Gamifying Accelerometer Use Increases Physical Activity Levels of Sedentary Office Workers

Resistance exercise breaks during prolonged sitting augment the blood flow response to a subsequent oral glucose load in sedentary adults

Sitting-induced impairments in postprandial blood flow are an important link between sedentary behaviour and cardiometabolic disease risk. The objective of this work was to examine the effects of resistance exercise breaks (REB) performed every 30 min during an otherwise sedentary 3-h period on the vasodilatory response to a subsequent oral glucose load in sedentary adults. Twenty-four sedentary adults (27 ± 7 years, 16 females) completed two conditions. Fasting blood glucose, insulin, popliteal artery blood flow (PABF) and gastrocnemius perfusion were measured immediately before standardized breakfast consumption. After breakfast, the 3-h REB or uninterrupted (SIT) intervention period commenced. Participants sat at a workstation, and popliteal artery shear rate (PASR) was measured 60 and 120 min into this period. In the REB condition, participants performed a 3-min REB (3 × [20 s squats, 20 s high knees, 20 s calf raises]) every 30 min. Following the intervention period, baseline measurements were repeated. Participants then consumed a 75 g glucose beverage, and PABF and perfusion were measured every 30-60 min for the following 120 min. Relative to SIT, REB increased PASR at 60 min (+31.4 ± 9.2/s, P = 0.037) and 120 min (+37.4 ± 10.2/s, P = 0.019) into the intervention period. Insulin and glucose increased (P < 0.001) in response to glucose consumption, with no differences between conditions (P ≥ 0.299). In response to the glucose load, perfusion (1.57 vs. 1.11 mL/100 mL/min, P = 0.023) and PABF (+45.3 ± 11.8 mL/min, P = 0.001) were greater after REB versus SIT. Performing 3-min REB every 30 min during an otherwise sedentary 3-h period augmented leg blood flow responses to an oral glucose load. HIGHLIGHTS: What is the central question of this study? Can 3-min resistance exercise breaks (REB) performed during an otherwise sedentary 3-h period augment the vasodilatory response to a subsequent oral glucose load in sedentary adults? What is the main finding and its importance? Performing 3-min REB, which included squats, high knees, and calf raises, every 30 min augmented lower limb blood flow responses to a subsequent oral glucose load compared to 3 h of uninterrupted sitting in sedentary adults. Sitting-induced impairment in postprandial vasodilatory function has been identified as a link between sedentary behaviour and cardiometabolic disease. Thus, the current study presents a potentially effective strategy to offset this risk.

Stand-Capable Workstations Reduce Occupational Sedentary Time Among Administrative Workers

OCCUPATIONAL APPLICATIONSIn this study, we found that workers who use stand-biased desks stood more and sat less during their workday compared to workers who use traditional desks. Stand-biased users also experienced significantly less lower back discomfort compared to both traditional and sit-stand workstation users. Based on these findings, we recommend that the use of stand-biased workstations be considered when designing or renovating work office workspaces. The health risks of sedentary behavior are inherent in most office work, but these risks can be alleviated with intentional equipment choices. Using stand-biased desks can encourage workers to move more throughout the workday without their productivity or comfort being disturbed.

Using a Fitbit-based Walking Game to Improve Physical Activity Among U.S. Veterans

INTRODUCTION

Physical inactivity, hereafter inactivity, is a serious health problem among U.S. veterans, hereafter veterans. Inactive adults are at risk for adverse cardiac events and premature mortality. Specifically, among veterans, inactivity has been associated with a 23% increase in mortality. In order to increase physical activity among veterans, we developed Veterans Affairs (VA) MapTrek, a mobile-phone-based web app that allows users to take a virtual walk in interesting locations around the world while tracking their progress against that of others like themselves on an interactive map. Steps are counted by a commercially available Fitbit triaxial accelerometer, and users see their progress along a predefined scenic path overlaid on Google Maps. The objective of this study was to determine the effectiveness of VA MapTrek to increase physical activity in a population of veterans at risk for obesity-related morbidity.

MATERIALS AND METHODS

We recruited overweight and obese veterans obtaining care at the Iowa City Veterans Affairs Health Center. Half of the veterans were assigned to participate in VA MapTrek. Each week, participants were assigned virtual walking races (Monday through Saturday), which followed a predetermined route that is displayed on Google Maps. The participant's position on the map is automatically updated each time their Fitbit syncs to their phone. In addition, challenges were issued periodically. Veterans in the control group were only given a Fitbit. We regressed daily step counts on the days of the week, the days since the start of the intervention period, whether the user was in the VA MapTrek or Control group, and an interaction between the study group and the days since the start of the intervention period. We included subject-specific random intercepts and subject-specific random slopes. This model was estimated using Bayesian Hamiltonian Monte Carlo using Stan's No-U-Turns sampler. We set vague, uniform priors on all the parameters.

RESULTS

We enrolled 276 participants, but only 251 (102 in the control group and 149 in the VA MapTrek group) contributed data during the intervention period. Our analysis suggests an 86.8% likelihood that the VA MapTrek intervention led to a minimum increase of 1,000 daily steps over the 8-week period, compared to the control group. Throughout the 8-week intervention, we project that VA MapTrek participants would have taken an extra 96,627 steps, equivalent to 77.8 additional kilometers (km) (48.3 additional miles), assuming an average of 1,242 steps per km (2,000 steps per mile).

CONCLUSIONS

Our study underscores the potential of VA MapTrek as an intervention for promoting walking among veterans who face elevated risks of obesity and cardiac issues. Rural veterans are a high-risk population, and new interventions like VA MapTrek are needed to improve veterans' health.

Protocol for a randomised controlled field experiment on the effect of different gamification designs of physical activity

Gamification is finding growing application in the field of physical activity, promising engaging and motivating experiences that foster behavioural change. However, existing empirical work has insufficiently scrutinised whether the reported positive outcomes emerge because of gamification and what type of gamification design leads to optimal results. This protocol for a parallel four-arm randomised controlled field experiment was purposely designed to investigate the effect of different gamification designs on motivation, perceived usefulness, and the intended behavioural change in physical activity (increase in step counts). Participants were randomly assigned to either: 1) a competitive gamified group; 2) a cooperative gamified group; 3) a hybrid (competitive-cooperative) gamified group; or 4) a control group. The design of the gamified interventions was guided by gamification design frameworks identified in literature. The data gathered includes: 1) a longitudinal panel dataset of step counts to investigate the causal effect of gamification on physical activity behaviour; and 2) self-reported data to examine the effect of gamification on the users' intrinsic motivation and perceived usefulness of the experience. This protocol outlines the procedure and processes followed during this experiment to facilitate replicability for future studies.

Effect of Active Workstations on Neurocognitive Performance and Typing Skills: A Randomized Clinical Trial

BACKGROUND

Extended sedentary behavior is a risk factor for chronic disease and mortality, even among those who exercise regularly. Given the time constraints of incorporating physical activity into daily schedules, and the high likelihood of sitting during office work, this environment may serve as a potentially feasible setting for interventions to reduce sedentary behavior.

