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Alley SJ, Schoeppe S, Moore H, To QG, van Uffelen J, Parker F, Duncan MJ, Schneiders A, Vandelanotte C. The moderating effect of social support on the effectiveness of a web-based, computer-tailored physical activity intervention for older adults. J Health Psychol 2024:13591053241241840. [PMID: 38618999 DOI: 10.1177/13591053241241840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024] Open
Abstract
This study aimed to assess the moderating effect of social support on the effectiveness of a web-based, computer-tailored physical activity intervention for older adults. In the Active for Life trial, 243 inactive adults aged 65+ years were randomised into: (1) tailoring + Fitbit (n = 78), (2) tailoring-only (n = 96) or (3) control (n = 69). For the current study, participants were categorised as having higher (n = 146) or lower (n = 97) social support based on the Duke Social Support Index (DSSI_10). Moderate-to-vigorous physical activity (MVPA) was measured through accelerometers at baseline and post-intervention. A linear mixed model analysis demonstrated that among participants with lower social support, the tailoring + Fitbit participants, but not the tailoring only participants increased their MVPA more than the control. Among participants with higher social support, no differences in MVPA changes were observed between groups. Web-based computer-tailored interventions with Fitbit integration may be more effective in older adults with lower levels of social support.
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Affiliation(s)
- Stephanie J Alley
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Australia
| | - Stephanie Schoeppe
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Australia
| | - Hayley Moore
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Australia
| | - Quyen G To
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Australia
- RMIT, Vietnam
| | | | - Felix Parker
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Australia
| | - Mitch J Duncan
- School of Medicine & Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Australia
| | - Anthony Schneiders
- School of Health, Medical and Applied Sciences, Central Queensland University, Australia
| | - Corneel Vandelanotte
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Australia
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Wu S, Li G, Shi B, Ge H, Chen S, Zhang X, He Q. Comparative effectiveness of interventions on promoting physical activity in older adults: A systematic review and network meta-analysis. Digit Health 2024; 10:20552076241239182. [PMID: 38601186 PMCID: PMC11005496 DOI: 10.1177/20552076241239182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 02/27/2024] [Indexed: 04/12/2024] Open
Abstract
Background Despite the well-established health benefits of physical activity, a large population of older adults still maintain sedentary life style or physical inactivity. This network meta-analysis (NMA) aimed to compare the effectiveness of wearable activity tracker-based intervention (WAT), electronic and mobile health intervention (E&MH), structured exercise program intervention (SEP), financial incentive intervention (FI) on promoting physical activity and reducing sedentary time in older adults. Methods The systematic review based on PRISMA guidelines, a systematic literature search of PubMed, Web of Science, Google Scholar, EMbase, Cochrane Library, Scopus were searched from inception to December 10th 2022. The randomized controlled trials (RCT) were included. Two reviewers independently conducted study selection, data extraction, risk of bias and certainty of evidence assessment. The effect measures were standard mean differences (SMD) and 95% confidence interval (CI) in daily steps, moderate-to-vigorous physical activity (MVPA) and sedentary time. Results A total of 69 studies with 14,120 participants were included in the NMA. Among these included studies, the results of daily steps, MVPA and sedentary time was reported by 55, 25 and 15 studies, respectively. The NMA consistency model analysis suggested that the following interventions had the highest probability (surface under the cumulative ranking, SUCRA) of being the best when compared with control: FI + WAT for daily steps (SUCRA = 96.6%; SMD = 1.32, 95% CI:0.77, 1.86), WAT + E&MH + SEP for MVPA (SUCRA = 91.2%; SMD = 0.94, 95% CI: 0.36, 1.52) and WAT + E&MH + SEP for sedentary time (SUCRA = 80.3%; SMD = -0.50, 95% CI: -0.87, -0.14). The quality of the evidences of daily steps, MVPA and sedentary time was evaluated by very low, very low and low, respectively. Conclusions In this NMA, there's low quality evidence that financial incentive combined with wearable activity tracker is the most effective intervention for increasing daily steps of older adults, wearable activity tracker combined with electronic and mobile health and structured exercise program is the most effective intervention to help older adults to increase MVPA and reduce sedentary time.
