. The relationship between vicarious experience and recommended LTPA (≥ 7.5 MET-h/week) was assessed via logistic regression. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) are reported.

RESULTS

Participants (N = 4579) were older (69.7 ± 9.4 years), 53% female, 41% Caucasian, 26% Black, 21% Hispanic, and 12% Chinese. Those who reported vicarious experience had 45% (95% CI 1.16-1.81) greater odds of attaining recommended LTPA. Unfavorable walking score was associated with lower odds of attaining recommended LTPA (OR = 0.89, 95% CI 0.79-1.00). The aesthetic and safety scales were not associated with LTPA (OR = 1.00 [95% CI 0.89-1.13] and OR = 0.91 [95% CI 0.82-1.10], respectively).

CONCLUSIONS

Programs exposing community-dwelling adults to peers engaging in PA could provide an effective public health approach to increase community-level PA participation.

Determinants of physical activity among adults in the United Kingdom during the COVID-19 pandemic: The DUK-COVID study

Objectives This study examined the impact of the COVID-19 lockdown on the physical activity (PA) of UK adults and potential motivational determinants of such behaviour. Design and methods A survey was conducted with 1,521 UK adults recruited through Prolific.co in early June 2020. Along with demographic information, questions assessed current PA, changes in PA modalities (i.e., overall, around the home, for transport, in the workplace, in the local neighbourhood, at recreation/sport facilities) related to the lockdown, and beliefs about capabilities, opportunities, and motivations according to the COM-B model. A series of logistic regressions were constructed to examine associations between shifts in the PA modalities and the COM-B components. Results The majority of respondents (57%) had either maintained or increased their levels of PA during the COVID-19 lockdown. However, the proportion meeting PA guidelines (31%) was low and engagement in sedentary-related behaviour for both work and leisure increased substantially during the lockdown. The components of the COM-B model were associated with shifts in PA. In particular, physical opportunity (odds ratios ranging from 1.14 to 1.20) and reflective motivation (odds ratios ranging from 1.11 to 1.25) appeared to be the most consistent predictors of behaviour. Conclusions If UK adults believed they had the physical opportunity and were motivated, they were more likely to have maintained or increased their PA during the COVID-19 lockdown. However, the majority of adults are not meeting the UK guidelines on PA and the prevalence of PA is substantially lower than national surveys prior to the pandemic. Statement of contribution What is already known on this subject? The COVID-19 pandemic has significantly disrupted the daily routines of citizens globally. Engagement in physical activity appears to have declined as a result of the requirement to self-isolate and stay in place. The COM-B model of behaviour change is a useful framework for identifying the correlates and determinants of behaviour. What does this study add? Though most UK adults maintained or increased their engagement in physical activity during the COVID-19 pandemic, the majority did not meet recommended guidelines. Reflective processes and physical opportunity were the primary predictors of change in physical activity.

Breast Cancer Survivors' Perspectives on Motivational and Personalization Strategies in Mobile App-Based Physical Activity Coaching Interventions: Qualitative Study

Background

Despite growing evidence supporting the vital benefits of physical activity (PA) for breast cancer survivors, the majority do not meet the recommended levels of activity. Mobile app–based PA coaching interventions might be a feasible strategy to facilitate adherence of breast cancer survivors to the PA guidelines. To engage these individuals, PA apps need to be specifically designed based on their needs and preferences and to provide targeted support and motivation. However, more information is needed to understand how these technologies can provide individual and relevant experiences that have the ability to increase PA adherence and retain the individual’s interest in the long term.

Objective

The aim of this study is to explore insights from breast cancer survivors on motivational and personalization strategies to be used in PA coaching apps and interventions.

Methods

A qualitative study was conducted, using individual semistructured interviews, with 14 breast cancer survivors. The moderator asked open-ended questions and made use of a slideshow presentation to elicit the participants’ perspectives on potential mobile app–based intervention features. Transcribed interviews were evaluated by 3 reviewers using thematic content analysis.