METHODS AND RESULTS

A randomized cross-over clinical trial was conducted at an employee wellness center. Four office settings were evaluated on 4 consecutive days: stationary or sitting station on day 1 (referent), and 3 subsequent active workstations (standing, walking, or stepper) in randomized order. Neurocognitive function (Selective Attention, Grammatical Reasoning, Odd One Out, Object Reasoning, Visuospatial Intelligence, Limited-Hold Memory, Paired Associates Learning, and Digit Span) and fine motor skills (typing speed and accuracy) were tested using validated tools. Average scores were compared among stations using linear regression with generalized estimating equations to adjust standard errors. Bonferroni method adjusted for multiple comparisons. Healthy subjects were enrolled (n=44), 28 (64%) women, mean±SD age 35±11 years, weight 75.5±17.1 kg, height 168.5±10.0 cm, and body mass index 26.5±5.2 kg/m2. When comparing active stations to sitting, neurocognitive test either improved or remained unchanged, while typing speed decreased without affecting typing errors. Overall results improved after day 1, suggesting habituation. We observed no major differences across active stations, except decrease in average typing speed 42.5 versus 39.7 words per minute with standing versus stepping (P=0.003).

CONCLUSIONS

Active workstations improved cognitive performance, suggesting that these workstations can help decrease sedentary time without work performance impairment.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT06240286.

Harnessing technology and gamification to increase adult physical activity: a cluster randomized controlled trial of the Columbia Moves pilot

BACKGROUND

The use of health technologies and gamification to promote physical activity has increasingly been examined, representing an opportunistic method for harnessing social support inherent within existing social ties. However, these prior studies have yielded mixed findings and lacked long-term follow-up periods. Thus, a pilot cluster randomized controlled trial was conducted to gauge the feasibility and preliminary efficacy of a digital gamification-based physical activity promotion approach among teams of insufficiently active adults with existing social ties.

METHODS

Teams (N = 24; 116 total participants) were randomized to either a 12-week intervention (Fitbit, step goals, app, feedback; TECH) or the same program plus gamification (TECH + Gamification). Mixed effects models were used to compare group differences in treatment adherence, and changes in social support, steps, and moderate-to-vigorous physical activity at 12 weeks and 52 weeks from baseline, adjusted for sociodemographic characteristics and team size.

RESULTS

TECH had a lower mean number of days of Fitbit self-monitoring versus TECH + Gamification during the intervention (adjusted difference: -.30; 95% CI, -.54 to -.07; P = .01). Post-intervention, TECH had 47% lower odds of self-monitoring 7 days per week versus TECH + Gamification (.53; 95% CI, .31 to .89; P = .02). No differences were observed between TECH + Gamification and TECH in increases in social support (0.04; 95% CI, -.21 to .29; P = .76), ActiGraph-measured daily steps (-425; 95% CI, -1065 to 215; P = .19), or moderate-to-vigorous physical activity minutes (-3.36; 95% CI, -8.62 to 1.91; P = .21) from baseline to 12 weeks or in the regression of these improvements by 1 year (Ps > .05). Although not significant in the adjusted models (Ps > .05), clinically meaningful differences in Fitbit-measured daily steps (TECH, 7041 ± 2520; TECH + Gamification, 7988 ± 2707) and active minutes (TECH, 29.90 ± 29.76; TECH + Gamification, 36.38 ± 29.83) were found during the intervention.

CONCLUSIONS

A gamified physical activity intervention targeting teams of adults with existing social ties was feasible and facilitated favorable, clinically meaningful additive physical activity effects while in place but did not drive enhanced, long-term physical activity participation. Future investigations should explore optimal team dynamics and more direct ways of leveraging social support (training teams; gamifying social support).

TRIAL REGISTRATION

Clinicaltrials.gov ( NCT03509129 , April 26, 2018).

Effects of Increased Standing and Light-Intensity Physical Activity to Improve Postprandial Glucose in Sedentary Office Workers: Protocol for a Randomized Crossover Trial

BACKGROUND

Prolonged bouts of sedentary time, independent from the time spent in engaging in physical activity, significantly increases cardiometabolic risk. Nonetheless, the modern workforce spends large, uninterrupted portions of the day seated at a desk. Previous research suggests-via improved cardiometabolic biomarkers-that this risk might be attenuated by simply disrupting sedentary time with brief breaks of standing or moving. However, this evidence is derived from acute, highly controlled laboratory experiments and thus has low external validity.

OBJECTIVE

This study aims to investigate if similar or prolonged cardiometabolic changes are observed after a prolonged (2-week) practice of increased brief standing and moving behaviors in real-world office settings.

METHODS

This randomized crossover trial, called the WorkWell Study, will compare the efficacy of two 2-week pilot intervention conditions designed to interrupt sitting time in sedentary office workers (N=15) to a control condition. The intervention conditions use a novel smartphone app to deliver real-time prompts to increase standing (STAND) or moving (MOVE) by an additional 6 minutes each hour during work. Our primary aim is to assess intervention-associated improvements to daily postprandial glucose using continuous glucose monitors. Our secondary aim is to determine whether the interventions successfully evoke substantive positional changes and light-intensity physical activity (LPA). Other outcomes include the feasibility and acceptability of the intervention conditions, fasting blood glucose concentration, femoral artery flow-mediated dilation (f-FMD), and systolic and diastolic blood pressure.

RESULTS

The trial is ongoing at the time of submission.

CONCLUSIONS

This study is a novel, randomized crossover trial designed to extend a laboratory-based controlled study design into the free-living environment. By using digital health technologies to monitor and prompt participants in real time, we will be able to rigorously test the effects of breaking up sedentary behavior over a longer period of time than is seen in traditional laboratory-based studies. Our innovative approach will leverage the strengths of highly controlled laboratory and free-living experiments to achieve maximal internal and external validity. The research team's multidisciplinary expertise allows for a broad range of biological measures to be sampled, providing robust results that will extend knowledge of both the acute and chronic real-life effects of increased standing and LPA in sedentary office workers. The WorkWell Study uses a rigorous transdisciplinary protocol that will contribute to a more comprehensive picture of the beneficial effects of breaking up sitting behavior.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04269070; https://clinicaltrials.gov/study/NCT04269070.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/45133.