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Affiliation(s)
- Shuang Wu
- School of Physical Education, Shandong University, Jinan, China
| | - Guangkai Li
- School of Physical Education, Shandong University, Jinan, China
| | - Beibei Shi
- School of Physical Education, Shandong University, Jinan, China
| | - Hongli Ge
- School of Physical Education, Shandong University, Jinan, China
| | - Si Chen
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xianliang Zhang
- School of Physical Education, Shandong University, Jinan, China
| | - Qiang He
- School of Physical Education, Shandong University, Jinan, China
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Kim H, Kim G, Kim Y, Ha J. The Effects of ICT-Based Interventions on Physical Mobility of Older Adults: A Systematic Literature Review and Meta-Analysis. Int J Clin Pract 2023; 2023:5779711. [PMID: 38020536 PMCID: PMC10656205 DOI: 10.1155/2023/5779711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 09/06/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Systematic literature review and meta-analysis were conducted to integrate and analyze intervention studies dealing with the effects of information and communications technology- (ICT-) based interventions on the physical mobility of older adults in the community. The PubMed/MEDLINE, Embase, CINAHL, and Cochrane CENTRAL databases were searched for studies published from January 2000 to December 2022. We used the Risk of Bias 2 (RoB 2) tool to evaluate the quality of the randomized controlled studies in the systematic review. The meta-analysis was performed using a random-effects model. The model was used to calculate the standardized mean difference (SMD) and 95% confidence interval (CI) for both effect measures. I2 tests were used to measure the presence of heterogeneity. Thirty-seven randomized controlled trials were included (2,419 intervention participants), of which 23 were included in the meta-analysis. ICT interventions significantly improved Timed Up and Go (TUG) as a marker of physical mobility variable in older adults (SMD = -0.33, 95% CI: -0.57 to -0.10, p=0.005, I2 = 74.7%). A sensitivity analysis was performed on subgroups, and interventions were found to be effective in improving TUG in the exergame group (SMD = -0.40, 95% CI: -0.72 to -0.08, p < 0.001, I2 = 75.0%) and in the exergame with virtual reality (VR) group (SMD = -0.33, 95% CI: -1.01 to 0.35, p < 0.001, I2 = 91.0%) but both groups showed high heterogeneity. A meta-analysis was also performed on Short Physical Performance Battery (SPPB) but statistically significant results were not found (SMD = -0.19, 95% CI: -0.61 to 0.23, p=0.375, I2 = 87.7%). For the Berg Balance Scale (BBS), the post-intervention scores were significantly better than baseline (SMD = 1.52, 95% CI: 0.48 to 2.57, p=0.004, I2 = 93.5%). However, the number of studies included in the meta-analysis was small and heterogeneity was high, so follow-up studies are needed. This study confirmed that exergames, telecommunication, e-health, information applications, and robots were used as effective ICT-based interventions for improving the physical mobility of older adults. It is necessary to develop and apply more diverse ICT-based interventions that will prevent impairments of mobility and encourage older adults to live more independently, with a higher quality of life, based on extensive research on ICT-based interventions.
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Affiliation(s)
- Hyori Kim
- College of Nursing, Seoul National University, Seoul 03080, Republic of Korea
| | - Gahye Kim
- College of Nursing, Seoul National University, Seoul 03080, Republic of Korea
| | - Yeonghun Kim
- Robotics Lab, Hyundai Motor Company, Uiwang 16082, Republic of Korea
| | - Jiyeon Ha
- College of Nursing, Research Institute of Nursing Science, Ajou University, Suwon 16499, Republic of Korea
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Hao L, Goetze S, Alessa T, Hawley MS. Effectiveness of Computer-Tailored Health Communication in Increasing Physical Activity in People With or at Risk of Long-Term Conditions: Systematic Review and Meta-Analysis. J Med Internet Res 2023; 25:e46622. [PMID: 37792469 PMCID: PMC10585448 DOI: 10.2196/46622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 08/06/2023] [Accepted: 08/25/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Regular physical activity (PA) is beneficial for enhancing and sustaining both physical and mental well-being as well as for the management of preexisting conditions. Computer-tailored health communication (CTHC) has been shown to be effective in increasing PA and many other health behavior changes in the general population. However, individuals with or at risk of long-term conditions face unique barriers that may limit the applicability of CTHC interventions to this population. Few studies have focused on this cohort, providing limited evidence for the effectiveness of CTHC in promoting PA. OBJECTIVE This systematic review and meta-analysis aims to assess the effectiveness of CTHC in increasing PA in individuals with or at risk of long-term conditions. METHODS A systematic review and meta-analysis were conducted to evaluate the effect of CTHC in increasing PA in people with or at risk of long-term conditions. Hedges g was used to calculate the mean effect size. The total effect size was pooled and weighted using inverse variance. When possible, potential moderator variables were synthesized, and their effectiveness was evaluated by subgroups analysis with Q test for between-group heterogeneity Qb. Potential moderator variables included behavior change theories and models providing the fundamental logic for CTHC design, behavior change techniques and tailoring strategies to compose messages, and computer algorithms to achieve tailoring. Several methods were used to examine potential publication bias in the results, including the funnel plot, Egger test, Begg test, fail-safe N test, and trim-and-fill method. RESULTS In total, 24 studies were included in the systematic review for qualitative analysis and 18 studies were included in the meta-analysis. Significant small to medium effect size values were found when comparing CTHC to general health information (Hedges g=0.16; P<.001) and to no information sent to participants (Hedges g=0.29; P<.001). Half of the included studies had a low to moderate risk of bias, and the remaining studies had a moderate to high risk of bias. Although the results of the meta-analysis indicated no evidence of publication bias, caution is required when drawing definitive conclusions due to the limited number of studies in each subgroup (N≤10). Message-tailoring strategies, implementation strategies, behavior change theories and models, and behavior change techniques were synthesized from the 24 studies. No strong evidence was found from subgroup analyses on the effectiveness of using particular behavior change theories and models or from using particular message-tailoring and implementation strategies. CONCLUSIONS This study demonstrates that CTHC is effective in increasing PA for people with or at risk of long-term conditions, with significant small to medium effects compared with general health information or no information. Further studies are needed to guide design decisions for maximizing the effectiveness of CTHC.
