Additional Behavioral Changes Research Articles

Efficacy of interventions and techniques on adherence to physiotherapy in adults: an overview of systematic reviews and panoramic meta-analysis

BackgroundAdherence to physiotherapeutic treatment and recommendations is crucial to achieving planned goals and desired health outcomes. This overview of systematic reviews synthesises the wide range of additional interventions and behaviour change techniques used in physiotherapy, exercise therapy and physical therapy to promote adherence and summarises the evidence of their efficacy.MethodsSeven databases (PEDro, PubMed, Cochrane Library, Web of Science, Scopus, PsycINFO and CINAHL) were systematically searched with terms related to physiotherapy, motivation, behaviour change, adherence and efficacy (last searched on January 31, 2023). Only systematic reviews of randomised control trials with adults were included. The screening process and quality assessment with AMSTAR-2 were conducted independently by the two authors. The extracted data was synthesised narratively. In addition, four meta-analyses were pooled in a panoramic meta-analysis.ResultsOf 187 reviews identified in the search, 19 were included, comprising 205 unique trials. Four meta-analyses on the effects of booster sessions, behaviour change techniques, goal setting and motivational interventions showed a significantly small overall effect (SMD 0.24, 95% CI 0.13, 0.34) and no statistical heterogeneity (I2 = 0%) in the panoramic meta-analysis. Narrative synthesis revealed substantial clinical and methodological diversity. In total, the certainty of evidence is low regarding the efficacy of the investigated interventions and techniques on adherence, due to various methodological flaws. Most of the RCTs that were included in the reviews analysed cognitive and behavioural interventions in patients with musculoskeletal diseases, indicating moderate evidence for the efficacy of some techniques, particularly, booster sessions, supervision and graded exercise. The reviews provided less evidence for the efficacy of educational and psychosocial interventions and partly inconsistent findings. Most of the available evidence refers to short to medium-term efficacy. The combination of a higher number of behaviour change techniques was more efficacious.ConclusionsThe overview of reviews synthesised various potentially efficacious techniques that may be combined for a holistic and patient-centred approach and may support tailoring complex interventions to the patient’s needs and dispositions. It also identifies various research gaps and calls for a more holistic approach to define and measure adherence in physiotherapy.Systematic review registrationPROSPERO CRD42021267355.

Documentary analysis of national and international guidance for community clinicians referring patients with suspected chronic limb-threatening ischaemia

BackgroundDelayed referral of patients with chronic limb-threatening ischaemia (CLTI) from the community to vascular services may increase risk of amputation due to delayed revascularisation. Lack of appropriate guidance for clinicians...

The COL6A5-p.Glu2272* mutation induces chronic itch in mice.

Pruritus is a common irritating sensation that provokes the desire to scratch. Environmental and genetic factors contribute to the onset of pruritus. Moreover, itch can become a major burden when it becomes chronic. Interestingly, the rare Collagen VI alpha 5 (COL6A5) gene variant p.Glu2272* has been identified in two families and an independent patient with chronic neuropathic itch. These patients showed reduced COL6A5 expression in skin and normal skin morphology. However, little progress has been made until now toward understanding the relationships between this mutation and chronic itch. Therefore, we developed the first mouse model that recapitulates COL6A5-p.Glu2272* mutation using the CRISPR-Cas technology and characterized this new mouse model. The mutant mRNA, measured by RT-ddPCR, was expressed at normal levels in dorsal root ganglia and was decreased in skin. The functional exploration showed effects of the mutation with some sex dysmorphology. Mutant mice had increased skin permeability. Elevated spontaneous scratching and grooming was detected in male and female mutants, with increased anxiety-like behavior in female mutants. These results suggest that the COL6A5-p.Glu2272* mutation found in patients contributes to chronic itch and induces in mice additional behavioral changes. The COL6A5-p.Glu2272* mouse model could elucidate the pathophysiological mechanisms underlying COL6A5 role in itch and help identify potential new therapeutic targets.