Young-onset colorectal cancer

In the past decades the incidence of colorectal cancer (CRC) in people under the age of 50 years has increased, which is referred to as early-onset CRC or young-onset CRC (YO-CRC). YO-CRC is expected to account for 11% of colon cancers and 23% of rectal cancers by 2030. This trend is observed in different parts of the world and in both men and women. In 20% of patients with YO-CRC, a hereditary cancer syndrome is found as the underlying cause; however, in the majority of patients no genetic predisposition is present. Beginning in the 1950s, major changes in lifestyle such as antibiotic use, low physical activity and obesity have affected the gut microbiome and may be an important factor in YO-CRC development. Owing to a lack of screening, patients with YO-CRC are often diagnosed with advanced-stage disease. Long-term treatment-related complications should be taken into account in these younger patients, making the more traditional sequential approaches of drug therapy not always the most appropriate option. To better understand the underlying mechanism and define relationships between environmental factors and YO-CRC development, long-term prospective studies are needed with lifestyle data collected from childhood.

Prolonged sitting and peripheral vascular function: potential mechanisms and methodological considerations

Sitting time is associated with increased risks for subclinical atherosclerosis and cardiovascular disease development, and this is thought to be partially due to sitting-induced disturbances in macro- and microvascular function as well as molecular imbalances. Despite surmounting evidence supporting these claims, contributing mechanisms to these phenomena remain largely unknown. In this review, we discuss evidence for potential mechanisms of sitting-induced perturbations in peripheral hemodynamics and vascular function and how these potential mechanisms may be targeted using active and passive muscular contraction methods. Furthermore, we also highlight concerns regarding the experimental environment and population considerations for future studies. Optimizing prolonged sitting investigations may allow us to not only better understand the hypothesized sitting-induced transient proatherogenic environment but to also enhance methods and devise mechanistic targets to salvage sitting-induced attenuations in vascular function, which may ultimately play a role in averting atherosclerosis and cardiovascular disease development.

Occupational sitting and work engagement among university employees

Objective: This study sought to determine the relationship between occupational sitting and work engagement among university employees. Participants: Participants included 103 university employees (age: 48.5 ± 10.4 years, 80% female, 77% staff). Methods: Participants completed an online survey based on the Utrecht Work Engagement Survey (UWES) and the Occupational Sitting and Physical Activity Questionnaire (OSPAQ). The UWES assessed elements of work engagement. The OSPAQ assessed time spent sitting, standing, walking, and in heavy labor during a workday. Results: Compared to staff members, faculty members self-reported less time seated during the workday (373.8 ± 109.7 min/day vs. 321.1 ± 97.3 min/day, p = 0.03). Work engagement was comparable among faculty and staff members (vigor: p = 0.44; absorption: p = 0.68; dedication: p = 0.71). Associations of work engagement with occupational sitting were not significant. Conclusions: These pilot findings suggest that university staff tend to engage in more occupational sitting compared to faculty. Being absorbed and engaged at work is not associated with occupational sitting.

Multi-Component Intervention to Promote Physical Activity in Japanese Office Workers: A Single-Arm Feasibility Study

This study investigated the feasibility of a multi-component intervention to promote physical activity (PA) among Japanese office workers. It was an 8-week single-arm trial conducted in Japan in 2021, in which 76 employees aged 20 or older, from an insurance company, participated. They received a multi-component PA intervention that comprised individual (lecture, print material, goal setting, and feedback), socio-cultural (team building and supportive atmosphere), physical (poster), and organizational (encouraging message from an executive) strategies. The primary outcome was change in objectively measured moderate-to-vigorous PA (MVPA). A paired t-test was used to compare the changes between weeks 0 and 8. We also conducted a subdomain analysis of PA divided into four domains (working, non-working, commuting working, and remote working). Excluding 26 participants who could not complete valid assessments, the MVPA among participants (n = 50, age 49.6 ± 9.7) significantly increased by +7.3 min/day [95% confidence interval (CI) 0.8 to 13.8]. We also identified significant changes in MVPA by +10.0 min/day [95% CI, 3.7 to 16.3] in working days (n = 40), and by +7.1 min/day [95% CI, 0.4 to 13.7] in remote working days (n = 34). We demonstrated that multi-component PA interventions might improve MVPA among Japanese office workers.

Assessing the Pragmatic Nature of mHealth Interventions Promoting Physical Activity: A Systematic Review and Meta-Analysis (Preprint)

BACKGROUND

Mobile health (mHealth) apps can promote physical activity; however, the pragmatic nature (ie, how well research translates into real-world settings) of these studies is unknown. The impact of study design choices, for example, intervention duration, on intervention effect sizes is also understudied.

OBJECTIVE

This review and meta-analysis aims to describe the pragmatic nature of recent mHealth interventions for promoting physical activity and examine the associations between study effect size and pragmatic study design choices.

METHODS

The PubMed, Scopus, Web of Science, and PsycINFO databases were searched until April 2020. Studies were eligible if they incorporated apps as the primary intervention, were conducted in health promotion or preventive care settings, included a device-based physical activity outcome, and used randomized study designs. Studies were assessed using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) and Pragmatic-Explanatory Continuum Indicator Summary-2 (PRECIS-2) frameworks. Study effect sizes were summarized using random effect models, and meta-regression was used to examine treatment effect heterogeneity by study characteristics.

RESULTS

Overall, 3555 participants were included across 22 interventions, with sample sizes ranging from 27 to 833 (mean 161.6, SD 193.9, median 93) participants. The study populations' mean age ranged from 10.6 to 61.5 (mean 39.6, SD 6.5) years, and the proportion of males included across all studies was 42.8% (1521/3555). Additionally, intervention lengths varied from 2 weeks to 6 months (mean 60.9, SD 34.9 days). The primary app- or device-based physical activity outcome differed among interventions: most interventions (17/22, 77%) used activity monitors or fitness trackers, whereas the rest (5/22, 23%) used app-based accelerometry measures. Data reporting across the RE-AIM framework was low (5.64/31, 18%) and varied within specific dimensions (Reach=44%; Effectiveness=52%; Adoption=3%; Implementation=10%; Maintenance=12.4%). PRECIS-2 results indicated that most study designs (14/22, 63%) were equally explanatory and pragmatic, with an overall PRECIS-2 score across all interventions of 2.93/5 (SD 0.54). The most pragmatic dimension was flexibility (adherence), with an average score of 3.73 (SD 0.92), whereas follow-up, organization, and flexibility (delivery) appeared more explanatory with means of 2.18 (SD 0.75), 2.36 (SD 1.07), and 2.41 (SD 0.72), respectively. An overall positive treatment effect was observed (Cohen d=0.29, 95% CI 0.13-0.46). Meta-regression analyses revealed that more pragmatic studies (-0.81, 95% CI -1.36 to -0.25) were associated with smaller increases in physical activity. Treatment effect sizes were homogenous across study duration, participants' age and gender, and RE-AIM scores.

CONCLUSIONS

App-based mHealth physical activity studies continue to underreport several key study characteristics and have limited pragmatic use and generalizability. In addition, more pragmatic interventions observe smaller treatment effects, whereas study duration appears to be unrelated to the effect size. Future app-based studies should more comprehensively report real-world applicability, and more pragmatic approaches are needed for maximal population health impacts.

TRIAL REGISTRATION

PROSPERO CRD42020169102; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=169102.