Results

Participants (mean age 53.3, SD 8.7 years) were White women. In total, 57% (8/14) of the participants did not adhere to the PA guidelines. In general, participants had access to and were interested in using technology. The identified themes included (1) barriers to PA, (2) psychological mediators of PA motivation, (3) needs and suggestions for reinforcing motivation support, (4) personalization aspects of the PA coaching experience, and (5) technology trustworthiness. Motivational determinants included perceived control, confidence and perceived growth, and connectedness. Participants were interested in having a straightforward app for monitoring and goal setting, which would include a prescribed activity program and schedule, and positive communication. Opinions varied in terms of social and game-like system possibilities. In addition, they expressed a desire for a highly personalized coaching experience based on as much information collected from them as possible (eg, disease stage, physical limitations, preferences) to provide individualized progress information, dynamic adjustment of the training plan, and context-aware activity suggestions (eg, based on weather and location). Participants also wanted the app to be validated or backed by professionals and were willing to share their data in exchange for a more personalized experience.

Conclusions

This work suggests the need to develop simple, guiding, encouraging, trustworthy, and personalized PA coaching apps. The findings are in line with behavioral and personalization theories and methods that can be used to inform intervention design decisions. This paper opens new possibilities for the design of personalized and motivating PA coaching app experiences for breast cancer survivors, which might ultimately facilitate the sustained adherence of these individuals to the recommended levels of activity.

'If they do it, so can I': a test of a moderated serial mediation model of descriptive norms, self-efficacy, and perceived similarity for predicting physical activity

OBJECTIVE

Though engaging in physical activity (PA) is associated with several health benefits, physical inactivity rates remain high. Previous research revealed that descriptive norms (i.e., perceptions of others' PA) positively relate to PA intentions/behaviours. This study tested whether self-efficacy mediated the influence of descriptive norms on PA intentions and behaviours, and whether the relationship between descriptive norms and self-efficacy was moderated by perceived similarity with normative referents.

DESIGN

Online questionnaires were administered.Measures: Baseline measures included descriptive norms, perceived similarity, self-efficacy, and PA intentions. Weekly PA behaviour frequency was assessed at baseline and two weeks post-baseline.

RESULTS

Descriptive norms positively predicted PA behaviour frequency at time 2 indirectly via self-efficacy and PA intentions. These indirect effects were attenuated when baseline PA behaviour frequency was accounted for. There was no support for perceived similarity as a moderator, which may be attributed to a potential ceiling effect or the nature of items used to assess this perception.

CONCLUSION

The findings support the notion that individuals may feel more efficacious when they perceive that others are successfully engaging in the targeted task/activity. Future interventions may consider providing descriptive norm messages to individuals who lack self-efficacy or previous PA experience to promote their PA.

Effectiveness of Acceptance and Commitment Therapy (ACT) interventions for promoting physical activity: a systematic review and meta-analysis

Physical inactivity is a key risk factor for non-communicable diseases, and there is a need for interventions to increase the adoption and maintenance of regular physical activity. Interventions based on Acceptance and Commitment (ACT) have shown promise for promoting a range of health behaviours, including physical activity. The aims of this review were to (1) determine the effectiveness of ACT interventions for physical activity; and (2) identify the ACT processes, behaviour change techniques (BCTs) and intervention characteristics associated with ACT interventions. Eight electronic databases were searched for ACT interventions that aimed to increase physical activity. Seven eligible studies were included in the systematic review, and ACT processes, Behaviour Change Techniques and other intervention components and characteristics of the included interventions were coded. Six studies were randomised controlled trials that were included in a random-effects meta-analysis, which indicated small-to-moderate effects on physical activity (SMD = 0.32, 95% CI (0.07, 0.57), p = 0.01). ACT interventions show promise for increasing physical activity, but very few of the 'active ingredients' of ACT interventions could be characterised as BCTs. Future development of ACT interventions for physical activity should attempt to describe and name the ACT processes targeted by the intervention, and the BCTs used to target those processes.

Updating goal-setting theory in physical activity promotion: a critical conceptual review

Goal-setting is a widely used and accepted strategy for promoting physical activity. Locke and Latham's goal-setting theory is the primary theoretical framework for setting goals in psychology and plays a prominent role in physical activity promotion. Recently, however, there have been calls to reconsider current goal-setting practice in this field. Therefore, we aimed to critically review and update the application of goal-setting theory in physical activity promotion, by examining core developments in this theory since 1990. Current practice relies on setting specific 'performance' goals as a means of increasing physical activity (e.g., 10,000 steps; national physical activity guidelines). This approach was initially consistent with key tenets of goal-setting theory. However, since 1990 this theory has evolved to differentiate between performance and learning goals. Both goal types are context-dependent and it is now recognised that, in some cases, performance goals can even be detrimental to the achievement of desired outcomes. Consequently, current practice may be theoretically appropriate for physically active individuals but a different approach (e.g., learning goals) may be preferable for inactive individuals who are new to physical activity (i.e., most of the population). We conclude by discussing implications for policy, research, and practice in goal-setting for physical activity promotion.

