Ecological Momentary Assessment in Physical Activity Research

The pleasure of moving: A compositional data analysis of the association between replacing sedentary time with physical activity on affective valence in daily life

Although the independent within-person association between physical activity and sedentary behaviour with valence in daily life has been extensively studied, few studies have used compositional data analysis to examine how different movement behaviour compositions are related to valence in daily life. This study aimed to examine the within-person association between wake-time movement behaviour compositions with affective valence and the extent to which replacing time spent sedentary with physical activity was associated with valence within individuals in daily life. A 7-day ecological momentary study design was used whereby 94 Canadian university students (Mage = 19.45, SD = 2.21, 78.7 % female) reported on affective valence using an adapted version of the Feeling Scale at 7 randomly timed prompts each day. In addition, activPAL accelerometers were worn continuously by participants on their right thigh for the duration of the study to determine time spent engaging in sedentary behaviours and physical activity. Compositional data analysis with isotemporal substitution models were used to examine the within-person association between movement behaviour compositions and affective valence. The within-person association between movement behaviours and affective valence was weak (r2 = 0.013). Nevertheless, engaging in less sedentary time than usual and instead engaging in physical activity was significantly related to more positive affective valence. Considering light intensity physical activity (LPA) and moderate-to-vigorous intensity physical activity (MVPA) separately, replacing time spent sedentary with time engaged in MVPA and LPA both had a significant positive association on affective valence, although the association with MVPA was stronger than the association with LPA. The results provide unique insights into how replacing sedentary time with physical activity in daily life, especially MVPA, may be associated with more feelings of pleasure. These results may be useful to help inform the development of just-in-time adaptive interventions.

Cognitive Health Benefits of Everyday Physical Activity in a Diverse Sample of Middle-Aged Adults

BACKGROUND

Physical activity has been associated with a wide range of health benefits including long-term benefits for cognitive and brain health. Whether episodes of everyday physical activity are associated with immediate cognitive benefits remains unknown.

PURPOSE

The purpose of the current study was to examine whether episodes of physical activity, occurring over the course of participants' daily lives, are associated with short-term improvements in cognitive health.

METHODS

Participants completed a 9-day ecological momentary assessment protocol involving 5 daily assessments of self-reported physical activity and ambulatory cognitive assessments of processing speed and visuospatial working memory. Data were analyzed in a multilevel modeling framework to explore changes in performance on each task associated with physical activity during the period leading up to the assessment as well as individual differences in average frequency of physical activity.

RESULTS

Results of MLMs indicated that engaging in physical activity during the period (~3.5 hr) leading up to an assessment was associated with improvements in processing speed equivalent to 4 years of cognitive aging. Such improvements were observed for both light and moderate-to-vigorous physical activity levels. No association was observed for visuospatial working memory accuracy; however, response time during the working memory task reliably mirrored the association observed for processing speed. The short-term benefits were observed, particularly, for individuals with an overall higher frequency of reported physical activity.

CONCLUSIONS

Our findings suggest that engaging in everyday physical activity of any intensity level may have short-term, acute benefits for cognitive health and point to new potential targets for intervention.

CLINICAL TRIAL INFORMATION

NCT03240406.

Exploring Regular Exercisers' Experiences with Readiness/Recovery Scores Produced by Wearable Devices: A Descriptive Qualitative Study

Meta-session autoregulation, a person-adaptive exercise programming approach, is characterized by individuals' matching exercise demands specifically to their current readiness states. Some consumer wearables provide 'recovery' or 'readiness' scores, computed primarily based on heart rate variability. Despite the growing popularity of consumer wearables and interest in person-adaptive programming, limited research exists on how exercisers interact, interpret and use these scores. This study explores individuals' experiences with wearable devices and their associated readiness or recovery scores. Seventeen regular exercisers who owned and used a Whoop™ band or Oura™ ring for at least 3 months participated in a one-on-one virtual semi-structured interview. Interviews were analyzed using reflexive thematic analysis, with themes supported by 'in-vivo' quotes. This paper focuses on three key themes for a comprehensive demonstration. Theme 1, 'It's more about how I can make adjustments to optimize my programming,' (MPR) highlights users' intended use of wearables for guiding training decisions. Theme 2, 'So many things outside of training modifications have changed,' (Misty) reveals that users also modify non-exercise behaviors to manage and optimize their scores. Theme 3, 'You can't really capture the complexities of a human on a device' (Letty) underscores users' recognition of the limitations and errors associated with these devices emphasizing self-reliance to further direct behavioral adjustments. While wearable devices provide a numeric approach to measuring readiness and recovery, users prioritize self-awareness, flexibility, and personal judgment for exercise decisions. Understanding these experiences, in addition to exploring the psycho-behavioral aspects of user interactions, can contribute to refining meta-session autoregulation.

Momentary Dynamics Implicate Emotional Features in the ADHD Phenotype

Emotional dysregulation is increasingly recognized as important to the attention-deficit/hyperactivity disorder (ADHD) phenotype alongside inattention and hyperactivity-impulsivity. Studies of ADHD have relied primarily on trait-based conceptualizations that emphasize stability of symptoms across moderate developmental timescales (i.e., months to years). Trait-based conceptualizations provide a critical view but fail to account for short-term dynamic variations in the expression of ADHD symptoms and emotion. This leaves a gap in our understanding of the short-term variation in ADHD symptom expression and the dynamic relationships among ADHD symptoms and emotion. Here, we assessed caregiver report of ADHD symptoms and positive and negative emotion using ecological momentary approaches over 2 weeks in a sample of 36 children with and without ADHD between the ages of 7-12 years old. Between-person (RKF) and within-person (RC) reliability were estimated. Multilevel models tested specific covariation hypotheses between ADHD symptoms and emotion. Analyses confirmed that ADHD and emotion ratings were reliable as individual differences (i.e., between-person; RKF range 0.93-1.0) and moment-to-moment change (i.e., within-person; Rc range 0.66-0.88) measures. Multilevel models found little evidence for lagged effects between domains, but consistently identified concurrent expression of ADHD symptoms and emotions; inattention covaried most strongly with negative emotion and hyperactivity-impulsivity covaried most strongly with positive emotion. Results demonstrate the importance of complementing trait-level conceptualizations with assessment of momentary dynamics. Momentary assessment suggests important covariation of ADHD symptoms and emotion as part of the ADHD phenotype.

Time-Use Sequences: A Mixed-Methods Study Exploring How, When, and Where Spatiotemporal Patterns of Everyday Routines Can Strengthen Public Health Interventions

BACKGROUND

Behavior change interventions are critical for the secondary prevention of cardiovascular disease and for reducing the risk of a repeat event or mortality. However, the effectiveness of behavior change interventions is challenged by a lack of spatiotemporal contexts, limiting our understanding of factors that influence the timing and location in which day-to-day activities occur and the maintenance of behavior change. This study explored how behavior change interventions could incorporate spatiotemporal contexts of patient activities for modifying behaviors.

METHODS

A mixed-methods approach with adapted geo-ethnography techniques was used to solicit detailed descriptions of patients' day-to-day routines, including where, when, and how patients spend time. Data were gathered from patients in one cardiac intervention program in Nova Scotia, Canada, from June to September 2021.

RESULTS

A total of 29 individuals (19 men and 10 women) between the ages of 45 and 81 and referred to the program after a cardiac event participated. The results show three key findings: (1) most patients exceeded the minimum guidelines of 30 min of daily physical activity but were sedentary for long periods of time, (2) patient time-use patterns are heterogenous and unique to contexts of individual space-time activity paths, and (3) time-use patterns reveal when, where, and how patients spend significant portions of time and opportunities for adapting patients' day-to-day health activities.

CONCLUSIONS

This study demonstrates the potential for interventions to integrate tools for collecting and communicating spatial and temporal contexts of patient routines, such as the types of activities that characterize how patients spend significant portions of time and identification of when, where, and how to encourage health-promoting changes in routine activities. Time-use patterns provide insight for tailoring behavior change interventions so that clinic-based settings are generalizable to the contexts of where, when, and how patient routines could be adapted to mitigate cardiovascular risk factors.

Understanding the biopsychosocial knee osteoarthritis pain experience: an ecological momentary assessment

Introduction

Psychological, social, and lifestyle factors contribute to the knee osteoarthritis (OA) pain experience. These factors could be measured more accurately using smartphone ecological momentary assessment (EMA).

Objectives

The objective of this study was to characterise the pain experiences of those with knee OA by a smartphone EMA survey and explain how momentary psychological and social states influence knee OA pain experiences.

Methods

A smartphone EMA survey was designed and piloted. Eligible participants completed smartphone EMA assessing the knee OA pain experience 3 times daily for 2 weeks. Descriptive statistics were used to characterise factors involved in knee OA pain followed by the development of mixed-effects location scale models to explore heterogeneity and relationships between symptoms involved in the knee OA pain experience.

Results

Eighty-six community-dwelling volunteers with knee OA were recruited. Pain, psychosocial, and lifestyle factors involved in knee OA pain experience were heterogeneous and variable. Those with greater variability in pain, fatigue, negative affect, and stress had worse levels of these symptoms overall. In addition, fatigue, negative affect, stress, anxiety, loneliness, and joint stiffness demonstrated within-person relationships with knee OA pain outcomes.

Conclusions

Knee OA pain is a heterogeneous biopsychosocial condition. Momentary experiences of psychological, social, fatigue, and joint stiffness explain individual and between-individual differences in momentary knee OA pain experiences. Addressing these momentary factors could improve pain and functional outcomes in those with knee OA. Validation studies, including individuals with more severe knee OA presentations, are required to support findings and guide clinical interventions to improve outcomes for those with knee OA.