Do physical activity interventions combining self-monitoring with other components provide an additional benefit compared with self-monitoring alone? A systematic review and meta-analysis

Objective

To determine the net effect of different physical activity intervention components on step counts in addition to self-monitoring.

Design

A systematic review with meta-analysis and meta-regression.

Data sources

Five databases (PubMed, Scopus, Web of Science, ProQuest and Discus) were searched from inception to May 2022. The database search was complemented with backward and forward citation searches and search of the references from relevant systematic reviews.

Eligibility criteria

Randomised controlled trials comparing an intervention using self-monitoring (active control arm) with an intervention comprising the same treatment PLUS any additional component (intervention arm).

Data extraction and synthesis

The effect measures were mean differences in daily step count. Meta-analyses were performed using random-effects models, and effect moderators were explored using univariate and multivariate meta-regression models.

Results

Eighty-five studies with 12 057 participants were identified, with 75 studies included in the meta-analysis at postintervention and 24 at follow-up. At postintervention, the mean difference between the intervention and active control arms was 926 steps/day (95% CI 651 to 1201). At a follow-up, the mean difference was 413 steps/day (95% CI 210 to 615). Interventions with a prescribed goal and involving human counselling, particularly via phone/video calls, were associated with a greater mean difference in the daily step count than interventions with added print materials, websites, smartphone apps or incentives.

Conclusion

Physical activity interventions that combine self-monitoring with other components provide an additional modest yet sustained increase in step count compared with self-monitoring alone. Some forms of counselling, particularly remote phone/video counselling, outperformed other intervention components, such as websites and smartphone apps.

PROSPERO registered number

CRD42020199482.

Exercise in Obesity-the Role of Technology in Health Services: Can This Approach Work?

PURPOSE OF REVIEW

Physical activity (PA) is an important strategy to prevent and treat obesity. Electronic health (eHealth) interventions, such as wearable activity monitors and smartphone apps, may promote adherence to regular PA and successful weight loss. This review highlights the evidence for eHealth interventions in promoting PA and reducing weight.

RECENT FINDINGS

Wearables can increase PA and are associated with moderate weight loss in middle/older-aged individuals, with less convincing effects long-term (> 1 year) and in younger people. Data for interventions such as mobile phone applications, SMS, and exergaming are less robust. Investigations of all eHealth interventions are often limited by complex, multi-modality study designs, involving concomitant dietary modification, making the independent contribution of each eHealth intervention on body weight challenging to assess. eHealth interventions may promote PA, thereby contributing to weight loss/weight maintenance; however, further evaluation is required for this approach to be adopted into routine clinical practice.

Effects of a Gamified, Behavior Change Technique-Based Mobile App on Increasing Physical Activity and Reducing Anxiety in Adults With Autism Spectrum Disorder: Feasibility Randomized Controlled Trial

BACKGROUND

Physical activity (PA) has an impact on physical and mental health in neurotypical populations, and addressing these variables may improve the prevalent burden of anxiety in adults with autism spectrum disorder (ASD). Gamified mobile apps using behavior change techniques present a promising way of increasing PA and reducing sedentary time, thus reducing anxiety in adults with ASD.

OBJECTIVE

This study aimed to compare the effectiveness of a gamified and behavior change technique-based mobile app, PuzzleWalk, versus a commercially available app, Google Fit, on increasing PA and reducing sedentary time as an adjunct anxiety treatment for this population.

METHODS

A total of 24 adults with ASD were assigned to either the PuzzleWalk or Google Fit group for 5 weeks using a covariate-adaptive randomization design. PA and anxiety were assessed over 7 days at 3 different data collection periods (ie, baseline, intervention start, and intervention end) using triaxial accelerometers and the Beck Anxiety Inventory. Group differences in outcome variables were assessed using repeated-measures analysis of covariance, adjusting for age, sex, and BMI.

RESULTS

The findings indicated that the PuzzleWalk group spent a significantly longer amount of time on app use compared with the Google Fit group (F2,38=5.07; P=.01; partial η2=0.21), whereas anxiety was unfavorably associated with increases in light PA and decreases in sedentary time after intervention (all P<.05).

CONCLUSIONS

Further research is needed to clarify the determinants of physical and mental health and their interrelationship in adults with ASD to identify the factors that facilitate the use and adoption of mobile health technologies in these individuals. Despite these mixed results, the small changes in PA or anxiety may be clinically significant for adults with ASD.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05466617; https://clinicaltrials.gov/show/NCT05466617.

Effects of Sedentary Behavior Interventions on Mental Well-Being and Work Performance While Working from Home during the COVID-19 Pandemic: A Pilot Randomized Controlled Trial

Sedentary behavior negatively impacts mental health, which can decrease employee productivity. Employee mental well-being and work performance may improve with sedentary reduction interventions, especially strategies that include environmental workplace modifications and behavior-changing strategies. However, such interventions have not been examined among employees working remotely during the COVID-19 pandemic. As part of the Stand Up Kansas program, 95 sedentary university employees working from home were randomized into one of four intervention arms: height-adjustable desk provision (Desk Only), online sedentary behavior modification program (Program Only), Desk + Program, or Control. The outcomes were measured at a baseline (November 2020) and following the 12-week intervention (February 2021). Employees reported mood (positive and negative affect), stress, fatigue (duration, interference with activities and severity) and work performance (irritability, focus, work satisfaction, non-work satisfaction and productivity) were measured using established self-report instruments. The effect sizes, by comparing the Control arm to the Desk + Program arm, revealed large improvements in mood (positive affect, d = 1.106). Moderate improvements were also seen in fatigue (duration, d = −0.533, and interference with activities, d = −0.648) and several aspects of work performance (focus, d = 0.702, work satisfaction, d = 0.751, and productivity, d = 0.572). Moderate effect sizes were also seen for positive affect (d = 0.566) and fatigue severity (d = 0.577) among the Program Only arm, whereas no noteworthy effect sizes were observed among the Desk Only arm. Combining an online sedentary behavior modification program with height-adjustable desk provisions appeared to positively affect mental well-being and work performance among remote employees.

Gamification in a Physical Activity App: What Gamification Features Are Being Used, by Whom, and Does It Make a Difference?