Relationship of Consistency in Timing of Exercise Performance and Exercise Levels Among Successful Weight Loss Maintainers

OBJECTIVE

This study aimed to evaluate whether consistency in time of day that moderate- to vigorous-intensity physical activity (MVPA) is performed relates to MVPA levels among successful weight loss maintainers in the National Weight Control Registry.

METHODS

Participants (n = 375) reporting MVPA on ≥ 2 d/wk completed measures of temporal consistency in physical activity (PA) (> 50% of MVPA sessions per week occurring during the same time window: early/late morning, afternoon, or evening), PA levels, PA automaticity, and consistency in cues underlying PA habit formation (e.g., location).

RESULTS

Most (68.0%) participants reported temporally consistent MVPA. These individuals reported higher MVPA frequency (4.8 ± 1.6 vs. 4.4 ± 1.5 d/wk; P = 0.007) and duration (median [IQR]: 350.0 [200.0-510.0] vs. 285.0 [140.0-460.0] min/wk; P = 0.03), and they were more likely to achieve the national MVPA guideline (≥ 150 min/wk) than temporally inconsistent exercisers (86.3% vs. 74.2%, P = 0.004). Among temporally consistent exercisers, 47.8% were early-morning exercisers; MVPA levels did not differ by time of day of routine MVPA performance (P > 0.05). Greater automaticity and consistency in several cues were related to greater MVPA among all participants.

CONCLUSIONS

Most participants reported consistent timing of MVPA. Temporal consistency was associated with greater MVPA, regardless of the specific time of day of routine MVPA performance. Consistency in exercise timing and other cues might help explain characteristic high PA levels among successful maintainers.

Predicting physical activity among urban adolescent girls: A test of the health promotion model

The purpose of this study was to test hypothesized relationships of the health promotion model (HPM) as a means of predicting moderate-to-vigorous physical activity (MVPA) among urban, adolescent girls. A secondary analysis of baseline data from a group randomized controlled trial was conducted. The study involved eight urban schools in the Midwestern United States. The sample included girls (N = 517) in the 5th-8th grades. Data were collected on age, body mass index, pubertal status, enjoyment, self-efficacy, social support, options for physical activity (PA), and commitment to PA. MVPA was measured via accelerometers worn by the girls for 7 days. Structural equation modeling was used to analyze study aims. Mean age of the sample was 11.8 years (standard deviation [SD] = 1.0). Girls attained an average of 3.0 (SD = 1.2) minutes per hour of MVPA. Self-efficacy had a positive direct (β = .337; p < .001) and total effect (β = .310; p < .001) on MVPA. Social support and options for PA were not significant predictors of commitment to PA or MVPA. Commitment to PA had a negative but nonsignificant effect (β = -.056; p = .357) on MVPA. The model predicted 10.1% of the variance in MVPA with 9.6% of the variance predicted by self-efficacy. Limitations include lack of longitudinal analysis and inability to generalize the results to other populations such as boys. PA self-efficacy continues to emerge as a significant predictor of MVPA in the HPM. Continued theory testing is needed to better understand the correlates and determinants of PA among adolescent girls before designing theory-based interventions to promote PA.

Individual differences influence exercise behavior: how personality, motivation, and behavioral regulation vary among exercise mode preferences

Personality traits, participatory motives, and behavior regulation have been linked to physical activity engagement. It is possible that these dimensions are associated with the type of physical activity one chooses to engage. Thus, the purpose of this study was to examine individual differences in those participating in various primary modes of physical activity (PMA) and determine which individual differences are predictive of exercise frequency.

Methods

403 adults (36.3 ± 11.6 yrs, 35.5% male) completed an online survey. The survey included questions related to their PMA, items for the Big Five Inventory (BFI), Exercise Motivation Inventory (EMI-2), and the Behavioral Regulation in Exercise Questionnaire (BREQ-3). PMAs were divided into 5 main groups: CrossFit® Training (n = 89), Group Exercise (n = 59), Aerobic Training (n = 97), Resistance Training (n = 127), and Sport (n = 31).

Results

A multivariate ANOVA revealed significant differences in exercise motivation [p_s ≤ .001, η²_p = .05 – .22] and behavior regulation [p_s ≤ .05, η²_p = .03 – .06] between PMAs, but personality dimensions did not differ. A linear regression revealed that differences in motivation and regulation explained 17.1% (p = .001) variance in exercise behavior.

