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

Determinants of physical activity adoption and maintenance in older adults: A dual process approach

BACKGROUND

Dual process models represent a useful framework for explaining physical activity (PA) in that behavior is explained by reflective (i.e., conscious, effortful) and automatic (i.e., unconscious, effortless) determinants. Yet the distinct momentary reflective and automatic determinants associated with PA adoption and maintenance are unclear.

METHODS

Older adults (N = 202; ≥60 years) wore accelerometers to measure PA (i.e., moderate to vigorous intensity PA [MVPA], step counts) and completed brief mobile phone prompts assessing general reflective (i.e., demands, deliberation, self-efficacy, self-control, stress coping, emotion regulation), behavior-specific reflective (i.e., PA intentions, self-efficacy, planning), and automatic determinants (i.e., affect, physical and social context, functional stability of one's routine) as part of three, 2-week waves of data collection spaced over one year. Multilevel modeling was used to examine the within- and between-person associations between these determinants and subsequent PA.

RESULTS

There were within- or between-person differences between general reflective, behavior specific, and automatic determinants and PA by adopter and maintainer status. General reflective determinants tended to be more predictive of step counts compared to MVPA. Within-person behavior-specific reflective determinants (i.e., intentions, self-efficacy, plans) were positively associated with PA behavior but associations tended to be more positive among PA maintainers. Automatic determinants were more predictive of the amount of PA as opposed to the likelihood of PA occurring.

CONCLUSION

Reflective and automatic determinants, as well as the levels at which these determinants operate (i.e., between vs within), need to be considered when attempting to explain and predict the adoption and maintenance of PA.

Moving Beyond Mean Levels: Associations Between Subject-Level Variability in Psychological Determinants and Physical Activity in Older Adults

BACKGROUND

Research investigating the psychological determinants of physical activity (PA) tends to conceptualize determinants as stable, trait-like factors. Growing evidence suggests that people and the processes that regulate people's behavior fluctuate over short timescales (eg, hours and days). This study explores the extent to which subject-level variability (vs stability) in determinants of PA, as well as the interaction between subject-level mean and variability in those determinants, is associated with moderate- to vigorous-intensity PA (MVPA) in older adults.

METHODS

Older adults (N = 202) enrolled in a measurement burst design study with 3 data collection waves occurring over a 1-year period. Each data collection wave consisted of accelerometers and ecological momentary assessment to capture MVPA and psychological determinants of MVPA, respectively. Mixed-effects location scale modeling was first used to estimate subject-level means and variability in psychological determinants. These estimates were then used as predictors of daily MVPA using multilevel modeling.

RESULTS

Subject-level variability in PA intentions (β = 0.199, SE = 0.062, P = .001), self-efficacy (β = 0.133, SE = 0.064, P = .037), and planning (β = 0.154, SE = 0.062, P = .014) were positively associated with daily MVPA. Associations between subject-level variability in PA intentions and self-efficacy decreased in strength, becoming nonsignificant at higher mean levels of PA intentions (β = -0.147, SE = 0.062, P = .018) and self-efficacy (β = -0.116, SE = 0.063, P = .062).

CONCLUSIONS

Greater subject-level variability in psychological determinants may be adaptive for PA engagement, especially among older adults experiencing low levels of those determinants. Moving beyond mean levels to include subject-level variability in psychological determinants of PA may help to improve our understanding of the processes that drive PA engagement.

Operationalization of the social cognitive theory to explain and predict physical activity in Germany: a scale development

Introduction

Social cognitive theory is one of the most prominent psychological theories regarding human behavior. Previous research tested and confirmed parts of the theory concerning the explanatory and predictive value of the theory, both in specific populations and in selected domains of physical activity. However, the value of this research is limited as researchers often use their own item sets rather than validated scales. Therefore, comparability of the studies is restricted and the quality of the individual findings can often not be conclusively assessed as psychometric properties of the measurement are unclear. The goal of this research was to develop a parsimonious, reliable, and valid questionnaire to assess the elements of SCT in the context of physical activity.

Methods

In total, 90 items were developed for the four factors of SCT, which were then examined by exploratory factor analysis and reduced to 18 items in total.

Results

Cross-validation was successful. Internal consistency was good for the four subscales, test-retest reliability was satisfactory, as were indicators for convergent and divergent validity.

Discussion

A short, reliable, and valid instrument was developed intended for use in the general adult population in Germany for research on theoretical assumptions and interventions based on social cognitive theory.