A park-based group mobility program for older adults with difficulty walking outdoors: a quantitative process evaluation of the Getting Older Adults Outdoors (GO-OUT) randomized controlled trial

BackgroundProcess evaluations of randomized controlled trials (RCTs) of community exercise programs are important to help explain the results of a trial and provide evidence of the feasibility for community implementation. The objectives of this process evaluation for a multi-centre RCT of outdoor walking interventions for older adults with difficulty walking outdoors, were to determine: 1) implementation fidelity (the extent to which elements of the intervention were delivered as specified in the original protocol) and 2) participant engagement (the receipt of intervention components by the participants) in the Getting Older Adults Outdoors (GO-OUT) trial.MethodsGO-OUT participants attended an active 1-day workshop designed to foster safe, outdoor walking skills. After the workshop, 190 people at 4 sites were randomized to an outdoor walk group (OWG) (n = 98) which met 2x/week for 10 weeks, or the weekly reminders (WR) group (n = 92) which received a phone reminder 1x/week for 10 weeks. The OWG had 5 components – warm-up, continuous distance walk, task-oriented walking activities, 2nd continuous distance walk, and cool-down. Data on implementation fidelity and participant engagement were gathered during the study through site communications, use of standardized forms, reflective notes of the OWG leaders, and accelerometry and GPS assessment of participants during 2 weeks of the OWG.ResultsAll sites implemented the workshop according to the protocol. Participants were engaged in all 8 activity stations of the workshop. WR were provided to 96% of the participants in the WR intervention group. The 5 components of the OWG sessions were implemented in over 95% of the sessions, as outlined in the protocol. Average attendance in the OWG was not high – 15% of participants did not attend any sessions and 64% of participants in the OWG attended > 50% of the sessions. Evaluations with accelerometry and GPS during week 3 and 9 OWG sessions suggest that participants who attended were engaged and active during the OWG.ConclusionsThis process evaluation helps explain the main study findings and demonstrates the flexibility required in the protocol for safe and feasible community implementation. Future research could explore the use of additional behaviour change strategies to optimize attendance for community implementation.Trial registrationClinicalTrials.gov NCT03292510 Date of registration: September 25, 2017.

Does the Quality of Behavior Change Counseling in Routine HIV Care Vary According to Topic and Demand?

HIV clinicians face increasing time constraints. Our objective was to describe the prevalence and quality of behavior change counseling within routine HIV visits and to explore whether clinicians may provide lower quality counseling when facing increased counseling demands. We audio-recorded and transcribed encounters between 205 patients and 12 clinicians at an urban HIV primary care clinic. We identified and coded episodes of behavior change counseling to determine clinicians' consistency with motivational interviewing (MI) and used multi-level regression to evaluate counseling quality changes with each additional topic. Clinician counseling for at least one behavior was indicated in 92% of visits (mean 2.5/visit). Behavioral topics included antiretroviral medication adherence (80%, n = 163), appointment adherence (54%, n = 110), drug use (46%, n = 95), tobacco use (45%, n = 93), unsafe sex (43%, n = 89), weight management (39%, n = 80), and alcohol use (35%, n = 71). Clinician counseling was most MI-consistent when discussing drug and tobacco use and least consistent for medication and appointment adherence, unsafe sex, and alcohol use. In multilevel analyses, clinician counseling was significantly less MI-consistent (β = -0.14, 95% CI -0.29 to -0.001) with each additional behavior change counseling need. This suggests that HIV ambulatory care be restructured to allocate increased time for patients with greater need for behavior change.

Addressing Behavioral Barriers to COVID-19 Testing With Health Literacy-Sensitive eHealth Interventions: Results From 2 National Surveys and 2 Randomized Experiments.