Conclusions

These findings support the notion that individual differences exist between motivational dimensions and individuals' preference to engage in a particular physical activity mode. Further, these differences in motivation influence physical activity engagement (i.e., frequency).

Brief Exercise Counseling and High-Intensity Interval Training on Physical Activity Adherence and Cardiometabolic Health in Individuals at Risk of Type 2 Diabetes: Protocol for a Randomized Controlled Trial

Background

Worldwide incidence of type 2 diabetes (T2D) is rapidly increasing. Given the numerous negative health consequences associated with T2D, prevention of this disease has become a priority. Lifestyle changes, including regular exercise, can reduce the onset of T2D in those at elevated risk. However, long-term adherence to exercise is often poor in this population. Existing lifestyle interventions targeting exercise are labor intensive and costly for staff and participants. Evidence-informed counseling delivered in a manner that reduces dependence on staff and facilitates self-regulatory skills could alleviate time and financial barriers while promoting independent exercise.

Objective

This protocol outlines the design, recruitment, and proposed analysis of a brief, 2-week evidence-informed exercise counseling intervention combined with either high-intensity interval training (HIIT) or traditional moderate-intensity continuous training (MICT).

Methods

Small Steps for Big Changes is a 2-arm randomized controlled trial that will examine the effectiveness of combining brief exercise counseling with HIIT or MICT on adherence to moderate and vigorous exercise over 1 year. Cardiorespiratory fitness will be assessed at baseline, post intervention (2 weeks), and at 6- and 12-month follow-up. Physical activity behavior will be examined at baseline, post intervention, and 3-, 6-, 9-, and 12-month follow-up. The impact of the intervention on psychosocial outcomes pertinent to exercise adherence will be examined.

Results

Data collection was complete in March 2017. Data analysis is currently underway, and the first results are expected to be submitted for publication in 2019.

Conclusions

The results of this brief intervention have the potential to inform future public health efforts designed to increase exercise in individuals at risk of T2D.

Trial Registration

ClinicalTrials.gov NCT02164474; https://clinicaltrials.gov/ct2/show/NCT02164474 (Archived by WebCite at http://www.webcitation.org/74Hx1ipj6)

International Registered Report Identifier (IRRID)

DERR1-10.2196/11226

Feel good now or regret it later? The respective roles of affective attitudes and anticipated affective reactions for explaining health-promoting and health risk behavioral intentions

Evidence supporting the incorporation of affective constructs, such as affective attitudes and anticipated regret, into theoretical models of health behavior has been mounting in recent years; however, the role of positive anticipated affective reactions (e.g., pride) has been largely unexplored. The purpose of the present investigation was to assess how affective attitudes and anticipated affective reactions (both pride and regret for performing a behavior or not) may provide distinct utility for understanding intentions to perform health-promoting and health risk behaviors over and above cognitive attitudes and other established theoretical constructs from the theory of planned behavior (TPB). Participants (N = 210) were recruited via Amazon's Mechanical Turk to complete a one-time online battery assessing TPB and affective constructs. Self-reported intentions served as the main outcome measure, and hierarchical linear modeling was used to examine the effects of TPB and affective constructs across behaviors. Controlling for TPB constructs, more positive affective attitudes and greater anticipated regret, but not anticipated pride, predicted intentions to engage in future health behaviors. Anticipated affective reactions contributed explanatory variance for intentions to perform health risk behaviors, but anticipated pride and regret were not associated with intentions to perform health risk behaviors. Contributions made via the inclusion of both positively and negatively valence anticipated affective reactions for both action and inaction (performing a behavior or not) across a range of health promoting and health risk behaviors are discussed, as well as implications for future intervention work.

Personalized models of physical activity responses to text message micro-interventions: A proof-of-concept application of control systems engineering methods

OBJECTIVES

The conceptual models underlying physical activity interventions have been based largely on differences between more and less active people. Yet physical activity is a dynamic behavior, and such models are not sensitive to factors that regulate behavior at a momentary level or how people respond to individual attempts at intervening. We demonstrate how a control systems engineering approach can be applied to develop personalized models of behavioral responses to an intensive text message-based intervention.