The integration of geographic methods and ecological momentary assessment in public health research: A systematic review of methods and applications

With the widespread prevalence of mobile devices, ecological momentary assessment (EMA) can be combined with geospatial data acquired through geographic techniques like global positioning system (GPS) and geographic information system. This technique enables the consideration of individuals' health and behavior outcomes of momentary exposures in spatial contexts, mostly referred to as "geographic ecological momentary assessment" or "geographically explicit EMA" (GEMA). However, the definition, scope, methods, and applications of GEMA remain unclear and unconsolidated. To fill this research gap, we conducted a systematic review to synthesize the methodological insights, identify common research interests and applications, and furnish recommendations for future GEMA studies. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to systematically search peer-reviewed studies from six electronic databases in 2022. Screening and eligibility were conducted following inclusion criteria. The risk of bias assessment was performed, and narrative synthesis was presented for all studies. From the initial search of 957 publications, we identified 47 articles included in the review. In public health, GEMA was utilized to measure various outcomes, such as psychological health, physical and physiological health, substance use, social behavior, and physical activity. GEMA serves multiple research purposes: 1) enabling location-based EMA sampling, 2) quantifying participants' mobility patterns, 3) deriving exposure variables, 4) describing spatial patterns of outcome variables, and 5) performing data linkage or triangulation. GEMA has advanced traditional EMA sampling strategies and enabled location-based sampling by detecting location changes and specified geofences. Furthermore, advances in mobile technology have prompted considerations of additional sensor-based data in GEMA. Our results highlight the efficacy and feasibility of GEMA in public health research. Finally, we discuss sampling strategy, data privacy and confidentiality, measurement validity, mobile applications and technologies, and GPS accuracy and missing data in the context of current and future public health research that uses GEMA.

Within- and between-person associations of time-varying determinants with snacking in older adults: an ecological momentary assessment study

Promoting healthy snacking is important in addressing malnutrition, overweight and obesity among an ageing population. However, little is known about the factors underlying snacking behaviour in older adults. The present study aimed to explore within- and between-person associations between determinants (i.e. intention, visibility of snacks, social modelling and emotions) and snacking behaviours (i.e. decision to snack, health factor of the snack and portion size) in older adults (60+). Conducting a two-part intensive longitudinal design, data were analysed from forty-eight healthy older adults consisting of (1) an event-based self-report ecological momentary assessment (EMA) diary every time they had a snack and (2) a time-based EMA questionnaire on their phone five times per day. Analysis through generalised linear mixed models indicated that higher intention to snack healthily leads to healthier snacking while higher levels of social modelling and cheerfulness promote unhealthier choices within individuals. At the between-person level, similar results were found for intention and social modelling. Visibility of a snack increased portion size at both a within- and between-person level, while the intention to eat a healthy snack only increased portion size at the between-person level. No associations were found between the decision to snack and all determinants. This is the first study to investigate both within- and between-person associations between time-varying determinants and snacking in older adults. Such information holds the potential for incorporation into just-in-time adaptive interventions, allowing for personalised tailoring, more effective promotion of healthier snacking behaviours and thus pursuing the challenge of healthy ageing.

Exploring person-specific associations of situational motivation and readiness with leisure-time physical activity effort and experience

Identifying determinants of leisure-time physical activity (LTPA) often relies on population-level (nomothetic) averages, potentially overlooking person-specific (idiographic) associations. This study uses an idiographic perspective to explore how subjective readiness and motives for LTPA relate to volitional effort (duration, intensity) and affective experience (pleasure, displeasure). We also highlight the potential for different interpretations when data are averaged within individuals and assessed using a variable-centered approach. Participants (N = 22, 25±8 years old, 54.5% women) were asked to continue their regular PA patterns for 10 weeks. Ecological momentary assessment procedures allowed participants to provide pre-activity reports (physical, cognitive, emotional readiness and situational motive for activity) and post-activity reports (activity type, duration, perceived exertion, ratings of affective valence). Spearman rank correlation was implemented to interpret within- and between-person associations. Data visualization approaches were used to showcase person-specific differences in associations. Participants provided 519 reports of LTPA (24±11 events/person), which displayed between- and within-person variety in type, duration, intensity, and affective experience. Exemplar cases highlight discrepancies in interpretation based on level of analysis, such that the nomothetic association (rho = .42, p = .05; 95% CI -.02, .72) between motive to replenish energy and LTPA duration was observed in only one within-person analysis (41% were weak-to-large inverse effects). Alternatively, the negligible nomothetic association (rho = .02, p = .93; 95% CI -.41, .44) between physical readiness and LTPA-related affect did not reflect the 59% of within-person analyses showing moderate-to-large, positive effects. Future research aiming to identify determinants of LTPA effort and experience should integrate contemporary, idiographic analyses in early-stage research for developing person-specific strategies for LTPA promotion.

Rationale, Design, and Baseline Characteristics of Participants in the Health@NUS mHealth Augmented Cohort Study Examining Student-to-Work Life Transition: Protocol for a Prospective Cohort Study

BACKGROUND

Integration of mobile health data collection methods into cohort studies enables the collection of intensive longitudinal information, which gives deeper insights into individuals' health and lifestyle behavioral patterns over time, as compared to traditional cohort methods with less frequent data collection. These findings can then fill the gaps that remain in understanding how various lifestyle behaviors interact as students graduate from university and seek employment (student-to-work life transition), where the inability to adapt quickly to a changing environment greatly affects the mental well-being of young adults.

OBJECTIVE

This paper aims to provide an overview of the study methodology and baseline characteristics of participants in Health@NUS, a longitudinal study leveraging mobile health to examine the trajectories of health behaviors, physical health, and well-being, and their diverse determinants, for young adults during the student-to-work life transition.

METHODS

University students were recruited between August 2020 and June 2022 in Singapore. Participants would complete biometric assessments and questionnaires at 3 time points (baseline, 12-, and 24-month follow-up visits) and use a Fitbit smartwatch and smartphone app to continuously collect physical activity, sedentary behavior, sleep, and dietary data over the 2 years. Additionally, up to 12 two-week-long bursts of app-based ecological momentary surveys capturing lifestyle behaviors and well-being would be sent out among the 3 time points.

RESULTS

Interested participants (n=1556) were screened for eligibility, and 776 participants were enrolled in the study between August 2020 and June 2022. Participants were mostly female (441/776, 56.8%), of Chinese ethnicity (741/776, 92%), undergraduate students (759/776, 97.8%), and had a mean BMI of 21.9 (SD 3.3) kg/m2, and a mean age of 22.7 (SD 1.7) years. A substantial proportion were overweight (202/776, 26.1%) or obese (42/776, 5.4%), had indicated poor mental well-being (World Health Organization-5 Well-Being Index ≤50; 291/776, 37.7%), or were at higher risk for psychological distress (Kessler Psychological Distress Scale ≥13; 109/776, 14.1%).

CONCLUSIONS

The findings from this study will provide detailed insights into the determinants and trajectories of health behaviors, health, and well-being during the student-to-work life transition experienced by young adults.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05154227; https://clinicaltrials.gov/study/NCT05154227.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/56749.

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.

The contribution and interplay of implicit and explicit processes on physical activity behavior: empirical testing of the physical activity adoption and maintenance (PAAM) model

The adoption and maintenance of physical activity (PA) is an important health behavior. This paper presents the first comprehensive empirical test of the Physical Activity Adoption and Maintenance (PAAM) model, which proposes that a combination of explicit (e.g., intention) and implicit (e.g., habit,, affect) self-regulatory processes is involved in PA adoption and maintenance. Data were collected via online questionnaires in English, German, and Italian at two measurement points four weeks apart. The study included 422 participants (Mage= 25.3, SDage= 10.1; 74.2% women) from Germany, Switzerland, Italy, Canada, and the U.S. The study results largely supported the assumptions of the PAAM model, indicating that intentions and habits significantly mediate the effects of past PA on future PA. In addition, the effect of past PA on future PA was shown to be significant through a mediation chain involving affect and habit. Although the hypothesis that trait self-regulation moderates the intention-behavior relationship was not supported, a significant moderating effect of affect on the same relationship was observed. The results suggest that interventions targeting both explicit and implicit processes may be effective in promoting PA adoption and maintenance.

Accelerometer-Based Physical Activity and Shape and Weight Concerns Among Youth With Overweight and Obesity: A Pilot Exploratory Ecological Momentary Assessment Study

Background: A bidirectional association between shape and weight concerns (SWC) and physical activity (PA) has been previously documented. This relationship may be particularly salient among youth with overweight/obesity, given that social marginalization of larger bodies has been associated with elevated SWC and barriers to PA. This pilot study explores reciprocal relationships between momentary SWC and accelerometer-assessed PA behavior. Methods: Youth with overweight/obesity (N = 17) participated in a 14-day ecological momentary assessment protocol, during which they were prompted to respond to questions about SWC several times per day. They also continuously wore Actiwatch 2 accelerometers to capture light and moderate-to-vigorous PA behavior. Results: Hierarchical linear modeling revealed a unidirectional association between SWC and PA, whereby after engaging in a higher duration of PA, participants reported lower SWC. SWC did not predict subsequent PA. Conclusion: The findings support a negative temporal relationship between PA and SWC. While further work is needed to replicate and extend these preliminary findings, they may suggest that PA acutely benefits SWC among youth with overweight and obesity.