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Affiliation(s)
- Longdan Hao
- Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Stefan Goetze
- Department of Computer Science, University of Sheffield, Sheffield, United Kingdom
| | - Tourkiah Alessa
- Biomedical Technology Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Mark S Hawley
- Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
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Alley S, Plotnikoff RC, Duncan MJ, Short CE, Mummery K, To QG, Schoeppe S, Rebar A, Vandelanotte C. Does matching a personally tailored physical activity intervention to participants' learning style improve intervention effectiveness and engagement? J Health Psychol 2023; 28:889-899. [PMID: 36440676 DOI: 10.1177/13591053221137184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023] Open
Abstract
This study aims to compare the effectiveness, engagement, usability, and acceptability of a web-based, computer-tailored physical activity intervention (provided as video or text) between participants who were matched or mismatched to their self-reported learning style (visual and auditory delivery through video or text-based information). Generalised linear mixed models were conducted to compare time (baseline, 3 months) by group (matched, mismatched) on ActiGraph-GT3X+measured moderate-to-vigorous physical activity (MVPA) and steps. Generalised linear models were used to compare group (matched and mismatched) on session completion, time-on-site, usability, and acceptability. MVPA and steps improved from baseline to 3-months, however this did not differ between participants whose learning styles were matched or mismatched to the intervention they received. Session completion, time-on-site, usability, and acceptability did not differ between matched and mismatched participants. Therefore, aligning intervention delivery format to learning style is unlikely to influence intervention effectiveness or engagement.
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Affiliation(s)
- Stephanie Alley
- Appleton Institute, Physical Activity Research Group, Central Queensland University, Rockhampton, QLD, Australia
| | - Ronald C Plotnikoff
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, NSW, Australia
| | - Mitch J Duncan
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, NSW, Australia
| | - Camille E Short
- Faculty of Medicine, Dentistry and Health Science, Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Kerry Mummery
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Quyen G To
- Appleton Institute, Physical Activity Research Group, Central Queensland University, Rockhampton, QLD, Australia
| | - Stephanie Schoeppe
- Appleton Institute, Physical Activity Research Group, Central Queensland University, Rockhampton, QLD, Australia
| | - Amanda Rebar
- Appleton Institute, Physical Activity Research Group, Central Queensland University, Rockhampton, QLD, Australia
| | - Corneel Vandelanotte
- Appleton Institute, Physical Activity Research Group, Central Queensland University, Rockhampton, QLD, Australia
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Gallucci A, Trimarchi PD, Tuena C, Cavedoni S, Pedroli E, Greco FR, Greco A, Abbate C, Lattanzio F, Stramba-Badiale M, Giunco F. Technologies for frailty, comorbidity, and multimorbidity in older adults: a systematic review of research designs. BMC Med Res Methodol 2023; 23:166. [PMID: 37434136 PMCID: PMC10334509 DOI: 10.1186/s12874-023-01971-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 06/09/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Frailty, neurodegeneration and geriatric syndromes cause a significant impact at the clinical, social, and economic level, mainly in the context of the aging world. Recently, Information and Communication Technologies (ICTs), virtual reality tools, and machine learning models have been increasingly applied to the care of older patients to improve diagnosis, prognosis, and interventions. However, so far, the methodological limitations of studies in this field have prevented to generalize data to real-word. This review systematically overviews the research designs used by studies applying technologies for the assessment and treatment of aging-related syndromes in older people. METHODS Following the PRISMA guidelines, records from PubMed, EMBASE, and Web of Science were systematically screened to select original articles in which interventional or observational designs were used to study technologies' applications in samples of frail, comorbid, or multimorbid patients. RESULTS Thirty-four articles met the inclusion criteria. Most of the studies used diagnostic accuracy designs to test assessment procedures or retrospective cohort designs to build predictive models. A minority were randomized or non-randomized interventional studies. Quality evaluation revealed a high risk of bias for observational studies, while a low risk of bias for interventional studies. CONCLUSIONS The majority of the reviewed articles use an observational design mainly to study diagnostic procedures and suffer from a high risk of bias. The scarce presence of methodologically robust interventional studies may suggest that the field is in its infancy. Methodological considerations will be presented on how to standardize procedures and research quality in this field.