DESIGN & METHOD

To establish proof-of-concept for this approach, 10 adults wore activity monitors for 16 weeks and received five text messages daily at random times. Message content was randomly selected from three types of messages designed to target (1) social-cognitive processes associated with increasing physical activity, (2) social-cognitive processes associated with reducing sedentary behavior, or (3) general facts unrelated to either physical activity or sedentary behavior. A dynamical systems model was estimated for each participant to examine the magnitude and timing of responses to each type of text message.

RESULTS

Models revealed heterogeneous responses to different message types that varied between people and between weekdays and weekends.

CONCLUSIONS

This proof-of-concept demonstration suggests that parameters from this model can be used to develop personalized algorithms for intervention delivery. More generally, these results demonstrate the potential utility of control systems engineering models for optimizing physical activity interventions.

Effectiveness of Approaches to Increase Physical Activity Behavior to Prevent Chronic Disease in Adults: A Brief Commentary

Effective behavior change approaches are necessary to help individuals avoid or mitigate risk factors, engage in behavioral patterns that lead to better health, and consequently, prevent several chronic diseases. Physical inactivity is considered one of the most harmful risk factors for chronic medical conditions, and although different strategies are used to tackle this behavior, not all of them lead to the expected or desired results. This brief commentary examines recent approaches aimed at physical activity behavior change. We find that a combination of strategies focusing on streamlining the access to physical activity seems to be more effective than individual approaches, in order to increase physical activity engagement to prevent chronic diseases in adults.

Application of Transtheoretical Model on Behavioral Changes, and Amount of Physical Activity Among University's Students

This study's purpose was to examine the structural relationship of the transtheoretical model (TTM) and the amount of physical activity (PA) among undergraduate students in health and medicine at Universiti Sains Malaysia. A cross-sectional study was carried out among students who took part in the co-curricular program. Co-curricular program includes activities that take place outside of the regular lectures or tutorials in the University. Students recruited through purposive sampling were informed that their participation was entirely voluntarily. Those interested completed the self-administered questionnaire, which consisted of the decisional balance, processes of change, self-efficacy, stages of change scales, and Godin leisure-time exercise questionnaire. Data were analyzed using Mplus version 8 for descriptive statistics and structural equation modeling analysis for inferential statistics. A total of 562 students participated in the study. The majority of the students was female (79.0%) and Malay (73.3%) and average of exercise sessions per week was 2.62, with a mean of 43.37 min per exercise session. The final structural model fit the data well based on several fit indices (SRMR = 0.046, RMSEA (CI: 90%) = 0.061 (0.045, 0.078), RMSEA p = 0.130). The model showed that stages of change significantly affected self-efficacy (p < 0.001), pros (benefits of exercise; p < 0.001), cons (barriers to exercise; p = 0.022), and processes of change (p < 0.001). The model also showed significant inter-relationships among the TTM constructs and supported seven hypotheses. Among all the variables examined, only processes of change significantly affected PA (p < 0.001). However, stages of change (p < 0.001) and pros (p =< 0.001) had significant indirect effects on PA via processes of change. The findings support that individuals' stages of change affect their self-efficacy level, or the ability to make positive and negative decisions and perform behavior accordingly. The study confirms that making correct decisions and taking action accordingly can increase PA levels.

Intention and automaticity toward physical and sedentary screen-based leisure activities in adolescents: A profile perspective

PURPOSE

Physical activity (PA) and sedentary behavior (SB) are increasingly considered independent health behaviors. Additionally, current research suggests that both controlled and automatic determinants account for their adoption. The purpose of this article was to identify intention-automaticity profiles toward PA and screen-based SB and to examine how those profiles are associated with different behavioral patterns.

METHOD

Two cross-sectional studies based on self-report questionnaires were conducted with French high school students (Study 1: n = 198; Study 2: n = 185).

RESULTS

In all, 4 distinct motivational profiles appeared. The first 3 clusters emerged in both studies: "PA" (high levels of automaticity and intention for PA, low levels of automaticity and intention for screen-based SB); "screen" (high levels of automaticity and intention for screen-based SB, low levels of automaticity and intention for PA), and "mixed" (high levels of all variables), whereas the fourth cluster was observed only in Study 2: "high control" (below-mean levels of automaticity, high levels of intention toward both PA and screen-based SB). Adolescents with a screen profile displayed the least healthy behavioral pattern, whereas those in the PA profile demonstrated the most favorable behaviors.

CONCLUSION

Future research is needed to extend these results to other populations using complementary assessment methods of automatic psychological processes and PA and SB behaviors.