Polymerase chain reaction (PCR) testing for COVID-19 was crucial in Australia's prevention strategy in the first 2 years of the pandemic, including required testing for symptoms, contact with cases, travel, and certain professions. However, several months into the pandemic, half of Australians were still not getting tested for respiratory symptoms, and little was known about the drivers of and barriers to COVID-19 PCR testing as a novel behavior at that time. We aimed to identify and address COVID-19 testing barriers, and test the effectiveness of multiple eHealth interventions on knowledge for people with varying health literacy levels. The intervention was developed in 4 phases. Phase 1 was a national survey conducted in June 2020 (n=1369), in which testing barriers were coded using the capability-opportunity-motivation-behavior framework. Phase 2 was a national survey conducted in November 2020 (n=2034) to estimate the prevalence of testing barriers and health literacy disparities. Phase 3 was a randomized experiment testing health literacy-sensitive written information for a wide range of barriers between February and March 2021 (n=1314), in which participants chose their top 3 barriers to testing to view a tailored intervention. Phase 4 was a randomized experiment testing 2 audio-visual interventions addressing common testing barriers for people with lower health literacy in November 2021, targeting young adults as a key group endorsing misinformation (n=1527). In phase 1, barriers were identified in all 3 categories: capability (eg, understanding which symptoms to test for), opportunity (eg, not being able to access a PCR test), and motivation (eg, not believing the symptoms are those of COVID-19). Phase 2 identified knowledge gaps for people with lower versus higher health literacy. Phase 3 found no differences between the intervention (health literacy-sensitive text for top 3 barriers) and control groups. Phase 4 showed that a fact-based animation or a TikTok-style video presenting the same facts in a humorous style increased knowledge about COVID-19 testing compared with government information. However, no differences were found for COVID-19 testing intentions. This study identified a wide range of barriers to a novel testing behavior, PCR testing for COVID-19. These barriers were prevalent even in a health system where COVID-19 testing was free and widely available. We showed that key capability barriers, such as knowledge gaps, can be improved with simple videos targeting people with lower health literacy. Additional behavior change strategies are required to address motivational issues to support testing uptake. Future research will explore health literacy strategies in the current context of self-administered rapid antigen tests. The findings may inform planning for future COVID-19 variant outbreaks and new public health emergencies where novel testing behaviors are required. Australian New Zealand Clinical Trials Registry ACTRN12621000876897, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382318 ; Australian New Zealand Clinical Trials Registry ACTRN12620001355965, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380916&isReview=true.

Codevelopment of a Text Messaging Intervention to Support Adherence to Adjuvant Endocrine Therapy in Women With Breast Cancer: Mixed Methods Approach.

Adjuvant endocrine therapy (AET) reduces breast cancer recurrence and mortality in women with early-stage breast cancer. Unintentional nonadherence to AET is common (eg, forgetting to take medication). Forming habits surrounding medication taking could reduce reliance on memory and improve AET adherence. SMS text messaging interventions may offer a low-cost approach for promoting medication-taking habits. To optimize the likely effectiveness of such SMS text messages, the content should be developed using a transparent approach to ensure fidelity to relevant psychological theory and with user input to increase acceptability. This study aimed to develop a pool of brief SMS text messages promoting habit formation to support AET adherence, which are acceptable to women with breast cancer and show fidelity to theory-based behavior change techniques (BCTs). According to published literature, we selected 6 BCTs derived from the habit formation model: action planning, habit formation, restructuring the physical environment, adding objects to the environment, prompts/cues, and self-monitoring of behavior. In study 1, behavior change experts (n=10) created messages, each based on 1 of the 6 BCTs, in a web-based workshop and rated the fidelity of the messages to the intended BCT. In study 2, women with experience of taking AET discussed the acceptability of the messages in a focus group (n=5), and the messages were refined following this. In study 3, women with breast cancer rated the acceptability of each message in a web-based survey (n=60). In study 4, additional behavior change experts rated the fidelity of the remaining messages to the intended BCT in a web-based survey (n=12). Finally, a consultant pharmacist reviewed a selection of messages to ensure that they did not contradict general medical advice. In study 1, 189 messages were created targeting the 6 BCTs. In total, 92 messages were removed because they were repetitious, unsuitable, or >160 characters, and 3 were removed because of low fidelity (scoring <5.5/10 on a fidelity rating scale). Following study 2, we removed 13 messages considered unacceptable to our target population. In study 3, all remaining messages scored above the midpoint on an acceptability scale (1-5); therefore, no messages were removed (mean 3.9/5, SD 0.9). Following study 4, we removed 13 messages owing to low fidelity (scoring <5.5/10 on a fidelity rating scale). All the remaining messages showed fidelity to the intended BCTs (mean 7.9/10, SD 1.3). Following the pharmacist review, 2 messages were removed, and 3 were amended. We developed a pool of 66 brief SMS text messages targeting habit formation BCTs to support AET adherence. These showed acceptability to women with breast cancer and fidelity to the intended BCTs. The delivery of the messages will be further evaluated to assess their effect on medication adherence.