Background: Gamification is purported to enhance engagement with health behavior apps, ultimately improving their effectiveness. This study aimed to examine (1) whether the inclusion of gamification features in a physical activity smartphone app was associated with improved app usage and goal adherence, describe (2) use of the gamification features, and (3) by whom, and determine (4) whether engagement was associated with increased physical activity. Methods: Data from community-dwelling adult participants (mean age 42.1 years, standard deviation [SD 11.9], 74% female) in the gamified (n = 134) and nongamified (n = 155) conditions from a three-group randomized controlled trial were analyzed. Physical activity was assessed at baseline and 9 months using a survey and accelerometers. App usage (number of days steps were logged), goal adherence (number of days step count was ≥10,000), and behavioral engagement with gamification features were obtained from server logs. Multilevel modeling was used to examine the study aims. Results: Participants who received the gamified app showed more days of usage than those who received the nongamified app (M = 113 days [SD 88] vs. M = 81 days [SD 54], P = 0.006), whereas goal adherence did not differ between groups. The leaderboard and "status" gamification features were the most frequently used gamification features (M = 83 [SD 114] and M = 50 [SD 67] views, respectively). Older age (P = 0.008) and lower body mass index (P = 0.004) were associated with more status views. Participants who reported higher stress symptoms sent more gifts (P = 0.04). The use of gamification features was associated with increased physical activity (P = 0.04). Conclusion: The gamified app was used substantially longer than the nongamified app. Use of gamification features was positively associated with change in physical activity. Leaderboards promoting social comparison may be a promising form of gamification. Research on different forms of gamification is warranted.

Gamification for HRD: Systematic Review and Future Research Directions

Gamification integrates game components into contexts such as workplace learning and performance. A decade of research has shown that gamification is prevalent in various settings such as education, healthcare, and business. Recently, gamification has been applied and studied in interventions and contexts related to the field of human resource development (HRD). Given the emerging use of gamification in HRD, this paper undertakes a systematic literature review (SLR) to synthesize existing research on gamification in HRD. This paper identifies four areas where gamification has been studied in HRD: employee learning, task performance, employee wellness, and rising contexts. In addition, this SLR collects and organizes a series of future research directions and offers a set of potential research questions. These future research directions center around four areas of gamification for HRD: designing gamification, influencing factors, experiential outcomes, and sustaining gamification. Implications for HRD practice and research, as well as limitations, are discussed.

Effects of Gamified Smartphone Applications on Physical Activity: A Systematic Review and Meta-Analysis

INTRODUCTION

This systematic review and meta-analysis aims to examine the impacts of standalone gamified smartphone application-delivered interventions on physical activity.

METHODS

Web of Science, Scopus, PubMed, PsycINFO, and ACM Digital Library were searched for publications that were published between January 1, 2008 and August 31, 2021. Eligibility criteria were RCTs or single-arm pre-to-post interventions delivered by standalone gamified applications and targeting physical activity. Study-specific results were analyzed using random-effects meta-analysis, with a standardized mean difference. Meta-regressions, subgroup analyses, and sensitivity analyses were performed. PRISMA guidelines were followed, and the Grading of Recommendations Assessment, Development and Evaluation system was used to determine the strength of the evidence.

RESULTS

A total of 19 studies with 24 gamified applications were eligible, and 16 studies were included in the meta-analysis. Standalone gamified applications had a small-to-moderate effect on physical activity in both the between-group RCTs (n=12 applications, standardized mean difference=0.34, 95% CI=0.06, 0.62, I²=72%, p<0.01; Grading of Recommendations Assessment, Development and Evaluation: moderate) and the within-group pre-to-post interventions (n=18 applications, standardized mean difference=0.38, 95% CI=0.17, 0.59, I²=74%, p<0.01; Grading of Recommendations Assessment, Development and Evaluation: very low). Leave-one-out sensitivity analyses sustained the main effects with lower heterogeneity (I² of 31.0% and 47.8%, respectively).

DISCUSSION

Using gamified smartphone applications as standalone interventions may increase physical activity. Future research could investigate the impacts of gamified applications on physical activity by isolating the role of specific single or clustered groups of application features.

Evaluating the Effectiveness of Gamification on Physical Activity: Systematic Review and Meta-analysis of Randomized Controlled Trials

BACKGROUND

Gamification refers to the use of game elements in nongame contexts. The use of gamification to change behaviors and promote physical activity (PA) is a promising avenue for tackling the global physical inactivity pandemic and the current prevalence of chronic diseases. However, there is no evidence of the effectiveness of gamified interventions with the existence of mixed results in the literature.

OBJECTIVE

The aim of this systematic review and meta-analysis is to evaluate the effectiveness of gamified interventions and their health care potential by testing the generalizability and sustainability of their influence on PA and sedentary behavior.

METHODS

A total of 5 electronic databases (PubMed, Embase, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials) were searched for randomized controlled trials published in English from 2010 to 2020. Eligibility criteria were based on the components of the participants, interventions, comparators, and outcomes framework. Studies were included when they used gamified interventions in daily life with an active or inactive control group and when they assessed a PA or sedentary behavior outcome. We conducted meta-analyses using a random-effects model approach. Sensitivity analyses, influence analyses, and publication bias analyses were performed to examine the robustness of our results.

RESULTS

The main meta-analysis performed on 16 studies and 2407 participants revealed a small to medium summary effect of gamified interventions on PA behavior (Hedges g=0.42, 95% CI 0.14-0.69). No statistical difference among different subgroups (adults vs adolescents and healthy participants vs adults with chronic diseases) and no interaction effects with moderators such as age, gender, or BMI were found, suggesting good generalizability of gamified interventions to different user populations. The effect was statistically significant when gamified interventions were compared with inactive control groups, such as waiting lists (Hedges g=0.58, 95% CI 0.08-1.07), and active control groups that included a nongamified PA intervention (Hedges g=0.23, 95% CI 0.05-0.41). This suggests that gamified interventions are not only efficient in changing behavior but also more effective compared with other behavioral interventions. The long-term effect (measured with follow-up averaging 14 weeks after the end of the intervention) was weaker, with a very small to small effect (Hedges g=0.15, 95% CI 0.07-0.23).

CONCLUSIONS

This meta-analysis confirms that gamified interventions are promising for promoting PA in various populations. Additional analyses revealed that this effect persists after the follow-up period, suggesting that it is not just a novelty effect caused by the playful nature of gamification, and that gamified products appear effective compared with equivalent nongamified PA interventions. Future rigorous trials are required to confirm these findings.

Outcomes of a smartphone-based application with live health-coaching post-percutaneous coronary intervention

Background

The interval between inpatient hospitalization for symptomatic coronary artery disease (CAD) and post-discharge office consultation is a vulnerable period for adverse events.

Methods

Content was customized on a smartphone app-based platform for hospitalized patients receiving percutaneous coronary intervention (PCI) which included education, tracking, reminders and live health coaches. We conducted a single-arm open-label pilot study of the app at two academic medical centers in a single health system, with subjects enrolled 02/2018–05/2019 and 1:3 propensity-matched historical controls from 01/2015–12/2017. To evaluate feasibility and efficacy, we assessed 30-day hospital readmission (primary), outpatient cardiovascular follow-up, and cardiac rehabilitation (CR) enrollment as recorded in the health system. Outcomes were assessed by Cox Proportional Hazards model.