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Affiliation(s)
| | | | - Cosimo Tuena
- Department of Psychology, Catholic University of the Sacred Hearth, Milan, Italy
| | - Silvia Cavedoni
- Applied Technology for Neuro‑Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Elisa Pedroli
- Applied Technology for Neuro‑Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Faculty of Psychology, University of eCampus, Novedrate, Italy
| | - Francesca Romana Greco
- Geriatric Unit, Department of Medical Sciences, IRCCS ''Casa Sollievo della Sofferenza'', San Giovanni Rotondo, Italy
| | - Antonio Greco
- Geriatric Unit, Department of Medical Sciences, IRCCS ''Casa Sollievo della Sofferenza'', San Giovanni Rotondo, Italy
| | - Carlo Abbate
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | | | - Marco Stramba-Badiale
- Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Alley SJ, Schoeppe S, To QG, Parkinson L, van Uffelen J, Hunt S, Duncan MJ, Schneiders A, Vandelanotte C. Engagement, acceptability, usability and satisfaction with Active for Life, a computer-tailored web-based physical activity intervention using Fitbits in older adults. Int J Behav Nutr Phys Act 2023; 20:15. [PMID: 36788546 PMCID: PMC9926785 DOI: 10.1186/s12966-023-01406-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/05/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Preliminary evidence suggests that web-based physical activity interventions with tailored advice and Fitbit integration are effective and may be well suited to older adults. Therefore, this study aimed to examine the engagement, acceptability, usability, and satisfaction with 'Active for Life,' a web-based physical activity intervention providing computer-tailored physical activity advice to older adults. METHODS Inactive older adults (n = 243) were randomly assigned into 3 groups: 1) tailoring + Fitbit, 2) tailoring only, or 3) a wait-list control. The tailoring + Fitbit group and the tailoring-only group received 6 modules of computer-tailored physical activity advice over 12 weeks. The advice was informed by objective Fitbit data in the tailoring + Fitbit group and self-reported physical activity in the tailoring-only group. This study examined the engagement, acceptability, usability, and satisfaction of Active for Life in intervention participants (tailoring + Fitbit n = 78, tailoring only n = 96). Wait-list participants were not included. Engagement (Module completion, time on site) were objectively recorded through the intervention website. Acceptability (7-point Likert scale), usability (System Usability Scale), and satisfaction (open-ended questions) were assessed using an online survey at post intervention. ANOVA and Chi square analyses were conducted to compare outcomes between intervention groups and content analysis was used to analyse program satisfaction. RESULTS At post-intervention (week 12), study attrition was 28% (22/78) in the Fitbit + tailoring group and 39% (37/96) in the tailoring-only group. Engagement and acceptability were good in both groups, however there were no group differences (module completions: tailoring + Fitbit: 4.72 ± 2.04, Tailoring-only: 4.23 ± 2.25 out of 6 modules, p = .14, time on site: tailoring + Fitbit: 103.46 ± 70.63, Tailoring-only: 96.90 ± 76.37 min in total, p = .56, and acceptability of the advice: tailoring + Fitbit: 5.62 ± 0.89, Tailoring-only: 5.75 ± 0.75 out of 7, p = .41). Intervention usability was modest but significantly higher in the tailoring + Fitbit group (tailoring + Fitbit: 64.55 ± 13.59, Tailoring-only: 57.04 ± 2.58 out of 100, p = .003). Participants reported that Active for Life helped motivate them, held them accountable, improved their awareness of how active they were and helped them to become more active. Conversely, many participants felt as though they would prefer personal contact, more detailed tailoring and more survey response options. CONCLUSIONS This study supports web-based physical activity interventions with computer-tailored advice and Fitbit integration as engaging and acceptable in older adults. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry: ACTRN12618000646246. Registered April 23 2018, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374901.
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Affiliation(s)
- Stephanie J. Alley
- grid.1023.00000 0001 2193 0854Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD Australia
| | - Stephanie Schoeppe
- grid.1023.00000 0001 2193 0854Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD Australia
| | - Quyen G. To
- grid.1023.00000 0001 2193 0854Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD Australia
| | - Lynne Parkinson
- grid.266842.c0000 0000 8831 109XSchool of Medicine & Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW Australia
| | - Jannique van Uffelen
- grid.5596.f0000 0001 0668 7884Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Susan Hunt
- grid.1023.00000 0001 2193 0854School of Nursing, Midwifery and Social Sciences, Central Queensland University, Melbourne, VIC Australia
| | - Mitch J. Duncan
- grid.266842.c0000 0000 8831 109XSchool of Medicine & Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, NSW Australia
| | - Anthony Schneiders
- grid.1023.00000 0001 2193 0854School of Health, Medical and Applied Sciences, Central Queensland University, Gladstone, QLD Australia
| | - Corneel Vandelanotte
- grid.1023.00000 0001 2193 0854Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD Australia
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Tummers SCMW, Hommersom A, Lechner L, Bemelmans R, Bolman CAW. Determinants of physical activity behaviour change in (online) interventions, and gender-specific differences: a Bayesian network model. Int J Behav Nutr Phys Act 2022; 19:155. [PMID: 36536443 PMCID: PMC9762063 DOI: 10.1186/s12966-022-01381-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Physical activity (PA) is known to be beneficial for health, but adherence to international PA guidelines is low across different subpopulations. Interventions have been designed to stimulate PA of different target groups by influencing relevant psycho-social determinants, essentially based on a combination of the Integrated Model for Change, the Theory of Planned Behaviour, its successor the Reasoned Action Approach and the self-determination theory. The current study investigates the pathways through which interventions influence PA. Further, gender differences in pathways of change are studied. METHODS An integrated dataset of five different randomised controlled trial intervention studies is analysed by estimating a Bayesian network. The data include measurements, at baseline and at 3, 6 (short-term), and 12 (long-term) months after the baseline, of important socio-cognitive determinants of PA, demographic factors, and PA outcomes. A fragment is extracted from the Bayesian network consisting of paths between the intervention variable, determinants, and short- and long-term PA outcomes. For each relationship between variables, a stability indicator and its mutual information are computed. Such a model is estimated for the full dataset, and in addition such a model is estimated based only on male and female participants' data to investigate gender differences. RESULTS The general model (for the full dataset) shows complex paths, indicating that the intervention affects short-term PA via the direct determinants of intention and habit and that self-efficacy, attitude, intrinsic motivation, social influence concepts, planning and commitment have an indirect influence. The model also shows how effects are maintained in the long-term and that previous PA behaviour, intention and attitude pros are direct determinants of long-term PA. The gender-specific models show similarities as well as important differences between the structures of paths for the male- and female subpopulations. For both subpopulations, intention and habit play an important role for short-term effects and maintenance of effects in the long-term. Differences are found in the role of self-efficacy in paths of behaviour change and in the fact that attitude is relevant for males, whereas planning plays a crucial role for females. The average of these differences in subpopulation mechanisms appears to be presented in the general model. CONCLUSIONS While previous research provided limited insight into how interventions influence PA through relevant determinants, the Bayesian network analyses show the relevance of determinants mentioned by the theoretical framework. The model clarifies the role that different determinants play, especially in interaction with each other. The Bayesian network provides new knowledge about the complex working mechanism of interventions to change PA by giving an insightful overview of influencing paths. Furthermore, by presenting subpopulation-specific networks, the difference between the influence structure of males and females is illustrated. These new insights can be used to improve interventions in order to enhance their effects. To accomplish this, we have developed a new methodology based on a Bayesian network analysis which may be applicable in various other studies.