An unusual case of a Puerto Rican patient with involuntary pelvic movements, behavioral changes and mutism associated to VSP13A gene (P3-4.001)

<h3>Objective:</h3> To present a case of a Puerto Rican woman with Chorea-Acanthocytosis positive for VSP13A gene variant presenting with severe pelvic movements. <h3>Background:</h3> Chorea-Acanthocytosis is an autosomal recessive inherited neurodegenerative disorder originated from variants of the VPS13A gene. It is characterized by clinical features that may include chorea, tics, parkinsonism, dystonia, speech disturbances, and epilepsy. Most case reports of Puerto Rican descent have been reported in the United States. <h3>Design/Methods:</h3> NA <h3>Results:</h3> We present the case of a 41-year-old Puerto Rican woman with unusual involuntary movements and mutism. At onset she developed irritability and generalized choreiform movements that worsened over the years. There is family history of undiagnosed involuntary movements and family consanguinity. Clinical symptoms worsened to non-verbal communication, dysphagia, additional behavioral changes, and involuntary movements. Neurological examination showed choreiform movements, orofacial movements and blepharospasm. She presented forceful, brisk and disabling movements of the pelvis and neck present while lying down and worsened with activity. Genetic test for Huntington disease was negative, repeated blood smear did not show acanthocytes. CPK was mildly elevated, liver enzymes and serum ceruloplasmin levels were normal. CSF analysis was unremarkable. Autoimmune encephalitis was suspected and she received a course of IVIG without benefit. EEG was normal. Brain MRI showed abnormal signal intensity of bilateral gray matter involving putamen and caudate nuclei with associated ex vacuo dilation of frontal horns and lateral ventricles. Genetic testing was positive for autosomal recessive homozygous VSP13A gene variant. <h3>Conclusions:</h3> This case illustrates the variable presentation of chorea-acanthocytosis and emphasizes the importance of early recognition and timely genetic testing among Hispanic patients presenting with involuntary movements. Our patient had an uncommon initial presentation with predominant severe pelvic and neck movements making the diagnosis challenging and delayed. An accurate and early diagnosis is important to offer symptomatic treatment, identify potential future complications, and provide genetic counseling. <b>Disclosure:</b> Dr. Enriquez-Gonzalez has nothing to disclose. The institution of Dr. Serrano has received research support from Eli Lilly. The institution of Dr. Serrano has received research support from Abbvie.

The factors influencing inappropriate child feeding practices among families receiving nutrition allowance in the Himalayan region of Nepal

BackgroundChild feeding practices during the first two years of life are crucial to ensure good health and nutrition status. This study aimed to assess the factors influencing inappropriate child feeding practices in children aged 6 − 23 months in families receiving nutrition allowance in the remote Mugu district, Nepal.MethodsA community-based cross-sectional study was conducted among 318 mothers who had children aged 6 − 23 months of age in the seven randomly selected wards. Systematic random sampling technique was used to select the desired number of respondents. Data were collected using pre-tested semi-structured questionnaire. Bivariate and multivariable binary logistic regression was used to estimate crude odds ratio (cOR), and adjusted odds ratio (aOR), and 95% confidence intervals (CIs) to understand factor associated with child feeding practices.ResultsAlmost half of the children aged 6 − 23 months were not consuming a diverse diet (47.2%; 95% CI: 41.7%, 52.7%), did not meet the recommended minimum meal frequency (46.9%; 95% CI: 41.4%, 52.4%) and did not consume minimum acceptable diet (51.7%; 95% CI: 46.1%, 57.1%). Only 27.4% (95% CI: 22.7%, 32.5%) of children met the recommended complementary feeding practices. Multivariable analysis showed maternal characteristics such as mothers who gave birth at home (aOR = 4.70; 95% CI: 1.03, 21.31) and mothers in unpaid employment (aOR = 2.56; 95% CI: 1.06, 6.19) were associated with increased odds of inappropriate child feeding practices. Household economy (i.e. family with < 150 USD monthly income) was also associated with increased odds of inappropriate child feeding practices (aOR = 1.19; 95% CI: 1.05, 2.42).ConclusionDespite the receipt of nutritional allowances, child feeding practices among 6 − 23 months children were not optimal. Additional context-specific behavior change strategies on child nutrition targeting mothers may be required.

Implementing a Community-Led Arsenic Mitigation Intervention for Private Well Users in American Indian Communities: A Qualitative Evaluation of the Strong Heart Water Study Program.

