Multi-Process Action Control in Physical Activity: A Primer

Predicting physical activity behavior among university students using the multi-process action control framework

Most university students do not engage in enough physical activity (PA) despite the known physical and mental health benefits. Action control theories such as the Multi-Process Action Control (M-PAC) framework have been proposed to better understand the translation of intentions into action by incorporating post-intentional processes. However, the explanatory power of the M-PAC framework beyond traditional social cognitive constructs has received limited attention. This study examined the predictive utility of the M-PAC framework for explaining variance in self-reported and device-measured PA behavior among university students. A total of 2418 undergraduate students (Mean age = 19.1 ± 1.73 [SD] years) completed an online survey that included a self-reported measure of moderate-to-vigorous PA (MVPA) as well as constructs outlined in the M-PAC framework: instrumental and affective attitudes, perceived capability and opportunity, behavioral regulation, habit and identity. A subsample (n = 376) also wore an ActiGraph wGT3x-BT accelerometer on their non-dominant wrist for seven full days to assess MVPA. Robust linear regression models were computed to investigate associations between M-PAC framework constructs and PA behavior. Findings showed the M-PAC framework explained as high as 14.3 % and 37.9 % of the variance in device-measured and self-reported MVPA, respectively. Regulatory (behavioral regulation), and reflexive (habit and identity) processes were significant predictors of self-reported MVPA when examining the full M-PAC framework, whereas the role identity dimension of PA identity was the only significant predictor of device-assessed MVPA. Taken together, these results reinforce the importance of post-intentional processes, specifically role identity, in understanding PA behavior among university students.

"We are an active family": a randomized trial protocol to evaluate a family-system social identity intervention to promote child physical activity

BACKGROUND

Regular engagement in moderate-to-vigorous physical activity (MVPA) during childhood yields a myriad of health benefits, and contributes to sustained MVPA behaviors into adulthood. Given the influence of parents on shaping their child's MVPA behaviour, the family system represents a viable target for intervention. The purpose of this study is to compare the effects of two intervention conditions designed to increase child MVPA: (1) A standard education + planning intervention providing information about benefits, action planning, and coping planning; and (2) An augmented physical activity education + planning intervention that includes the components of the standard intervention, as well as a focus on family identity promotion and developing as an active member of the family.

METHODS

A two-arm parallel single-blinded randomized trial will compare the two conditions over 6 months. Eligible families have at least one child aged 6-12 years who is not meeting the physical activity recommendations within the Canadian 24-Hour Movement Guidelines (i.e.,<60 min/day of MVPA). Intervention materials targeting family identity promotion will be delivered online via zoom following baseline assessment, with booster sessions at 6-weeks and 3-months. Child MVPA will be measured by wGT3X-BT Actigraph accelerometry at baseline, 6-weeks, 3-months, and 6-months as the primary outcome. At these same time points, parent cognition (e.g., attitudes, perceived control, behavioral regulation, habit, identity) and support behaviours, and parent-child co-activity will be assessed via questionnaire as secondary outcomes. Child-health fitness measures will be also administered through fitness testing at baseline and 6-months as secondary outcomes. Finally, upon completion of the trial's 6-month measures, a follow-up end-of-trial interview will be conducted with parents to examine parents' experiences with the intervention.

RESULTS

So far, 30 families have been enrolled from the Southern Vancouver Island and Vancouver Lower Mainland area. Recruitment will be continuing through 2026 with a target of 148 families.

DISCUSSION

This study will contribute to the understanding of effective strategies to increase child physical activity by comparing two intervention approaches. Both provide parents with education on physical activity benefits, action planning, and coping planning supports. However, one intervention also incorporates components focused on promoting an active family identity and involving all family members in physical activity together. The findings from this study have the potential to inform the design and implementation of public health initiatives aimed at improving physical activity participation in children and guide the development of more effective interventions that leverage the crucial role of parents and the family system in shaping children's physical activity behaviors.

TRIAL REGISTRATION

The clinical trial registration ID is NCT05794789. This trial was registered with clinicaltrials.gov on March 2nd, 2023, with the last updated release on September 28th, 2023.

Predictive Utility of the Multi-Process Action Control Framework for Self-Reported and Device-Measured Physical Activity Behavior of Adolescents

Understanding the correlates of physical activity behavior is imperative for informing the development of interventions to address the low rates of physical activity guideline adherence among adolescents living in the United States. This cross-sectional study examined the predictive utility of the Multi-Process Action Control (M-PAC) framework for explaining self-reported and device-measured physical activity behavior among a Hispanic-majority sample of adolescents. A total of 1849 high school students (mean age = 16.0 ± 1.22 SD years; 52.3% women; 87.8% Hispanic) enrolled in one school district in south-central Texas completed a survey including instruments to assess M-PAC framework constructs (instrumental and affective attitudes, perceived capability and opportunity, behavioral regulation, habit, identity) and moderate-to-vigorous physical activity (MVPA) behavior. A subsample (n = 435) wore accelerometers for seven days. The results from robust linear regression models revealed role identity and habit were significant predictors of self-reported MVPA. Role identity was a significant predictor of accelerometer-derived daily MVPA and raw acceleration in the most active hour but not daily raw acceleration. The findings indicated reflexive processes are robust predictors of adolescent physical activity and should be the focus of interventions designed to promote adoption and maintenance of physical activity during this developmental life stage.