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Affiliation(s)
| | - Arjen Hommersom
- grid.36120.360000 0004 0501 5439Open University of the Netherlands, Heerlen, The Netherlands ,grid.5590.90000000122931605Radboud University, Nijmegen, The Netherlands
| | - Lilian Lechner
- grid.36120.360000 0004 0501 5439Open University of the Netherlands, Heerlen, The Netherlands
| | - Roger Bemelmans
- grid.413098.70000 0004 0429 9708Zuyd University of Applied Sciences, Heerlen, The Netherlands
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Solis-Navarro L, Gismero A, Fernández-Jané C, Torres-Castro R, Solá-Madurell M, Bergé C, Pérez LM, Ars J, Martín-Borràs C, Vilaró J, Sitjà-Rabert M. Effectiveness of home-based exercise delivered by digital health in older adults: a systematic review and meta-analysis. Age Ageing 2022; 51:afac243. [PMID: 36346736 PMCID: PMC9642810 DOI: 10.1093/ageing/afac243] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/05/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND regular physical exercise is essential to maintain or improve functional capacity in older adults. Multimorbidity, functional limitation, social barriers and currently, coronavirus disease of 2019, among others, have increased the need for home-based exercise (HBE) programmes and digital health interventions (DHI). Our objective was to evaluate the effectiveness of HBE programs delivered by DHI on physical function, health-related quality of life (HRQoL) improvement and falls reduction in older adults. DESIGN systematic review and meta-analysis. PARTICIPANTS community-dwelling older adults over 65 years. INTERVENTION exercises at home through DHI. OUTCOMES MEASURES physical function, HRQoL and falls. RESULTS twenty-six studies have met the inclusion criteria, including 5,133 participants (range age 69.5 ± 4.0-83.0 ± 6.7). The HBE programmes delivered with DHI improve muscular strength (five times sit-to-stand test, -0.56 s, 95% confidence interval, CI -1.00 to -0.11; P = 0.01), functional capacity (Barthel index, 5.01 points, 95% CI 0.24-9.79; P = 0.04) and HRQoL (SMD 0.18; 95% CI 0.05-0.30; P = 0.004); and reduce events of falls (odds ratio, OR 0.77, 95% CI 0.64-0.93; P = 0.008). In addition, in the subgroup analysis, older adults with diseases improve mobility (SMD -0.23; 95% CI -0.45 to -0.01; P = 0.04), and balance (SMD 0.28; 95% CI 0.09-0.48; P = 0.004). CONCLUSION the HBE programmes carried out by DHI improve physical function in terms of lower extremity strength and functional capacity. It also significantly reduces the number of falls and improves the HRQoL. In addition, in analysis of only older adults with diseases, it also improves the balance and mobility.