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

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

Associations Between Intersecting Sociodemographic Characteristics and Device-Measured Physical Activity Among Children and Adolescents Living in the United States

BACKGROUND

Despite robust evidence demonstrating sociodemographic characteristics may underly some of the disparities in physical activity observed among children and adolescents, the often-overlooked nexus of potential interactions between these characteristics warrants further exploration. This study explored the intersectionality of gender, race/ethnicity, parental education, and household income in relation to device-measured physical activity volume and intensity in a nationally representative sample of US children and adolescents.

METHODS

Cross-sectional data from 3 cycles of the US National Health and Nutrition Survey (2011-2012; 2012 National Youth Fitness Survey; and 2013-2014) were used. A total of 6116 participants (49% female) between 3 and 17 years of age wore an accelerometer on their nondominant wrist for 7 days. Monitor-independent movement summary units were used to represent physical activity volume and intensity. A Social Jeopardy Index was created to represent increasing levels of intersecting social disadvantages based on combinations of gender, race/ethnicity, parental education, and household income-to-poverty ratio tertiles. Generalized linear regression models were computed.

RESULTS

The results showed social disadvantages become increasingly evident among children and adolescents during the most intense 60 minutes of daily physical activity (B = -48.69 [9.94] SE, P < .001), but disparities in total volume were not observed (B = 34.01 [44.96] SE, P = .45).

CONCLUSIONS

Findings suggest that patterns of physical activity behavior may differ based on intersecting sociodemographic characteristics-more socially disadvantaged children and adolescents appear to accumulate activity at lighter intensities. Collecting contextual information about device-measured physical activity represents an important next step for gaining insight into these sociodemographic differences.

Effect of Physical Exercise Programs Based on Mobile Health and Ecological Momentary Assessment on the Physical and Mental Health, Cognitive Functions, and Social Environment of Adults in Developing Countries: A Systematic Review

Background and Objectives: Although there is strong evidence of the positive effects of physical exercise on health, adherence to face-to-face exercise programs in the adult population is low, identifying several barriers that hinder their practice. There is research that demonstrates the viability of physical exercise programs with the use of Mobile Health in Ecological Momentary Assessment (EMA) mode, which contributes to overcoming many reported barriers. To synthesize the methodological characteristics and health effects of physical exercise programs based on mobile health in EMA modality in adults in developing countries. Materials and Methods: This systematic review was conducted according to guidelines established by the PRISMA statement in APA PsycArticles and CINAHL databases by EBSCOhost, Cochrane Library, PubMed, and Web of Science for articles published between 2008 and March 2024. Results: Telephone counseling on clinical-behavioral factors is believed to reduce morbidity and mortality in developed countries, but this aspect is not explored in developing countries. We included nine randomized controlled trials with a total of 4394 male and female participants aged 18 to 60 years. The interventions were mainly carried out by text messages, lasting between 20 to 80 min per session, 3 to 5 days per week, and most were carried out over 12 months. The interventions on the variables of physical activity, nutrition, and medical assessments showed significant effects, and variables such as quality of life and anthropometric measurements were not significant in most studies. Conclusions: This systematic review included studies from different developing countries, the most common diseases being diabetes, overweight, obesity, and hypertension. All the studies used mobile devices as the technology, finding a profile of the adults studied, as well as the characteristics of exercise programs based on mobile health in EMA modality.

Experiences of successful physical activity maintenance among adults with type 2 diabetes: a theory-based qualitative study

OBJECTIVE

Approximately 70% of adults with type 2 diabetes (T2D) fail to achieve the 150 minutes of weekly physical activity (PA) recommended for self-management. Interventions to promote PA adoption in T2D rarely achieve stable maintenance. Analysis of lived experiences of adults with T2D who have successfully transitioned to long-term PA maintenance can build understanding of factors influencing long-term maintenance.

DESIGN

Semi-structured interviews were conducted among 18 adults with T2D who had transitioned to a lifestyle incorporating maintenance of recommended PA. Interview topics were informed by the three phases of the 'Multi-Process Action Control' (M-PAC) Framework, and explored attitudes, beliefs and experiences relating to PA decision, adoption and the transition to stable maintenance. Transcripts were thematically analysed.

FINDINGS

Seven themes emerged. Results variously showed that negative affect engendered by T2D diagnosis and inspiration from peers influenced intention formation, and that setting easy, fun goals, and experiencing biopsychosocial gains were important to behaviour adoption. PA maintenance was regulated by habit, expectations of positive affect, and a new sense of identity.

CONCLUSION

Phase-based frameworks can help understand how regulation of behaviour evolves over time. PA promotion strategies for inactive adults with T2D should be phase-tailored, to help people transition from intentions to maintenance.

Mobile-based ecological momentary assessment and intervention: bibliometric analysis

Objective

The aim of this article was to review existing documents in the field of mobile-based EMA and EMI, provide an overview of current hot topics, and predict future development trends.

Methods

We conducted a bibliometric study on mobile-based EMA and EMI publications that were collected from the Web of Science Core Collection database. Biblioshiny and CiteSpace were utilized to analyze scientific productions, leading sources, authors, affiliations, documents, research hot topics, keywords, and trend topics.

Results

A total of 2222 documents related to EMA and EMI published between 1992 and 2023 were retrieved. In recent years, scholarly publications have generally increased in mobile-based EMA and EMI research, particularly in the last decade. JMIR mHealth and uHealth (n=86), as well as JMIR (n=73), showed the highest number of publications. The United States (n=1038), Germany (n=218) and Netherlands (n=175) were leading countries. Regarding keyword co-occurrence and trend topics analysis, mental health, health behaviors, and feasibility were hot topics in mobile-based EMA and EMI research. Future research trends included using EMA for tailoring EMI, just-in-time adaptive interventions (JITAI), and digital phenotyping.

Conclusion

This bibliometric study on mobile-based EMA and EMI is a valuable resource for understanding the field's evolution and future trends. Our analysis indicates that EMA and EMI have great potential in health behaviors and mental health, but implementation should consider feasibility and reactivity issues carefully. Emerging trends include EMA-tailored EMI, JITAI, and digital phenotyping. In the future, strengthening multidisciplinary cooperation will be necessary to promote the continued development of the field.

The relationship of affective and bodily states with goals and plans to increase physical activity: An 8-day study in students

Planning is an important tool to translate intentions into physical activity (PA) behavior. Affective and bodily states are known to influence how much PA individuals perform, but their impact on to formulation of PA plans is not yet known. The aim of the current study is to explore the effect of within- and between-subject variations in affective and bodily states on the content of PA goals and plans. Over eight consecutive days, 362 students created action and coping plans to achieve their daily PA goals. They also reported their affective and bodily states. Generalized linear mixed effect models were used to analyze the associations between these states and the content of the goals and plans. The results showed that both between- and within-subject variations in affective and bodily states were associated with goals formulated in terms of minutes, the intensity and context of planned activities, and anticipated barriers, though more effects were found for within-subject differences. Affective and bodily states impact daily PA goals and plans, highlighting the dynamic nature of planning. Our findings can be a first step toward personalized suggestions for goals, action plans, and coping strategies that are based on individual affective and bodily states.

The association between morning pleasant anticipation and daily positive incidental affect on adults' daily steps: An ecological momentary assessment study

OBJECTIVE

This study investigated the association between morning pleasant anticipation (i.e., how pleasant will the day be?) and daily positive incidental affect (PIA, e.g., feeling enjoyable, energetic) on daily steps as measured by ecological momentary assessment (EMA) and accelerometry.

METHODS

A total of 152 adults in Taiwan (female = 67.1 %, age range = 18-59, M = 24.97) completed smartphone-based surveys upon waking and at three quasi-random times during the day for seven days during the COVID-19 outbreak (February-July 2022). They also wore accelerometers for the same seven days to measure physical activity (daily steps). The morning survey asked participants to self-report pleasant anticipation throughout the day, and the three quasi-random time surveys assessed current PIA. Multilevel modeling was used to examine day-level associations between morning pleasant anticipation, PIA, and daily steps. A list of key covariates (i.e., age, sex, educational attainment, marital status, living arrangement, chronic disease, body mass index [BMI], smoking, drinking, wellbeing, daily sleep quality, daily sleep hours, and accelerometer wear time) were included in the models to adjust for the covariates' potential effects on the study outcomes.

RESULTS

The study sample consisted of 989 morning observations and 2714 quasi-random time observations (EMA response rate = 87.01 %). Findings suggest that higher-than-usual levels of pleasant anticipation in the morning were significantly associated with more same-day daily steps (b = 0.03, SD = 0.01, p = .03) after adjusting for covariates. In addition, daily PIA was a significant moderator between morning pleasant anticipation and daily steps (b = 0.02, SD = 0.01, p < .01), such that higher levels of daily PIA were associated with greater increases in daily steps in response to higher levels of morning pleasant anticipation.

CONCLUSION

On days when participants had higher levels of pleasant anticipation in the morning, they took more steps per day. In addition, the association between morning pleasant anticipation and steps per day was stronger on days when participants had higher levels of PIA. These findings have practical implications for future EMA studies investigating the "anticipatory" affective processes on movement behaviors with the goal of promoting physical activity in daily life.

Fitbit's accuracy to measure short bouts of stepping and sedentary behaviour: validation, sensitivity and specificity study

Objective

This study aims to assess the suitability of Fitbit devices for real-time physical activity (PA) and sedentary behaviour (SB) monitoring in the context of just-in-time adaptive interventions (JITAIs) and event-based ecological momentary assessment (EMA) studies.

