Increase In Daily Steps Research Articles

Longitudinal Assessment of Seasonal Impacts and Depression Associations on Circadian Rhythm Using Multimodal Wearable Sensing: Retrospective Analysis.

Previous mobile health (mHealth) studies have revealed significant links between depression and circadian rhythm features measured via wearables. However, the comprehensive impact of seasonal variations was not fully considered in these studies, potentially biasing interpretations in real-world settings. This study aims to explore the associations between depression severity and wearable-measured circadian rhythms while accounting for seasonal impacts. Data were sourced from a large longitudinal mHealth study, wherein participants' depression severity was assessed biweekly using the 8-item Patient Health Questionnaire (PHQ-8), and participants' behaviors, including sleep, step count, and heart rate (HR), were tracked via Fitbit devices for up to 2 years. We extracted 12 circadian rhythm features from the 14-day Fitbit data preceding each PHQ-8 assessment, including cosinor variables, such as HR peak timing (HR acrophase), and nonparametric features, such as the onset of the most active continuous 10-hour period (M10 onset). To investigate the association between depression severity and circadian rhythms while also assessing the seasonal impacts, we used three nested linear mixed-effects models for each circadian rhythm feature: (1) incorporating the PHQ-8 score as an independent variable, (2) adding seasonality, and (3) adding an interaction term between season and the PHQ-8 score. Analyzing 10,018 PHQ-8 records alongside Fitbit data from 543 participants (n=414, 76.2% female; median age 48, IQR 32-58 years), we found that after adjusting for seasonal effects, higher PHQ-8 scores were associated with reduced daily steps (β=-93.61, P<.001), increased sleep variability (β=0.96, P<.001), and delayed circadian rhythms (ie, sleep onset: β=0.55, P=.001; sleep offset: β=1.12, P<.001; M10 onset: β=0.73, P=.003; HR acrophase: β=0.71, P=.001). Notably, the negative association with daily steps was more pronounced in spring (β of PHQ-8 × spring = -31.51, P=.002) and summer (β of PHQ-8 × summer = -42.61, P<.001) compared with winter. Additionally, the significant correlation with delayed M10 onset was observed solely in summer (β of PHQ-8 × summer = 1.06, P=.008). Moreover, compared with winter, participants experienced a shorter sleep duration by 16.6 minutes, an increase in daily steps by 394.5, a delay in M10 onset by 20.5 minutes, and a delay in HR peak time by 67.9 minutes during summer. Our findings highlight significant seasonal influences on human circadian rhythms and their associations with depression, underscoring the importance of considering seasonal variations in mHealth research for real-world applications. This study also indicates the potential of wearable-measured circadian rhythms as digital biomarkers for depression.

Digital Peer-Supported App Intervention to Promote Physical Activity Among Community-Dwelling Older Adults: Nonrandomized Controlled Trial.

The use of mobile apps has promoted physical activity levels. Recently, with an increasing number of older adults accessing the internet, app-based interventions may be feasible in older populations. Peer support-based interventions have become a common method for promoting health-related behavior change. To our knowledge, the feasibility of using digital peer support apps (DPSAs) to increase physical activity among older adults and its impact on physical activity and physical function have not been investigated. This study aims to assess the feasibility of using DPSAs in older adults and to assess changes in physical activity and physical function in DPSA users. We conducted a nonrandomized controlled trial of older adults aged ≥65 years. We recruited participants for 2 distinct 12-week programs designed to increase physical activity. Participants could choose between an intervention group (app program and exercise instruction) or a control group (exercise instruction only). DPSA creates a group chat for up to 5 people with a common goal, and participants anonymously post to each other in the group. Once a day, participants posted a set of their step counts, photos, and comments on a group chat box. The intervention group used the DPSA after receiving 2 face-to-face lectures on its use. The participants were characterized using questionnaires, accelerometers, and physical function assessments. The feasibility of the DPSA was assessed using retention and adherence rates. Physical activity was assessed using accelerometers to measure the daily step count, light intensity physical activity, moderate to vigorous intensity physical activity (MVPA), and sedentary behavior. Physical function was assessed using grip strength and the 30-second chair-stand test. The participants in the intervention group were more frequent users of apps, were more familiar with information and communication technology, and had a higher baseline physical activity level. The retention and adherence rates for the DPSA intervention were 88% (36/41) and 87.7%, respectively, indicating good feasibility. Participants in the intervention group increased their step count by at least 1000 steps and their MVPA by at least 10 minutes using the DPSA. There was a significant difference in the interaction between groups and intervention time points in the daily step count and MVPA (step count, P=.04; duration of MVPA, P=.02). The DPSA increased physical activity, especially in older adults with low baseline physical activity levels. The feasibility of DPSA was found to be good, with the intervention group showing increases in daily steps and MVPA. The effects of DPSA on step count, physical activity, and physical function in older adults with low baseline physical activity should be investigated using randomized controlled trials.