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Affiliation(s)
- Lilian Solis-Navarro
- Departmentof Physical Therapy, Facultat Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
- Global Research on Wellbeing (GRoW), Facultat Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
- Department of Physical Therapy, University of Chile, Santiago, Chile
| | - Aina Gismero
- Global Research on Wellbeing (GRoW), Facultat Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Carles Fernández-Jané
- Global Research on Wellbeing (GRoW), Facultat Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Rodrigo Torres-Castro
- Department of Physical Therapy, University of Chile, Santiago, Chile
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Pulmonary Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | - Clara Bergé
- Department of Physiotherapy, School of Health Sciences, TecnoCampus-Pompeu Fabra University, Barcelona, Spain
| | - Laura Mónica Pérez
- RE-FiT Barcelona Research Group, Vall d’Hebron Institute of Research & Parc Sanitari Pere Virgili, Barcelona, Spain
| | - Joan Ars
- RE-FiT Barcelona Research Group, Vall d’Hebron Institute of Research & Parc Sanitari Pere Virgili, Barcelona, Spain
- Medicine Department, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Carme Martín-Borràs
- Departmentof Physical Therapy, Facultat Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
- Facultat de Psicologia, Ciències de l’Educació i l’Esport (FPCEE), Universitat Ramon Llull, Barcelona, Spain
| | - Jordi Vilaró
- Global Research on Wellbeing (GRoW), Facultat Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Mercè Sitjà-Rabert
- Global Research on Wellbeing (GRoW), Facultat Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
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10
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Lavoie A, Dubé V. Web-Based Interventions to Promote Healthy Lifestyles for Older Adults: Scoping Review. Interact J Med Res 2022; 11:e37315. [PMID: 35998024 PMCID: PMC9449830 DOI: 10.2196/37315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/14/2022] [Accepted: 08/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background With the aging of the population and rising rates of chronic diseases, web-based interventions could be considered to support older adults in adopting healthy lifestyles. To date, published knowledge syntheses have focused on quantitative studies among older adults aged ≥50 years. However, those aged ≥65 years may have different needs to be met by these interventions because of the biological and physiological changes associated with aging, and qualitative studies could help advance knowledge in this field. Objective The objective of this scoping review is to explore the extent of the literature on web-based interventions aimed at promoting healthy lifestyles among people aged ≥65 years. Methods A scoping review was conducted based on the framework proposed by Levac et al. Six databases (ie, MEDLINE, CINAHL, PsycINFO, Web of Science, the Cochrane Database of Systematic Reviews, and the Joanna Briggs Library) and gray literature (ie, Google Scholar and OpenGrey) were searched. The final search was conducted on June 23, 2021. The studies were selected by 2 persons (AL and ML) independently. The included studies were systematic reviews and qualitative and quantitative studies focusing on web-based interventions to promote healthy lifestyles in people aged ≥65 years that were published in French or English between 1990 and 2021. Data were extracted in a table and synthesized based on the conceptualization of web-based interventions (ie, according to the use parameters, behavior change techniques, delivery modes, and theories). A thematic analysis was performed. Results In total, 20 articles were included in this review, which represents studies focused on 11 distinct interventions. All of the interventions (11/11, 100%) aimed to promote physical activity among older adults. The number of intervention sessions varied from 5 to 16, with a frequency from daily to once every 2 weeks. Diverse delivery modes such as electronic diary, video, and phone call were found. The most used behavior change techniques were instruction, feedback, and self-monitoring. Few interventions (6/11, 55%) were based on a theory. A favorable trend was observed in increasing physical activity, and 5 themes emerged that appeared to be central to behavior change among older adults: motivation, support, tailoring, barriers, and perceptions. Conclusions This scoping review provides a better understanding of the components of web-based interventions and their outcomes on the healthy lifestyles of people aged ≥65 years. These findings could provide important guidance for the design and development of future web-based interventions in this field. Further research is needed to continue the development and evaluation of innovative and accessible interventions to promote healthy lifestyles among older adults. International Registered Report Identifier (IRRID) RR2-10.2196/23207
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Affiliation(s)
- Audrey Lavoie
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada.,Université de Montréal Marguerite-d'Youville Research Chair on Humanistic Nursing Interventions, Montreal, QC, Canada.,Research center, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Véronique Dubé
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada.,Université de Montréal Marguerite-d'Youville Research Chair on Humanistic Nursing Interventions, Montreal, QC, Canada.,Research center, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
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11
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Alley SJ, van Uffelen J, Schoeppe S, Parkinson L, Hunt S, Power D, Waterman N, Waterman C, To QG, Duncan MJ, Schneiders A, Vandelanotte C. The Effectiveness of a Computer-Tailored Web-Based Physical Activity Intervention Using Fitbit Activity Trackers in Older Adults (Active for Life): Randomized Controlled Trial. J Med Internet Res 2022; 24:e31352. [PMID: 35552166 PMCID: PMC9136649 DOI: 10.2196/31352] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 01/14/2022] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Physical activity is an integral part of healthy aging; yet, most adults aged ≥65 years are not sufficiently active. Preliminary evidence suggests that web-based interventions with computer-tailored advice and Fitbit activity trackers may be well suited for older adults. OBJECTIVE The aim of this study was to examine the effectiveness of Active for Life, a 12-week web-based physical activity intervention with 6 web-based modules of computer-tailored advice to increase physical activity in older Australians. METHODS Participants were recruited both through the web and offline and were randomly assigned to 1 of 3 trial arms: tailoring+Fitbit, tailoring only, or a wait-list control. The computer-tailored advice was based on either participants' Fitbit data (tailoring+Fitbit participants) or self-reported physical activity (tailoring-only participants). The main outcome was change in wrist-worn accelerometer (ActiGraph GT9X)-measured moderate to vigorous physical activity (MVPA) from baseline to after the intervention (week 12). The secondary outcomes were change in self-reported physical activity measured by means of the Active Australia Survey at the midintervention point (6 weeks), after the intervention (week 12), and at follow-up (week 24). Participants had a face-to-face meeting at baseline for a demonstration of the intervention and at baseline and week 12 to return the accelerometers. Generalized linear mixed model analyses were conducted with a γ distribution and log link to compare MVPA and self-reported physical activity changes over time within each trial arm and between each of the trial arms. RESULTS A total of 243 participants were randomly assigned to tailoring+Fitbit (n=78, 32.1%), tailoring only (n=96, 39.5%), and wait-list control (n=69, 28.4%). Attrition was 28.8% (70/243) at 6 weeks, 31.7% (77/243) at 12 weeks, and 35.4% (86/243) at 24 weeks. No significant overall time by group interaction was observed for MVPA (P=.05). There were no significant within-group changes for MVPA over time in the tailoring+Fitbit group (+3%, 95% CI -24% to 40%) or the tailoring-only group (-4%, 95% CI -24% to 30%); however, a significant decline was seen in the control group (-35%, 95% CI -52% to -11%). The tailoring+Fitbit group participants increased their MVPA 59% (95% CI 6%-138%) more than those in the control group. A significant time by group interaction was observed for self-reported physical activity (P=.02). All groups increased their self-reported physical activity from baseline to week 6, week 12, and week 24, and this increase was greater in the tailoring+Fitbit group than in the control group at 6 weeks (+61%, 95% CI 11%-133%). CONCLUSIONS A computer-tailored physical activity intervention with Fitbit integration resulted in improved MVPA outcomes in comparison with a control group in older adults. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12618000646246; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618000646246.