Methods

Thirty-seven adults (18-65 years) and 32 older adults (65+) from Belgium and the Czech Republic wore four devices simultaneously for 3 days: two Fitbit models on the wrist, an ActiGraph GT3X+ at the hip and an ActivPAL at the thigh. Accuracy measures included mean (absolute) error and mean (absolute) percentage error. Concurrent validity was assessed using Lin's concordance correlation coefficient and Bland-Altman analyses. Fitbit's sensitivity and specificity for detecting stepping events across different thresholds and durations were calculated compared to ActiGraph, while ROC curve analyses identified optimal Fitbit thresholds for detecting sedentary events according to ActivPAL.

Results

Fitbits demonstrated validity in measuring steps on a short time scale compared to ActiGraph. Except for stepping above 120 steps/min in older adults, both Fitbit models detected stepping bouts in adults and older adults with sensitivities and specificities exceeding 87% and 97%, respectively. Optimal cut-off values for identifying prolonged sitting bouts achieved sensitivities and specificities greater than 93% and 89%, respectively.

Conclusions

This study provides practical insights into using Fitbit devices in JITAIs and event-based EMA studies among adults and older adults. Fitbits' reasonable accuracy in detecting short bouts of stepping and SB makes them suitable for triggering JITAI prompts or EMA questionnaires following a PA or SB event of interest.

The association between sedentary behaviour and sarcopenia in older adults: a systematic review and meta-analysis

BACKGROUND

Sedentary behaviour is considered to contribute to sarcopenia when combined with physical inactivity. Whether sedentary behaviour is independently associated with sarcopenia remains controversial. The aim of this study is to explore the association between sedentary behaviour and sarcopenia in older adults in community and long-term care facility settings.

METHODS

Eight electronic databases including MEDLINE, PsycINFO, Wanfang were searched from inception until August 2023. The review included cross-sectional and longitudinal studies concerning the association between sedentary behaviour and sarcopenia among participants over 60 years old. Evidence was pooled by both random-effects meta-analysis and narrative synthesis. Subgroup analyses explored variation according to adjustment of physical activity, settings, and measurements of sedentary behaviour and sarcopenia. Quality assessment for individual studies was performed with the Joanna Briggs Institute (JBI) Critical Appraisal Checklist.

RESULTS

Seventeen articles (16 cross-sectional studies and 1 longitudinal study) of 25,788 participants from community or long-term care facility settings were included. The overall quality of the included studies was rated high. Meta-analysis of 14 cross-sectional studies showed that sedentary behaviour was independently positively associated with sarcopenia: pooled odd ratio 1.36 (95% confidence interval, 1.18-1.58). The independent positive association remained in subgroup analyses by adjustment of physical activity, settings, and measurements of sedentary behaviour and sarcopenia. The narrative analysis corroborated the findings of the meta-analysis and provided additional evidence suggesting that interruptions in sedentary periods were linked to a decreased likelihood of developing sarcopenia.

CONCLUSIONS

The findings support the hypothesis that sedentary behaviour is independently positively associated with sarcopenia in older adults, providing vital indications for the development of strategies to prevent sarcopenia.

SYSTEMATIC REVIEW REGISTRATION

The systematic review protocol has been registered with the PROSPERO database (CRD42022311399).

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Investigating real-time physical activity behavior using ecological momentary assessment: Effects of mental fatigue and benefit-cost valuations

BACKGROUND

Current research investigating the relationship between mental fatigue and physical activity behaviors relies on laboratory-based, experimental studies which lack ecological validity.

OBJECTIVE

This study used ecological momentary assessment (EMA) to assess feelings of mental fatigue and subjective evaluations (benefits and costs) as predictors of moderate-to-vigorous intensity physical activity in the everyday lives of young adults.

METHODS

One hundred participants (n = 22 males, n = 78 females, Mage = 20.60 years, 70% meeting or exceeding physical activity guidelines) responded to digital survey prompts up to four times a day and wore an accelerometer for seven consecutive days. Moderate-to-vigorous intensity physical activity in the 180-min time window following each survey prompt was recorded. Data from the 28 survey-moderate-to-vigorous intensity physical activity epochs were analyzed using multilevel mixed-effects linear modelling.

RESULTS

Higher levels of mental fatigue than one's average level were associated with engaging in fewer moderate-to-vigorous intensity physical activity minutes (p = .004) and lower benefit vs. cost scores (p = .001). Higher benefit vs. cost scores than one's average level were associated with engaging in more minutes of moderate-to-vigorous intensity physical activity (p < .001).

CONCLUSIONS

Results are the first to demonstrate outside the lab, that mental fatigue experienced in everyday life may amplify the perceived costs of moderate-to-vigorous intensity physical activity, with both factors playing a potential role in moderate-to-vigorous intensity physical activity decision-making. Future research may apply insights gained from this study in design and testing of real-time interventions promoting moderate-to-vigorous intensity physical activity.

Body-related emotions and subsequent physical activity behaviour: An ecological momentary assessment

Body-related shame and guilt are theorized to be time-varying affective determinants of physical activity, yet research has predominantly relied on self-report measures of physical activity and between-person associations. To address these limitations, the present study used ecological momentary assessment to examine within- and between-person associations between body-related shame and guilt, and subsequent time spent in moderate-to-vigorous physical activity (MVPA) measured by continuously worn accelerometers. University students (n = 98; 79.6% female; mage = 19.45) were prompted 49 times over seven days to report body-related shame and guilt, and wore activPAL accelerometers to monitor movement behaviours. Higher levels of within-person body-related guilt, but not shame, were associated with increased subsequent time spent in MVPA. Contrary to existing literature, neither body-related shame nor guilt demonstrated a significant association with average levels of MVPA between individuals. These findings support theoretical propositions that body-related guilt may impact engagement in physical activity in daily life.

Affective reactions to real-life stressors and the role of physical activity in sports students - An Ambulatory Assessment study

Students are exposed to a variety of stressors that can negatively affect their health and performance. Using an Ambulatory Assessment approach, this study investigated whether and how positive affect (PA) and negative affect (NA) changed in response to real-life stressors in sports students. In addition, the study investigated how physical activity (PhyA) moderated affective reactions to stressors. 62 participants of a German university (m = 23, f = 38, d = 1; age: M = 21.55 years, SD = 2.47) reported their daily stressors, affective states and PhyA (context, intensity and duration) six times per day via smartphone over five days (30 prompts per participants). To test the hypotheses multilevel models were calculated. Stressor context predicted affective reactions. PA was lower and NA was higher when general (financial problems) or academic (exam periods) stressors were reported. General PhyA had a positive effect on sports students affect (higher PA, lower NA). However, when PhyA was performed in exercise classes within their study program and a stressor was reported, PA decreased. The results showed that certain stressors interact negatively with affective states. Furthermore, the results suggested that PhyA, depending on the context where it occurred, may also induce negative affective changes in this target group of sport students. More studies need to examine how PhyA moderates affective reactions to stressors and examine the influences of context specific PhyA (e.g., type of PhyA) in more detail.

Investigating Ecological Momentary Assessed Physical Activity and Core Executive Functions in 18- to 24-Year-Old Undergraduate Students

Although evidence for young children (<10) and older adults (>64) highlights an association between physical activity (PA) and executive functions (EFs), there is a paucity of research on adolescents aged 18-24 years. Thus, this study examined the associations between PA and EF and the difference in EF between individuals who achieve the moderate-to-vigorous (MVPA) guidelines and those who do not. Forty-seven participants engaged in a Stroop task, a reverse Corsi-block test, and a task-switching test, to measure inhibition, working memory, and cognitive flexibility, respectively. An ecological momentary assessment (EMA) was used to determine the participant's MVPA and step count, through the "Pathverse" app. Multiple regressions were run to predict the task-switch cost, the Stroop effect, and the backward Corsi span from time spent in MVPA. A two-way ANCOVA examined the effects of achieving the MVPA guidelines on EF. MVPA and step count did not significantly predict EF. There were no significant differences in EF between participants achieving the MVPA guidelines and those that did not. Time spent in MVPA and step count were not significantly associated with working memory, cognitive flexibility, or inhibition in adolescents. Further research is warranted to understand other factors that may significantly affect EF, within and outside an individual's control.

Evaluating the Effects of Rewards and Schedule Length on Response Rates to Ecological Momentary Assessment Surveys: Randomized Controlled Trials

BACKGROUND

Ecological momentary assessments (EMAs) are short, repeated surveys designed to collect information on experiences in real-time, real-life contexts. Embedding periodic bursts of EMAs within cohort studies enables the study of experiences on multiple timescales and could greatly enhance the accuracy of self-reported information. However, the burden on participants may be high and should be minimized to optimize EMA response rates.

OBJECTIVE

We aimed to evaluate the effects of study design features on EMA response rates.

METHODS

Embedded within an ongoing cohort study (Health@NUS), 3 bursts of EMAs were implemented over a 7-month period (April to October 2021). The response rate (percentage of completed EMA surveys from all sent EMA surveys; 30-42 individual EMA surveys sent/burst) for each burst was examined. Following a low response rate in burst 1, changes were made to the subsequent implementation strategy (SMS text message announcements instead of emails). In addition, 2 consecutive randomized controlled trials were conducted to evaluate the efficacy of 4 different reward structures (with fixed and bonus components) and 2 different schedule lengths (7 or 14 d) on changes to the EMA response rate. Analyses were conducted from 2021 to 2022 using ANOVA and analysis of covariance to examine group differences and mixed models to assess changes across all 3 bursts.