Arsenic is a naturally occurring toxicant in groundwater, which increases cancer and cardiovascular disease risk. American Indian populations are disproportionately exposed to arsenic in drinking water. The Strong Heart Water Study (SHWS), through a community-centered approach for intervention development and implementation, delivered an arsenic mitigation program for private well users in American Indian communities. The SHWS program comprised community-led water arsenic testing, point-of-use arsenic filter installation, and a mobile health program to promote sustained filter use and maintenance (i.e., changing the filter cartridge). Half of enrolled households received additional in-person behavior change communication and videos. Our objectives for this study were to assess successes, barriers, and facilitators in the implementation, use, and maintenance of the program among implementers and recipients. We conducted 45 semi-structured interviews with implementers and SHWS program recipients. We analyzed barriers and facilitators using the Consolidated Framework for Implementation Research and the Risks, Attitudes, Norms, Abilities, and Self-regulation model. At the implementer level, facilitators included building rapport and trust between implementers and participating households. Barriers included the remoteness of households, coordinating with community plumbers for arsenic filter installation, and difficulty securing a local supplier for replacement filter cartridges. At the recipient level, facilitators included knowledge of the arsenic health risks, perceived effectiveness of the filter, and visual cues to promote habit formation. Barriers included attitudes towards water taste and temperature and inability to procure or install replacement filter cartridges. This study offers insights into the successes and challenges of implementing an arsenic mitigation program tailored to American Indian households, which can inform future programs in partnership with these and potentially similar affected communities. Our study suggests that building credibility and trust between implementers and participants is important for the success of arsenic mitigation programs.

Acute lethal toxicity of dried garlic (Allium sativum) powder on orange-spotted grouper (Epinephelus coioides) juveniles under static exposure

The present study was carried out to assess the toxic effect and determine the lethal concentration of dried garlic (Allium sativum) powder on the orange-spotted grouper (Epinephelus coioides) juveniles. Laboratory static bioassays were conducted to determine the 96-h LC50 of different concentrations of garlic (0, 30, 60, 90, 120, 150 and 180 mg L-1) on grouper juveniles (mean weight, 35.4±6.18 g and mean length, 13.2±0.51 cm). The 96-h LC50 was 74.78 mg L-1 with lower and upper confidence limits of 62.8 and 89.06 mg L-1, respectively. All fish exposed to 30 to 180 mg L-1 exhibited rapid movement, faster opercular activity and erratic swimming whereas at higher concentrations (90 mg L-1 to 180 mg L-1) fish showed additional behavioral changes such as loss of balance, lethargy, gulping for air and respiratory distress. Water quality parameters were within the recommended acceptable limits. This LC50 value can be used as a baseline reference to generate an effective concentration of garlic for future prophylaxis and treatment for parasitic, viral and bacterial infection in grouper.

Feasibility of Fitbit Use in Adolescent Survivors of Pediatric Cancer: Who Consistently Uses It and for How Long?

Purpose: Wearable activity trackers with real-time feedback and goal-setting features are being incorporated into programs to increase physical activity among childhood cancer survivors. This analysis describes the adoption and use of a Fitbit® Flex™ among adolescent-aged survivors of childhood cancer without incentives, reminders, or interventions to encourage use. Procedures: Cancer survivors aged 13-18 and ≥2 years from therapy received a Fitbit Flex with instructions to wear it daily. Researchers downloaded participants' daily total steps and active minutes for 1 year. Participants were classified as consistent (≥5 days/week for >4 weeks during the first 12 weeks) or inconsistent users, and comparisons between user types were made. Longitudinal use of the Fitbit and participants' 1-year acceptability evaluations are described. Results: Overall, 67.1% (47/70) of survivors enrolled, and Fitbit data were available for 36 participants. Initially, 30.6% (11/36) were consistent users. Consistent users had lower body mass index z-scores at enrollment (0.4 ± 0.7 vs. 1.2 ± 0.9; p = 0.01), but were otherwise comparable with inconsistent users. Over time survivors' use declined; at 12 months, only one participant was using his or her Fitbit. Survivors who completed a survey (n = 22) reported their Fitbit helped them self-monitor their exercise (72.7%, 16/22) and lead a more active lifestyle (63.6%, 14/22), but found it challenging to charge and not lose, forget about, or break the device. Conclusions: In the real-world setting, only a small subset of adolescent-aged survivors will initially consistently use a Fitbit and their interest diminishes over time. To maximize engagement, interventions incorporating wearable activity trackers likely need to include additional behavior change strategies.