The iterative development and refinement of health psychology theories through formal, dynamical systems modelling: a scoping review and initial expert-derived 'best practice' recommendations

This scoping review aimed to synthesise methodological steps taken by researchers in the development of formal, dynamical systems models of health psychology theories. We searched MEDLINE, PsycINFO, the ACM Digital Library and IEEE Xplore in July 2023. We included studies of any design providing that they reported on the development or refinement of a formal, dynamical systems model unfolding at the within-person level, with no restrictions on population or setting. A narrative synthesis with frequency analyses was conducted. A total of 17 modelling projects reported across 29 studies were included. Formal modelling efforts have largely been concentrated to a small number of interdisciplinary teams in the United States (79.3%). The models aimed to better understand dynamic processes (69.0%) or inform the development of adaptive interventions (31.0%). Models typically aimed to formalise the Social Cognitive Theory (31.0%) or the Self-Regulation Theory (17.2%) and varied in complexity (range: 3-30 model components). Only 3.4% of studies reported involving stakeholders in the modelling process and 10.3% drew on Open Science practices. We conclude by proposing an initial set of expert-derived 'best practice' recommendations. Formal, dynamical systems modelling is poised to help health psychologists develop and refine theories, ultimately leading to more potent interventions.

Psychological needs and exercise behaviour: a comparison of two psychological needs models

OBJECTIVE

Psychological need satisfaction, from a self-determination theory (SDT) perspective, has been applied extensively to understand predictors of exercise behaviour. Dweck proposed a psychological needs framework that includes basic needs (optimal predictability, competence, acceptance), compound needs derived from combinations of basic needs (self-esteem/status, trust, control), and a superordinate compound need for self-coherence that includes identity and meaning. The purpose was to examine whether psychological needs operationalized within Dweck's model account for variance in exercise behaviour in ways that the SDT model does not.

METHODS AND MEASURES

A community sample of 403 adults completed measures of demographics, psychological needs, and exercise motivation at Time 1, and self-reported moderate-to-vigorous minutes of exercise at both Times 1 and 2 four weeks later.

RESULTS

Two structural equation models operationalizing Dweck's needs framework and SDT (basic needs and motivation) were examined in relation to exercise behaviour. In both models, exercise identity and integrated regulation (conceptually similar) were the most salient correlates of prospectively measured exercise behaviour, and both accounted for the relationship between competence and exercise behaviour.

CONCLUSION

The results support the importance of identity in the context of exercise behaviour. Future research should investigate factors associated with adopting and maintaining an exercise identity.

A Web-Based Intervention for Insufficiently Active College Students: Feasibility and Preliminary Efficacy

BACKGROUND

One third of college students do not achieve aerobic activity levels recommended for physical and mental health. The web-based "I Can Be Active!" intervention was designed to help college students increase their physical activity. The intervention was grounded in the Multi-Process Action Control (M-PAC) framework which emphasizes translating intention into sustainable action.

OBJECTIVE

The primary purpose was to evaluate the feasibility of the intervention with insufficiently active young adult college students. The secondary purposes were to describe the preliminary effects of the intervention on: (1) the M-PAC constructs and (2) physical activity.

METHODS

Twenty-one college students, ages 18 to 24, were enrolled in the pre-post quasi-experimental study to test the 8-week intervention during Spring 2021. Data were collected via self-report questionnaires, web-analytics, and interviews. Feasibility outcomes included recruitment, retention, acceptability, practicality, and implementation. Preliminary efficacy outcomes were self-report M-PAC constructs and physical activity. Data analyses included descriptive statistics, t tests, Wilcoxon signed rank tests, Hedge's g, and thematic analysis.

RESULTS

Recruitment and retention rates were 70% and 71%, respectively. Participants reacted positively to the program, content, and features, except the manual entry step tracker and private social media group. Positive trends and significant increases were found in the regulatory and reflexive M-PAC constructs (self-regulation, habit, and identity) and physical activity.

CONCLUSIONS

Findings support the feasibility and preliminary effects of the intervention for insufficiently active college students and highlight implications for intervention refinement. Future research will test intervention effectiveness using a randomized controlled trial with a larger diverse sample of college students.