Predictors associated with an increase in daily steps among people with prediabetes or type 2 diabetes participating in a two-year pedometer intervention

BackgroundThis study aimed to explore predictors associated with intermediate (six months) and post-intervention (24 months) increases in daily steps among people with prediabetes or type 2 diabetes participating in a two-year pedometer intervention.MethodsA secondary analysis was conducted based on data from people with prediabetes or type 2 diabetes from two intervention arms of the randomised controlled trial Sophia Step Study. Daily steps were measured with an ActiGraph GT1M accelerometer. Participants were divided into two groups based on their response to the intervention: Group 1) ≥ 500 increase in daily steps or Group 2) a decrease or < 500 increase in daily steps. Data from baseline and from six- and 24-month follow-ups were used for analysis. The response groups were used as outcomes in a multiple logistic regression together with baseline predictors including self-efficacy, social support, health-related variables, intervention group, demographics and steps at baseline. Predictors were included in the regression if they had a p-value < 0.2 from bivariate analyses.ResultsIn total, 83 participants were included. The mean ± SD age was 65.2 ± 6.8 years and 33% were female. At six months, a lower number of steps at baseline was a significant predictor for increasing ≥ 500 steps per day (OR = 0.82, 95% CI 0.69–0.98). At 24 months, women had 79% lower odds of increasing ≥ 500 steps per day (OR = 0.21, 95% CI 0.05–0.88), compared to men. For every year of increase in age, the odds of increasing ≥ 500 steps per day decreased by 13% (OR = 0.87, 95% CI 0.78–0.97). Also, for every step increase in baseline self-efficacy, measured with the Self-Efficacy for Exercise Scale, the odds of increasing ≥ 500 steps per day increased by 14% (OR = 1.14, 95% CI 1.02–1.27).ConclusionsIn the Sophia Step Study pedometer intervention, participants with a lower number of steps at baseline, male gender, lower age or higher baseline self-efficacy were more likely to respond to the intervention with a step increase above 500 steps per day. More knowledge is needed about factors that influence response to pedometer interventions.Trial registrationClinicalTrials.gov, NCT02374788.

Clinical and physiological advances in sedentary behavior research.

Sedentary behavior, defined as sitting with low energy expenditure, has emerged as a modifiable risk factor that affects our physiology and health. Evidence for the detrimental effects of sedentary behavior/physical inactivity on health, however, stems largely from epidemiological studies, which cannot address causalities. Acute and short-term sedentary behavior reduction interventions have been performed; however, in these studies, sitting has often been replaced by formal physical activity options, such as exercise, and long-term studies in subjects with cardiometabolic risk factors are still relatively few. We have recently conducted a long-term randomized controlled trial (RCT) to reduce daily sitting, without formal exercise, in metabolic syndrome patients, and this mini-review presents these studies with physiological aspects. The findings indicate that sedentary behavior reduction can prevent the increase in levels of many cardiometabolic risk factors after 3 months, but more intense physical activity rather than only reducing daily sitting time may be needed to further reduce the risk factor levels. At 6-month time point reduced sitting reduced fasting insulin, while successfully reducing sitting and body fat had beneficial effects also on whole-body insulin sensitivity, but other effects were relatively minor. Reduced sitting did not improve maximal aerobic fitness after 6 months, but an increase in daily steps was positively associated with an increase in fitness. However, the more the participants replaced sitting with standing, the more their maximal aerobic fitness was reduced. Overall, although the analysis of the collected data is still ongoing, our RCT findings suggest that the physiological and health effects of reduced sitting are relatively minor and that physical activities such as taking more daily walking steps are needed, which would be more beneficial and time-efficient for improving human health.