CN76 Cost effectiveness of high versus low-to-moderate intensity exercise during oncological treatment: The Phys-Can RCT

A cost-effectiveness analysis, considering both costs and health outcomes of interventions, are important for decision-making and implementation in the health care. Exercise during oncological treatment is beneficial for health and have been found to counteract side effects of treatment. The Swedish Phys-Can RCT compared a six-month exercise program combining supervised resistance training and homebased endurance training of high-intensity ( HI ) versus low-to-moderate intensity (LMI), with or without additional behaviour change support. At post intervention, HI yielded small improvements of fitness and physical fatigue compared with LMI. At 18 months, no differences were found in total costs between the intensities. However, knowledge of the cost effectiveness in exercise interventions with regard to intensity is limited. In this study, we aimed to evaluate the long-term cost-effectiveness of an exercise program at HI versus LMI during oncological treatment. A cost-effectiveness analysis was undertaken from a societal perspective for 18 months. 189 (n=99 HI and n=90 LMI) participants with breast, colorectal, or prostate cancer were included from the Phys-Can RCT. Health outcomes were measured as quality-adjusted life years (QALYs), using EQ-5D-5L at baseline, six months and 18 months. Costs included the exercise intervention, health care utilisation and productivity loss. At 18 months, the total cost per participant did not differ significantly between HI (€27,314) and LMI exercise (€29,788). There was no significant difference in health outcome between the intensities. On average HI generated 1.190 (SD = 0.223) QALYs and LMI 1.185 (SD = 0.211) QALYs for 18 months, meaning HI led to an additional 0.005 QALYs. The incremental cost-effectiveness ratio (ICER) indicates that HI was more effective and saved costs compared with LMI. The uncertainty around the ICER was large, however our results indicates that HI exercise was cost-effective compared to LMI exercise at longer term since there was lower total costs per QALY gained. Thus, we suggest that exercise with its health benefits may be implemented regardless of intensity.

Do zoo animals use off-exhibit areas to avoid noise? A case study exploring the influence of sound on the behavior, physiology, and space use of two pied tamarins (Saguinus bicolor).

Noise can be a known stressor but our understanding of its effects on animals living in zoo environments remains limited. Although exposure to loud, chronic noise may be expected to negatively impact welfare, providing access to quiet areas to escape loud noise may buffer these negative effects. In this study, we explored the benefits of access to quiet, off-exhibit areas for animals living in a chronically loud sound environment. Two pied tamarins (Saguinus bicolor) living near a large waterfall feature that emitted loud, chronic noise were experimentally exposed to varying sound levels during 2-week treatment conditions. Baseline conditions (waterfall feature on and access to quiet, off-exhibit areas), were followed by a Quiet sound condition (waterfall off), a Loud sound condition (waterfall on and a speaker in the off-exhibit area playing volume-matched white noise), and a final Baseline condition. During Baseline conditions, sound levels were greater than 10 dBA higher in the exhibit than in the off-exhibit area (i.e., roughly twice as loud). The number of visitor groups present during behavior observations were consistent throughout the study. Both tamarins modified their space use during treatment conditions. Under Baseline conditions, both individuals showed frequent usage of quiet, off-exhibit areas. During the Quiet and Loud conditions, where sound levels were generally consistent across spaces, both individuals used off-exhibit areas less and their use of exhibit and off-exhibit areas was not significantly different than would be expected by chance, given the size of the areas. Additional behavioral changes were minimal. No significant differences in fecal glucocorticoid metabolites were observed. Although the monkeys in this study appeared to avoid noise, the overall impact on welfare appeared to be minimal considering the limited behavioral and hormonal changes observed. This study highlights the potential benefits of off-exhibit spaces as a quiet refuge from noise in the zoo environment.

A randomized trial to promote physical activity in adult pre-hypertensive and hypertensive patients

ABSTRACT The purpose of the pilot study was to determine the effectiveness of wearable activity trackers alone or in combination with behaviour change strategies for promoting physical activity (PA) among individuals with pre-hypertension or hypertension. A sample of 44 adults (68% female and mean age 55) were randomized to receive either a Fitbit Charge HR 3 alone (FB) or the Fitbit in combination with behaviour change strategies (i.e., goal setting, behaviour goal review, adaptive feedback) delivered by a trained health coach (FB+) for 12 weeks. Moderate and vigorous PA (MVPA), steps, and sedentary time (ST) were assessed using ActiGraph wGT3X-BT. The FB+ group significantly increased PA [+1854 (2518) steps/day, p < .01] and MVPA [+26 (34) mins/day, p < .05], and decreased their ST [−63 (73) mins/day, p < .01]. The FB group significantly increased MVPA [+11 (16) mins/day, p < .05], and decreased their ST [−87 (117) mins/day, p < .01]. Participants in FB+ had a significantly greater increase in MVPA/day compared to FB only with a between-group effect size of 0.6 (p < .05). Using Fitbit for self-monitoring is effective in increasing PA and reducing ST among pre-hypertensive and hypertensive participants. Additional behaviour change support amplified the intervention effectiveness for promoting MVPA.