Exercise identity and physical activity behavior during late adolescence: A four wave cross-lagged panel model

Research has shown that physical activity behavior tends to decline across adolescence before stabilizing in adulthood. Identifying salient factors underlying these behavioral changes is therefore imperative for informing intervention development. This study explored the temporal nature of the relationship between exercise identity and physical activity behavior during the transition out of high school. An analysis of data from the Application of integrated Approaches to understanding Physical activity during the Transition to emerging adulthood (ADAPT) prospective cohort study was conducted, involving 1451 Canadian adolescents (Mage = 15.93 ± 0.53 years; 52.4% female). Participants completed the International Physical Activity Questionnaire-Short Form to report weekly moderate-to-vigorous physical activity and an abbreviated version of the Exercise Identity Scale yearly for four years beginning in Grade 11. A four-wave cross-lagged panel model was used to test bi-directional associations between exercise identity and physical activity behavior. Significant auto-regressive effects for exercise identity and physical activity were observed across all four time points. Significant positive cross-lagged paths were observed for exercise identity predicting future physical activity at all time points; however, none of the cross-lagged paths with physical activity predicting future exercise identity were significant. Collectively, these findings support existing theory that emphasizes the role that identity plays in physical activity behavior. Interventions seeking to attenuate the physical activity declines typically observed during the transition to emerging adulthood should therefore consider adopting behavior change techniques that target identity, as it appears to be an important psychological determinant underlying future physical activity engagement.

Exploring the reasons for wanting a peer partner to be physically active among women living with and beyond a cancer diagnosis: a content analysis

BACKGROUND

Initiating and maintaining exercise is challenging for women during and post-cancer treatment. Adopting a peer partner model to provide social support to be active may contribute to lasting behaviour change of both partners. Despite this, finding a "like peer" can be challenging.

PURPOSE

To explore women's reasons for seeking an online exercise partner following a diagnosis with cancer (through  www.activematch.ca ). We also examined women's potential sociodemographic and cancer-related differences by reported reasons for wanting an exercise partner.

METHODS

Individuals creating an ActiveMatch profile completed demographic and physical activity questions (N = 199, Mage(SD) = 51.9(10.8) years), including an open-ended question regarding their "reason for wanting an exercise partner". An inductive content analysis was completed focusing on the participants' peer exercise partner preferences. Additional chi-square tests were run to assess whether participants differed based on sociodemographic and cancer-related characteristics and their motivations to be active by category of "reason for wanting an exercise partner" endorsed in the open-ended question.

RESULTS

The participants' reasons for wanting an exercise partner were coded into seven categories, with most participants highlighting the reasons of motivation (52.3%), social support (48.7%), and accountability and adherence (26.6%). Women < 50 years of age were more likely to report accountability and adherence-related preferences for a partner. Those reporting endorsing weight loss as their primary reason for becoming active were more likely to be categorized as wanting a peer partner for motivation.

CONCLUSIONS

While finding a peer partner can be challenging, matching women living with and beyond a cancer diagnosis based on their reason for wanting an exercise partner, as well as their reasons for wanting to be active, may be important to build successful peer exercise partnerships.

Determinants Influencing Health-Promoting Behaviors in Individuals at High Risk of Stroke: A Cross-Sectional Study

BACKGROUND

Health-promoting behaviors and positive lifestyle changes are crucial for effective stroke prevention. However, individuals at high risk of stroke exhibit poor health behavior due to a deficiency of individual motivation. Moreover, there are only a few studies on health-promoting behaviors that have applied behavior change theories in individuals at high risk of stroke.

OBJECTIVE

This study aimed to use the theory of the planned behavior (TPB) model to investigate determinants of health-promoting behaviors for stroke prevention and control.

METHOD

In this cross-sectional study, 263 participants were recruited from five community health centers in Qingdao. Confirmatory factor analysis was performed to assess the reliability and validity of the constructs, and structural equation modeling was used to analyze the proposed relationships between the TPB-related variables.

RESULTS

The attitudes, subjective norms, and perceptions of behavioral control positively influenced behavioral intention. The behavioral intention had a positive effect on health-promoting behaviors. Attitudes, subjective norms, and perceived behavioral control were influenced primarily by the mediating variable behavioral intention to affect health-promoting behaviors. Stroke knowledge was an influential facilitator of behavioral attitudes, subjective norms, and perceived behavior control.

CONCLUSION

The TPB-based model is suitable for explaining health-promoting behaviors in individuals at risk of stroke and for guiding the development of effective health management programs. A comprehensive person-centered motivation behavior strategy that is based on health education and complemented by social support and health resource optimization is critical in promoting health behavior motivation and health promotion behaviors in stroke high-risk groups.