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Affiliation(s)
- Stephanie J Alley
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Rockhampton, Australia
| | | | - Stephanie Schoeppe
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Rockhampton, Australia
| | - Lynne Parkinson
- School of Medicine & Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Susan Hunt
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Melbourne, Australia
| | - Deborah Power
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Rockhampton, Australia
| | - Natasha Waterman
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Rockhampton, Australia
| | - Courtney Waterman
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Rockhampton, Australia
| | - Quyen G To
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Rockhampton, Australia
| | - Mitch J Duncan
- School of Medicine & Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Anthony Schneiders
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Rockhampton, Australia
| | - Corneel Vandelanotte
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Rockhampton, Australia
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12
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Feasibility of the Remote Physical Activity Follow-Up Intervention after the Face-to-Face Program for Healthy Middle-Aged Adults: A Randomized Trial Using ICT and Mobile Technology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084922. [PMID: 35457787 PMCID: PMC9025389 DOI: 10.3390/ijerph19084922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/07/2022] [Accepted: 04/16/2022] [Indexed: 02/05/2023]
Abstract
Although the effectiveness of face-to-face and remote intervention for increasing and maintaining physical activity (PA) have been compared, the effect of combining the two forms of intervention is unknown. The purpose of this study was to examine the feasibility of the remote PA follow-up intervention after the face-to-face PA program on changing PA behaviors and some health outcomes in healthy middle-aged adults. As a secondary analysis, we also attempted a preliminary analysis of the difference in the number of behavior change interviews in the remote PA follow-up intervention. After the face-to-face intervention, 30 healthy subjects were randomly divided into four behavior change coaching interviews (BCI4 group) or three BCI (BCI3 group). The results of this study showed that body weight, body fat mass, and waist circumference were significantly reduced after face-to-face intervention, and were further reduced after remote PA follow-up intervention. However, the difference in the number of BCI affected only body fat mass. The remote PA follow-up intervention may have potential to maintain the effects of face-to-face intervention. In the future, it is necessary to refine the research design and conduct a full-scale intervention study.
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13
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Boekhout JM, Volders E, Bolman CAW, de Groot RHM, Lechner L. Long-Term Effects on Loneliness of a Computer-Tailored Intervention for Older Adults With Chronic Diseases: A Randomized Controlled Trial. J Aging Health 2021; 33:865-876. [PMID: 33962517 PMCID: PMC8641036 DOI: 10.1177/08982643211015027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objectives: This study explores the effects of the Active Plus intervention aiming to decrease loneliness among older adults (>65 years) with chronic diseases. Methods: A randomized controlled trial (RCT) was performed (N = 585; age: M = 74.5 years, SD = 6.4), assessing loneliness at baseline, 6 months and 12 months. Outcome measures in the multilevel linear regression analyses were total, social and emotional loneliness. Results: At 12 months, significant decreases in total (B = -.37, p = .01) and social loneliness (B = -.24, p = .02) were found. Age was a significant moderator for total and social loneliness; however, the intervention was effective only for participants aged 80 years and older. Discussion: The Active Plus intervention showed a significant decrease in total and social loneliness and was especially beneficial for the vulnerable age group of 80 years and older. A more comprehensive tool for measuring social activity and mobility impairments, and using a longer time frame to detect loneliness changes, may form interesting future research.
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Affiliation(s)
- Janet M. Boekhout
- Faculty of Psychology, Open University of The Netherlands, Heerlen, The Netherlands
| | - Esmee Volders
- Faculty of Psychology, Open University of The Netherlands, Heerlen, The Netherlands
| | | | - Renate H. M. de Groot
- Faculty of Educational Sciences, Open University of The Netherlands, Heerlen, The Netherlands
- Nutrition and Translational Research in Metabolism (School NUTRIM), Maastricht University, Limburg, The Netherlands
| | - Lilian Lechner
- Faculty of Psychology, Open University of The Netherlands, Heerlen, The Netherlands
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14
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Volders E, de Groot RHM, Bolman CAW, Lechner L. The longitudinal associations between change in physical activity and cognitive functioning in older adults with chronic illness (es). BMC Geriatr 2021; 21:478. [PMID: 34481465 PMCID: PMC8418733 DOI: 10.1186/s12877-021-02429-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Regular physical activity (PA) is potentially beneficial for age-related cognitive decline. Although moderate-to-vigorous physical activity (MVPA) is mostly advised, older adults with chronic illnesses might benefit more from light physical activity (LPA), as they suffer from mobility problems, pain, and fatigue, limiting high-intensity PA. Therefore, the longitudinal association between change in LPA and MVPA and the change in cognitive functioning (CF) is investigated in older adults with chronic illnesses. METHODS In total 432 older adults (mean age 73.7 [±6.1] years; 46.8% female) with at least one chronic illness participated in this longitudinal observational study. Longitudinal associations between accelerometer-assessed change in PA (LPA and MVPA) and change in CF, measured with an objective validated neuropsychological test battery, were tested with multivariate linear regressions. RESULTS An increase in LPA between baseline and 6 months follow-up was significantly associated with improved short-term verbal memory and inhibition over the first 6 months. In addition, the change score in LPA over the first 6 months was predictive for the change score in short-term verbal memory over 12 months. Furthermore, an increase in MVPA between baseline and 6 months follow-up was significantly associated with a decrease in longer-term verbal memory scores over the same six-month period. CONCLUSIONS For older adults with chronic illnesses who may experience difficulties in being sufficiently active, an increase in LPA is probably more achievable than an increase in MVPA. In addition, an increase in LPA enhances CF more than an increase in MVPA does. TRIAL REGISTRATION Netherlands Trial Register NL6005 ; Date of Registration 21-03-2017.