Occupational daily walking steps have inverse relationship with papillary thyroid cancer risk and progression: a retrospective analysis.

Investigate the impact of daily occupational walking steps on the progression of papillary thyroid cancer (PTC), a topic hitherto underresearched. The authors analyzed the data from 800 individuals with PTC across stages 0-IV. Participants were evenly divided into 2 distinct occupational groups: office workers and construction workers (N = 400 each). Data included comprehensive records of daily walking steps, demographic information, and clinical indicators. Pearson's correlation coefficients or analysis of variance (ANOVA) were employed to assess the linkage between daily walking steps and PTC risk and stage, as well as associated biochemical markers. The analysis revealed a significant inverse relationship between daily walking steps and PTC risk. A higher frequency of daily steps was associated with reduced chances of PTC onset and a lower diagnostic stage of the disease. This protective effect of physical activity was particularly pronounced in the construc- tion worker cohort. Subsequent evaluations showed that construction workers who consistently logged higher daily steps had markedly lower levels of thyroid-stimulating hormone (TSH), free triiodothyronine, free thyroxine, thyroid peroxidase antibody, thyroglobulin antibody, and thy- roglobulin (Tg). Notably, daily walking steps exhibited a strong inverse correlation with body mass index (BMI), age, PTC volumes, and levels of TSH and Tg across both occupational groups (ρ < -0.37). The increase in daily steps was associated with the reduction in PTC stages (p < 0.001). The research underscores the potential benefits of increased daily walking steps, suggesting that they may play a protective role in reducing PTC risk and moderating its progression. Int J Occup Med Environ Health. 2024;37(1):58-71.

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

ObjectiveThis study investigated the association between morning pleasant anticipation (i.e., how pleasant will the day be?) and daily positive incidental affect (PIA, e.g., feeling enjoyable, energetic) on daily steps as measured by ecological momentary assessment (EMA) and accelerometry. MethodsA total of 152 adults in Taiwan (female = 67.1 %, age range = 18–59, M = 24.97) completed smartphone-based surveys upon waking and at three quasi-random times during the day for seven days during the COVID-19 outbreak (February–July 2022). They also wore accelerometers for the same seven days to measure physical activity (daily steps). The morning survey asked participants to self-report pleasant anticipation throughout the day, and the three quasi-random time surveys assessed current PIA. Multilevel modeling was used to examine day-level associations between morning pleasant anticipation, PIA, and daily steps. A list of key covariates (i.e., age, sex, educational attainment, marital status, living arrangement, chronic disease, body mass index [BMI], smoking, drinking, wellbeing, daily sleep quality, daily sleep hours, and accelerometer wear time) were included in the models to adjust for the covariates’ potential effects on the study outcomes. ResultsThe study sample consisted of 989 morning observations and 2714 quasi-random time observations (EMA response rate = 87.01 %). Findings suggest that higher-than-usual levels of pleasant anticipation in the morning were significantly associated with more same-day daily steps (b = 0.03, SD = 0.01, p = .03) after adjusting for covariates. In addition, daily PIA was a significant moderator between morning pleasant anticipation and daily steps (b = 0.02, SD = 0.01, p < .01), such that higher levels of daily PIA were associated with greater increases in daily steps in response to higher levels of morning pleasant anticipation. ConclusionOn days when participants had higher levels of pleasant anticipation in the morning, they took more steps per day. In addition, the association between morning pleasant anticipation and steps per day was stronger on days when participants had higher levels of PIA. These findings have practical implications for future EMA studies investigating the “anticipatory” affective processes on movement behaviors with the goal of promoting physical activity in daily life.