Adolescents' attitudes, habits, identity and social support in relation to physical activity after the COVID-19 pandemic

This study focuses on adolescents' cognitive processes, behaviors and social support (SS) as they relate to physical activity (PA) before and after the pandemic. The aims of the study were: (1) to investigate the changes in adolescents' engagement in moderate and vigorous physical activity (MVPA), and examine the changes in PA-related attitudes and behaviors before and after the COVID-19 pandemic; (2) to analyze the correlations between the significant changes that were found, PA engagement, and SS. The survey targeted third-year middle school students of Italian nationality, attending male and female mixed classes, residents in urban, periphery and sub-urban areas, living in families with different incomes, and different habits of engaging in PA. A longitudinal study was developed using a standardized questionnaire. The questionnaire was administered in April-May 2023 to a sample of 952 students aged 11/14 residing in the Marche region in Central Italy. Increasing values were found in the post-COVID-19 phase for all the cognitive processes and attitudes, in particular, those regarding habits (0.66 vs 0.50, + 32%) and identity (0.70 vs 0.55, + 27%) related to PA. Significant correlations were found between these values and VPA engagement and between the values of the same indicators and SS (p < 0.01). The strongest relationship was found with the dimension of identity (r = 0.51; r = 054).

Increasing Health Behaviors and Psychological Measures with an Adapted Version of the ACCELERATION Program

BACKGROUND

Recent evidence highlights the importance of interventions tackling physical inactivity and unhealthy eating in lower-income countries. The purpose of this study was to examine the effectiveness of the Canadian ACCELERATION lifestyle program adapted to Brazilians. The main outcomes of the study were changes in the engagement in weekly moderate-to-vigorous physical activity (MVPA) and in the daily consumption of fruits/vegetables.

METHODS

The adapted intervention consisted of a 12-week quasi-randomized controlled trial delivered through email. The data from the original Canadian experimental group (CE, n = 194) and the two groups of Portuguese-speaking Brazilians living in Canada in the adapted program - Brazilian experimental (BE, n = 41) and Brazilian control (BC, n = 35) - were assessed at baseline and post-intervention. The data of the 270 participants were analyzed using two-way repeated measures factorial ANCOVA (group x time) for ratio variables and Chi-square and McNemar tests for the categorical variables.

RESULTS

The BE group had a significant increase in MVPA (mean difference, 95% CI: 86.3, 38.1-134.4 min/week) and fruits/vegetables intake (3.2, 1.4-5.1 servings/day) after the intervention (both p < 0.001). The proportion of participants engaging in ≥ 150 min of MVPA increased from 4.9% to 73.2%, while adoption of a healthy diet increased from 4.9% to 53.7% in the BE group (both p < 0.001). The CE group also improved on these variables (p < 0.05) with no difference vs the BE group (p > 0.05), whereas BC did not show changes (p > 0.05).

CONCLUSION

The Brazilian version of the ACCELERATION program effectively promoted positive health behavior changes in its participants and has the potential to contribute to the fight against risk factors for chronic diseases in Brazilians.

Parent Support for Physical Activity and Motor Skills During Early Childhood: A Mixed-Methods Application of the Multi-process Action Control Framework

BACKGROUND

Promoting physical activity (PA) and fundamental movement skills (FMS) in early childhood is necessary to address the high rates of inactivity in children. Parent support is a determinant of PA in children, however, parental intentions to support are not always translated into behavior resulting in an intention-behavior gap.

PURPOSE

Positioned within the multi-process action control (M-PAC) framework, this study used an explanatory concurrent mixed-methods design to explore parents' intentions and support of PA and FMS during early childhood.

METHODS

Parents (N=124) of children aged 3-4 years completed an online survey consisting of items assessing reflective (e.g., attitudes), regulatory (e.g., planning), and reflexive (e.g., habit) processes of M-PAC and intentions and support for child PA and FMS. A subset of parents (n=20) completed a semi-structured online interview guided by the M-PAC framework.

RESULTS

Significantly more parents intended to support PA (71%) compared with FMS (44%; p<0.001) and successfully translated intentions into action for PA (57%) compared with FMS (27%; p<0.001). Discriminant function analysis showed parent behavior profiles for PA and FMS support were associated with a combination of reflective, regulatory, and reflexive processes, however, these differed based on support behavior. Qualitative findings highlighted parents' differential views on PA and FMS support and contextualized the psychological processes associated with each.

CONCLUSIONS

Parent PA support interventions during early childhood should include strategies for supporting FMS. Interventions should prioritize fostering a combination of reflective, regulatory, and reflexive behaviors to translate intentions to support PA and FMS into behavior among parents of young children.