Winner and loser effects influence subsequent mating interactions in crayfish

In species whose social structure includes dominance relationships, individuals are likely to engage in frequent agonistic interactions with conspecifics, and these interactions can have substantial effects on participants. For example, ‘winner’ and ‘loser’ effects, whereby winning or losing a contest increases the probability of winning or losing subsequent encounters, have been described in many species. However, a smaller body of research has shown that winning or losing a contest can lead to additional behavioral changes that affect other domains of an individual’s social experiences. Here, we report on an experiment designed to evaluate the effects of prior contests on subsequent mating interactions in the crayfish (Faxonius virilis). We presented males with mating opportunities either immediately following or 7 days after a contest with a conspecific male. We predicted that winners would be more likely to mate than losers, because of either or both winner/loser effects and differences in male competitiveness. We found that, when presented with a mating opportunity immediately following a contest, winning males were more likely to mate than were losing males. We also found that these differences had eroded within 7 days, such that there was no significant difference in the proportions of winners and losers that mated after that period. We concluded that the changes in mating behavior that we observed immediately after a contest were likely due to relatively short-term winner and loser effects, rather than any differences in the males’ competitiveness, which would presumably be of longer duration.

Fighting Hypertension In The Digital Age - A Lifestyle Intervention To Promote Physical Activity

PURPOSE: Although activity trackers are widely utilized, little is known about the effectiveness of activity trackers alone or combined with additional behavior change strategies to promote healthy lifestyles in individuals with pre-hypertension or hypertension. The purpose of the study was to determine the effectiveness of wearable activity trackers alone or in combination with behavior change strategies for promoting physical activity (PA) among individuals with pre-hypertension or hypertension. METHODS: A sample of 44 adults with pre-hypertension or hypertension (68% female) were randomized to receive either a Fitbit Charge HR 3 alone (FB) or the Fitbit in combination with behavior change strategies delivered by a trained health coach (FB+) for 12 weeks. Activity behaviors were assessed using ActiGraph wGT3X-BT, and psychological measures of social support, self-efficacy, self-regulation, and self-motivation were assessed using validated questionnaires. Compliance of wear time and daily activity data were tracked by Fitbit. The within-group and between-group effect size of Cohen’s d for change scores were calculated in the PA outcomes and psychological measures. The effect of the intervention on change in PA was tested with multiple linear regression controlling for demographic variables. RESULTS: Participants in FB+ had higher adherence with an average of 70.4 valid days (at least 10 h/day) out of 84 days in total compared to FB (65.0 days). The FB+ group showed significant increases in daily steps (+1854 steps/day, p < .01), moderate and vigorous physical activity (MVPA; +26 mins/day, p < .05), and decreases in sedentary time (-63 mins/day, p < .01). A similar pattern was found in participants from the FB but with smaller change from baseline to post-intervention (steps: +764/day, p < .1; MVPA: +10 mins/day, p < .05; sedentary time: -89 mins/day, p < .01). Participants from FB+ had significantly greater increases in MVPA/day compared to FB only group with a between-group effect size of 0.6 (p < .05). CONCLUSIONS: The study indicated that the usage of Fitbit for self-monitoring is effective in increasing PA and reducing sedentary time among pre-hypertensive and hypertensive participants. Additional behavior change support amplified the intervention effectiveness for promoting MVPA.

Developing a self-management intervention to manage hypermobility spectrum disorders (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS): an analysis informed by behaviour change theory