Findings

118 of 324 eligible (36·4%) 21–85 year-old patients who underwent PCI for symptomatic CAD who owned a smartphone or tablet enrolled. Mean age was 62.5 (9·7) years, 87 (73·7%) were male, 40 of 118 (33·9%) had type 2 diabetes mellitus, 68 (57·6%) enrolled underwent PCI for MI and 59 (50·0%) had previously known CAD; demographics were similar among matched historical controls. No significant difference existed in all-cause readmission within 30 days (8·5% app vs 9·6% control, ARR -1.1% absolute difference, 95% CI -7·1–4·8, p = 0·699) or 90 days (16·1% app vs 19·5% control, p = 0.394). Rates of both 90-day CR enrollment (HR 1·99, 95% CI 1·30–3·06) and 1-month cardiovascular follow up (HR 1·83, 95% CI 1·43–2·34) were greater with the app. Weekly engagement at 30- and 90-days, as measured by percentage of weeks with at least one day of completion of tasks, was mean (SD) 73·5% (33·9%) and 63·5% (40·3%). Spearman correlation analyses indicated similar engagement across age, sex, and cardiovascular risk factors.

Interpretations

A post-PCI smartphone app with live health coaches yielded similarly high engagement across demographics and safely increased attendance in cardiac rehabilitation. Larger prospective randomized controlled trials are necessary to test whether this app improves cardiovascular outcomes following PCI.

Funding

National Institutes of Health, Boston Scientific.

Clinical trial registration

NCT03416920 (https://clinicaltrials.gov/ct2/show/NCT03416920).

Gamifying accelerometer use increases physical activity levels of individuals pre-disposed to type II diabetes

Physical activity is important for preventing obesity and diabetes, but most obese and pre-diabetic patients are not physically active. We developed a Fitbit-based game called MapTrek that promotes walking. We recruited obese and pre-diabetic patients. Half were randomly assigned to the control group and given a Fitbit alone. The others were given a Fitbit plus MapTrek. The MapTrek group participated in 6 months of weekly virtual races. Each week, participants were placed in a race with 9 others who achieved a similar number of steps in the previous week's race. Participants moved along the virtual route by the steps recorded on their Fitbit and received daily walking challenges via text message. Text messages also had links to the race map and leaderboard. We used a Bayesian mixed effects model to analyze the number of steps taken during the intervention. A total of 192 (89%) participants in the control group and 196 (91%) in the MapTrek group were included in the analyses. MapTrek significantly increased step counts when it began: MapTrek participants walked almost 1,700 steps more than the control group on the first day of the intervention. We estimate that there is a 97% probability that the effect of MapTrek is at least 1,000 additional steps per day throughout the course of the 6-month intervention and that MapTrek participants would have walked an additional 81 miles, on average, before the effect ended. Our MapTrek intervention led to significant extra walking by the MapTrek participants.

Wrist actigraphic approach in primary, secondary and tertiary care based on the principles of predictive, preventive and personalised (3P) medicine

Abstract

Sleep quality and duration as well as activity-rest-cycles at individual level are crucial for maintaining physical and mental health. Although several methods do exist to monitor these parameters, optimal approaches are still under consideration and technological development. Wrist actigraphy is a non-invasive electro-physical method validated in the field of chronobiology to record movements and to allow for monitoring human activity-rest-cycles. Based on the continuous recording of motor activity and light exposure, actigraphy provides valuable information about the quality and quantity of the sleep–wake rhythm and about the amount of motor activity at day and night that is highly relevant for predicting a potential disease and its targeted prevention as well as personalisation of medical services provided to individuals in suboptimal health conditions and patients. Being generally used in the field of sleep medicine, actigraphy demonstrates a great potential to be successfully implemented in primary, secondary and tertiary care, psychiatry, oncology, and intensive care, military and sports medicines as well as epidemiological monitoring of behavioural habits as well as well-being medical support, amongst others.

Prediction of disease development and individual outcomes

Activity-rest-cycles have been demonstrated to be an important predictor for many diseases including but not restricted to the development of metabolic, psychiatric and malignant pathologies. Moreover, activity-rest-cycles directly impact individual outcomes in corresponding patient cohorts.

Targeted prevention

Data acquired by actigraphy are instrumental for the evidence-based targeted prevention by analysing individualised patient profiles including light exposure, sleep duration and quality, activity-rest-cycles, intensity and structure of motion pattern.

Personalised therapy

Wrist actigraphic approach is increasingly used in clinical care. Personalised measurements of sedation/agitation rhythms are useful for ICU patients, for evaluation of motor fatigue in oncologic patients, for an individual enhancement of performance in military and sport medicine. In the framework of personalised therapy intervention, patients can be encouraged to optimise their behavioural habits improving recovery and activity patterns. This opens excellent perspectives for the sleep-inducing medication and stimulants replacement as well as for increasing the role of participatory medicine by visualising and encouraging optimal behavioural patterns of the individual.

Smart wearable devices in cardiovascular care: where we are and how to move forward

Technological innovations reach deeply into our daily lives and an emerging trend supports the use of commercial smart wearable devices to manage health. In the era of remote, decentralized and increasingly personalized patient care, catalysed by the COVID-19 pandemic, the cardiovascular community must familiarize itself with the wearable technologies on the market and their wide range of clinical applications. In this Review, we highlight the basic engineering principles of common wearable sensors and where they can be error-prone. We also examine the role of these devices in the remote screening and diagnosis of common cardiovascular diseases, such as arrhythmias, and in the management of patients with established cardiovascular conditions, for example, heart failure. To date, challenges such as device accuracy, clinical validity, a lack of standardized regulatory policies and concerns for patient privacy are still hindering the widespread adoption of smart wearable technologies in clinical practice. We present several recommendations to navigate these challenges and propose a simple and practical 'ABCD' guide for clinicians, personalized to their specific practice needs, to accelerate the integration of these devices into the clinical workflow for optimal patient care.

Exploration of individualized goals and ergonomic modifications to address sedentary behaviors and perceived health and well-being among office workers

BACKGROUND

Office workers spend significant time in sedentary behaviors. Exploration of interventions to address this concern is warranted.

OBJECTIVE

This study explored the impact of individualized goals and ergonomic modifications on sedentary behaviors and perceived health and well-being among office workers.

METHODS

A six-week, one-group, pre- and post-test design was utilized to assess sedentary behaviors and perceptions of health and well-being among office workers using the RAND 36-Item Short Form Survey (SF-36), Numerical Pain Rating Scale (NPRS), Pittsburgh Sleep Quality Index (PSQI), Sedentary Behavior Questionnaire (SBQ), actigraphy, and a workstation assessment.

RESULTS

Statistically significant improvements were noted from pre- to post-test on the RAND SF-36 for energy/fatigue (p = 0.000) and emotional well-being (p = 0.049) and subjective sleep quality using the PSQI (p = 0.005). Participants (n = 17) could set up to two goals related to health and well-being. A majority of the 31 established goals were met: increase physical activity (n = 11/16), reduce sedentary behavior (n = 8/11), and improve personal health (n = 3/4).