Determinants of sedentary behavior in community-dwelling older adults with type 2 diabetes based on the behavioral change wheel: a path analysis

BACKGROUND

Sedentary behavior (SB) is deeply ingrained in the daily lives of community-dwelling older adults with type 2 diabetes mellitus (T2DM). However, the specific underlying mechanisms of the determinants associated with SB remain elusive. We aimed to explore the determinants of SB based on the behavior change wheel framework as well as a literature review.

METHODS

This cross-sectional study recruited 489 community-dwelling older adults with T2DM in Jinan City, Shandong Province, China. Convenience sampling was used to select participants from relevant communities. This study used the Measure of Older Adults' Sedentary Time-T2DM, the Abbreviated-Neighborhood Environment Walkability Scale, the Social Support Rating Scale, the Lubben Social Network Scale 6, the Subjective Social Norms Questionnaire for Sedentary Behavior, the Functional Activities Questionnaire, the Numerical Rating Scale, the Short Physical Performance Battery, and the Montreal Cognitive Assessment Text to assess the levels of and the determinants of SB. Descriptive statistical analysis and path analysis were conducted to analyze and interpret the data.

RESULTS

Pain, cognitive function, social isolation, and social support had direct and indirect effects on SB in community-dwelling older adults with T2DM (total effects: β = 0.426, β = -0.171, β = -0.209, and β = -0.128, respectively), and physical function, walking environment, and social function had direct effects on patients' SB (total effects: β = -0.180, β = -0.163, and β = 0.127, respectively). All the above pathways were statistically significant (P < 0.05). The path analysis showed that the model had acceptable fit indices: RMSEA = 0.014, χ 2/df = 1.100, GFI = 0.999, AGFI = 0.980, NFI = 0.997, RFI = 0.954, IFI = 1.000, TLI = 0.996, CFI = 1.000.

CONCLUSION

Capability (physical function, pain, and cognitive function), opportunity (social isolation, walking environment, and social support), and motivation (social function) were effective predictors of SB in community-dwelling older adults with T2DM. Deeper knowledge regarding these associations may help healthcare providers design targeted intervention strategies to decrease levels of SB in this specific population.

Role of Chinese Acupuncture in the Treatment for Chemotherapy-Induced Cognitive Impairment in Older Patients With Cancer: Protocol for a Randomized Controlled Trial

BACKGROUND

Older patients with cancer experience cognitive impairment and a series of neurocognitive symptoms known as chemobrain due to chemotherapy. Moreover, older populations are disproportionately affected by chemobrain and heightened negative mental health outcomes after cytotoxic chemical drug therapy. Chinese acupuncture is an emerging therapeutic option for chemotherapy-induced cognitive impairment in older patients with cancer, despite limited supporting evidence.

OBJECTIVE

Our study aims to directly contribute to the existing knowledge of this novel Chinese medicine mode in older patients with cancer enrolled at the Department of Oncology/Chinese Medicine, Nanjing First Hospital, China, thereby establishing the basis for further research.

METHODS

This study involves a 2-arm, prospective, randomized, assessor-blinded clinical trial in older patients with cancer experiencing chemobrain-related stress and treated with Chinese acupuncture from September 30, 2023, to December 31, 2025. We will enroll 168 older patients with cancer with clinically confirmed chemobrain. These participants will be recruited through screening by oncologists for Chinese acupuncture therapy and evaluation. Electroacupuncture will be performed by a registered practitioner of Chinese medicine. The electroacupuncture intervention will take about 30 minutes every session (2 sessions per week over 8 weeks). For the experimental group, the acupuncture points are mainly on the head, limbs, and abdomen, with a total of 6 pairs of electrically charged needles on the head, while for the control group, the acupuncture points are mainly on the head and limbs, with only 1 pair of electrically charged needles on the head.

RESULTS

Eligible participants will be randomized to the control group or the experimental group in 1:1 ratio. The primary outcome of this intervention will be the scores of the Montreal Cognitive Assessment. The secondary outcomes, that is, attentional function and working memory will be determined by the Digit Span Test scores. The quality of life of the patients and multiple functional assessments will also be evaluated. These outcomes will be measured at 2, 4, 6, and 8 weeks after the randomization.

CONCLUSIONS

This efficacy trial will explore whether Chinese electroacupuncture can prevent chemobrain, alleviate the related symptoms, and improve the quality of life of older patients with cancer who are undergoing or are just going to begin chemotherapy. The safety of this electroacupuncture intervention for such patients will also be evaluated. Data from this study will be used to promote electroacupuncture application in patients undergoing chemotherapy and support the design of further real-world studies.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05876988; https://clinicaltrials.gov/ct2/show/NCT05876988.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/53853.