RESULTS

Participants (N=384) were university students (n=232, 60.4% female; mean age 23, SD 1.3 y) in Singapore. Changing the reward structure did not significantly change the response rate (F3,380=1.75; P=.16). Changing the schedule length did significantly change the response rate (F1,382=6.23; P=.01); the response rate was higher for the longer schedule (14 d; mean 48.34%, SD 33.17%) than the shorter schedule (7 d; mean 38.52%, SD 33.44%). The average response rate was higher in burst 2 and burst 3 (mean 50.56, SD 33.61 and mean 48.34, SD 33.17, respectively) than in burst 1 (mean 25.78, SD 30.12), and the difference was statistically significant (F2,766=93.83; P<.001).

CONCLUSIONS

Small changes to the implementation strategy (SMS text messages instead of emails) may have contributed to increasing the response rate over time. Changing the available rewards did not lead to a significant difference in the response rate, whereas changing the schedule length did lead to a significant difference in the response rate. Our study provides novel insights on how to implement EMA surveys in ongoing cohort studies. This knowledge is essential for conducting high-quality studies using EMA surveys.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05154227; https://clinicaltrials.gov/ct2/show/NCT05154227.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Unraveling the interplay between daily life fatigue and physical activity after subarachnoid hemorrhage: an ecological momentary assessment and accelerometry study

BACKGROUND

Fatigue is one of the most commonly reported symptoms after subarachnoid hemorrhage (SAH) and is indirectly associated with physical activity (PA). Associations between fatigue and PA are primarily examined based on conventional measures (i.e. a single fatigue score or average PA levels), thereby assuming that fatigue and PA do not fluctuate over time. However, levels of fatigue and PA may not be stable and may interrelate dynamically in daily life. Insight in direct relationships between fatigue and PA in daily life, could add to the development of personalized rehabilitation strategies. Therefore we aimed to examine bidirectional relationships between momentary fatigue and PA in people with SAH.

METHODS

People (n = 38) with SAH who suffer from chronic fatigue were included in an observational study using Ecological Momentary Assessment (EMA) and accelerometry. Momentary fatigue was assessed on a scale from 1 to 7 (no to extreme fatigue), assessed with 10-11 prompts per day for 7 consecutive days using EMA with a mobile phone. PA was continuously measured during this 7-day period with a thigh-worn Activ8 accelerometer and expressed as total minutes of standing, walking, running and cycling in a period of 45 min before and after a momentary fatigue prompt. Multilevel mixed model analyses including random effects were conducted.

RESULTS

Mean age was 53.2 years (SD = 13.4), 58% female, and mean time post SAH onset was 9.5 months (SD = 2.1). Multilevel analyses with only time effects to predict fatigue and PA revealed that fatigue significantly (p < 0.001) increased over the day and PA significantly (p < 0.001) decreased. In addition, more PA was significantly associated with higher subsequent fatigue (β = 0.004, p < 0.05) and higher fatigue was significantly associated with less subsequent PA (β=-0.736, p < 0.05). Moreover, these associations significantly differed between participants (p < 0.001).

CONCLUSIONS

By combining EMA measures of fatigue with accelerometer-based PA we found that fatigue and PA are bidirectionally associated. In addition, these associations differ among participants. Given these different bidirectional associations, rehabilitation aimed at reducing fatigue should comprise personalized strategies to improve both fatigue and PA simultaneously, for example by combining exercise therapy with cognitive behavioral and/or energy management therapy.

Decision Trade-Offs in Ecological Momentary Assessments and Digital Wearables Uptake: Protocol for a Discrete Choice Experiment

BACKGROUND

Ecological momentary assessments (EMAs) and digital wearables (DW) are commonly used remote monitoring technologies that capture real-time data in people's natural environments. Real-time data are core to personalized medical care and intensively adaptive health interventions. The utility of such personalized care is contingent on user uptake and continued use of EMA and DW. Consequently, it is critical to understand user preferences that may increase the uptake of EMA and DW.

OBJECTIVE

The study aims to quantify users' preferences of EMA and DW, examine variations in users' preferences across demographic and behavioral subgroups, and assess the association between users' preferences and intentions to use EMA and DW.

METHODS

We will administer 2 discrete choice experiments (DCEs) paired with self-report surveys on the internet to a total of 3260 US adults through Qualtrics. The first DCE will assess participants' EMA preferences using a choice-based conjoint design that will ask participants to compare the relative importance of prompt frequency, number of questions per prompt, prompt type, health topic, and assessment duration. The second DCE will measure participants' DW preferences using a maximum difference scaling design that will quantify the relative importance of device characteristics, effort expectancy, social influence, and facilitating technical, health care, and market factors. Hierarchical Bayesian multinomial logistic regression models will be used to generate subject-specific preference utilities. Preference utilities will be compared across demographic (ie, sex, age, race, and ethnicity) and behavioral (ie, substance use, physical activity, dietary behavior, and sleep duration) subgroups. Regression models will determine whether specific utilities are associated with attitudes toward or intentions to use EMA and DW. Mixture models will determine the associations of attitudes toward and intentions to use EMA and DW with latent profiles of user preferences.

RESULTS

The institutional review board approved the study on December 19, 2022. Data collection started on January 20, 2023, and concluded on May 4, 2023. Data analysis is currently underway.

CONCLUSIONS

The study will provide evidence on users' preferences of EMA and DW features that can improve initial uptake and potentially continued use of these remote monitoring tools. The sample size and composition allow for subgroup analysis by demographics and health behaviors and will provide evidence on associations between users' preferences and intentions to uptake EMA and DW. Limitations include the cross-sectional nature of the study, which limits our ability to measure direct behavior. Rather, we capture behavioral intentions for EMA and DW uptake. The nonprobability sample limits the generalizability of the results and introduces self-selection bias related to the demographic and behavioral characteristics of participants who belong to web-based survey panels.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/47567.

Traditional surveys versus ecological momentary assessments: Digital citizen science approaches to improve ethical physical activity surveillance among youth

The role of physical activity (PA) in minimizing non-communicable diseases is well established. Measurement bias can be reduced via ecological momentary assessments (EMAs) deployed via citizen-owned smartphones. This study aims to engage citizen scientists to understand how PA reported digitally by retrospective and prospective measures varies within the same cohort. This study used the digital citizen science approach to collaborate with citizen scientists, aged 13-21 years over eight consecutive days via a custom-built app. Citizen scientists were recruited through schools in Regina, Saskatchewan, Canada in 2018 (August 31-December 31). Retrospective PA was assessed through a survey, which was adapted from three validated PA surveys to suit smartphone-based data collection, and prospective PA was assessed through time-triggered EMAs deployed consecutively every day, from day 1 to day 8, including weekdays and weekends. Data analyses included paired t-tests to understand the difference in PA reported retrospectively and prospectively, and linear regressions to assess contextual and demographic factors associated with PA reported retrospectively and prospectively. Findings showed a significant difference between PA reported retrospectively and prospectively (p = 0.001). Ethnicity (visible minorities: β = - 0.911, 95% C.I. = -1.677, -0.146), parental education (university: β = 0.978, 95% C.I. = 0.308, 1.649), and strength training (at least one day: β = 0.932, 95% C.I. = 0.108, 1.755) were associated with PA reported prospectively. In contrast, the number of active friends (at least one friend: β = 0.741, 95% C.I. = 0.026, 1.458) was associated with retrospective PA. Physical inactivity is the fourth leading cause of mortality globally, which requires accurate monitoring to inform population health interventions. In this digital age, where ubiquitous devices provide real-time engagement capabilities, digital citizen science can transform how we measure behaviours using citizen-owned ubiquitous digital tools to support prevention and treatment of non-communicable diseases.

Within-person association of volitional factors and physical activity: Insights from an ecological momentary assessment study

OBJECTIVE

Current health behavior models of physical activity (PA) suggest that not all PA intentions are translated into actual PA behavior, resulting in a significant intention-behavior gap (IBG) of almost 50%. These models further suggest that higher self-efficacy and specific planning can aid in decreasing this gap. However, as most evidence stems from between-person (trait level), questionnaire-based research, it is unclear how large short-term IBGs are, how self-efficacy and planning covary within-persons across time and whether they similarly predict smaller IBGs. It is likely that day-to-day changes in circumstances and barriers affect these variables thus the applicability of theoretical models is uncertain. Here, within-person prospective analyses of ecological momentary assessment (EMA) data can provide insights.

METHODS

35 healthy participants (aged 23-67) completed four EMA-based questionnaires every day for three weeks. Each prompt assessed PA (retrospectively, "since the last EMA prompt"); PA intentions, planning specificity, self-efficacy, and intrinsic motivation (prospectively, "until the next EMA prompt") and momentary affect. Generalized logistic mixed-effect modeling was used to test predictors of PA.

RESULTS

Across the 2341 answered EMA prompts, PA intentions were not enacted in 25% of the episodes (IBG). In episodes with given intentions, PA likelihood increased with higher levels of self-efficacy, planning specificity, and intrinsic motivation. The latter two also positively predicted PA duration and intensity.

CONCLUSIONS

Short-term intention behavior gaps seem to be smaller than what is known from more long-term studies, most likely as individuals can anticipate the actual circumstances of PA. Further, current health behavior models show validity in explaining within-person dynamics in IBGs across time. Knowing the relevance of planning specificity, self-efficacy and intrinsic motivation for day-to-day variations in PA enactment can inform respective real-time mHealth interventions for facilitating PA.