CONCLUSIONS

The use of individualized goals and ergonomic modifications is effective for addressing perceived health and well-being among office workers. However, limited statistical significance was found regarding the impact of these interventions on sedentary behaviors or activity levels.

Use of Fitbit Devices in Physical Activity Intervention Studies Across the Life Course: Narrative Review

BACKGROUND

Commercial off-the-shelf activity trackers (eg, Fitbit) allow users to self-monitor their daily physical activity (PA), including the number of steps, type of PA, amount of sleep, and other features. Fitbits have been used as both measurement and intervention tools. However, it is not clear how they are being incorporated into PA intervention studies, and their use in specific age groups across the life course is not well understood.

OBJECTIVE

This narrative review aims to characterize how PA intervention studies across the life course use Fitbit devices by synthesizing and summarizing information on device selection, intended use (intervention vs measurement tool), participant wear instructions, rates of adherence to device wear, strategies used to boost adherence, and the complementary use of other PA measures. This review provides intervention scientists with a synthesis of information that may inform future trials involving Fitbit devices.

METHODS

We conducted a search of the Fitabase Fitbit Research Library, a database of studies published between 2012 and 2018. Of the 682 studies available on the Fitabase research library, 60 interventions met the eligibility criteria and were included in this review. A supplemental search in PubMed resulted in the inclusion of 15 additional articles published between 2019 and 2020. A total of 75 articles were reviewed, which represented interventions conducted in childhood; adolescence; and early, middle, and older adulthood.

RESULTS

There was considerable heterogeneity in the use of Fitbit within and between developmental stages. Interventions for adults typically required longer wear periods, whereas studies on children and adolescents tended to have more limited device wear periods. Most studies used developmentally appropriate behavior change techniques and device wear instructions. Regardless of the developmental stage and intended Fitbit use (ie, measurement vs intervention tool), the most common strategies used to enhance wear time included sending participants reminders through texts or emails and asking participants to log their steps or synchronize their Fitbit data daily. The rates of adherence to the wear time criteria were reported using varying metrics. Most studies supplemented the use of Fitbit with additional objective or self-reported measures for PA.

CONCLUSIONS

Overall, the heterogeneity in Fitbit use across PA intervention studies reflects its relative novelty in the field of research. As the use of monitoring devices continues to expand in PA research, the lack of uniformity in study protocols and metrics of reported measures represents a major issue for comparability purposes. There is a need for increased transparency in the prospective registration of PA intervention studies. Researchers need to provide a clear rationale for the use of several PA measures and specify the source of their main PA outcome and how additional measures will be used in the context of Fitbit-based interventions.

Multilevel mHealth Intervention Increases Physical Activity of Older Adults Living in Retirement Community

BACKGROUND

Regular physical activity is crucial for healthy aging, but older adults are the least active age group. This study explored the feasibility, acceptability, and efficacy of a multilevel mHealth intervention for increasing physical activity of older adults living in a retirement community.

METHODS

Participants included 54 older adults (mean age = 81.2 y, 77.8% female, 98.1% white) living in a retirement community. Participants received a Fitbit Zip and access to a multilevel mHealth physical activity intervention (MapTrek Residential) for 8 weeks. Physical activity (in steps per day) and intervention compliance (days worn) were measured objectively with the Fitbit for 12 weeks (8-wk intervention plus 4-wk follow-up). Psychosocial outcomes (social support, self-efficacy, and outcome expectations) were assessed at baseline and 8 weeks. Acceptability outcomes were assessed with an open-ended process evaluation survey and focus groups. Descriptive statistics and linear mixed models were used to examine intervention effects.

RESULTS

Participants increased daily steps from 5438 steps per day at baseline (95% CI, 4620 to 6256) to 6201 steps per day (95% CI, 5359 to 7042) at week 8 (P < .0001) but this was not maintained at 12 weeks (P = .92).

CONCLUSIONS

Our multilevel mHealth physical activity intervention was effective for increasing physical activity older adults over 8 weeks. Additional research focused on maintaining physical activity gains with this approach is warranted.

Combining Web-Based Gamification and Physical Nudges With an App (MoveMore) to Promote Walking Breaks and Reduce Sedentary Behavior of Office Workers: Field Study

Background

Sedentary behavior (SB) and lack of physical activity (PA) have been associated with poorer health outcomes and are increasingly prevalent in individuals working in sedentary occupations such as office jobs. Gamification and nudges have attracted attention as promising strategies to promote changes in health behavior. However, most effectiveness studies thus far lacked active controls, and few studies have tested interventions combining these strategies.

Objective

This study investigates the effectiveness of combining a gamified digital app with physical nudges to increase PA and reduce SB in Dutch office workers.

Methods

Employees in the municipality of Rotterdam (N=298) from two office locations were randomized at the location level to either a 10-week intervention, combining a 5-week gamification phase encompassing a gamified digital app with social support features and a 5-week physical nudges phase, or to an active control (ie, basic digital app with self-monitoring and goal setting). The primary outcome was the daily step count, objectively measured via accelerometers. Secondary outcomes were self-reported PA and SB measured at baseline and at 5, 10, and 14 weeks. Mixed effects models were used to analyze the effects of the intervention on the outcome measures.

Results

A total of 78.5% (234/298) of participants completed the study and provided accelerometer data, whereas 36.9% (110/298) participants completed the self-report measures at 14 weeks. In the gamification phase, step count data were missing for 13.5% (473/3492) of observations in the control and 11.4% (445/3888) in the intervention condition; however, these percentages increased to 39.6% (1154/2910) and 59.6% (1932/3492) at follow-up, respectively. During the gamification phase, intervention participants increased their number of daily steps by 634 (95% CI 154.2-1113.8; P=.01) more than participants in the control group, after controlling for relevant factors. Improvements were not sustained during the physical nudges phase (P=.76) or follow-up (P=.88).

Conclusions

A digital intervention with gamification and social support features significantly increased the step count of office workers compared with an active control. Physical nudges in the workplace were insufficient to promote the maintenance of behavioral changes achieved in the gamification phase. Future research should explore the long-term effectiveness of similar gamified digital interventions.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN) 49129401; https://www.isrctn.com/ISRCTN14881571

Effectiveness of a Mobile Health Management Program With a Challenge Strategy for Improving the Cardiovascular Health of Workers

BACKGROUND

Workers' cardiovascular health can be influenced by individual willingness to practice healthy behaviors. A mobile health management program with a challenge strategy was administered to promote workers' healthy behaviors among small to medium-sized enterprises.

METHODS

A 12-week program consisted of health communication with a challenge strategy was administered to the workers.

RESULTS

The intervention group showed significantly improved scores for cardiovascular disease-related health behavior (Z = -2.44, P = 0.013), the job stress contributing factor of inadequate social support (F = 4.10, P = 0.049), and the cardiovascular disease-related health status of waist circumference (t = 3.22, P = 0.004), body fat (Z = -2.23, P = 0.024), and triglycerides (Z = -3.04, P = 0.001).