Testing the moderative role of automatic-reflective affect divergence in predicting physical activity

Dual process theories postulate that behaviour is the product of two distinct cognitive systems, the automatic and reflective, and that congruence/divergence between the two types of cognitions can influence the predictive strength of either system on behaviour. However, the congruence/divergence hypothesis has yet to experience strong empirical support. The aim of this study was to test a novel dual process model to determine the moderating effect of affect divergence on the relationship between automatic affective evaluations-affective judgements, and physical activity. A sample of 315 university students recruited from an undergraduate research pool completed the Affective Misattribution Procedure and Affective Exercise Experiences Questionnaire, followed by a measure of physical activity behaviour one week later. A path analysis revealed a significant moderation effect such that the predictive strength of affective judgements was stronger when participants' automatic affective evaluations and affective judgements were congruent. Findings support current dual process theory and contributes to calls for more interventions, such as evaluative conditioning that target automatic processes alongside consciously held beliefs.

Psychometric validation of four-item exercise identity and healthy-eater identity scales and applications in weight loss maintenance

BACKGROUND

Identifying as someone who engages in health promoting behaviors like healthy eating and exercising may be associated with sustained engagement in those behaviors, but reliable and valid instruments are needed to improve the rigor of this research. Two studies were conducted to (1) examine the psychometric properties of a four-item exerciser identity measure (4-EI) and an adapted healthy-eater identity measure (4-HEI) and (2) examine differences in identity strengths across categories of weight loss success.

METHODS

Data from 1,709 community dwelling adults in the International Weight Control Registry (IWCR) were used. A random half of the sample was used to assess the proposed unidimensional factor structure of the 4-EI and 4-HEI and examine convergent and discriminant validity using Spearman rank-order correlations. One-way ANOVA was used in the other random half of the sample to compare 4-EI and 4-HEI scores (-3 to + 3) across three self-defined weight loss categories ('Successful', 'Regain', and 'Unsuccessful') and those maintaining ≥ 5% weight loss for > 1 year vs. not.

RESULTS

Results support the unidimensional factor structure with all four items (eigenvalue scores > 2.89) as well as convergent and discriminant validity for both measures. Exercise identity was strongly correlated with self-reported physical activity (r (735) = 0.52, p <.001) and measures of autonomous motivation. Healthy eating identity was moderately correlated with cognitive restraint in eating (r (744) = 0.42, p <.001) and other measures predictive of eating behavior. 4-EI and 4-HEI are stronger in Successful (4-EI: M = 0.90, SD = 1.77; 4-HEI: M = 1.56 SD = 1.37) vs. Regain (4-EI: M=-0.18, SD = 1.68; 4-HEI: M =.57, SD = 1.48) and Unsuccessful (4-EI:M=-0.28, SD = 1.62; 4-HEI: M = 0.51, SD = 1.33) and those maintaining ≥ 5% weight loss (4-EI:M = 0.47, SD = 1.78; 4-HEI: M = 1.13, SD = 1.49) vs. not (4-EI:M=-0.27, SD = 1.66; 4-HEI: M = 0.53, SD = 1.47), p's < 0.001.

CONCLUSIONS

The 4-EI and 4-HEI have acceptable psychometric properties and can advance understanding of the role of identity in exercise and dietary behaviors and weight loss maintenance.

TRIAL REGISTRATION

The parent observational study, International Weight Control Registry (IWCR), for these sub-studies is registered in ClinicalTrials.gov (NCT04907396).

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

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

Guidelines for assessment of affect-related constructs

Research on affect-related constructs as determinants of health behavior is increasing. The Affect and Health Behavior Framework (AHBF) provides a schematic structure to label, organize, and integrate affect-related constructs. To further facilitate research and theory development in health behavior science, the purpose of the present paper is to provide a critical review and guidelines for assessment of the affect-related constructs in the AHBF. The paper is organized based on the categories of constructs in the AHBF: Affective response to health behavior, incidental affect, affect processing, and affectively charged motivation. Future research should work toward parsing constructs where possible as well as identifying overlap. Researchers are advised to consider conceptual underpinnings and methodological nuances when assessing affect-related constructs in order to build a cumulative science of affective determinants of health behavior.

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

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

A school-family blended multi-component physical activity program for Fundamental Motor Skills Promotion Program for Obese Children (FMSPPOC): protocol for a cluster randomized controlled trial

BACKGROUND

Fundamental motor skills (FMSs) are crucial for children's health and comprehensive development. Obese children often encounter a considerable challenge in the development of FMSs. School-family blended PA programs are considered a potentially effective approach to improve FMSs and health-related outcomes among obese children, however, empirical evidence is still limited. Therefore, this paper aims to describe the development, implementation, and evaluation of a 24-week school-family blended multi-component PA intervention program for promoting FMSs and health among Chinese obese children, namely the Fundamental Motor Skills Promotion Program for Obese Children (FMSPPOC) employing behavioral change techniques (BCTs) and building on the Multi-Process Action Control (M-PAC) framework as well as using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework for improving and evaluating the program.