Stress buffering after physical activity engagement: An experience sampling study

OBJECTIVES

While encountering daily hassles is a normative experience, it poses a threat to individuals' daily affective well-being. However, physical activity engagement may help to reduce the current stress-related impact on affective well-being (i.e. stress buffering), which we investigate in this study. Furthermore, we examined the possible moderating role of people's global stress context (i.e. exposure to major life events and chronic stress) on this within-person stress-buffering effect.

DESIGN

We approached these ideas using six-times-a-day experience sampling assessments over a period of 22 days.

METHODS

Drawing on a broad national sample of 156 middle-aged adults from the EE-SOEP-IS study, we aimed to elucidate the naturally occurring within-person dynamics of current stress, physical activity engagement, and momentary affect within individuals' everyday lives. Major life events and chronic stress were measured as between-person variables.

RESULTS

Multilevel analyses revealed significant within-person associations of current stress and physical activity engagement with momentary affect. Stress-related negative affect was lower when individuals engaged in physical activity, in accordance with the idea of a within-person stress-buffering effect of physical activity engagement. For individuals exposed to more severe major life events, the stress-buffering effect of physical activity engagement for negative affect was lower. Chronic stress did not moderate the within-person stress-buffering effect.

CONCLUSIONS

Overall, results add to the existing literature that links physical activity to increased stress resilience and emphasizes the need for taking the global between-person stress context into account.

Dietary Patterns and Their Associations with Symptom Levels Among People with Multiple Sclerosis: A Real-World Digital Study

INTRODUCTION

The objective of the study was to investigate long-term food intake patterns and establish possible associations between the inferred dietary habits and levels of reported symptoms among people with multiple sclerosis (MS) in Denmark.

METHODS

The present study was designed as a prospective cohort study. Participants were invited to register daily food intake and MS symptoms and were observed during a period of 100 days. Dropout and inclusion probabilities were addressed using generalized linear models. Dietary clusters were identified among 163 participants using hierarchical clustering on principal component scores. Associations between the dietary clusters and the levels of self-assessed MS symptoms were estimated using inverse probability weighting. Furthermore, the effect of a person's position on the first and second principal dietary component axis on symptom burden was investigated.

RESULTS

Three dietary clusters were identified: a Western dietary cluster, a plant-rich dietary cluster and a varied dietary cluster. Analyses further indicated a vegetables-fish-fruit-whole grain axis and a red-meat-processed-meat axis. The plant-rich dietary cluster showed reduction in symptom burden in nine pre-defined MS symptoms compared to the Western dietary cluster (between 19 and 90% reduction). This reduction was significant for pain and bladder dysfunction as well as across all nine symptoms (pooled p value = 0.012). Related to the two dietary axes, high intake of vegetables resulted in 32-74% reduction in symptom burden compared to low levels of vegetable intake. Across symptoms, this was significant (pooled p value = 0.015), also regarding walking difficulty and fatigue.

CONCLUSIONS

Three dietary clusters were identified. Compared to levels of self-assessed MS-related symptoms, and adjusted for potential confounders, the results suggested less symptom burden with increased intake of vegetables. Although the research design limits the possibilities of establishing causal inference, the results indicate that general guidelines for healthy diet may be relevant as a tool in coping with MS symptoms.

Studying Movement-Related Behavioral Maintenance and Adoption in Real Time: Protocol for an Intensive Ecological Momentary Assessment Study Among Older Adults

BACKGROUND

Older adults struggle to maintain newly initiated levels of physical activity (PA) or sedentary behavior (SB) and often regress to baseline levels over time. This is partly because health behavior theories that inform interventions rarely address how the changing contexts of daily life influence the processes regulating PA and SB or how those processes differ across the behavior change continuum. Few studies have focused on motivational processes that regulate the dynamic nature of PA and SB adoption and maintenance on microtimescales (ie, across minutes, hours, or days).

OBJECTIVE

The overarching goal of Project Studying Maintenance and Adoption in Real Time (SMART) is to determine the motivational processes that regulate behavioral adoption versus maintenance over microtimescales, using a dual process framework combined with ecological momentary assessment and sensor-based monitoring of behavior. This paper describes the recruitment, enrollment, data collection, and analytics protocols for Project SMART.

METHODS

In Project SMART, older adults engaging in at least 30 minutes of moderate-to-vigorous intensity PA per week complete 3 data collection periods over 1 year, with each data collection period lasting 14 days. Across each data collection period, participants wear an ActiGraph GT3X accelerometer (ActiGraph, LLC) on their nondominant waist and an ActivPAL micro4 accelerometer (PAL Technologies, Ltd) on their anterior thigh to measure PA and SB, respectively. Ecological momentary assessment questionnaires are randomly delivered via smartphone 10 times per day on 4 selected days in each data collection period and assess reflective processes (eg, evaluating one's efficacy and exerting self-control) and reactive processes (eg, contextual cues) within the dual process framework. At the beginning and end of each data collection period, participants complete a computer-based questionnaire to learn more about their typical motivation for PA and SB, physical and mental health, and life events over the course of the study.

RESULTS

Recruitment and enrollment began in January 2021; enrollment in the first data collection period was completed by February 2022; and all participants completed their second and third data collection by July 2022 and December 2022, respectively. Data were collected from 202 older adults during the first data collection period, with approximate retention rates of 90.1% (n=182) during the second data collection period and 88.1% (n=178) during the third data collection period. Multilevel models and mixed-effects location scale modeling will be used to evaluate the study aims.

CONCLUSIONS

Project SMART seeks to predict and model the adoption and maintenance of optimal levels of PA and SB among older adults. In turn, this will inform the future delivery of personalized intervention content under conditions where the content will be most effective to promote sustained behavior change among older adults.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/47320.

Use of Electronic Ecological Momentary Assessment Methodologies in Physical Activity, Sedentary Behavior, and Sleep Research in Young Adults: Systematic Review

BACKGROUND

Recent technological advances allow for the repeated sampling of real-time data in natural settings using electronic ecological momentary assessment (eEMA). These advances are particularly meaningful for investigating physical activity, sedentary behavior, and sleep in young adults who are in a critical life stage for the development of healthy lifestyle behaviors.

OBJECTIVE

This study aims to describe the use of eEMA methodologies in physical activity, sedentary behavior, and sleep research in young adults.

METHODS

The PubMed, CINAHL, PsycINFO, Embase, and Web of Science electronic databases were searched through August 2022. Inclusion criteria were use of eEMA; sample of young adults aged 18 to 25 years; at least 1 measurement of physical activity, sedentary behavior, or sleep; English language; and a peer-reviewed report of original research. Study reports were excluded if they were abstracts, protocols, or reviews. The risk of bias assessment was conducted using the National Heart, Lung, and Blood Institute's Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Screening, data extraction, and risk of bias assessments were conducted by independent authors, with discrepancies resolved by consensus. Descriptive statistics and narrative synthesis were used to identify overarching patterns within the following categories guided by the Checklist for Reporting Ecological Momentary Assessments Studies: study characteristics, outcomes and measures, eEMA procedures, and compliance.

RESULTS

The search resulted in 1221 citations with a final sample of 37 reports describing 35 unique studies. Most reports (28/37, 76%) were published in the last 5 years (2017-2022), used observational designs (35/37, 95%), consisted of samples of college students or apprentices (28/35, 80%), and were conducted in the United States (22/37, 60%). The sample sizes ranged from 14 to 1584 young adults. Physical activity was measured more frequently (28/37, 76%) than sleep (16/37, 43%) or sedentary behavior (4/37, 11%). Of the 37 studies, 11 (30%) reports included 2 movement behaviors and no reports included 3 movement behaviors. eEMA was frequently used to measure potential correlates of movement behaviors, such as emotional states or feelings (25/37, 68%), cognitive processes (7/37, 19%), and contextual factors (9/37, 24%). There was wide variability in the implementation and reporting of eEMA procedures, measures, missing data, analysis, and compliance.

CONCLUSIONS

The use of eEMA methodologies in physical activity, sedentary behavior, and sleep research in young adults has greatly increased in recent years; however, reports continue to lack standardized reporting of features unique to the eEMA methodology. Additional areas in need of future research include the use of eEMA with more diverse populations and the incorporation of all 3 movement behaviors within a 24-hour period. The findings are intended to assist investigators in the design, implementation, and reporting of physical activity, sedentary behavior, and sleep research using eEMA in young adults.

TRIAL REGISTRATION

PROSPERO CRD42021279156; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021279156.

Motivation states to move, be physically active and sedentary vary like circadian rhythms and are associated with affect and arousal

Introduction

Motivation to be physically active and sedentary is a transient state that varies in response to previous behavior. It is not known: (a) if motivational states vary from morning to evening, (b) if they are related to feeling states (arousal/hedonic tone), and (c) whether they predict current behavior and intentions. The primary purpose of this study was to determine if motivation states vary across the day and in what pattern. Thirty adults from the United States were recruited from Amazon MTurk.

Methods

Participants completed 6 identical online surveys each day for 8 days beginning after waking and every 2-3 h thereafter until bedtime. Participants completed: (a) the CRAVE scale (Right now version) to measure motivation states for Move and Rest, (b) Feeling Scale, (c) Felt Arousal Scale, and (d) surveys about current movement behavior (e.g., currently sitting, standing, laying down) and intentions for exercise and sleep. Of these, 21 participants (mean age 37.7 y; 52.4% female) had complete and valid data.