Clinical and biomechanical effectiveness of foot-ankle exercise programs and weight-bearing activity in people with diabetes and neuropathy: A systematic review and meta-analysis.

Most interventions to prevent foot ulcers in people with diabetes do not seek to reverse the foot abnormalities that led to the ulcer. Foot-ankle exercise programs target these clinical and biomechanical factors, such as protective sensation and mechanical stress. Multiple RCTs exist investigating the effectiveness of such programs, but these have never been summarised in a systematic review and meta-analysis. We searched the available scientific literature in PubMed, EMBASE, CINAHL, Cochrane databases and trial registries for original research studies on foot-ankle exercise programs for people with diabetes at risk of foot ulceration. Both controlled and non-controlled studies were eligible for selection. Two independent reviewers assessed the risk of bias of controlled studies and extracted data. Meta-analysis (using Mantel-Haenszel's statistical method and random effect models) was performed when >2 RCTs were available that met our criteria. Evidence statements, including the certainty of evidence, were formulated according to GRADE. We included a total of 29 studies, of which 16 were RCTs. A foot-ankle exercise programme of 8-12weeks duration for people at risk of foot ulceration results in:(a) no increase or decrease risk of foot ulceration or pre-ulcerative lesion (Risk Ratio (RR): 0.56 (95% CI: 0.20-1.57)); (b) no increase or decrease risk of adverse events (RR: 1.04 (95% CI: 0.65-1.67)); (c) not increase or decrease barefoot peak plantar pressure during walking (Mean Difference (MD): -6.28kPa (95% CI: -69.90-57.34)); (d) no increase or decrease health-related quality of life (no meta-analysis possible). Likely results in increases in ankle joint and first metatarsalphalangeal joint range of motion (MD: 1.49° (95% CI: -0.28-3.26)) may result in improvements in neuropathy signs and symptoms (MD: -1.42 (95% CI: -2.95-0.12)), may result in a small increase in daily steps in some people (MD: 131 steps (95% CI: -492-754)), and may not increase or decrease foot and ankle muscle strength and function (no meta-analysis was possible). In people at risk of foot ulceration, a foot-ankle exercise programme of 8-12weeks duration may not prevent or cause diabetes-related foot ulceration. However, such a programme likely improves the ankle joint and first metatarsalphalangeal joint range of motion and neuropathy signs and symptoms. Further research is needed to strengthen the evidence base, and should also focus on the effects of specific components of foot-ankle exercise programs.

IEngage: A digital health education program designed to enhance physical activity in young adolescents.

iEngage is a modular health education and behavioural change program designed to help adolescents increase moderate to vigorous physical activity (MVPA). The program is delivered through the iEngage app which integrates activity trackers data (Misfit Ray©) within 10 interactive learning modules. Key features include guidance to set goals, self-monitor and assess achievements, and experiential learning via the connected activity trackers which allows for continuous steps recording during the program. iEngage was implemented in two schools over 5 weeks with 10–12 years old adolescents (n = 57) and PA outcomes compared to control group (n = 26). Results show that adolescents successfully set goals and self-assessed achievements during the program, progressing toward higher physical activity (PA) levels as shown by the 30% increase in daily steps through the program (+ 2647 steps/day, P < .001) with boys increasing goals and achievements faster than girls. The consistency in days totalling at least 11,000 steps/day increased from 35% at the start to 48% at the end of the program. The increase in PA is confirmed through the assessment of MVPA during schooldays pre- and post- program via research grade wrist accelerometers in both iEngage and control participants. Contrasting with the control group, MVPA was increased in the week following the program (~+5 min/day, P = .023) in short bouts, particularly during lunch time, recess and after school. This study shows that a digital program integrating activity trackers data, health education, goals setting and self-monitoring of PA, helped young adolescents enhance PA goals, improve achievements and increase MVPA.