METHODS

Using a cluster randomized controlled trial (CRCT), 168 Chinese obese children (8-12 years) from 24 classes of six primary schools will be recruited and randomly assigned to one of two groups by a cluster randomization, including a 24-week FMSPPOC intervention group and a non-treatment waiting-list control group. The FMSPPOC program includes a 12-week initiation phase and a 12-week maintenance phase. School-based PA training sessions (2 sessions/week, 90 min each session) and family-based PA assignments (at least three times per week, 30 min each time) will be implemented in the initiation phase (semester time), while three 60-min offline workshops and three 60-min online webinars will be conducted in the maintenance phase (summer holiday). The implementation evaluation will be undertaken according to the RE-AIM framework. For intervention effectiveness evaluation, primary outcome (FMSs: gross motor skills, manual dexterity and balance) and secondary outcomes (health behaviors, physical fitness, perceived motor competence, perceived well-being, M-PAC components, anthropometric and body composition measures) will be collected at four time-points: at baseline, 12-week mid-intervention, 24-week post-intervention, and 6-month follow-up occasions.

DISCUSSION

The FMSPPOC program will provide new insights into the design, implementation, and evaluation of FMSs promotion among obese children. The research findings will also supplement empirical evidence, understanding of potential mechanisms, and practical experience for future research, health services, and policymaking.

TRIAL REGISTRATION

Chinese Clinical Trial Registry; ChiCTR2200066143; 25 Nov 2022.

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.

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.

Physical Movement Habit Formation in Sedentary Office Workers: Protocol Paper

Engaging in physical movement has a number of mental and physical health benefits, and yet 45% of Australia's population do not meet the recommended guidelines for physical activity. The current study aims to develop an online habit-based intervention designed to reduce sedentary behavior within the workplace, using environmental cues to instigate simple behavioral changes. Participants in this study will include full time office workers who self-report as having a highly sedentary job and work from either a commercial office, home office, or a mixture of both. Participants will complete a habit-based intervention over a four-week period designed to reduce sedentary behavior by increasing habitual responses to simple physical movement behaviors cued by their environment. Analysis will involve mixed methods ANOVAs to test the efficacy of the intervention. A successful intervention will show a reduction in sedentary behavior as a response to habitual simple physical movement behaviors.

Examining whether affectively-charged motivations predict subsequent affective response during physical activity: An ecological momentary assessment study

BACKGROUND

Evidence suggests positive affective response during physical activity increases the likelihood of engaging in and maintaining regular activity exercise in the future. Elucidating antecedents for a positive affective response may help identify intervention strategies to increase activity. Affectively-charged motivations (e.g., desires, urges, dreading) have been posited as proximal antecedents to physical activity but have yet to be examined in terms of their influence on affective response in real-world settings. The current study used ecological momentary assessment (EMA) to examine within-subject effects of pre-physical activity affectively-charged motivation on subsequent affective response during physical activity.

METHODS

Participants included 56 adults (M = 39.18 years, SD = 11.98; 67.86% female) who completed a 14-day smartphone-based EMA study. Prior to starting physical activity (time t), participants self-initiated an event-contingent EMA survey that assessed affectively-charged motivation for physical activity (i.e., rating scale from "dreading it" to "excited to do it"). EMA surveys prompted during subsequent physical activity (time t + 15 min) assessed affective response (i.e., feeling good-bad, energized-exhausted, thrilled-miserable, interested-bored, and relaxed-nervous). Multi-level linear regression models examined within-subject effects of pre- physical activity affectively-charged motivations on subsequent affective response during physical activity controlling for between-subjects effects of affectively-charged motivation, age, biological sex, time of day, and day of the week.

RESULTS

Overall, there were N = 304 physical activity occasions in the analysis (M = 5.43, SD = 3.97). When individuals reported more positive affectively-charged motivation for physical activity than usual before physical activity occasions, they reported feeling more energized (Estimate = 0.22, p < 0.001), good (Estimate = 0.25, p < 0.001), thrilled (Estimate = 0.12, p = 0.02), and interested (Estimate = 0.24, p < 0.001) during subsequent physical activity. Affectively-charged motivation was not associated with feeling more relaxed (Estimate = 0.11, p = 0.13) during subsequent physical activity.

CONCLUSION

Momentary affectively-charged motivations predicted more positive affective response during subsequent physical activity among active adults. Future research can explore potential sources of intraindividual differences in affectively-charged motivations and further examine these associations with future physical activity behavior. To improve positive affective responses, interventions may boost affectively-charged motivations through real-time mobile prompting in naturalistic settings.