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Affiliation(s)
- Esmee Volders
- Faculty of Psychology, Open University of the Netherlands, 6419 AT, Heerlen, the Netherlands.
| | - Renate H M de Groot
- Faculty of Educational Sciences, Open University of the Netherlands, 6419 AT, Heerlen, the Netherlands.,Nutrition and Translational Research in Metabolism (School NUTRIM), Maastricht University, 6200 MD, Maastricht, the Netherlands
| | - Catherine A W Bolman
- Faculty of Psychology, Open University of the Netherlands, 6419 AT, Heerlen, the Netherlands
| | - Lilian Lechner
- Faculty of Psychology, Open University of the Netherlands, 6419 AT, Heerlen, the Netherlands
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15
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Volders E, de Groot RHM, Coumans JMJ, Bolman CAW, Lechner L. A randomized controlled trial into the cognitive effects of a computer-tailored physical activity intervention in older adults with chronic disease(s). Eur Rev Aging Phys Act 2021; 18:3. [PMID: 33632130 PMCID: PMC7908734 DOI: 10.1186/s11556-021-00259-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/16/2021] [Indexed: 02/26/2023] Open
Abstract
Background Cognitive functioning (CF) is important for wellbeing and an independent life. However, older adults with chronic diseases are at a higher risk of poorer CF levels. Although, research suggests that physical activity (PA) could play an essential role in maintaining good CF, older adults with chronic diseases have low levels of PA. PA interventions to prevent cognitive decline for this specific group exist. Yet, until now these interventions focused on a single specific chronic disease. Active Plus is a proven effective computer-tailored PA stimulating intervention focused on increasing PA in daily life for the older adult population suffering from a broad range of chronic diseases. This study tests the cognitive effects of Active Plus in older adults with chronic diseases. Methods In this RCT older adults with at least one chronic disease (≥65 years) were allocated to the intervention group (N = 260, mean age = 74.2) or waiting list control group (N = 325, mean age = 74.5). In total, intervention group participants received three times computer-tailored PA stimulating advice within four months (i.e., at baseline, after two months, and after three to four months). The online and print delivered advice were tailored to the specific needs and wishes of the participant and focused on incorporating PA in daily life. Baseline and follow-up measurements of the CF verbal memory (Verbal Learning Test), shifting (Trailmaking Test), inhibition (Stop-signal Task) and processing speed (Letter Digit Substitution Test) were assessed after six and 12 months. Intervention effects were analyzed with multilevel linear mixed-effects models adjusted for the clustered design and confounding variables. Results The dropout rate was 19.1% after 6 months and 25.1% after 12 months. Although both conditions improved on all verbal memory outcomes after 6 months, and all CF outcomes except inhibition after 12 months, no intervention effects were found, not even in subgroups (p > .05). Conclusions To our knowledge this is the first study to test the cognitive effects of a computer-tailored PA stimulating intervention in older adults suffering from a broad range of chronic diseases. The effects of the Active Plus intervention were not strong enough to improve CF or prevent cognitive decline. A blended approach, in which this computer-tailored intervention is combined with a face-to-face PA intervention and / or cognitive training, might be a good suggestion to increase the effects of Active Plus on PA and CF in older adults with chronic diseases. Trial registration Netherlands Trial Register NL6005; Date of Registration 03-21-2017; https://www.trialregister.nl/trial/6005
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Affiliation(s)
- Esmee Volders
- Faculty of Psychology, Open University of the Netherlands, 6419, AT, Heerlen, the Netherlands.
| | - Renate H M de Groot
- Faculty of Educational Sciences, Open University of the Netherlands, 6419, AT, Heerlen, the Netherlands.,Nutrition and Translational Research in Metabolism (School NUTRIM), Maastricht University, 6200, MD, Maastricht, the Netherlands
| | - Juul M J Coumans
- Faculty of Psychology, Open University of the Netherlands, 6419, AT, Heerlen, the Netherlands
| | - Catherine A W Bolman
- Faculty of Psychology, Open University of the Netherlands, 6419, AT, Heerlen, the Netherlands
| | - Lilian Lechner
- Faculty of Psychology, Open University of the Netherlands, 6419, AT, Heerlen, the Netherlands
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