Feasibility, acceptability, and preliminary efficacy of a single-arm, remotely-delivered health coaching intervention to increase physical activity and reduce sedentary behavior during pregnancy

BackgroundInterventions targeting physical activity and sedentary behavior concurrently in pregnancy may be an ideal strategy to reduce the risk of pregnancy complications. We assessed the feasibility, acceptability, and preliminary efficacy of a single-arm, remotely-delivered health coaching intervention to promote physical activity and reduce sedentary behavior in pregnancy.MethodsWomen (n = 34) between 8 and 12 weeks gestation were recruited to take part in the INcreasing Steps in PREgnancy (INSPiRE) study. Participants were given an activity tracker (Fitbit Inspire) and met virtually with their health coach throughout the second and third trimesters of pregnancy. Feasibility was based on enrollment, retention, and adherence rates. Acceptance was assessed using a process evaluation survey. Intervention efficacy was based on activPAL data obtained at baseline and the end of the second trimester.ResultsFeasibility objectives were met, with greater than 70% enrollment, 97% retention, and 99% adherence. All participants reported high levels of satisfaction with the program. ActivPAL data indicated statistically significant increases in daily steps (+ 1715.8 steps/day, Cohen’s d = 0.97), stepping time (+ 1.9%, d = 0.75), standing time (+ 2.3%, d = 0.29), and decreases in total sedentary time (− 4.2%, d = 0.43) and sedentary bouts of 30 minutes (− 4.1%, d = 0.36) from baseline to the end of the second trimester, all p < 0.05. Decreases were also observed in sedentary bouts of 60 minutes (− 3.9%, d = 0.40), but this was not statistically significant.ConclusionsThe INSPiRE study demonstrated feasibility, high acceptability, and preliminary efficacy for improving movement behaviors in women during pregnancy, supporting future testing in a randomized controlled trial.

Safety and Efficacy of Home-Based Exercise Rehabilitation Using Remote Monitoring in New Left Ventricular Assist Device Recipients

<h3>Purpose</h3> Data on home-based exercise rehabilitation (HER), using a wearable activity monitor and smartphone app, are limited in LVAD recipients. The purpose of the MOVE-LVAD study is to evaluate the feasibility, safety, and effects of HER on activity levels and healthcare utilization in newly implanted HeartMate 3 (HM3) LVAD patients. <h3>Methods</h3> MOVE-LVAD is a randomized study conducted at a single center. We aim to enroll 30 subjects, and here we provide data on the first 14 patients. Subjects in the HER and usual care (UC) groups wear an activity watch to monitor steps. In the HER group, patients also use a smartphone app to rate perceived exertion on the Borg scale and complete video calls with an exercise physiologist. Borg rating and daily steps are used to titrate exercise prescriptions. Endpoints include mean steps and rehospitalization. Mean daily steps are calculated for individual patients during weeks 1, 4, 8, and 12, and averages at each timepoint for the HER and UC groups are calculated separately. <h3>Results</h3> We provide data for the first 14 subjects during 3-month follow-up. 6 patients (mean age 60 years, 83% male) were randomized to HER and 8 (mean age 56 years, 88% male) to UC. During week 1, mean daily steps were 1595 ± 1579 in the HER group and 1436 ± 1031 in the UC group (Figure). During week 12, mean daily steps were 3705 ± 2628 in the HER group and 1669 ± 991 in the UC group. From week 1 to week 12, the average increase in daily steps was 1711 ± 1106 in the HER group and 587 ± 923 in the UC group. HER was not associated with any adverse events. There were 0 rehospitalizations in the HER group and 7 rehospitalizations in the UC group in 4 separate patients. <h3>Conclusion</h3> Initial data from the MOVE-LVAD study suggest that HER with remote monitoring is feasible, safe, and may be associated with a greater increase in daily activity levels and lower rehospitalization rate compared to UC in newly implanted HM3 LVAD patients. Larger studies are needed to determine the effects of HER on long-term outcomes.

Motivational Interviewing, Readiness for Change, Walking, and Functional Ability in Older Adults.