Reflecting on physical activity across 2 years of the COVID-19 pandemic: Predictors of intention-behavior profiles

The COVID-19 pandemic has affected how many people engage in regular moderate-to-vigorous intensity physical activity (MVPA). The purpose of this study was to predict current and dynamic (across 2 years of the pandemic) intention and MVPA profiles using the multi-process action control (M-PAC) framework. A representative sample of 977 English-speaking Canadians (18 + years) completed measures of reflective (instrumental attitude, affective attitude, perceived capability, and opportunity), regulatory (planning and self-monitoring), and reflexive (habit and identity) processes, intention, and MVPA. These measures included current assessments and reflections prior to the COVID-19 restrictions. Three current intention-behavior profiles (nonintenders, unsuccessful intenders, and successful intenders) and five dynamic intention-MVPA by prepandemic MVPA profiles (consistent nonintenders, relapsed nonintenders, consistent unsuccessful intenders, relapsed unsuccessful intenders, and consistent successful intenders) emerged from these data, showing few increased MVPA across the pandemic. The current and dynamic profiles were subsequently predicted by changes in specific reflective, regulatory, and reflexive processes across the pandemic; however, only change in identity was the critical predictor of successful MVPA engagement in the dynamic 2-year MVPA profiles. Collectively, the findings support the joint promotion of reflective, regulatory, and reflexive processes in the choice of behavior change techniques to promote postpandemic MVPA intention and behavior.

The Development of a Hypertension Prevention and Financial Incentive Mobile Health Program Using a “No-Code” Mobile App Builder: A Development and Usability Study (Preprint)

BACKGROUND

Regular physical activity (PA) is a key lifestyle component for hypertension prevention. Previous studies have shown that mobile health (mHealth) apps can be an effective tool for improving PA behaviors. However, adherence to and poor engagement with these apps is a challenge. A potential solution to overcome this challenge may be to combine financial incentives with innovative behavior theory, such as the Multiprocess Action Control (M-PAC) framework. Currently, there is a lack of PA financial incentive-driven M-PAC mHealth programs aimed at hypertension prevention.

OBJECTIVE

We aimed to describe the process of developing an 8-week mHealth PA and financial-incentive hypertension education program (Healthy Hearts) and to evaluate usability of the Healthy Hearts program.

METHODS

The first 2 stages of the Integrate, Design, Assess, and Share framework were used to guide the development of the Healthy Hearts program. The development process consisted of 2 phases. In phase 1, the research team met to discuss implementing the M-PAC framework to adopt an existing web-based hypertension prevention program to a mobile app. The app was developed using a no-code app development platform, Pathverse (Pathverse Inc), to help decrease overall development time. In phase 2, we created a prototype and conducted usability testing to evaluate lesson 1 of the Healthy Hearts program to further enhance the user experience. We used semistructured interviews and the mHealth App Usability Questionnaire to evaluate program acceptability and usability.

RESULTS

Intervention development among the research team successfully created an 8-week financial-incentive hypertension education program for adults aged 40-65 years who did not currently meet the Canadian Physical Activity Guidelines (<150 minutes of moderate to vigorous PA per week). This program lasted 8 weeks and comprised 25 lessons guided by the M-PAC framework. The program used various behavior change techniques to further support PA adherence. Usability testing of the first lesson was successful, with 6 participants recruited for 2 rounds of testing. Feedback was gathered to enhance the content, layout, and design of the Healthy Hearts program to prepare the mHealth program for feasibility testing. Results of round 1 of usability testing suggested that the content delivered in the lessons was long. Therefore, the content was divided into multiple lessons before round 2 of usability testing, where feedback was only on design preferences. A minimum viable product was created with these results.

CONCLUSIONS

The iterative development process and the usability assessments suggested by the Integrate, Design, Assess, and Share framework enabled participants to provide valuable feedback on the content, design, and layout of the program before advancing to feasibility testing. Furthermore, the use of the "no-code" app development tool enabled our team to rapidly make changes to the app based on user feedback during the iterative design process.

Evaluating behavior change factors over time for a simple vs. complex health behavior

Background

Researchers are working to identify dynamic factors involved in the shift from behavioral initiation to maintenance-factors which may depend on behavioral complexity. We test hypotheses regarding changes in factors involved in behavioral initiation and maintenance and their relationships to behavioral frequency over time, for a simple (taking a supplement) vs. complex (exercise) behavior.

Methods

Data are secondary analyses from a larger RCT, in which young adult women, new to both behaviors, were randomly assigned to take daily calcium (N = 161) or to go for a daily, brisk walk (N = 171), for 4-weeks. Factors (intentions, self-efficacy, intrinsic motivation, self-identity, habit strength) were measured weekly. Multi-level modeling evaluated their change over time. Bivariate correlations and multiple regression determined the relationships between factors and the subsequent-week behavioral frequency (self-report and objective).