CONCLUSION

This study's significance is its potential for increasing the convenience and joy of participating in intervention programs and acquiring health information through mobile platforms, which are easily accessible to the workers.

Scoping Review of Healthcare Literature on Mobile, Wearable, and Textile Sensing Technology for Continuous Monitoring

Remote monitoring of health can reduce frequent hospitalisations, diminishing the burden on the healthcare system and cost to the community. Patient monitoring helps identify symptoms associated with diseases or disease-driven disorders, which makes it an essential element of medical diagnoses, clinical interventions, and rehabilitation treatments for severe medical conditions. This monitoring can be expensive and time-consuming and provide an incomplete picture of the state of the patient. In the last decade, there has been a significant increase in the adoption of mobile and wearable devices, along with the introduction of smart textile solutions that offer the possibility of continuous monitoring. These alternatives fuel a technology shift in healthcare, one that involves the continuous tracking and monitoring of individuals. This scoping review examines how mobile, wearable, and textile sensing technology have been permeating healthcare by offering alternate solutions to challenging issues, such as personalised prescriptions or home-based secondary prevention. To do so, we have selected 222 healthcare literature articles published from 2007 to 2019 and reviewed them following the PRISMA process under the schema of a scoping review framework. Overall, our findings show a recent increase in research on mobile sensing technology to address patient monitoring, reflected by 128 articles published in journals and 19 articles in conference proceedings between 2014 and 2019, which represents 57.65% and 8.55% respectively of all included articles.

A theory-based multicomponent intervention to reduce occupational sedentary behaviour in professional male workers: protocol for a cluster randomised crossover pilot feasibility study

BACKGROUND

Prolonged sitting, a significant risk factor for increased morbidity and mortality, is accumulated mostly in the workplace. There is limited research targeting specific at-risk populations to reduce occupational sedentary behaviour. A recent study found that professional males have the longest workplace sitting times. Current evidence supports the use of multi-level interventions developed using participative approaches. This study's primary aims are to test the viability of a future definitive intervention trial using a randomised pilot study, with secondary aims to explore the acceptability and feasibility of a multicomponent intervention to reduce workplace sitting.

METHODS

Two professional companies in Dublin, Ireland, will take part in a cluster randomised crossover pilot study. Office-based males will be recruited and randomised to the control or the intervention arms. The components of the intervention target multiple levels of influence including individual determinants (via mHealth technology to support behaviour change techniques), the physical work environment (via provision of an under-desk pedal machine), and the organisational structures and culture (via management consultation and recruitment to the study). The outcomes measured are recruitment and retention, minutes spent sedentary, and physical activity behaviours, work engagement, and acceptability and feasibility of the workplace intervention.

DISCUSSION

This study will establish the acceptability and feasibility of a workplace intervention which aims to reduce workplace SB and increase PA. It will identify key methodological and implementation issues that need to be addressed prior to assessing the effectiveness of this intervention in a definitive cluster randomised controlled trial.

Usability inquiry of a gamified behavior change app for increasing physical activity and reducing sedentary behavior in adults with and without autism spectrum disorder

The purpose of this study was to conduct the first usability inquiry of a gamified, behavior change theory-guided mobile app PuzzleWalk for increasing physical activity and reducing sedentary behavior in adults with and without autism spectrum disorder (ASD). Eighteen adults with and without ASD participated in a mixed-methods study that consisted of cognitive walkthrough, system usability assessment, and qualitative interviews. The results of the system usability testing indicated satisfactory quality of the PuzzleWalk system that can be readily applicable to both adults with and without ASD. Several notable issues were identified from the qualitative interviews that address critical insights into unique health and social needs in adults with ASD. Future work is warranted to examine the long-term effects of the PuzzleWalk system on increasing physical activity and reducing sedentary behavior in adults with and without ASD in real-world settings.

Feasible but Not Yet Efficacious: A Scoping Review of Wearable Activity Monitors in Interventions Targeting Physical Activity, Sedentary Behavior, and Sleep

Purpose of Review

The present review aimed to explore the range and characteristics of interventions that utilize WAM and descriptively summarize the efficacy of these interventions.

Recent Findings

A total of 65 articles (61 studies) were included in this review. Most of the WAM-based interventions (n=58) were designed to improve physical activity (PA). Interventions targeting sedentary behavior (SB) were much less common (n=12), and even less frequent were WAM-based sleep interventions (n=3). Most studies tested the feasibility of WAM-based interventions; hence, efficacy of these interventions in improving PA, SB, and/or sleep could not be conclusively determined. Nonetheless, WAM-based interventions showed considerable potential in increasing PA and decreasing SB.

Summary

WAM-based PA interventions exhibited preliminary efficacy in increasing PA. Although not as many interventions were focused on SB, current interventions also showed potential in decreasing sedentary time. Meanwhile, more evidence is needed to determine the utility of WAM in improving sleep. Major challenges with including WAM as part of interventions are reduced engagement in using the devices over time and the rapid changes in technology resulting in devices becoming obsolete soon after completion of an efficacy trial.

Mobile health interventions to promote physical activity and reduce sedentary behaviour in the workplace: A systematic review

Objective

This systematic review aimed to assess the effectiveness, feasibility and acceptability of mobile health (mHealth) technology (including wearable activity monitors and smartphone applications) for promoting physical activity (PA) and reducing sedentary behaviour (SB) in workplace settings.

Methods

Systematic searches were conducted in seven electronic databases (MEDLINE, SPORTDiscus, Scopus, EMBASE, PsycINFO, Web of Science and the Cochrane library). Studies were included if mHealth was a major intervention component, PA/SB was a primary outcome, and participants were recruited and/or the intervention was delivered in the workplace. Study quality was assessed using the Effective Public Health Practice Project (EPHPP) tool. Interventions were coded for behaviour change techniques (BCTs) using the Coventry, Aberdeen and London - Refined (CALO-RE) taxonomy.

Results

Twenty-five experimental and quasi-experimental studies were included. Studies were highly heterogeneous and only one was rated as 'strong' methodological quality. Common BCTs included self-monitoring, feedback, goal-setting and social comparison. A total of 14/25 (56%) studies reported a significant increase in PA, and 4/10 (40%) reported a significant reduction in sedentary time; 11/16 (69%) studies reported a significant impact on secondary outcomes including reductions in weight, systolic blood pressure and total cholesterol. While overall acceptability was high, a large decline in technology use and engagement was observed over time.

Conclusions

While methodological quality was generally weak, there is reasonable evidence for mHealth in a workplace context as a feasible, acceptable and effective tool to promote PA. The impact in the longer term and on SB is less clear. Higher quality, mixed methods studies are needed to explore the reasons for decline in engagement with time and the longer-term potential of mHealth in workplace interventions.Protocol registration: The review protocol was registered with PROSPERO: CRD42017058856.