Regular exercise in older adults can slow the physical, psychological, and functional decline that is associated with aging. Understanding what may contribute to the initiation and adherence of exercise within the older adult population might help identify interventions that would successfully increase physical activity. The purpose of the current study was to determine if motivational interviewing would increase readiness for change, daily steps, and functional ability among older adult participants. The Senior Fitness Test (SFT) and pedometers were used to assess functional ability and daily steps within two groups of older adults. All participants who completed the 8-week study, on average, demonstrated an increase in daily steps as well as overall fitness. Posttest analyses revealed that the outcome for the intervention group did not exceed the control group, with the exception of the 8-foot up-and-go test, a test within the SFT that measures agility and dynamic balance (p = 0.035). One-on-one, individualized socialization sessions may have contributed to the overall improvement noted in both groups. [Journal of Gerontological Nursing, 48(3), 23-29.].

No evidence of association between habitual physical activity and ECG traits: Insights from the electronic Framingham Heart Study

No evidence of association between habitual physical activity and ECG traits: Insights from the electronic Framingham Heart Study

Quantification of physical activity with activity tracking after transfemoral aortic valve replacement (TAVR)

Abstract Background and hypothesis TAVR is a well-established, safe and effective therapy for severe symptomatic aortic stenosis (AS), but improvement of physical activity after TAVR is difficult to assess objectively. The aim of this study was to quantify improvement of physical activity with Activity Tracking after TAVR with special focus on the different low-gradient subtypes of AS. Methods All patients who underwent TAVR for severe AS in our center between 01/2019 and 12/2019 were screened. Participants received an Activity Tracker for 7 days at two times: after hospital discharge following TAVR procedure and 6 months thereafter. The difference of mean daily steps was defined as study endpoint. Results The analysis is based on 230 patients. The median age was 79.7 years with 53.7% male participants. The median aortic valve area (AVA) was 0.75 cm2 and median mean pressure gradient was 38.7 mmHg (Table 1). The median amount of daily steps was 4409 [IQR 2581–7487] steps/day after hospital discharge and 5326 [IQR 3045–8668] steps/day 6 months thereafter. On a patient base, median difference of steps per day was Δ 529 [IQR −702–2152]). Whenever possible, patients were categorized into different subgroups of AS. Patients with high-gradient (HG) AS showed significant improvement in difference of daily steps at 6 months-FUP (Δ 951 [IQR −378–2.323], p&amp;lt;0.001), as well as patients with paradox low-flow-low-gradient (LFLG) AS (Δ 1392 [IQR −609–4444], p=0.02). Patients with classical LFLG AS also showed an improvement of daily steps at 6-months-FUP but without statistical significance (Δ 192 [IQR −687–770], p=0.79). Patients with a normal-flow-low-gradient (NFLG) AS have no significant difference in daily steps after 6-months and show a tendency of decline in daily steps at 6-months-FUP (Δ −300 [IQR −1334–1406], p=0.67) (Figure 1). Conclusions This is the first study of this sample size to evaluate physical activity after TAVR with an objective and reproducible method. Overall, physical activity improved significantly 6 months after TAVR and daily steps per day increased in all subtypes of AS besides NFLG AS, where a tendency of decline in daily steps without statistical significance was shown. However the increase in daily steps did not reach statistical significance in classical LFLG AS patients. Funding Acknowledgement Type of funding sources: None. Table 1Figure 1

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.

Long-Term Benefits of Adding a Pedometer to Pulmonary Rehabilitation for COPD: The Randomized Controlled STAR Trial