Results

Visual inspection of data determined that: a) motivation states varied widely across the day, and b) most participants had a single wave cycle each day. Hierarchical linear modelling revealed that there were significant linear and quadratic time trends for both Move and Rest. Move peaked near 1500 h when Rest was at its nadir. Cosinor analysis determined that the functional waveform was circadian for Move for 81% of participants and 62% for Rest. Pleasure/displeasure and arousal independently predicted motivation states (all p's < .001), but arousal had an association twice as large. Eating, exercise and sleep behaviors, especially those over 2 h before assessment, predicted current motivation states. Move-motivation predicted current body position (e.g., laying down, sitting, walking) and intentions for exercise and sleep more consistently than rest, with the strongest prediction of behaviors planned for the next 30 min.

Discussion

While these data must be replicated with a larger sample, results suggest that motivation states to be active or sedentary have a circadian waveform for most people and influence future behavioral intentions. These novel results highlight the need to rethink the traditional approaches typically utilized to increase physical activity levels.

Using photovoice to explore young women's experiences of behaviour change techniques in physical activity mobile apps

BACKGROUND

Research shows that inactive young women are attracted to using mobile phone applications (apps) to increase physical activity. Apps can promote physical activity by delivering a range of behaviour change techniques to influence determinants of user behaviour. Previous qualitative research has examined user experiences with techniques in physical activity apps, however there is little research specifically among young women. This study aimed to explore young women's experiences using commercial physical activity apps to change their behaviour.

METHODS

Young women were recruited online to use a randomly assigned app for two weeks to achieve a personal goal. Using photovoice, a qualitative participatory research method, participants generated insights about their experiences through photographs and semi-structured interviews. Thematic analysis was conducted on photograph and interview data.

RESULTS

Thirty-two female participants, aged 18-24 years, completed the study. Behaviour change techniques tended to cluster around four key themes: logging and monitoring physical activity; reminders and prompts; workout videos and written instructions; and social features. Social support also strongly influenced participants' experiences.

CONCLUSIONS

Results suggest that behaviour change techniques influenced physical activity in line with social cognitive models, and these models are useful to understand how apps can target user behaviour for young women. The findings identified factors important for young women that seemed to moderate their experiences, such as social norms about women's appearance, which should be further explored within the context of behaviour change models and app design.

Bridging the Built and Social Environments: A Systematic Review of Studies Investigating Influences on Physical Activity

BACKGROUND

The purpose of this review was to examine articles assessing aspects of the built and social environment simultaneously, and how these environments influence physical activity (PA). A thorough review of studies is needed to identify patterns across studies and gaps for future research and practice.

METHODS

To be included, articles needed to contain: (1) self-report or objective measure of PA; (2) a measure of the built environment; (3) a measure of the social environment; and (4) an analysis between built environment, social environment, and PA. A systematic literature search of 4358 articles resulted in 87 articles.

RESULTS

Several populations were present within the sample including various age groups and different countries. As previously established, the built environment and social environment were consistently associated with PA; however, mediating factors between these 2 layers were less clear. Further, there was a lack of longitudinal and experimental study designs.

CONCLUSIONS

Results suggest a need for longitudinal and experimental designs with validated and granular measures. As communities recover from the COVID-19 pandemic, a thorough understanding of how built environment factors enhance or detract from social connectedness and how this reciprocal relationship impacts PA behavior is needed for future policy, environment, and systematic change.

Domain specific association between physical activity and affect in adolescents' daily lives: an ecological momentary assessment study

OBJECTIVE

Little is known about the domain specific associations between moderate-to-vigorous physical activity (MVPA) and affect. This study aimed to determine whether the association between MVPA and affect differed by domain in adolescents.

DESIGN

Overall, 119 adolescents (mean age = 14.7 years) provided information about their affective states multiple times a day over a four-day period using ecological momentary assessment (EMA). Additionally, minutes of MVPA were measured using accelerometers and participants self-reported whether they were participating in recreational physical activity, active travel, or household physical activity at the time of an EMA prompt.

MAIN OUTCOME MEASURES

The main outcomes that were measured were affective valence, energetic arousal and tense arousal.

RESULTS

Participants who engaged in more recreational MVPA on average reported more positive valence, more energetic arousal, and less tense arousal. Additionally, participants reported more energetic arousal when they participated in greater levels of recreational MVPA than usual, but also more tense arousal. Active travel and household physical activity were not associated with valence, energetic arousal or tense arousal.

CONCLUSION

These findings highlight the importance of encouraging participation in recreational physical activities to promote positive affective outcomes.

Affective Response to Exercise and Affective Judgments as Predictors of Physical Activity Intention and Behavior among New Mothers in their first 6-Months Postpartum

BACKGROUND

Understanding the predictors of moderate to vigorous physical activity (MVPA) during early postpartum is important to improve promotion efforts. Affect-related constructs are key predictors of MVPA but have limited research in mothers during the postpartum period.

PURPOSE

To examine two affect-related constructs (affective response to exercise and affective judgments) as predictors of MVPA intention and behavior across three months, among a sample of new mothers.

METHODS

Participants were 105 mothers (M age = 30.64 years; SD = 3.93) who completed measures during postpartum at 2-months post-birth of their first child. The affective response to exercise (assessed at baseline [2-months postpartum] during a submaximal treadmill test), affective judgments and intention (baseline, 6-weeks after baseline), and MVPA (baseline, 6- and 12-weeks after baseline) were assessed via self-report.

RESULTS

Path analysis, using ordinary least squares regression, showed that the affective response during exercise was a significant predictor of intention (baseline, 6-weeks), as well as change in intention from baseline to 6-weeks. By contrast, affective judgments predicted intention at 6-weeks, but not at baseline or in the change model. Past MVPA did not moderate these findings, although the affective response during exercise also had a significant indirect effect on MVPA through intention at 6-weeks and 12-weeks.

CONCLUSIONS

Interventions targeting women's affective response during exercise may be important during postpartum, perhaps through self-paced physical activity guidance. Affective judgments may not be predictive of MVPA, in part due to unanticipated changes during early postpartum leading to inaccurate expectations of the physical activity experience.

Motivation, Physical Activity, and Affect in Community-Dwelling Stroke Survivors: An Ambulatory Assessment Approach

BACKGROUND

Motivation is a frequently reported but far less studied driver for post-stroke physical activity participation. Motivation and physical activity may be important contributors to the prevention management and alleviation of affective symptoms among stroke survivors.

PURPOSE

To investigate the real-time associations between motivation, physical activity, and affect in the daily lives of community-dwelling stroke survivors using ecological momentary assessment (EMA) and accelerometry.

METHODS

Forty community-dwelling stroke survivors wore an accelerometer on the thigh and completed EMA surveys assessing motivation (autonomous motivation, controlled motivation) and affect (negative affect, positive affect) eight times daily for 7 days. Multivariate regression analysis and multilevel modeling investigated the associations between motivation, physical activity, and affect.

RESULTS

Greater autonomous motivation for physical activity was associated with less sedentary behavior (β = -0.40, p = .049) and more moderate-to-vigorous physical activity (β = 0.45, p = .020) participation in daily life. Greater autonomous motivation was momentarily associated with less depressed affect (β = -0.05, p < .001) and greater positive affect (β = 0.13, p < .001). Moreover, greater controlled motivation was momentarily associated with greater depressed affect (β = 0.06, p < .001). More intense physical activity was momentarily associated with greater positive affect (β = 0.13, p = .016). No moderating effect of motivation on the association between physical activity and affect was found.

CONCLUSIONS

Motivation and physical activity are momentarily associated with affect among stroke survivors. Assessing and fostering autonomous motivation may be beneficial for promoting physical activity and managing positive and depressed affect as stroke survivors return to the community.

Exercise or not? An empirical illustration of the role of behavioral alternatives in exercise motivation and resulting theoretical considerations

Objective

Individuals' decisions to engage in exercise are often the result of in-the-moment choices between exercise and a competing behavioral alternative. The purpose of this study was to investigate processes that occur in-the-moment (i.e., situated processes) when individuals are faced with the choice between exercise and a behavioral alternative during a computerized task. These were analyzed against the background of interindividual differences in individuals' automatic valuation and controlled evaluation of exercise.

Method

In a behavioral alternatives task 101 participants were asked whether they would rather choose an exercise option or a behavioral alternative in 25 trials. Participants' gaze behavior (first gaze and fixations) was recorded using eye-tracking. An exercise-specific affect misattribution procedure (AMP) was used to assess participants' automatic valuation of exercise before the task. After the task, self-reported feelings towards exercise (controlled evaluation) and usual weekly exercise volume were assessed. Mixed effects models with random effects for subjects and trials were used for data analysis.

Results

Choosing exercise was positively correlated with individuals' automatic valuation (r = 0.20, p = 0.05), controlled evaluation (r = 0.58, p < 0.001), and their weekly exercise volume (r = 0.43, p < 0.001). Participants showed no bias in their initial gaze or number of fixations towards the exercise or the non-exercise alternative. However, participants were 1.30 times more likely to fixate on the chosen alternative first and more frequently, but this gaze behavior was not related to individuals' automatic valuation, controlled evaluation, or weekly exercise volume.

Conclusion

The results suggest that situated processes arising from defined behavioral alternatives may be independent of individuals' general preferences. Despite one's best general intention to exercise more, the choice of a non-exercise alternative behavior may seem more appealing in-the-moment and eventually be chosen. New psychological theories of health behavior change should therefore better consider the role of potentially conflicting alternatives when it comes to initiating physical activity or exercise.