Purpose Hypermobility Spectrum Disorders (HSD) and Hypermobile Ehlers-Danlos Syndrome (hEDS) are heritable connective tissue disorders associated with joint instability and pain, but with scant guidance for supporting patients. The aim was to determine recommendations for an HSD/hEDS self-management intervention. Materials and methods Barriers to self-management were mapped onto the Theoretical Domains Framework (TDF) and Capability, Opportunity, Motivation-Behaviour (COM-B) model in a behavioural analysis. A modified Nominal Group Technique was used to prioritise behaviour change technique (BCT) interventions (n = 9 women). Results Possible BCTs incorporated: Education Incorporating self-help strategies, education to improve their knowledge of HSD/hEDS, and how to judge information about HSD/hEDS. Training In activity pacing, assertiveness and communication skills, plus what to expect during pregnancy, when symptoms can worsen. Environmental restructuring and enablement Support from occupational therapists to maintain independence at work and home. Modelled behaviour That illustrates how other people with HSD/hEDS have coped with the psychosocial impact. Conclusions This study is the first to apply theoretically-informed approaches to the management of HSD/hEDS. Participants indicated poor access to psychological support, occupational therapy and a lack of knowledge about HSD/hEDS. Future research should evaluate which intervention options would be most acceptable and feasible. Implications for rehabilitation Patients with Hypermobility Spectrum Disorders or Hypermobile Ehlers-Danlos Syndrome can be active partners in the co-design of behaviour change interventions. Behaviour change interventions should target psychological support and patient education, particularly patient information. Additional behaviour change interventions included environmental restructuring and enablement; adaptations to participants’ environment with input from occupational therapy. Participants were keen to suggest opportunities for behavioural modelling; positive fist-person modelling narratives, written by those with HSD/hEDS, which addressed how they coped with the psychosocial impact of their condition.

Alcohol and Tobacco Use in a Tuberculosis Treatment Cohort during South Africa's COVID-19 Sales Bans: A Case Series.

Background: South Africa temporarily banned alcohol and tobacco sales for about 20 weeks during the COVID-19 lockdown. We described changes in alcohol and tobacco consumption after implementation of these restrictions among a small number of participants in a tuberculosis treatment cohort. Method: The timeline follow-back procedure and Fägerstrom test for nicotine dependence was used to collect monthly alcohol and tobacco use information. We report changes in heavy drinking days (HDD), average amount of absolute alcohol (AA) consumed per drinking day, and cigarettes smoked daily during the alcohol and tobacco ban compared to use prior to the ban. Results: Of the 61 participants for whom we have pre-ban and within-ban alcohol use information, 17 (27.9%) reported within-ban alcohol use. On average, participants reported one less HDD per fortnight (interquartile range (IQR): −4, 1), but their amount of AA consumed increased by 37.4 g per drinking occasion (IQR: −65.9 g, 71.0 g). Of 53 participants who reported pre-ban tobacco use, 17 (32.1%) stopped smoking during the ban. The number of participants smoking >10 cigarettes per day decreased from 8 to 1. Conclusions: From these observations, we hypothesize that policies restricting alcohol and tobacco availability seem to enable some individuals to reduce their consumption. However, these appear to have little effect on the volume of AA consumed among individuals with more harmful patterns of drinking in the absence of additional behavior change interventions.

Does exercise intensity matter for fatigue during (neo-)adjuvant cancer treatment? The Phys-Can randomized clinical trial.

Exercise during cancer treatment improves cancer-related fatigue (CRF), but the importance of exercise intensity for CRF is unclear. We compared the effects of high- vs low-to-moderate-intensity exercise with or without additional behavior change support (BCS) on CRF in patients undergoing (neo-)adjuvant cancer treatment. This was a multicenter, 2x2 factorial design randomized controlled trial (Clinical Trials NCT02473003) in Sweden. Participants recently diagnosed with breast (n=457), prostate (n=97) or colorectal (n=23) cancer undergoing (neo-)adjuvant treatment were randomized to high intensity (n=144), low-to-moderate intensity (n=144), high intensity with BCS (n=144) or low-to-moderate intensity with BCS (n=145). The 6-month exercise intervention included supervised resistance training and home-based endurance training. CRF was assessed by Multidimensional Fatigue Inventory (MFI, five subscales score range 4-20), and Functional Assessment of Chronic Illness Therapy-Fatigue scale (FACIT-F, score range 0-52). Multiple linear regression for main factorial effects was performed according to intention-to-treat, with post-intervention CRF as primary endpoint. Overall, 577 participants (mean age 58.7years) were randomized. Participants randomized to high- vs low-to-moderate-intensity exercise had lower physical fatigue (MFI Physical Fatigue subscale; mean difference -1.05 [95% CI: -1.85, -0.25]), but the difference was not clinically important (ie <2). We found no differences in other CRF dimensions and no effect of additional BCS. There were few minor adverse events. For CRF, patients undergoing (neo-)adjuvant treatment for breast, prostate or colorectal cancer can safely exercise at high- or low-to-moderate intensity, according to their own preferences. Additional BCS does not provide extra benefit for CRF in supervised, well-controlled exercise interventions.