PurposeThis Stay Active after Rehabilitation (STAR) study examined the effects of a pedometer-based behavioral intervention for individuals with COPD during three weeks of inpatient pulmonary rehabilitation (PR) on patients’ physical activity levels six weeks and six months after PR, including steps (primary outcome), moderate-intensity physical activity, and sedentary time as well as patient quality of life, symptoms, and other psychological and clinical variables.Patients and MethodsRehabilitation patients with COPD wore a triaxial accelerometer (ActiGraph wGT3X) for seven days two weeks before (T0) as well as six weeks (T3) and six months (T4) after PR. In addition to the three-week inpatient PR (control group, CG), the randomly allocated intervention group (IG) received a brief pedometer-based behavioral intervention with the application of the following behavior-change techniques: performing the behavior, individual goal-setting, self-monitoring, and feedback. The effects were analyzed using analysis of covariance with an intention-to-treat approach.ResultsA total of 327 patients (69% male, age: 58 years, FEV1 (%): 53.5, six-minute walk distance: 447.8 m) were randomly allocated to either the IG (n = 167) or CG (n = 160). Although both groups increased their daily steps after PR (IG: MT3-T0 = 1152, CG: MT3-T0 = 745; IG: MT4-T0 = 795, CG: MT4-T0 = 300), the slightly higher increases in daily steps in the IG compared to the CG at T3 (Δ388 steps, d = 0.16) and T4 (Δ458 steps, d = 0.15) were not statistically significant (p > 0.05 for all). Patients in both groups showed moderate to high pre-post-changes in terms of secondary outcomes, but no advantage favoring the IG was found.ConclusionThe results show that adding a pedometer-based behavioral intervention to standard German three-week inpatient PR for COPD patients did not result in more physical activity in terms of steps and moderate-intensity physical activity or less sedentary time. However, both groups (IG and CG) showed remarkably enhanced physical activity levels six weeks and six months after PR, as well as improvements in other secondary outcomes (eg, quality of life).

Daily Motivational Text Messages to Promote Physical Activity in University Students: Results From a Microrandomized Trial.

Low physical activity is an important risk factor for common physical and mental disorders. Physical activity interventions delivered via smartphones can help users maintain and increase physical activity, but outcomes have been mixed. Here we assessed the effects of sending daily motivational and feedback text messages in a microrandomized clinical trial on changes in physical activity from one day to the next in a student population. We included 93 participants who used a physical activity app, "DIAMANTE" for a period of 6 weeks. Every day, their phone pedometer passively tracked participants' steps. They were microrandomized to receive different types of motivational messages, based on a cognitive-behavioral framework, and feedback on their steps. We used generalized estimation equation models to test the effectiveness of feedback and motivational messages on changes in steps from one day to the next. Sending any versus no text message initially resulted in an increase in daily steps (729 steps, p = .012), but this effect decreased over time. A multivariate analysis evaluating each text message category separately showed that the initial positive effect was driven by the motivational messages though the effect was small and trend-wise significant (717 steps; p = .083), but not the feedback messages (-276 steps, p = .4). Sending motivational physical activity text messages based on a cognitive-behavioral framework may have a positive effect on increasing steps, but this decreases with time. Further work is needed to examine using personalization and contextualization to improve the efficacy of text-messaging interventions on physical activity outcomes. NCT04440553.

Increase in Daily Steps During the Early Phase of a Physical Activity Intervention for Type 2 Diabetes as a Predictor of Intervention Outcome.

This pilot study aimed to test whether increase in daily steps and day-to-day consistency in daily steps during the first several weeks of a physical activity intervention predicted outcomes. This was a secondary analysis from two concurrent studies testing a positive psychology-motivational interviewing intervention to increase physical activity and positive affect in individuals with type 2 diabetes. Steps were measured with accelerometers at study assessments (baseline, end-of-treatment, and 8-week follow-up) and were measured daily throughout the intervention by participants using provided pedometers. We calculated change in steps from intervention week 1 to week 3, along with variability in daily steps over the first 3weeks, using the best fitting regression line modeling their change. Multiple regression analyses tested whether these predictors were associated with change in physical activity at the end of treatment and at 8-week follow-up. Additionally, we explored the utility of specific cutoffs (e.g., 500 steps) for early step change using a minimum p-value approach. In 52 participants, larger step increases by week 3 predicted activity increase at end-of-treatment and follow-up. Variability in early steps was not associated with outcomes. Early increase cutoffs of 500 and 2000 steps may have practical relevance. Early response to a physical activity intervention appears to be a useful predictor of outcome and could be used to identify those unlikely to succeed in a given intervention early in treatment. ClinicalTrials.gov identifiers NCT03150199 and NCT03001999.