A Novel Approach to Assess Weekly Self-efficacy for Meeting Personalized Physical Activity Goals Via a Cellphone: 12-Week Longitudinal Study

BACKGROUND

Despite the health benefits of engaging in regular physical activity (PA), the majority of American adults do not meet the PA guidelines for aerobic and muscle-strengthening activities. Self-efficacy, the belief that one can execute specific actions, has been suggested to be a strong determinant of PA behaviors. With the increasing availability of digital technologies, collecting longitudinal real-time self-efficacy and PA data has become feasible. However, evidence in longitudinal real-time assessment of self-efficacy in relation to objectively measured PA is scarce.

OBJECTIVE

This study aimed to examine a novel approach to measure individuals' real-time weekly self-efficacy in response to their personalized PA goals and performance over the 12-week intervention period in community-dwelling women who were not meeting PA guidelines.

METHODS

In this secondary data analysis, 140 women who received a 12-week PA intervention were asked to report their real-time weekly self-efficacy via a study mobile app. PA (daily step counts) was measured by an accelerometer every day for 12 weeks. Participants rated their self-efficacy on meeting PA goals (ranging from "not confident" to "very confident") at the end of each week via a mobile app. We used a logistic mixed model to examine the association between weekly self-efficacy and weekly step goal success, controlling for age, BMI, self-reported White race, having a college education or higher, being married, and being employed.

RESULTS

The mean age was 52.7 (SD 11.5, range 25-68) years. Descriptive analyses showed the dynamics of real-time weekly self-efficacy on meeting PA goals and weekly step goal success. The majority (74.4%) of participants reported being confident in the first week, whereas less than half of them (46.4%) reported confidence in the final week of the intervention. Participants who met weekly step goals were 4.41 times more likely to be confident about achieving the following week's step goals than those who did not meet weekly step goals (adjusted odds ratio 4.41; 95% CI 2.59-7.50; P<.001). Additional analysis revealed that participants who were confident about meeting the following week's step goals were 2.07 times more likely to meet their weekly step goals in the following week (adjusted odds ratio 2.07; 95% CI 1.16-3.70; P=.01). The significant bidirectional association between real-time self-efficacy and weekly step goal success was confirmed in a series of sensitivity analyses.

CONCLUSIONS

This study demonstrates the potential utility of a novel approach to examine self-efficacy in real time for analysis of self-efficacy in conjunction with objectively measured PA. Discovering the dynamic patterns and changes in weekly self-efficacy on meeting PA goals may aid in designing a personalized PA intervention. Evaluation of this novel approach in an RCT is warranted.

Unpacking Habit With Bayesian Mixed Models: Dynamic Approach to Health Behaviors With Interchangeable Elements, Illustrated Through Multiple Sun Protection Behaviors

Analytics for behavioral habit typically model one behavior at a time, despite the fact that habit often involves multiple cooccurring behaviors, such as food choices and physical activities, where interrelated behaviors are often equally recommended. We propose a novel Mixed-Effects Dynamic hAbit model (MEDA) to simultaneously model multiple related, habitual behaviors. As an illustrative example, MEDA was applied to real-time assessments of sun protection (sunscreen, shade, hat, and protective clothing) reported twice daily by first-degree relatives of melanoma patients who are themselves at an elevated risk of skin cancer. MEDA aims to explicate habits in sun protection under varying environmental cues (e.g., sunny and hot weather). We found consistent between-group differences (e.g., men responding to weather cues more consistently than women) and interactions between cooccurring behaviors (e.g., being in shade discourages sunscreen wearing, more so in men than women). Moreover, MEDA transcends conventional methods to address longstanding challenges-how cue to action and volitional choices differ by groups or even by individual persons. Such nuances in interrelated habitual behaviors are relevant in numerous other applications, such as recommended dietary or physical activity behaviors. These methods best inform personalized behavioral interventions targeting individual preferences for precision behavioral intervention.

Understanding health behaviours in context: A systematic review and meta-analysis of ecological momentary assessment studies of five key health behaviours

Ecological Momentary Assessment (EMA) involves repeated, real-time sampling of health behaviours in context. We present the state-of-knowledge in EMA research focused on five key health behaviours (physical activity and sedentary behaviour, dietary behaviour, alcohol consumption, tobacco smoking, sexual health), summarising theoretical (e.g., psychological and contextual predictors) and methodological aspects (e.g., study characteristics, EMA adherence). We searched Ovid MEDLINE, Embase, PsycINFO and Web of Science until February 2021. We included studies focused on any of the aforementioned health behaviours in adult, non-clinical populations that assessed ≥1 psychological/contextual predictor and reported a predictor-behaviour association. A narrative synthesis and random-effects meta-analyses of EMA adherence were conducted. We included 633 studies. The median study duration was 14 days. The most frequently assessed predictors were 'negative feeling states' (21%) and 'motivation and goals' (16.5%). The pooled percentage of EMA adherence was high at 81.4% (95% CI = 80.0%, 82.8%, k = 348) and did not differ by target behaviour but was somewhat higher in student (vs. general population) samples, when EMAs were delivered via mobile phones/smartphones (vs. handheld devices), and when event contingent (vs. fixed) sampling was used. This review showcases how the EMA method has been applied to improve understanding and prediction of health behaviours in context.

Associations Between Social Cognitive Determinants and Movement-Related Behaviors in Studies using Ecological Momentary Assessment Methods: A Systematic Review (Preprint)

BACKGROUND

The social cognitive framework is a long-standing framework within physical activity promotion literature to explain and predict movement-related behaviors. However, applications of the social cognitive framework to explain and predict movement-related behaviors have typically examined the relationships between determinants and behavior across macrotimescales (eg, weeks and months). There is more recent evidence suggesting that movement-related behaviors and their social cognitive determinants (eg, self-efficacy and intentions) change across microtimescales (eg, hours and days). Therefore, efforts have been devoted to examining the relationship between social cognitive determinants and movement-related behaviors across microtimescales. Ecological momentary assessment (EMA) is a growing methodology that can capture movement-related behaviors and social cognitive determinants as they change across microtimescales.

OBJECTIVE

The objective of this systematic review was to summarize evidence from EMA studies examining associations between social cognitive determinants and movement-related behaviors (ie, physical activity and sedentary behavior).

METHODS

Studies were included if they quantitatively tested such an association at the momentary or day level and excluded if they were an active intervention. Using keyword searches, articles were identified across the PubMed, SPORTDiscus, and PsycINFO databases. Articles were first assessed through abstract and title screening followed by full-text review. Each article was screened independently by 2 reviewers. For eligible articles, data regarding study design, associations between social cognitive determinants and movement-related behaviors, and study quality (ie, Methodological Quality Questionnaire and Checklist for Reporting Ecological Momentary Assessment Studies) were extracted. At least 4 articles were required to draw a conclusion regarding the overall associations between a social cognitive determinant and movement-related behavior. For the social cognitive determinants in which a conclusion regarding an overall association could be drawn, 60% of the articles needed to document a similar association (ie, positive, negative, or null) to conclude that the association existed in a particular direction.

RESULTS

A total of 24 articles including 1891 participants were eligible for the review. At the day level, intentions and self-efficacy were positively associated with physical activity. No other associations could be determined because of conflicting findings or the small number of studies investigating associations.

CONCLUSIONS

Future research would benefit from validating EMA assessments of social cognitive determinants and systematically investigating associations across different operationalizations of key constructs. Despite the only recent emergence of EMA to understand social cognitive determinants of movement-related behaviors, the findings indicate that daily intentions and self-efficacy play an important role in regulating physical activity in everyday life.

TRIAL REGISTRATION

PROSPERO CRD42022328500; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=328500.

How do people feel while walking in the city? Using walking-triggered e-diaries to investigate the association of social interaction and environmental greenness during everyday life walking

Background

Light to moderate physical activity, which includes walking, is associated with positive effects on physical and mental health. However, concerning mental health, social and physical environmental factors are likely to play an important role in this association. This study investigates person-place interactions between environmental characteristics (greenness, social interaction) and momentary affective states during walking episodes. A within-subject design is implemented, in which affective states and environmental characteristics are assessed while participants are walking outside.

Methods

On smartphones, coupled with a motion sensor (move3), e-diaries were triggered as soon as people walked 100 m outside. E-diaries assessed momentary affective states (valence, calmness, energetic arousal), and social interaction (walking alone; seeing other people while walking; interacting with other people; walking with a known person) between 6 am and 10 pm over nine days. The percentage of greenness was determined afterward from recorded GPS and GIS data. Demographics were collected in advance via an online questionnaire. Multilevel models were calculated with R for 46 individuals (age = 41.2, ± 13.2; 52% female).

Results

Affective state dimension energetic arousal showed a significant association with social interaction and greenness, i.e., participants rated energetic arousal lower when walking alone, and if there was less greenness vs. when interacting shortly with someone while walking (β = 0.13, p = 0.02), and being in situations with more greenness (β = 0.08, p = 0.02). Furthermore, associations with social interaction and greenness were found for dimension calmness: walking together with someone was associated with higher calmness (β = 0.16, p = 0.02), and the higher the proportion of surrounding greenness during a walk, the higher calmness was rated, i.e., participants were calmer (β = 0.09, p = 0.01). Significant associations with valence were not present.

Conclusion

The findings indicate that the affective states varied significantly due to different social and physical environmental factors. In the future, the importance of environmental factors should be further investigated, e.g., by assessing environmental factors right in situations contrary to a subsequent imputation. Within-subject designs, and in particular triggered assessments with the addition of GPS, can aid in developing interventions for health-promoting urban environments.