Finding

Results were partly in-line with expectations, in that individuals' intentions and self-efficacy predicted initial behavioral engagement for both behaviors, and habit strength increased for both behaviors, becoming a significant predictor of behavioral frequency in later weeks of the study in some analyses. However, results depended on whether the outcome was self-reported or objectively measured and whether analyses were bivariate or multivariate (regression).

Discussion

The factors theorized to play a role in behavioral maintenance (intrinsic motivation, self-identity, and habit strength) started to develop, but only habit strength predicted behavioral frequency by study-end, for both behaviors. Differences in initiation and maintenance between behaviors of differing complexity may not be as stark as theorized, but longer follow-up times are required to evaluate maintenance factors.

A “No-Code” App Design Platform for Mobile Health Research: Development and Usability Study

Background

A challenge facing researchers conducting mobile health (mHealth) research is the amount of resources required to develop mobile apps. This can be a barrier to generating relevant knowledge in a timely manner. The recent rise of “no-code” software development platforms may overcome this challenge and enable researchers to decrease the cost and time required to develop mHealth research apps.

Objective

We aimed to describe the development process and the lessons learned to build Pathverse, a no-code mHealth app design platform.

Methods

The study took place between November 2019 and December 2021. We used a participatory research framework to develop the mHealth app design platform. In phase 1, we worked with researchers to gather key platform feature requirements and conducted an exploratory literature search to determine needs related to this platform. In phase 2, we used an agile software framework (Scrum) to develop the platform. Each development sprint cycle was 4 weeks in length. We created a minimum viable product at the end of 7 sprint cycles. In phase 3, we used a convenience sample of adults (n=5) to gather user feedback through usability and acceptability testing. In phase 4, we further developed the platform based on user feedback, following the V-model software development process.

Results

Our team consulted end users (ie, researchers) and utilized behavior change technique taxonomy and behavior change models (ie, the multi-process action control framework) to guide the development of features. The first version of the Pathverse platform included features that allowed researchers to (1) design customized multimedia app content (eg, interactive lessons), (2) set content delivery logic (eg, only show new lessons when completing the previous lesson), (3) implement customized participant surveys, (4) provide self-monitoring tools, (5) set personalized goals, and (6) customize app notifications. Usability and acceptability testing revealed that researchers found the platform easy to navigate and that the features were intuitive to use. Potential improvements include the ability to deliver adaptive interventions and add features such as community group chat.

Conclusions

To our knowledge, Pathverse is the first no-code mHealth app design platform for developing mHealth interventions for behavior. We successfully used behavior change models and the behavior change technique taxonomy to inform the feature requirements of Pathverse. Overall, the use of a participatory framework, combined with the agile and hybrid-agile software development process, enabled our team to successfully develop the Pathverse platform.

The utility of the integrated behavior change model as an extension of the theory of planned behavior

Introduction

There are several widely used theories of health behavior change, which mostly utilize the social cognitive approach. These theories tend to posit that intention is a direct predictor of behavior, do not include automatic influences on behavior, and propose a one-size-fits-all theory for both initiators and maintainers. However, the intention-behavior gap is a well-observed phenomenon, researchers have highlighted that both automatic and reflective factors promote behavioral engagement, and predictors of behavior have been shown to differ between initiators and maintainers-three issues that necessitate theory advancement. To that end, the present research compares the utility of the Integrated Behavior Change Model (IBCM) - a social cognitive model that includes automatic factors involved in behavioral engagement and a moderator of the intention-behavior gap - to its theoretical predecessor, the Theory of Planned Behavior (TPB). Further, the relevance of the IBCM factors for predicting exercise behavior is compared in initiators versus maintainers.

Method

Participants were 494 US undergraduates. Participants reported on variables from the IBCM (and TPB) at baseline and reported on their exercise behavior in two surveys at seven- and 14-days post-baseline.

Results

Findings supported the first hypothesis that the IBCM would be more relevant for initiators in comparison with maintainers, using structural equation modeling. Specifically, only the paths between intrinsic motivation and affective attitude, affective attitude and intention, and intention and behavior were reliably found for maintainers. For initiators, the aforementioned paths were also reliably supported and the additional following paths were also supported: intrinsic motivation and perceived behavioral control, perceived behavioral control and intention, and intention and action planning. However, results did not support the second hypothesis that the IBCM would predict significantly more variance in behavior than its theoretical predecessor, the TPB. Specifically, the addition of action planning, implicit attitude, implicit motivation, and the interaction between intention and action planning only predicted an additional 0.3% (p < 0:05) of the variance in exercise behavior above and beyond intention.

Conclusion

Results highlight the continued need for theoretical refinement in terms of delineating mechanisms of initiation and maintenance and the need for further development in terms of improving upon current predictions of behavior engagement and change.