Predictors of Walking Activity in Patients With Systolic Heart Failure Equipped With a Step Counter: Randomized Controlled Trial

Background Physical activity has been shown to decrease cardiovascular mortality and morbidity. Walking, a simple physical activity which is an integral part of daily life, is a feasible and safe activity for patients with heart failure (HF). A step counter, measuring daily walking activity, might be a motivational factor for increased activity. Objective The aim of this study was to examine the association between walking activity and demographical and clinical data of patients with HF, and whether these associations could be used as predictors of walking activity. Methods A total of 65 patients with HF from the Future Patient Telerehabilitation (FPT) program were included in this study. The patients monitored their daily activity using a Fitbit step counter for 1 year. This monitoring allowed for continuous and safe data transmission of self-monitored activity data. Results A higher walking activity was associated with younger age, lower New York Heart Association (NYHA) classification, and higher ejection fraction (EF). There was a statistically significant correlation between the number of daily steps and NYHA classification at baseline (P=.01), between the increase in daily steps and EF at baseline (P&lt;.001), and between the increase in daily steps and improvement in EF (P=.005). The patients’ demographic, clinical, and activity data could predict 81% of the variation in daily steps. Conclusions This study demonstrated an association between demographic, clinical, and activity data for patients with HF that could predict daily steps. A step counter can thus be a useful tool to help patients monitor their own physical activity. Trial Registration ClinicalTrials.gov NCT03388918; https://clinicaltrials.gov/ct2/show/NCT03388918 International Registered Report Identifier (IRRID) RR2-10.2196/14517

The Impact of a Short-Term Walking Intervention to Decrease Perceived Stress

This study examined a short-term, low-cost walking intervention developed and implemented at a small, private university in the upper Midwest. Results showed a significant decrease in perceived stress (pre-intervention PSQ mean = 0.41 ± 0.16 versus post-intervention PSQ mean = 0.30 ± 0.14, p &lt;0.001), and a significant increase in daily steps (pre-intervention mean = 6,810 ± 2,544 versus post-intervention mean = 9,352 ± 2,825, p &lt; 0.001). These results provide support for the effectiveness of a short-term walking intervention to increase daily steps and decrease perceived stress for university employees.

Longitudinal impact of changes in the residential built environment on physical activity: findings from the ENABLE London cohort study

BackgroundPrevious research has reported associations between features of the residential built environment and physical activity but these studies have mainly been cross-sectional, limiting inference. This paper examines whether changes in a range of residential built environment features are associated with changes in measures of physical activity in adults. It also explores whether observed effects are moderated by socio-economic status.MethodsData from the Examining Neighbourhood Activity in Built Living Environments in London (ENABLE London) study were used. A cohort of 1278 adults seeking to move into social, intermediate, and market-rent East Village accommodation was recruited in 2013–2015, and followed up after 2 years. Accelerometer-derived steps (primary outcome), and GIS-derived measures of residential walkability, park proximity and public transport accessibility were obtained both at baseline and follow-up. Daily steps at follow-up were regressed on daily steps at baseline, change in built environment exposures and confounding variables using multilevel linear regression to assess if changes in neighbourhood walkability, park proximity and public transport accessibility were associated with changes in daily steps. We also explored whether observed effects were moderated by housing tenure as a marker of socio-economic status.ResultsBetween baseline and follow-up, participants experienced a 1.4 unit (95%CI 1.2,1.6) increase in neighbourhood walkability; a 270 m (95%CI 232,307) decrease in distance to their nearest park; and a 0.7 point (95% CI 0.6,0.9) increase in accessibility to public transport. A 1 s.d. increase in neighbourhood walkability was associated with an increase of 302 (95%CI 110,494) daily steps. A 1 s.d. increase in accessibility to public transport was not associated with any change in steps overall, but was associated with a decrease in daily steps amongst social housing seekers (− 295 steps (95%CI − 595, 3), and an increase in daily steps for market-rent housing seekers (410 95%CI -191, 1010) (P-value for effect modification = 0.03).ConclusionTargeted changes in the residential built environment may result in increases in physical activity levels. However, the effect of improved accessibility to public transport may not be equitable, showing greater benefit to the more advantaged.